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stuck—if the rhythm is not being transmitted smoothly through these bony landmarks—I may apply gentle traction laterally, in essence spreading the mastoid processes apart. Hypoglossal Nerve: The hypoglossal nerve is the 12th cranial nerve (CN XII). This nerve provides motor innervation to the tongue, directing its movements for eating and speech. I consider this nerve any time an infant is described as having difficulty sucking or latching onto the nipple during breast-feeding, or even a general failure to gain weight normally. The muscular coordination that is required for swallowing is more complex than most people realize, and it doesn't help if the newborn's tongue is not properly innervated because of an impingement of the hypoglossal nerve. The hypoglossal nerve exits the skull through the hypoglossal canal, which runs right through the occipital condyles, anterior to the foramen magnum. During a vaginal birth, the occipital condyles are pressed into the articular facets of the atlas (vertebra C1) inferior to them. This compressive force risks compromising the hypoglossal canal and the nerve running through it. To address this region, I use the cranial base release hold, placing the tips of my fingers just inferior to the occiput and applying gentle traction superiorly. With this technique, I hope to decompress the atlanto-occipital joint, lifting the occipital condyles off the atlas (vertebra C1). Diaphragm: Given that the diaphragm is the muscle responsible for generating pressure gradients within the body, I like to check in with this region to see how it reacted to the birth process. Did it fight the increase in pressure that was experienced in the birth canal? Was it "shocked" by the sudden pressure drop experienced in a C-section birth? The diaphragm is actually an uncommon place to find dysfunction in the newborn (at least in my experience), but these are things to consider. The diaphragm, in addition to being the prime force behind respiration and venous return, has some very important anatomical relations. The vagus nerve, the greater and lesser splanchnic nerves, and other structures involved in the digestive process pass through the diaphragm. The esophagus also passes through the diaphragm, with the diaphragm acting as part of the lower esophageal sphincter. If the diaphragm is held too rigid or too lax after birth, it will interfere with these structures. I use two separate holds for this area. My standard diaphragm hold is one hand resting underneath the infant's back, with the palm at about the level of the T12 vertebra, and the other hand lightly resting on the anterior of the infant, with the palm at the level of the subcostal margin. With my hands in this position, I simply tune into the rhythm and listen. After this, I bring my hands to either side of the infant's lower thorax. Using the pads of my fingers, I gently hook onto the medial side of the angle of the 12th rib. Once my fingers have a hold on each side of the 12th rib, I apply a slight lateral traction, attempting to spread and open the diaphragm up. Sacrum/Pelvis: In my experience, this area is also an uncommon site of restriction, but given its importance, I always check it. The newborn pelvis is not fully ossified yet, and there is quite a bit of cartilage and flexibility in this region. While this usually means resilience, it can also mean vulnerability to compression. The spinal nerves that exit through the anterior sacral foramina carry all the parasympathetic innervation to the hindgut, the end of the digestive system. Just as an impinged vagus nerve can disrupt parasympathetic It's vital to take the time to transmit our intentions of caring and well-being to both mother and child during this initial meeting. I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 71