Chiropractic, Pregnancy and Birth

1. Chiropractic Care in Pregnancy for Safer, Easier Births
2. Please Hands Off! The Importance of Having a Non-Invasive Birth Process
3. Birth— What are the Philosophical Options?

Chiropractic Care in Pregnancy for Safer, Easier Births
By: Jeanne Ohm, D.C.
Originally Printed in: I.C.P.A. Newsletter May/June 2001

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.

Growing awareness of this technique is demonstrating the increased demand for trained Doctors. Daily, the ICPA receives many requests for referrals. Your current membership and proficiency in the Webster Technique supplies this growing demand that all pregnant women need chiropractic care!

We greatly appreciate your vision and commitment in offering pregnant women in your community the best possible care available. Together we are providing significant contributions to the important goal of safer, easier deliveries for both the mother and baby.

References:

1. Cunningham FG et al, "Dystocia Due to Pelvic Contraction", Williams Obstetrics, Nineteenth Ed 1989

2. Towbin A, "Dystocia", Brain Damage in the Newborn and its Neurologic Sequelle, 1998

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

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

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

Please Hands Off!
The Importance of Having a Non-Invasive Birth Process
 By Ryan French, DC
Originally published in ICPA Jan-Feb 2002 Newsletter

 
Most chiropractors encourage their pregnant patients to be well-informed and deal with the birth process with the least amount of interference possible. We do this because we care about the health of both the mother and the soon-to-be-born baby; and because it is congruent with the vitalistic philosophy that chiropractic is based upon. Moreover, scientific advancements are also showing why a non-interventionistic approach to birth is the healthier avenue to pursue.

Unfortunately for the humanity, the medical ‘drugs and intervention’ approach to health does not seem to provide all of the answers as once was thought. I say ‘unfortunate’ because it is the philosophy of health to which the majority of persons in North America currently subscribe. In an effort to clarify the situation, patients should be told about the statistics that science has to offer. Research estimates that there are 2,216,000 adverse drug reactions per year in hospitalized patients. 1 That translates into approximately 185,000 reactions per month, or over 6,000 per day! And that’s just the ones that are actually reported. Properly prescribed drugs are also estimated as responsible for 106,000 fatalities per year, or approximately 300 deaths per day. 1 This ranks adverse drug reactions from properly prescribed drugs as between the 4th and 6th leading cause of death! And, this doesn’t even include human error, patients treated outside the hospital, nor reactions from over the counter drugs. The director of public health at Harvard estimates that iatrogenic injuries, that is, injuries caused by the doctor’s actions, result in 180,000 deaths per year; or approximately 500 every single day.2

When it comes to obstetric accidents, it is interesting to know that although obstetricians make up only 3% of all medical doctors, they account for 29% of all the costs and damages 3, and account for 30% of all claims of negligence against medical doctors! 4 This means that one-third of all mistakes made by doctors are made by those responsible for delivering our children! A 1993 review of literature by Marc Gottlieb determined that despite these statistics “birth trauma still remains an under-publicized and, therefore, under-treated problem.” 5 And when it comes to trauma from the birth process, we are generally talking about damage to the skull, spinal column, and brachial areas.

Knowing this information, it becomes clear why it is imperative for the chiropractor to assess for subluxation and tissue trauma in the newborn. Tissue trauma causes the release of prostaglandin E2, leukotriene B4, bradykinin, histamine and 5-hydroxytryptamine, 6 which sensitize and cause depolarization of local nociceptors, eliciting the perception of pain. Subluxation, due to the component of restricted joint mobility, involves a reduction of mechanoreceptive stimulation, 7 and sensitization of the nociceptors, possibly eliciting the perception of discomfort by the newborn. If this joint area remains immobilized for even a few weeks in a position of ‘comfort,’ “contractures will develop in the surrounding tissue and as a consequence, a normal range of joint motion will be impossible.”8 Thus it is imperative that the newborn is checked as early as possible after delivery. 

Furthermore, the study by Mitchell et al. on the anatomy of the upper cervical spine elevates the importance of upper cervical subluxation correction because of the direct physical attachment of the superficial muscle and ligaments to the spinal cord itself. In this study the authors describe “previously unrecorded attachments of the ligamentum nuchae to the cervical posterior spinal dura, and to posterolateral parts of the occipital bone.” 9 They discovered a fibroelastic ligamentous attachment running from the nuchal ligament to the spinal dura in the midline between the atlas and axis vertebra. This information is so important since the majority of subluxations from birth trauma tend to be in this upper cervical region.

This extremely brief commentary on the literature is in no way exhaustive of the research supporting these concepts. We as chiropractors owe it to our patients to elevate our level of certainty by owning the principles, understanding the science, and being able to deliver the service. In doing this we will move a step closer to our vision of mandatory chiropractic examination for every pregnant mother and newborn.
 

 References:

1. Lazarou, Pomeranz, & Corey. Incidence of Adverse Drug Reactions in Hospitalized Patients. Journal of the American Medical Association, Apr 1998, Vol 279, No. 15, p 1200

2. Leape, L. Journal of the American Medical Association. Dec 1994, Vol 272, No. 23, p 1861

3. Medical Protection Society. Annual Report. London: MPS, 1989

5. Gottlieb, M. Neglected Spinal Cord, Brain Stem and Musculoskeletal Injuries Stemming From Birth Trauma. Journal of Manipulative and Physiological Therapeutics. Vol 16, No 8, 1993

7. Lephart S. Re-establishing proprioception, kinaesthesia, joint position sense, and neuromuscular control in rehabilitation. In: Prentice W, ed. Rehabilitation Techniques in Sports Medicine. St. Louis: Mosby; 1994, p 118-137.

9. Mitchell B, et al. Attachments of the Ligamentum Nuchae to Cervical Posterior Spinal Dura and the Lateral Part of the Occipital Bone. Journal of Manipulative and Physiological Therapeutics. Vol 21, No. 3, Mar/Apr 1998

Birth— What are the Philosophical Options?
By: Carol Phillips D.C.

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.

Before women can make decisions concerning which birth model best suits her own philosophical beliefs, she must know that she has several options. As a profession, we must educate ourselves and our patients about the two models that are most suited to our vitalistic belief system. If we all learn how to honor the inherent wisdom of women and developing newborns, we can have a positive impact on the mental, physical, and spiritual growth and development of the next generation.

For Your Information: Illustrated with more than 150 emotionally charged, color photographs of chiropractic families witnessing the miracle of birth, "Hands of Love," Dr Phillips' new book  can be ordered by contacting the ICPA office at 1-800- 670 - KIDS