Bulb Talk becomes Bulb Chat

Hi everybody,

To all my wonderful patients who have seen me at Bondi Junction or Clovelly, I’m about to change the way I connect with you.

I’m changing Bulb Talk to Bulb Chat. In addition to original articles on children’s and women’s health issues, I would now love to keep you informed of bits and pieces of info, specials and tips that other patients have found invaluable. And the other practitioners here at Bulb (yes we are growing!) will also contribute.

You will receive in the next couple of days, an email requesting you to click on a link to confirm you have signed up to Bulb Chat – a fortnightly newsletter on recent research/age old pearls of wisdom.

If you’d like to receive Bulb Chat, please click the link and get ready to be informed – every second Monday morning!

Until then, warmest winter wishes,

Nicole and the team from Bulb Osteopathy.

Give your pelvic floor a lift

What and where is your pelvic floor?

Your pelvic floor is a muscular and connective tissue ‘hammock’ that is diamond shaped. It runs from your pubic bones in front, out to your sitting bones either side then back in to your tail bone (coccyx). If you are female, there are three holes that pass through your pelvic floor (from front to back):

• The opening for your bladder (urethra),
• The opening for your vagina, and
• The opening for your bowel (anus). 

Males only have two openings passing through their pelvic floor and don’t carry babies on top of theirs, so are therefore less prone to pelvic floor weakness. In fact, in a survey of 3010 Australians aged 15 – 97 years, only 4.4% of males reported urinary incontinence, while 35.3% of women surveyed reported suffering from the same complaint.

Role of the pelvic floor

Your pelvic floor is an amazing piece of equipment! It prevents your pelvic ‘bits and pieces’ (ovaries, uterus, bladder, bowel) from falling out, supports your bowel when you pass a bowel motion, along with your abdominal ‘core’ muscles, forms part of the muscular ‘brace’ that supports your spine, and contributes to sexual arousal and pleasure. If your pelvic floor becomes weak, this can lead to incontinence (loss of bladder and or bowel control) or prolapse (dropping or sagging of) your bladder, uterus and or bowel. According to an Australian study published in 2000, pregnancy, regardless of how you deliver your baby (caesarean, vaginal delivery), simply being pregnant and giving birth greatly increases the likelihood of incontinence and or prolapse later on. Other factors that make you more likely to have problems with your pelvic floor:

• Increasing age
• Being overweight
• Excess coughing
• Numerous pregnancies

When to have your pelvic floor assessed

Because your pelvic floor is mostly muscular, it can, like any other muscle become overused, strained or torn.  Your pelvic floor can also be a source of pain during the second and third trimesters if it is overused or strained from an uneven gait caused by an old ankle, knee or hip injury. If you feel this may be a problem for you, make an appointment with an osteopath who works with pregnant women for a thorough assessment. Your closest osteopath can be located at www.osteopathic.com.au and search under the ‘Find an Osteopath’ tab.  A strong but elastic pelvic floor during pregnancy will go a long way in preparing you for a smoother vaginal delivery and recovery.

Exercises to strengthen pelvic floor:

There are two different types of muscle fibres in your pelvic floor. The first are slow twitch ‘endurance’ fibres that should be slightly switched on most of the time to hold your pelvic ‘bits and pieces’ in place. The second are fast twitch ‘power’ fibres that should be able to switch on quickly when you bend, sneeze, cough or laugh to prevent any ‘accidents’. And as there are two different types of fibres, there are two different types of exercises. They are:

Endurance fibres: Gently lift your pelvic floor about 1 cm and hold. You should be able to hold for at least 6 – 10 seconds.  Repeat up to 10 times or until you fatigue. Some ideas to make sure you’re actually lifting your pelvic floor:

• Imagine holding in a bowel motion
• Imagine holding a full bladder
• Imagine resisting against a tampon being pulled out

Power fibres: Quickly lift your pelvic floor as high as you can and release again straight way (don’t hold it). Repeat 10 – 20 times or until you fatigue. Rest for a couple of seconds in between each contraction.

DO NOT:

• Clench your glutes. Your glutes are NOT part of your pelvic floor.
• Hold your breath. You should be able to do your pelvic floor exercises while breathing.
• Squeeze your knees together. These muscles are also NOT part of your pelvic floor.

When to do pelvic floor exercises

Do the above exercises twice a day during your pregnancy. Vary the position you do the exercises in eg. when standing in line at the supermarket, sitting in the car, lying in bed. You should be able to switch on your pelvic floor exercises in any position.  You should always switch on your pelvic floor before and during a cough, sneeze or bend to prevent it from straining.

So for a healthy pelvic floor, remember your endurance and power exercises – twice a day and if you are experiencing pelvic pain or would like to have your pelvic floor assessed, see an osteopath who works with pregnant women.  

Further reading

• Womens Health – a textbook for physiotherapists, Sapsford, Bullock-Saxton, Markwell, WB Saunders Great Britain.
• http://www.pelvicfloorexercise.com.au
• http://www.thewomens.org.au/PelvicFloorExercises
• The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery, Maclennan, Taylor, Wilson and Wilson, BJOG: An International Journal of Obstetrics and Gynaecology, 2000 Dec:107(12): 1460-70

My baby has a flat head – plagiocephaly

Most of us are not perfectly even, straight and round everywhere. Babies are the same.  Slight asymmetries make us who we are. Head shapes, like the rest of our bodies are genetically determined. If you or your husband has a broad, flattish head, then there’s a good chance your baby will too.

But occasionally a baby’s preferred lying position can contribute, especially if your baby will only lie with his/her head turned to one side or they spend most of her time lying on firm surfaces on her back (when they’re sleeping and when they’re awake).

Definition

Plagiocephaly is an asymmetry or flattening of the bones that make up the skull. There are two main types of plagiocephaly:

1. Synostotic: caused by abnormal development and premature closure of the joins between the individual skull bones (known as sutures). Synostotic plagiocephaly is rare (1 in 2000 babies) and requires surgery to open the sutures that have closed prematurely.

1. Deformational: caused by external forces such as lying in the one position for too long (baby’s skull bones are malleable and can deform/flatten). Deformational plagiocephaly is the far more common form of flattening of the skull bones.

What are the implications?

The most obvious implication is cosmetic one. Although, a number of studies have suggested that deformational plagiocephaly is a “possible” reason for developmental delay that occurs in a small percentage of children.

Why does it happen?

An article published in Pediatrics in 2002 identified the following as risk factors for developing plagiocephaly before/during birth:

• Prolonged labour
• Use of forceps or suction
• Sharing the uterus with someone else (being a twin/triplet etc)
• Being a boy (boy babies have higher risk of plagiocephaly)

After birth, laying your baby on her back on hard surfaces (hard car seats, the floor etc.) in the same position again and again could possibly result in a flat spot developing in the soft bones of her head.

Is it treatable?

Yes of course! There is a lot you can do to minimise the flattening:

• Encourage your baby to turn away from the flattened side by having the door or something they like to look at towards on the opposite side to the flattening. If your baby is in bed with you, make sure the mother lies on the unaffected side.
• Supervise tummy time when your baby is awake (once she has enough head and neck control)
• Don’t leave your baby on her back on a hard car seat for long periods throughout the day when she could be on her side (alternate sides) or being held.

If the flattening is very definite and doesn’t respond to changing the position your baby lies in, another treatment option is a cranial moulding helmet – a polystyrene helmet, sort of like the inside of a bike helmet. There is some debate as to the efficacy of this treatment.

Sydney Children’s Hospital has a helmet clinic that fits children with helmets, ideally between the ages of 8 and 10 months of age. They require a referral from your medical practitioner and your baby needs to fit set criteria to be able to be referred in the first place.

How can an osteopath help?  

An osteopath can examine your baby’s neck muscles and make sure that she doesn’t have a spasm that prevents her from turning her head both ways. An osteopath should also look at the joint between the base of the skull and the top of the neck for signs of compression that may have occurred in the uterus or during delivery and at the sutures of the skull.

There should be a small amount of give between the individual skull bones. An osteopath who works with children will use some gentle “spreading” techniques to restore this give to the sutures, so that as your baby’s brain grows, it will expand the bones of the skull evenly.

Note: this blog is not a substitute for medical advice. If you are concerned that your baby may have plagiocephaly, please see your GP or paediatrician.

_________________

Further reading:

• Carreiro, J, 2003 An osteopathic approach to children, Churchill Livinstone, Edinburgh. 
• Littlefield, TR, Kelly, KM, Pomatto, JK and Cherney, JC. (2003) Infant car seats, carriers, bouncy seats and swings: Their role in deformational plagiocephaly. [pdf file] Journal of Prosthetics and Orthototics. 15: 102-106.
• Peitsch, WK, Keefer, CH, LaBrie, RA and Mulliken, JB (2002) Incidence of Cranial Asymmetry in Healthy Newborns [pdf file] Pediatrics, 110: e72.
• Pediatrics 2002; 110(6). URL: http://www.pediatrics.org/cgi/content/full/
• Pediatrics 2002; 110/6/e72; cranial asymmetry, deformational plagiocephaly
• Neurodevelopmental implications of ‘deformational’ plagiocephaly, Collett B, Breiger D, King D, Cunningham M, Speltz M. J Dev Behav Pediatr. 2005 Oct;26(5):379-89.
•  Neurodevelopmental delays in children with deformational plagiocephaly, Plast Reconstr Surg. 2006 Jan;117(1):207-18; discussion 219-20.

Pacifiers The Pros And Cons

Summary
Are pacifiers a good way to help your baby to self calm or do they promote bad habits, interrupt breastfeeding patterns and ruin your baby’s teeth? There are advantages and disadvantages of using pacifiers. The decision about whether to use one or not is entirely up to you.
This blog post is designed to help you make an informed decision about whether to use a pacifier or not by outlining the advantages and disadvantages of pacifier use.
Should you choose to use one, a good choice is a pacifier with a cherry shaped teat that complies with AS2432 Australian Standards and is BPA free. A review of pacifiers by Choice Magazine in 2006 recommends only five of the 12 it reviewed. See link to article below in list of further reading.
Advantages
·         reduced risk of SIDS
·         pain relieving effects
·         maintaining your sanity
Reduced risk of SIDS: in a review of literature published in the mid to late 1990’s, 8 publications demonstrated a link between pacifier use and a decreased incidence in SIDS, 1 found no difference. How? A few theories are postulated, the main ones being that pacifiers are more likely to keep your baby’s nose free from the mattress so they can still breathe if your baby rolls onto their stomach while sleeping.  Another theory is that the pacifier keeps your baby’s tongue forward, preventing it from falling backwards to occlude the airway.
Pain relieving effects: Pacifiers have been studied and recommended for pain relief in newborns and infants undergoing common, minor procedures in the emergency department e.g immunisations.
Your sanity: despite the best intentions not to use a pacifier, I see a number of parents who change their mind about using a pacifier to assist in settling their baby once their best attempts at settling fail. Sucking is a powerful reflex that is present at birth to encourage feeding and is a useful method in calming an unsettled baby. Giving your baby a pacifier to assist them in calming themselves after ruling out other usual causes of crying (hungry, wet nappy, overstimulated, too hot, too cold, wanting to be held) is certainly not going to make you a bad parent. Note: if your baby continues to cry, has a temperature or goes off feeding, seek medical advice.
Disadvantages
·         Possible failure of breastfeeding
·         Possible dental deformities
·         Possible recurrent ear infections
·         Possibility of accidents
Failure of breastfeeding: To avoid ‘nipple confusion’ in breastfed infants, it is recommended that pacifiers are not introduced until breast feeding is established (ie not before you’ve left hospital/birthing centre, some articles recommend not before the age of 4 weeks) and pacifiers are used sparingly.
Dental deformities: A review of published articles written in English between 1992 and 2003 published in 2006 looked at the effects of pacifiers on the shape of babies’ mouths and teeth. The conclusion was that pacifier use up until the age of 2 or 3 does not alter the shape of babies’ mouths/teeth, however, if your baby continues to use a pacifier (or a thumb!) beyond the age of three, you’re more likely to have to fork out for braces later on to correct and high, narrow palate.
Recurrent ear infections: middle ear infections are usually caused by a bacterial infection entering the middle ear through the Eustachian tube – a hollow tube that runs between the middle ear and the back of the throat. A review of literature between 1950 and 2003 demonstrates a statistically significant but ‘modest’ relationship between pacifier use and ear infections. Sucking or blowing on the pacifier before you give it to your baby may transfer bacteria or fungus to your baby, which may travel into the middle ear and cause infection.
Possibility of accidents: Choose pacifiers that meet Australian Standards and don’t put a cord around the pull ring to avoid risk of strangulation. Check that your baby hasn’t chewed through the teat so it won’t dislodge and become stuck in their throat.
Further reading

Which hormones are affected when I’m pregnant?

Hormone producing glands and their proximity to other organWhether you love them or hate them, there are a number of hormones that have specific roles during pregnancy – and it’s not just oestrogen and progesterone.

Here’s a guide to some of the main hormones that will play a part in your pregnancy. They are grouped together according to which gland in your body produces them.

Placenta

Human Placental Lactogen (HPL)

Breaks down your fat to provide nutrients for your baby. It can lead to gestational diabetes in you.

Human Chorionic Gonadotrophin (HCG)

Produced by the embryo soon after conception and later by the placenta.  Purpose is to support the corpus luteum so that the corpus luteum can produce progesterone. HCG levels are highest in the first three months after which, levels greatly decrease. For this reason, it’s thought that HCG levels are in part responsible for morning sickness in the first trimester.
Note: the corpus luteum is the left over packaging that previously surrounded the egg before it was ejected from the ovary. This left over packaging turns into a progesterone powerhouse until the placenta takes over the role of producing progesterone.

Ovaries

Oestrogen

Enlarges the muscle fibres in the uterus.

Progesterone

Relaxes muscle tone in the uterus, encourages breast development, increases body temperature.

Relaxin

A hormone produced during pregnancy that facilitates the birth process by causing a softening and lengthening of the cervix and the pubic symphysis (the place where the pubic bones unite at the front of your pelvis). Relaxin also inhibits contractions of the uterus and may play a role in timing of delivery.

Thyroid

Thyroid hormone (T3)

Controls metabolic rate. During pregnancy, increases metabolic rate and pulse rate. Takes six weeks after pregnancy to return to pre pregnancy levels.

Pituitary gland

(pea sized gland that produces a number of hormones in the body, found a few centimetres behind your eyes)

Oxytocin

Stimulates uterus to go into labour. Also required to eject milk from your breasts if you’re breast feeding. Said to be partly responsible for feelings of love and maternal bonding.

Prolactin

Responsible for growth and activity of your uterus, breast enlargement and producing breast milk.

Melanocyte Stimulating Hormone (MSH)

Production increases during pregnancy. MSH produces skin pigmentation that can make your nipples darker and produce the dark line between your belly button and your pubic bone – called the linea nigra (Latin translation: black line).

Adrenocorticotrophic hormone (ACTH)

One of the hormones produced in response to long term stress. During pregnancy, it’s responsible for stimulating your baby’s production of the same hormone. ACTH is good in small doses, but if you’re chronically stressed throughout your pregnancy, chances are you’re more likely to have a stressed baby.

Further reading:

Hip Dysplasia

Hip dysplasia (HD) is a “malformation” of the hip joint. The hip is a ball and socket joint, and hip dysplasia is either a problem with the development of the ball (femoral head) or the socket (acetabulum).

How do I know if my baby has hip dysplasia?

In Australia, babies are routinely checked at birth to make sure their hip joints are properly positioned. A hip that isn’t formed properly doesn’t have a full range of movement and makes a clunking sound as the ball of the ball of the femur moves in and out of the socket when tested. An ultrasound is usually performed to confirm the diagnosis and help determine the extent of the dislocation.

How common is it?

1 in 600 girls are affected, compared to just 1 in 3000 boys. The left hip is affected 3 times more often than the right hip and there is a family history of hip dysplasia in one third of all cases.

What causes it?

There are a number of causes or known risk factors
for developing hip dysplasia:
·         Family history – approx  one third of babies with HD have a relative who also had the condition

·         Breech delivery – travelling buttocks first down the birth canal puts a large compression force through the hips in a flexed position.

·         Multiple babies in the uterus – twins or triplets or more inside the uterus crowding and squashing hips into awkward positions.

·         Oligohydraminos – (insufficient amniotic fluid in the uterus) which discourages the baby from moving around and changing positions.

Treatment

Depending on the degree of the dysplasia, treatment can range from wearing a firm nappy to keep the hip in optimal position to more stable harnesses. The harness holds the hip joints in place while your baby’s skeleton grows and matures.

The Pavlik harness is effective in over 85 per cent of cases. Most babies will require the harness for between 6 and 12 weeks and have good results without complications.

If the dysplasia persists beyond six months or isn’t picked up until after six months, the hips will generally not be able to be corrected with a simple brace and a cast is often necessary, a procedure performed under a general anaesthetic.
While wearing the brace, the goal of osteopathic treatment is to maintain mobility of the other joints affected by the brace (knees, ankles, pelvic joints and shoulders). Osteopaths will also keep an eye on your baby’s leg lengths to make sure the muscles and ligaments around the affected hip/hips don’t shorten and contract to create a leg length discrepancy. After the brace is removed, an osteopath will test the mobility and symmetry of the joints restrained in the harness and treat accordingly to achieve symmetry required for correct crawling, sitting and walking.

References

Mattress Review

Summary:

If you want a good mattress at a fair price, check out the endorsed inner spring mattresses. If you have a bigger budget to play with, consider a natural rubber latex mattress. If you have pressure sores and aren’t concerned about synthetic materials, try the Tempur (memory foam). Whichever you decide, make sure you and your partner lie on the mattress for at least 10 minutes and see if you can arrange a return or swap within a month if you’re not happy with it once you get it home!

Have you:

·        Got lumps and dips in your mattress?
·        Had your current mattress for more than 8 – 13 years?
·        Do you wake up stiff and sore?
·        Does your spine look like the centre or bottom image to the right when you’re lying on your side?
…then it’s probably time for a new mattress!!!

Types of mattresses

There are three main types of construction:
·        Inner spring
·        Latex
·        Memory foam

Inner spring mattresses are the traditional style of mattress. The spring unit is the main source of support for your body. According to Choice magazine, there are five factors can influence the degree of comfort, support and durability of a mattress: the number of springs or coils, their shape, the gauge of wire used, the number of turns in each spring and the distribution of the springs.

Latex mattresses can be made from natural rubber or synthetic rubber or a combination of the two. There are many types of synthetic latex, polyurethane is one of these (see memory foam). There are varying grades of latex. Good quality latex mattresses are quite expensive, but you can expect a good quality one to last for 20 – 25 years. Consider a latex mattress if you suffer from allergies, as the natural rubber is less likely to host dust mites and moulds.  A cheaper alternative to a full latex mattress is a latex overlay on a firm inner spring mattress, which a lot of companies produce.

Memory foam (Referred to as visco elastic when made in Australia). The original memory foam mattress is the Tempur mattress, produced by a Danish company. The technology behind the Tempur mattress was instigated by NASA in the 1970’s. NASA wanted to produce a material that would improve seating comfort and decrease the affects of g-forces in spacecrafts. Tempur products have been available to public since 1991. The memory foam is so called because it heats up with your body temperature, softens and moulds around your body and ‘remembers’ your shape for a short while after you move. This means less pressure points, which is why Tempur mattresses are used in some hospitals and nursing homes.

Endorsements

The Australian Osteopathic Association (AOA) endorses Selectopedic range, available at Snooze (formerly Capt’n Snooze). These are Australian made inner spring mattresses, the springs are hand assembled.  Price:  $1649 for a Queen size ensemble.

The Chiropractors Association of Australia (CAA) endorses the Sleepmaker chiropractic range. These are a range of inner spring mattresses, widely available.  These are machine assembled, Australian made inner spring mattresses, firmer than the Selectopedic mattress endorsed by the AOA. Price $2349 for queen size.
The Australian Physiotherapy Association (APA) recommends Simmons BackCare range of beds available from Forty Winks and some Harvey Norman stores. Simmons is a U.S. company, but made in Australia. Price: RRP $1559 (Back care firm model) to $1859 (Back Care Elite). (Forty Winks RRP). These are pocket spring mattresses – the individual springs are in their own fabric pocket and not joined at the top or bottom, designed to minimise partner disturbance. The APA also endorses Sleepmaker physio range of beds, however, this range is only available from Bedshed stores and there are no Bedshed stores in metropolitan NSW (there’s one in Mittagong).

Further information:

Welcome

Welcome to bulb talk – the official blog of bulb osteopathy!
Bulb talk is where you’ll find relevant updates & content posted on a regular basis. The purpose of bulb talk is to provide well researched, balanced information on everything to do with maternal and child health, growth and wellbeing as well as quality references for further research.
If you want to be updated every time we post useful information here, simply add your email address to the box on the right hand side, or subscribe by clicking on the  button.
Helping you to grow healthy mums and bubs!
Nicole Wilson, Osteopath.