Torsten Liem, M.Sc. Ost., M.Sc. paed. Ost., D.O., D.P.O., Osteopath G.Os.C. (GB). Founder and CEO of the Osteopathie Schule Deutschland (OSD) from 1999-2019, developer of Psychosomatic Osteopathy and an M.Sc. program in pediatric osteopathy, head of an osteopathic teaching clinic, author of numerous publications, and co-editor of Osteopathische Medizin<\/i>. International lecturer. <\/p>\nThe term birth trauma is used very differently in osteopathy: What do you understand by birth trauma?<\/h2>\n
By this, I mean physical and\/or psychological impairments that can be traced back to events during the birth process. Many factors that affect the child during the birth process can be mentioned here. These can act from the outside or from the inside, for example, the consequences of oxygen deficiency in the brain. The processes can go too fast or too slow \u2013 too fast, for example, in the context of an induction of labor, precipitous birth, emergency C-section, premature birth, etc., or too slow, such as when the birth process stalls. Birth can involve excessive force, for example, if the mother’s pelvic floor is too tense, the mother’s coccyx is anteriorly displaced or fixed, and\/or external forces such as a vacuum extractor, forceps, or the Kristeller maneuver are applied. Any birth process that overwhelms the child in its intensity could subsequently be described as trauma. These moments can physically damage tissue, such as the brain, and potentially hinder biological maturation; they can also express themselves psychologically and impair further emotional development. Trauma can, for example, be accompanied by feelings of powerlessness, helplessness, hopelessness, or a sense of severe loss of control, or a permanent feeling of a lack of safety. These deep feelings can potentially accompany the person throughout their entire life as a background vibration and favor coping reactions\/avoidance strategies, character structures, and life plans, and\/or be triggered by specific situations in everyday life. Dissociation can also occur. Hyperarousals or rather rigid or frozen states arise. These processes are assigned to the autonomic nervous system, the ANS, and can be explained using the Polyvagal Theory. However, since there is no episodic memory yet during this early period, these feelings and moments can hardly be captured linguistically, but can only be experienced deeply implicitly and manifest in local or systemic tissue tensions and muscle tone, as well as in certain dysregulated activity patterns of the neurovegetative system and\/or excessively strong or persistent early childhood reaction or reflex patterns. For example, we see a child with an excessive Moro reflex, hypertonic psoas, sleep disorders, constricted sutures of the neuroendocrine system, and high tone in the area of the celiac ganglion. The term fetal trauma should also be differentiated here, because equivalent situations for the unborn child can also arise before birth, such as oxygen deficiency in smoking mothers \u2013 or fathers, as the smoke could also evaporate through the skin in bed. Or alcohol consumption during pregnancy with toxic effects on the child or excessive stress, as stress hormones can cross the placenta; twin stillbirths should also be mentioned here, etc. Perhaps in a few years, we will also know more about the extent to which the act of conception itself could act as traumatic for the developing human being. Cultural and biosocial differences must be observed in treatment. The way birth is handled and the early time spent together by the toddler and parents can vary greatly from country to country. This includes, for example, the frequency of C-section births or circumcision rituals \u2013 the latter, of course, do not count as birth trauma, but can potentially intensify its effects. <\/p>\n
With this question, the first thing to clarify would be how body, mind, and soul are defined. Still’s perspective, for example, was certainly different from how most people would understand it today. If physical, mental, and emotional effects are meant, then trauma can have physical, emotional, and mental effects and usually does. Physical traumas usually have clear psychological representations, as they represent severe emergency situations in the early experience of the human being. Thus, these so-called components cannot actually be separated; rather, the facets of a trauma are reflected in all facets. Soma and psyche are not to be considered separately. Their mutual interactions are more than just two sides of a coin. They are dynamic, process-oriented, and most intimately interwoven. Therefore, every therapeutic touch and work on the tissue, especially in the case of trauma, always has a potential influence on both soma and psyche. Nonetheless, a key factor is the dysregulation of the nervous system, which is why the influence on the ANS is essential in trauma and its treatment. <\/p>\n
For years, I have been teaching the importance of dynamics, how biography manifests in the tissue or structure via biochemistry, the neurovegetative system, metabolism, etc., and vice versa. This relational structure acts reciprocally and with process dynamics. However, traumas can also manifest more strongly in the physical or the psychological. Significant for clinical practice are the multi-layered interactions \u2013 by this, I mean the many mutual influences in the tissue, emotionally, in mental maturation processes, in neuromotor development, in diverse functional systems, and the child’s inner experience. An increased and persistent Moro reflex or asymmetrical tonic neck reflex, for example, hinders further eye-hand coordination. Added to this are influences such as disposition, viral loads, microbiome, immune system, and toxin exposure, which can lower the tolerance or integration of traumas and processing competence, or vice versa. Here, it is important to know, differentiate, consider, and also utilize bottom-up and top-down processes in treatment. <\/p>\n
I have already mentioned some examples. One of the main locations is the child’s head. It is exposed to mechanical forces that can result from a disproportion between head and pelvic size; this is phylogenetically located in increasing brain development. Pelvic dysfunctions of the mothers in the area of the sacrum, the coccyx, the symphysis, the pelvic floor, scarring, a rigid pelvis due to lack of movement, or increased tone of the pelvic floor muscles are examples to be mentioned here. If a birth is unnecessarily forced, for example with oxytocin, instead of letting it take place naturally, the birth process can potentially be too violent. Although there are, of course, many circumstances that make the use of labor-inducing measures necessary. Factors can be examined that support the birth process or potentially hinder it. The mother’s birthing positions would be discussed here: For example, a squatting birthing position, which increases the pelvic diameter, offers advantages over supine variants. During different phases of birth, different areas of the head region can be affected. In the case of an umbilical cord wrapped around the neck, it affects the neck region and, due to the lack of oxygen, primarily the brain. The brain is very sensitive to oxygen deficiency, which means it is affected in every situation that causes it. Meconium aspiration, which usually takes place before the actual birth begins, affects the entire organism, as does the use of anesthetics. The latter would have to be discussed more differentially depending on the procedure and substance. A high release of adrenaline at birth is an important protective reaction of the child, which may be missing in a planned C-section. Physical traumas can also occur in the shoulder area, for example, at the clavicle or the brachial plexus. <\/p>\n
All our senses are involved in the assessment. We look for physical, emotional, and cognitive signs and the social behavior of the child. I attach great importance to the anamnesis, the conversation. How was the pregnancy, the birth, the birthing position, what were the first reactions after birth? What is the behavior of the newborn or child, its reflex pattern? Can it be breastfed, does it show swallowing or sucking problems, a torticollis, etc.? Post-traumatically, we always find changes in the ANS. Therefore, the assessment of the ANS is very essential. What are the qualities of the heartbeat? We can also measure the neurovegetative system using heart rate variability. Not only high obvious stress values, but also paradoxical values are an indication of trauma. What is the child’s facial expression, does it make eye contact? How is the skin, cold or warm, what color is it? How is the breathing, do the lungs expand well during breathing, how does the belly move? Is the child restless or indifferent, does it show startle reactions? What are the early childhood reactions or the reflex pattern? How is the muscle tone, hyper- or hypotonic? How do the joints feel? Are there problems falling asleep or staying asleep? How is the interaction between the parents and the child? I also assess active burdens in children via a visual stress scale or the arm length test. Palpation gives us further important information: Is the tissue tone too flaccid or too high? How do the skull, the craniocervical junction, the cranial bones and brain structures, and the abdominal cavity feel? How about the solar plexus, the psoas muscles? If the child reacts to gentle hand contact on the head with defense, presses strongly into the hands, or twists, these can be indications that traumatic effects from the birth process are still active. Often, the child puts itself into a trauma position or remains in it. We can also assess such trauma positions using gentle compressions. <\/p>\n
When we copy the tensions in the body through our hand contact on the head and pelvis with gentle longitudinal compression, the child usually assumes birthing positions in which it may have experienced traumatic situations, for example, a stalling birth process, a birth that was too fast, or a C-section birth. For example, the child becomes calm when it experiences pressure at certain points in the body. Or vice versa: It reacts in certain positions with hyperarousal or with a freezing reaction. I also examine the midline structures or functions, that is, the neural tube, the notochord, and the anterior midline. After trauma, I often have the impression that dysfunctions occur here. For me, this feels palpatorily as if compressions, interruptions, stagnations, slowed dynamics, or thinning, alterations in flow directions occur. Subsequently, I palpate via the arms and legs to see whether tensions manifest more in the splanchnopleure or somatopleure. Strong tension zones would be contacted as part of the trauma treatment. <\/p>\n
It is absolutely essential that the parents are on board and cooperate if necessary. Here, it is important to me that the parents understand and have empathy for their child’s processes. If the children who come to me are already older than three years, then I have the relationship structures in the family reenacted \u2013 using small figures representing parents and siblings, and green and red threads that the child can place between the individual figures. Considering the resources or burdens within the family is significant for the success of healing. Feelings of safety, security, being held, physical contact, empathetic touch, eye contact, facial interaction, and alternating between rest and activity are general aspects of how parents can support their child’s healing and general well-being. Consideration of control systems is also essential in the treatment of trauma, as they influence the resilience of the system and the resources in the child. Exposure to toxins, etc., can potentially hinder regulation and adaptation processes of trauma processing. This means that overarching disruptive factors, such as antibiotic use, heavy metal exposure via the mother, nutritional deficiencies in the mother, color pigments in children’s toys, or influences from the place of residence such as electrosmog, must be considered here. After the conversation with the parents, I always begin by establishing contact; empathetic contact is essential here. Of course, establishing contact already begins with making the appointment, entering the practice, and the start of the consultation. The way I sit opposite the parents and the child, the practice furnishings, the way I listen, my speaking and my questions, my facial expressions and posture \u2013 all of this affects the child and the parents and influences the treatment. This establishment of contact or the environment is like a uterus that carries, envelops, and accompanies our treatment. Then follows the hand contact, usually at the feet, initially in the sense of “letting oneself be shown.” Without interpreting, I approach via the hands and try to consciously refuse any assignment of meaning at first. This helps to establish empathetic contact. Usually, it also happens by itself that my facial expressions copy the child’s facial expressions, and my posture copies the child’s posture. If I notice here that, for example, certain reactions of the child trigger me, I can process this internally later, but first set it aside in the therapeutic contact. In such moments, it may also be that I consciously align my facial expressions with those of the child. Treating children means, above all, understanding processes, a listening palpation. The child has the tendency to deal with trauma situations in the best possible way. We use this best possible reaction \u2013 an expression of our homeostasis \u2013 in the treatment. To integrate misguided processes, it is indispensable to know biological, psychological, mental, and other developments, such as motor development and language development. To use the child’s own resources in the treatment via palpation, I synchronize with palpable rhythms \u2013 the breathing rhythm and other inherent rhythms, for example, with the so-called craniosacral rhythms, etc. \u2013 and with the flow in the body. <\/p>\n
If the child shows a position in which it remains or reacts, it can be useful to reenact the birth process in a resource-rich state. For example, I take the newborn in both arms, empathetically encompass the head with my hands, and exert very gentle compression on the head. Or I hold the child with one hand on the sacrum and the other hand on the head and exert gentle longitudinal compression. Here, I use a compression field with the intention of bringing the child into contact with birth-traumatic positions or situations. Movements of the child and its tissues are allowed or supported in a slowed-down manner. The slowing down of the movements of the child and its tissues that then take place is essential. The process of birth is, in a sense, relived with resources. We always ensure that the child relives this process with sufficient resources so that the sensation and reaction do not overwhelm the child this time. We give the child space and time to breathe, protection from too much intensity, force, and speed, and support the tissue process, for example, through synchronization with inherent rhythms. Then I look for possible dysfunctions. The tissue tone also gives me insights into possible burdens, such as in the C0\/C1\/C2 region, the solar plexus, all spinal junctions, etc. In treatment, I direct my attention to synchronization with inherent resources, and simultaneously to synchronization with dysfunction patterns and to homeostatic forces slumbering within the dysfunction patterns. I frequently use gentle compression fields, and much less often stretching fields. I usually choose indirect approaches, but gentle direct tension releases also occur. In doing so, I also use gentle bilateral stimulations, for example, cross-body stroking and polarity hand placements, as I learned from Rob Fulford. I have spent the last eleven years intensively involved in the development of osteopathic trauma treatments. I also apply elements of these to toddlers, but it would go too far to discuss them all here. I wrote a short article about this in issue 2\/2016 of Osteopathische Medizin<\/i>. I combine the palpation of tissue qualities, flow, etc., with the perception of the energetic interaction in the body field, which I follow with my eyes \u2013 I learned this from Bernard Darraillans, a French osteopath; before that, I always laboriously detached my hands from the body to palpate body fields. During the treatment, I constantly observe facial expressions and breathing, as the therapeutic process and inner experience are directly expressed here. Observing breathing is particularly important to me because it gives me immediate feedback on possible changes: Does the breathing go deep into the belly or does it stall? Does it become calmer or faster? I regularly harmonize midline structures or functions, that is, the dynamics in the neural tube, in the area of the notochord, and the anterior midline. Gentle palpations of the nervous system, for example, the amygdala, may be helpful. Every child always requires an individual approach. If the psoas is hyper- or hypotonic, for example, this is an indication of different processes and requires different treatments. For newborns, and even more so for premature babies, a very, very gentle touch is mandatory. Deceleration is essential in treatment. Intellectual models of embryonic movements should by no means impair the immediacy of the touch, but can sometimes represent possible access points. I always use various variants for synchronization by means of the occiput-sacrum swing, whether at the beginning or at the end of the treatment as a conclusion. It is important, even very important, to know the limits of our treatment and not to withhold any other necessary treatments from the child, as the osteopathic treatment could otherwise potentially lead to a chronifying factor in further development. Article at ScienceDirect<\/a>The interview was conducted by Anne Henle [1] Liem T, Plothe C (2009) Kinder-Osteopathie Sanfte Ber\u00fchrung in den ersten Lebensjahren.<\/p>\n","protected":false},"excerpt":{"rendered":" Table of Contents Torsten Liem, M.Sc. Ost., M.Sc. paed. Ost., D.O., D.P.O., Osteopath G.Os.C. (GB). Founder and CEO of the Osteopathie Schule Deutschland (OSD) from 1999-2019, development of<\/p>\n","protected":false},"author":2,"featured_media":2521,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_seopress_titles_title":"Birth Trauma: Diagnosis & Osteopathic Therapy","_seopress_titles_desc":"Interview with Torsten Liem: How to recognize birth trauma and provide targeted osteopathic treatment. Diagnostic markers and techniques for clinical practice.","_seopress_robots_index":"","_seopress_robots_follow":"","_seopress_robots_imageindex":"","_seopress_robots_snippet":"","_seopress_robots_primary_cat":"","_seopress_robots_breadcrumbs":"","_seopress_robots_freeze_modified_date":"","_seopress_robots_custom_modified_date":"","_seopress_robots_canonical":"","_seopress_social_fb_title":"","_seopress_social_fb_desc":"","_seopress_social_fb_img":"","_seopress_social_fb_img_attachment_id":0,"_seopress_social_fb_img_width":0,"_seopress_social_fb_img_height":0,"_seopress_social_twitter_title":"","_seopress_social_twitter_desc":"","_seopress_social_twitter_img":"","_seopress_social_twitter_img_attachment_id":0,"_seopress_social_twitter_img_width":0,"_seopress_social_twitter_img_height":0,"_seopress_redirections_value":"","_seopress_redirections_enabled":"","_seopress_redirections_enabled_regex":"","_seopress_redirections_logged_status":"","_seopress_redirections_param":"","_seopress_redirections_type":0,"_seopress_analysis_target_kw":"","_seopress_news_disabled":"","_seopress_video_disabled":"","_seopress_video":[],"_seopress_pro_schemas_manual":[],"_seopress_pro_rich_snippets_disable_all":"","_seopress_pro_rich_snippets_disable":[],"_seopress_pro_schemas":[],"iawp_total_views":0,"footnotes":""},"categories":[106],"tags":[],"themenbereich":[],"class_list":["post-4596","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-osteopathic-research-clinic"],"acf":[],"_links":{"self":[{"href":"https:\/\/psychosomatic-osteopathy.com\/en\/wp-json\/wp\/v2\/posts\/4596","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/psychosomatic-osteopathy.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/psychosomatic-osteopathy.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/psychosomatic-osteopathy.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/psychosomatic-osteopathy.com\/en\/wp-json\/wp\/v2\/comments?post=4596"}],"version-history":[{"count":1,"href":"https:\/\/psychosomatic-osteopathy.com\/en\/wp-json\/wp\/v2\/posts\/4596\/revisions"}],"predecessor-version":[{"id":5472,"href":"https:\/\/psychosomatic-osteopathy.com\/en\/wp-json\/wp\/v2\/posts\/4596\/revisions\/5472"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/psychosomatic-osteopathy.com\/en\/wp-json\/wp\/v2\/media\/2521"}],"wp:attachment":[{"href":"https:\/\/psychosomatic-osteopathy.com\/en\/wp-json\/wp\/v2\/media?parent=4596"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/psychosomatic-osteopathy.com\/en\/wp-json\/wp\/v2\/categories?post=4596"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/psychosomatic-osteopathy.com\/en\/wp-json\/wp\/v2\/tags?post=4596"},{"taxonomy":"themenbereich","embeddable":true,"href":"https:\/\/psychosomatic-osteopathy.com\/en\/wp-json\/wp\/v2\/themenbereich?post=4596"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}