Predictability of cranial base strains as related to birth presentation: a review of literature.

CONTEXT: The etiology of cranial base strains (CBS) in newborns is poorly elucidated in historical and current literature. There have only been a handful of studies examining the prevalence of CBS in newborns or vaginal birth presentation prevalence individually, let alone their relationship. Defining this link could help to further the applications of osteopathic manipulative medicine in neonates.

OBJECTIVES

The objective of this review was to consolidate all historical and current research on the potential link between vaginal birth presentation and CBS in infants.

METHODS

A review of historical and current literature was completed in October 2023 by all authors utilizing the PubMed database and Google Scholar with the following search terms: cranial strain, osteopathy, fetal, molding, pediatric, birth presentation, delivery, and labor. These terms were utilized in various combinations and individually. Inclusion criteria included description of infant skull morphology, CBS patterns, and vaginal birth presentation. Exclusion criteria included studies with noninfant populations that did not address cranial morphology and/or discussed plagiocephaly unrelated to birth. There was no date range in the exclusion criteria due to the scarcity of research. Texts that included an evaluation and treatment of children at various ages were selected for partial reviews, only including the sections relevant to infancy. The best judgment of the authors was utilized to recognize reliable articles and texts. Extensive research returned very few recorded associations of CBS caused by vaginal birth and their accompanying mechanisms; thus, a review of citations in articles sought for retrieval was also completed. Most of the information procured was found in academic and historical texts rather than research articles.

RESULTS

The results of this review are inconclusive and can only align with the theory that physiological CBS are the most common and that pathological CBS are uncommon; no relationship to vaginal birth presentation can be concluded with the available research. However, the literature reviewed illustrates a statistically significant increase in somatic dysfunction/cranial asymmetry in infants after prolonged labor, an increase in the rates of plagiocephaly in infants born to nulliparous women and/or the use of assistive devices, improvement of symmetry with the administration of osteopathic manipulative treatment (OMT), and the improvement of symptomatology after OMT.

CONCLUSIONS

More research needs to be completed on this topic to increase knowledge in the field of infantile CBS. A better understanding of the effect of vaginal birth presentation on infant CBS and occipital flattening could optimize infant development and the prevention of common diagnoses such as plagiocephaly, developmental delay, torticollis, colic, and feeding difficulties.