Pregnancy and the Chiropractic Advantage

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How can chiropractic add comfort? Chiropractic care in pregnancy is an essential ingredient to your pre-natal care choices. A large percent of all pregnant women experience back discomfort/pain during pregnancy. This is due to the rapid growth of the baby and an interference to your body’s normal structural adaptations to that growth.

Pre-existing unnoticed imbalances in your spine and pelvis become overtaxed during these times. The added stresses lead to discomfort and difficulty while performing routine, daily activities. Chiropractic care throughout pregnancy can relieve and even prevent the common discomforts experienced in pregnancy. Specific adjustments eliminate these stresses in your spine, restore balance to your pelvis and result in greater comfort and lifestyle improvements.

Comfort for your baby, too. As your baby develops, your uterus enlarges to accommodate the rapid growth. So long as the pelvis is in a balanced state, the ligaments connected to the uterus maintain an equalized, supportive suspension for the uterus. If your pelvis is out of balance in any way, these ligaments become torqued and twisted causing a condition known as constraint to your uterus. This constraint limits the space of the developing baby. Any compromised position for the baby throughout pregnancy will affect his or her optimal development. Conditions such as torticollis occur because a baby’s space was cramped in utero. If the woman’s uterus is constrained as birth approaches, the baby is prevented from getting into the best possible position for birth.

Even if the baby is in the desirable head down position, often times constraint to the uterus affects the baby’s head from moving into the ideal presentation for delivery. The head may be slightly tilted off to one side or even more traumatically, present in the posterior position.

Any baby position even slightly off during birth will slow down labor, and add pain to both the mother and baby. Many women have been told that their babies were too big, or labor “just slowed down” when it was really the baby’s presentation interfering with the normal process and progression. Avoidable interventions are implemented turning a natural process into an operative one.

Doctors of Chiropractic work specifically with your pelvis throughout pregnancy restoring a state of balance and creating an environment for an easier safer delivery.

Preparing for a Safer Birth Dystocia is defined as difficult labor and is something every woman wants to avoid. In addition to the pain and exhaustion caused by long, difficult labors, dystocia leads to multiple, medical interventions which may be physically and emotionally traumatic to both you and your baby.

Some of these interventions are the administering of pitocin, the use of epidurals, painful episiotomies, forceful pulling on the baby’s fragile spine, vacuum extraction, forceps and perhaps even c-sections. Each of these procedures carry a high risk of injury to you, your baby or both. However, all of these procedures used to hasten the delivery process can be avoided if delivery goes more smoothly to begin with.

Originally Printed in: I.C.P.A. Newsletter January/February 1999

A woman's body is exquisitely designed to conceive, nurture, and birth another human being. After conception, a woman and unborn child will unite in an oceanic blend of energy and identity... where one ends and the other begins no one knows.

A woman becomes a parent at the moment of conception. Every decision made from that moment on will affect her unborn child in some way. In order for her influence to have a positive affect, a woman must be prepared to make educated and informed decisions concerning the foods she will consume, the thoughts and images she will imprint on her baby's developing brain, and the birth model she will embrace - technological, holistic, or humanistic. A female child spends her entire early life preparing for the possibility of motherhood so she can inadvertently make those decisions.

During childhood, a young girl learns to parent by example. She watches her mother and records subconsciously what she observes. Later, a teenage girl prepares her body for motherhood. Without her conscious knowledge, a teenager stores some of the nutrients she consumes to insure she has the building blocks to form a body for future children. For example, she must consume folic acid to prevent birth defects; essential fatty acids to build the central nervous system and peripheral nerves of a future embryo; and calcium for future fetal bone growth. Nature does its best to insure that a woman is prepared for parenting, but the forces of nature are not enough if she is not an active participant. Her body can not store what she does not consume. Consequently, we must educate our young girls early on about the concept of preparing their bodies for conception.

Conceiving and nurturing the unborn child are only two of the most important concepts we must teach future parents. Entrusted with the guardianship of a new life, a pregnant mother must also learn that all decisions surrounding her pregnancy, labor, and delivery should be based on knowledge and confidence rather than fear or impatience. Therefore, one of the most important concepts a parent must educate herself about is the birth model she will choose to adopt.There are three basic philosophical models that a pregnant parent may choose from. The first and most commonly adopted is the technocratic model. In this paradigm, a parent accepts that the human body functions like a machine. Robbie Davis-Floyd in Birth As An American Rite of Passage demonstrates how this model, which is the foundation of modern obstetrics, views the female body as unpredictable and inherently defective. Consequently, it may malfunction at any time. The basic tenet of this model of birth holds that some degree of intervention is necessary in all births. Women who embrace the technocratic model enter the birthing room believing that science is there to take care of them and save them from the pain and anguish of childbirth.

On the opposite end of the spectrum is the holistic model. Within this paradigm of birth, the family is the significant social unit instead of the hospital. Under the holistic model, the human body is a living organism with its own innate wisdom, an energy field constantly responding to all other energy fields. Female physiological processes, including birth, are healthy and safe and need no medical intervention. Under this model, the mother's mental and emotional attitudes affect her performance during birth, as do the beliefs and actions of the partner. It is almost impossible for a parent who adopts the holistic paradigm to deliver within the hospital environment because of the inherent institutional management of birth associated with the technocratic approach.

In-between these two diametrically opposed models of birth lie the humanistic model. When adopting this paradigm, a mother believes she is an individual and must be treated as such. She believes she has the right to promote shared decision-making and responsibility for all aspects of the birth process. This model views the parent holistically while remaining open to the use of technology if applied judiciously. When a pregnant parent adopts a humanistic model, she surrounds herself with loving people who are willing to assist her by walking with her, rubbing her back, helping her move in and out of the bath, holding her, encouraging her, and providing support for any decision she makes. Her birth may occur either in the home, a birthing center, or a hospital if she has a birth attendant who also adopts the humanistic model.

Chiropractic care is essential for the pregnant mother. Her systems and organs are now providing for two and their optimal function is critical for the baby's healthy development. The mother's spine and pelvis undergoes many changes and adaptations to compensate for the growing baby and the risk of interference to her nervous system is increased. Specific chiropractic care throughout pregnancy works with enhancing nervous system function providing greater health potential for both the mother and baby.

Another important reason for care throughout pregnancy is to help establish balance in the mother's pelvis. Because of a lifetime of stress and trauma to her spine and pelvis, her pelvic opening may be compromised, resulting in a less than optimum passage for the baby. Williams Obstetrics Text tells us that, "Any contraction of the pelvic diameters that diminish the capacity of the pelvis can create dystocia (difficulty) during labor." They further state that the diameter of the woman's pelvis is decreased when the sacrum is displaced. Dr. Abraham Towbin, medical researcher on birth tells us that the bony pelvis may become "deformed" this way by trauma. Chiropractors define this displacement/ deformation as spinal misalignment or subluxation primarily caused by the stress of trauma.

Additionally, these compensations to her spine and pelvis during pregnancy are likely to cause an imbalance to her pelvic muscles and ligaments. The woman's pelvis supports her growing uterus with specific ligaments. When the pelvic bones are balanced, the uterus is able to enlarge symmetrically with the growing baby. If the bones of the pelvis are out of alignment or subluxated, this will directly affect the way the uterus will be supported. Unequal ligament support of the uterus will torque the uterus reducing the maximum amount of room for the developing baby. The term used to describe this is intrauterine constraint.

In some cases, this constraint restricts the baby's positions during pregnancy adversely affecting his/her developing spine and cranium. Additionally, these limitations on the baby's movement during pregnancy may prevent him/her from getting into the best possible position for birth. Any birth position other than the ideal vertex, occiput anterior position of the baby indicates the inhibiting effects of constraint. Such positions lead to longer more painful labors with increased medical interventions in birth. Often c-sections are resorted to and both the mother and baby miss the many benefits of a natural vaginal birth.

The Webster Technique, discovered by Dr. Larry Webster, founder of the ICPA, is a specific chiropractic adjustment for pregnant mothers. Working to correct sacral subluxations, this technique balances pelvic muscles and ligaments in the woman's pelvis, removes constraint and allows the baby to get into the best possible position for birth. Dr. Webster instructed many Doctors of Chiropractic in this technique and their combined results showed a high success rate in allowing babies in the breech position to go into the normal head down or vertex position. Because of its ability to facilitate easier, safer deliveries for both the mother and baby, many birth care providers are actively seeking Doctors of Chiropractic with the skills in this technique.

References:
Cunningham FG et al, "Dystocia Due to Pelvic Contraction", Williams Obstetrics, Nineteenth Ed 1989 Towbin A, "Dystocia", Brain Damage in the Newborn and its Neurologic Sequelle, 1998

Netter F. "Pelvic Viscera and Perineum" Atlas of Human Anatomy ; 1994

Hellstrom B, Sallmander U "Prevention of Spinal Cord Injury in Hyperextension of the Fetal Head" JAMA 1968; 204(12): 1041-4

Anrig C, Plaugher G; “Chiropractic Management of In-Utero Constraint” Pediatric Chiropractic, 1998: Chapter 5 page 102.

In my professional experience as a chiropractor I have had the opportunity to work with many midwives. I have come to learn that there are many similarities in the approach to healthcare between midwives and chiropractors. Both groups share an acknowledgement of, and trust in, the body's inner wisdom. Chiropractors call this wisdom "innate intelligence". When allowed to perform without interference, innate intelligence coordinates the responses to the body's needs at any given moment, thus maintaining the body's optimal health.

In chiropractic, we recognize that this inborn wisdom uses the nervous system as its conduit to transmit electrical impulses of intelligence to all systems and functions of the body, thus maintaining a state of homeostasis and balance. Mechanical pressure on the nervous system by the bones of the cranium and spine may interfere with this normal transmission of intelligence and result in a state of dis-ease. Chiropractors call this mechanical pressure on a nerve by the spine "vertebral subluxation". The specific chiropractic adjustment removes the pressure from the nervous system, restoring the pathways of transmission and therefore allowing for better overall function of the body.

Moreover, within both professions is profound support and commitment to non-invasive birthing procedures. Chiropractors and midwives alike share a genuine respect for the process of natural birthing, encouraging the mother to follow her intuition for guidance throughout the process. Managing labor from within rather than through the use of external drugs and obstetrical procedures allows for safer and easier deliveries for both the mother and baby. When subjected to unnecessary interventions not only is a mother's well being at risk, but many times the baby is also put at risk.

A particular concern of chiropractors is when there is force applied to the baby's head and neck during delivery, as this is a cause of much birth trauma. 1 Unnatural birthing positions also add to the risk of birth trauma. 2 The use of drugs during labor and delivery that may interfere with the mothers' intuition of natural birthing can also contribute to the use of additional force during delivery. 3 External forces applied during delivery may cause undetected injury to the baby's spine and cranium as well as to the delicate nervous system they are protecting. 4 Sometimes these injuries are obvious, but more often than not injury has occurred during the course of normal obstetric delivery procedures that is not detected. Birth trauma may have long lasting effects on the child's future health status. 5

Midwives and chiropractors also offer care that is personal to each individual and specific to every case. Midwives and chiropractors also share the unique ability to assess a patient's status with their own hands, and both professions are blessed with the privilege of touching others to bring about a greater expression of life.

These three common bonds have been enough to establish life-long supportive relationships between the two groups. 6 However there is a fourth cause for alliance and reciprocity between us. It is a specific chiropractic adjustment called the Webster Technique. Developed by Dr. Larry Webster and formerly called the Webster Breech Turning Technique, this particular chiropractic adjustment was classically used during the seventh through ninth months of pregnancy. It is primarily focused on women whose babies are presenting breech or transverse. Doctors of Chiropractic reported an >85% success rate in its ability to balance pelvic structures and remove constraint to the woman's uterus therefore allowing the baby to turn into the vertex position.

Midwives around the country are hearing about this technique and seeking out chiropractors trained in its use. Alliances are forming in communities and both mothers and babies are spared the irreparable damage caused by the growing number of c-sections. Midwives are referring patients to chiropractors even before malpresentations are evident, and their practices are reaping the benefits of overall easier, safer deliveries for both the mother and baby.The ICPA responded to the growing demand for this skill and began a marathon of classes to train Doctors in the correct application and use of this adjustment. Today, we maintain the only database available of Chiropractors who have been tested and are proficient in the Webster Technique.

Doctors trained through the International Chiropractic Pediatric Association have learned how to apply this specific adjustment, along with other chiropractic techniques, to benefit the mother and baby throughout pregnancy. Because we are working specifically to balance pelvic muscles and ligaments with their adjustments, we are removing constraint to the woman's uterus. This allows the baby to get into the best possible position for birth in a timely manner and the need for "crisis care" in the last couple of months of pregnancy is being eliminated.

Working with chiropractors almost every weekend, I know that one of their greatest objectives is to eliminate as many variables that lead to traumatic birth and therefore injury of the newborn's spine, cranium and nervous system. To achieve this goal, we need the help of midwives! We need their valuable services and care to the women in our communities. Our growing support of midwifery will fulfill their mission for natural birthing and ours as well.Specific chiropractic care helps to provide an environment for safer, easier, faster deliveries. 7,8 Midwifery care is known to do so as well. 9

References:
. Towbin A. Latent spinal cord and brain stem injury in newborn infants. Develop Med Child Neurol 1969; 11:54-68
. Gardosi J, Hutson N. Randomised controlled trial of squatting in the second stage of labour. Lancet 1989; 2(8654): 74-7
. Studd JW, Crawford JS, Duignan NM, Rowbotham CJ, Hughes AO. The effect of lumbar epidural analgesia on the rate of cervical dilatation and the outcome of labour of spontaneous onset. Br J Obstet Gynaecol 1980; 87(11): 1015-21
. Yashon, David, “Birth Injury”, Spinal Injury 1996,8, 347-352
. Biedermann H. Kinematic imbalance due to suboccipital strain in newborns. Manuelle Medizin 1992; 6:151-6
. Allaire AD, Moos MK, Wells SR. Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midwives. Obstet Gynecol 2000; 95(1): 19-23
. Forrester J, Anrig C. The prenatal and perinatal period. In: Anrig C, Plaugher G, Eds. Pediatric Chiropractic. Baltimore, MD: Williams and Wilkins 1998: 75-161
. Hofmeyr GJ, Nikodem VC, Wolman WL, Chalmers BE, Kramer T. Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding. Br J Obstet Gynaecol. 1991 ;98(8):756-64
. Sosa R, Kennell J, Klaus M, Robertson S, Urrutia J. The effect of a supportive companion on perinatal problems, length of labor, and mother-infant interaction. N Engl J Med 1980; 303(11): 597-600.

Chiropractic in the 9^th Month of Pregnancy
The 9^th Month. William Sears, MD, Martha Sears, RN. Parenting, June/July 1997.

The 9^th Month. William Sears, MD, Martha Sears, RN. Parenting, June/July 1997.

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This puts expectant moms in a quandary; whether to go for the Epidural or to pass on the one pain alleviator that will allow them to experience the ecstasy of childbirth without the agony. Experts caution against forgoing a n epidural solely for this reason, however, because a new mom’s temperature may rise even without it. "if a woman labors in a heated birthing room for many hours, the physical effort alone may result in a slight fever," "says David Birnbach, M.D., director of obstetric anesthesiology at St. Luke’s – Roosevelt Hospital in New York.

Besides, experts agree that epidurals are the best labor-pain relief available. So that expectant women won’t have to factor in the possibility of a fever when considering an epidural, researchers hope to find ways other that a mother’s temperature to determine whether a newborn has an infection.

Meanwhile, if you’re expecting, your doctor should go over all the pros and cons of having an epidural so that when the time comes you’ll be prepared to make the choice that is best for you.

Researchers report that half of all C-section deliveries needlessly risk the mother’s life or health without benefit to the baby.