The Expectant Parent’s Guide to Chiropractic

 Note:  This article is a sneak preview of a Chapter in Dr. Rosenberg’s second book (due out in late 2010) “Natural Pregnancy, Natural Baby – Second Edition – Natural Remedies From Pre-Conception to Post-Partum.”

Your Nervous System

A person’s spine is made of twenty-four moveable bones called vertebrae, plus the sacrum (tailbone), pelvis, and skull. From the brain, nerve impulses travel down the spinal cord, branch out into nerves, and exit between the vertebrae. When the vertebrae become misaligned or unable to move properly – a condition called vertebral subluxation – it irritates and interferes with the nerves. The message from the brain is slowed down and the life-energy carried by the nerve is unable to reach the organs and tissues at one hundred percent of its potential. A Doctor of Chiropractic aligns the vertebrae and pelvis through gentle adjustments to the spine, thereby relieving the pressure on the nerves and allowing one hundred percent of the nerve energy to reach the tissues it serves.

Chiropractic is a medical system based on the premise that disease and disorders are caused by nerve interference which is caused by a misalignment of the bones, especially in the spine. Specific chiropractic care throughout pregnancy works to enhance nervous system function providing greater health potential for both the mother and baby. It also removes interference to your nervous system allowing your uterus to work at its maximum potential. Chiropractors offer a conservative approach to treatment of pregnant women, without the use of any drug interventions. The aim is to alleviate the stresses and strains of pregnancy and to improve comfort for both mother and baby. [3, 4, 6]

Chiropractic care prior to conception promotes a more regular menstrual cycle and optimum uterine function. It prepares the body to be strong, flexible and as balanced as possible to carry the pregnancy. As your baby grows, your musculoskeletal system must also adjust accordingly to accommodate the growing uterus and prepare for delivery. [5] And adjusting women through pregnancy and labour is one of the most rewarding parts of our jobs as chiropractors, because a healthier pregnancy means an easier labour and delivery – a much better transition for the next generation into this world! [2]

Dr. Stacey and Udo Rosenberg Pregnancy Photo

As you gain weight, especially in the abdomen, this exerts a downward, forward pull on the lower spine. This extra weight combined with changes in your gait and centre of gravity can set the stage for backache and neck pain. Additionally, as labour approaches, your body secretes a hormone called Relaxin, which loosens ligaments. This may exaggerate the effects of an existing spinal or pelvis problem. [3, 11] The positioning of the baby and its movement as well as expansion of the lower part of the ribcage to accommodate your growing baby can also cause discomfort in the ribs and upper portion of the lower back. Additionally, your increasing breast size in preparation for lactation can create upper back subluxations. [3, 4, 8, 10, 11, 12, 18, 19, 20, 21, 22, 24]

An imbalance in the spine and pelvis is likely to cause an imbalance in the pelvic muscles and ligaments which support the uterus. The uterus is suspended by eight ligaments and a node caused the perineal body. The uterus is connected to the pelvis by ligaments: the broad ligament, the uterosacral ligaments, and the round ligaments. Like a hot air balloon tethered to the ground, these ligaments work to keep the uterus in the proper place in the pelvis and allow support as the uterus grows to accommodate the growing baby. [12] Some of these ligaments attach directly to the pelvis and sacrum, some attach to the labia and are affected by the alignment of the pubic bones. [10, 11, 12, 13]

These suspensory ligaments must all function properly without tension or spasm for the uterus to be suspended properly and itself be without spasm. 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 will torque the uterus reducing the amount of room for the developing baby. When the ligaments are affected, they directly affect the position of the uterus which can result in the baby not being in an optimal position. This type of situation may result in a breech baby or a transverse (sideways) baby. This is called intrauterine constraint. This constraint restricts the baby’s positioning during pregnancy adversely affecting his/her developing spine and cranium. Additionally, these limitations on baby’s movement during pregnancy may prevent him/her from getting into the best possible position for the birth (ideal is vertex, occiput anterior). [3, 7, 9, 11, 12, 13]

Any position other than the ideal, including occiput posterior, breech, transverse, oblique or “sunny side up” (face up) lies, lead to longer, more painful labours with increased medical interventions. Any baby position even slightly off during birth will slow down labour, and add pain to both mother and baby. Many women have been told that their baby’s were too big of labour just slowed down when it was really the baby’s presentation interfering with the normal process and progression. Often interventions and c-sections are resorted to and both mother and baby miss the many benefits of a natural, vaginal birth. And because they are so common, many people forget that a c-section is major abdominal surgery and has risks to the mother and baby. [3, 14, 16, 17]

Specific gentle, chiropractic techniques address intrauterine constraint, with the greatest success rates at turning breech (or other less than optimum lies) babies being had if begun at 30 weeks gestation. After 35 weeks, it becomes more difficult to turn the baby due to a lack of room for the baby to make the move. The two most common techniques that address intrauterine constraint are Webster or Bagnell Chiropractic Techniques. [11, 17, 18]

Chiropractic Hip Capsule/Glut Muscle Release Technique - Elbow contact

According to recent studies, chiropractic care may result in easier pregnancy, including increased comfort during the third trimester and delivery and reduced need for analgesics. In one study, women receiving chiropractic care through their first pregnancy had twenty-four per cent shorter labour times and subjects giving birth for the second or third time reported thirty-nine per cent shorter labour times. In another study, the need for analgesics was reduced by fifty per cent in the patients who had received adjustments. In addition, eighty-four per cent of women report relief of back pain during pregnancy with chiropractic care! And because the sacroiliac joints of the pelvis function better, there is significantly less likelihood of back labour (contractions and sharp pain felt in the lower back/sacral area during labour) when receiving chiropractic care during pregnancy. Chiropractic care has helped new mothers become more comfortable breastfeeding (posture-wise) as well as to produce more milk. [8, 10, 12, 18, 19, 20, 21, 22]

Doctors of chiropractic specifically work with your pelvis, including the muscles and ligaments, throughout pregnancy restoring a state balance and thereby creating an environment for an easier safer birth. Gentle chiropractic adjustments during pregnancy can help relieve many of the physical discomforts caused by the shift in gravity and softening of the ligaments to accommodate your growing belly and in preparation for childbirth. Simply put, chiropractic care may keep your pelvis, spine and supporting muscles more flexible, resulting in an easier pregnancy and thereby alleviating the resulting aches and pains in the lower back, hips, sacroiliac joints, and lower ribs. As discomforts shift to the mid-back and neck during the post-partum period from breastfeeding and carrying a newborn, chiropractic care can also help keep you moving and improve your posture as the ligaments slowly tighten back into place. [3, 4, 10, 11, 12, 18, 19, 20, 21, 22]

Pregnancy chiropractic table modification

Choose a doctor of chiropractic who is experienced in treating pregnant women (you may need to call a few offices in your area to determine this if your primary care giver is unsure). Your chiropractor should be trained in gentle, pregnancy-specific, short-lever, minimal rotation techniques that address intrauterine constraint or foetal mal-positions (e.g. they should be Webster or Bagnell Technique certified) and be able to modify their technique for your comfort (e.g. a table with a drop-away thoraco-lumbar piece, a tilt-up pelvis piece or special pregnancy pillows to accommodate your growing belly). [11, 17, 23, 24]

As your pregnancy advances, some chiropractic techniques will need to be modified for your comfort. Your Chiropractor is aware of this and will make the necessary changes. In particular, special pregnancy pillows and/or tables with drop-away or tilt–up pelvic pieces are used to accommodate your growing belly and breasts. As little force as possible should be used to adjust a pregnant woman due to the Relaxin loosening all the ligaments in the body. In fact, very little force is necessary to accomplish the adjustment for the very same reason! In my opinion, side-lying twisting-type of manual adjustments and long lever lumbar or pelvic manipulation techniques should be avoided in the second and third trimester. Your chiropractor will check for misalignment of the pelvic bones (including the pubis), misalignment of the sacrum and vertebrae, and spasm of the ligaments that support the uterus and help hold the pelvis together. [11, 17, 23, 24]

[1] Foti T, Davids J et al. “A Biomechanical Analysis of Gait During Pregnancy.” The Journal of Bone and Joint Surgery. (2000) Vol 82: 625-632

[2] Collins M. “Pregnancy and Chiropractic.” www.planetchiropractic.com.

[3] Ohm J. “Chiropractic Care in Pregnancy for Safer, Easier Births.” ICPA Newsletter. May/June 2001.

[4] Bagnell KG. “How To Explain Chiropractic Care to the Mother-to-be.” Handout. www.pregnancychiropractic.com

[5] Beingessner M. (2008) Getting Ready for Baby: A Practical Five-Step Guide to Help You Prepare for Labour, Birth and For Life as a Family. Heartlights Publishing: Calgary AB.

[6] www.isischiropractic.co.uk/chiropractic_pregnancy.html

[7] Cunningham FG et al. (1989) ”Dystocia Due to Pelvic Contraction.” Williams Obstetrics, 19th edition.

[8] Alcantara J, Ohm J, Ohm J. “Chiropractic Care of a Patient with Dystocia and Pelvic Subluxation.” Journal of Pediatric, Maternal and Family Health. 2009: (Winter, Issue 1), p1-5.

[9] Towbin A. “Dystocia.” Brain Damage in the Newborn and its Neurologic Sequelle. 1998.

[10] Daly JM, Frame PS, Rapoza PA. “Sacroiliac Subluxation: A Common Treatable Cause of Low Back Pain in Pregnancy.” Fam Prac Res Journal. (1991) 11(2): 149-159.

[11] Bagnell K. (2005). Pre-Natal Chiropractic Care. Instantpublisher.com.

[12] Walters S. “Chiropractic Brings Better Birth Outcomes.” http://www.naturalnews.com/025669.html.

[13] Netter F. (1994) “Pelvic Viscera and Perineum.” Atlas of Human Anatomy.

[14] Gaskin IM. (2003). Ina May’s Guide to Childbirth. Bantam Books: USA.

[15] Hikel K. “The Real Risks for Caesareans: An Expert Interview With Pamela K. Spry, BSN, MS, PhD” www.medscape.com.

[16] Almeida ECS, Nogueira AA et al. “Caesarean Section as a Cause of Chronic Pelvic Pain.” International Journal of Gynaecology. (2002) Vol 79: 101-104.

[17] Ohm, J. “Webster Technique Defined.” ICPA Newsletter.

[18] www.cmaj.ca/content/full/176/4/455; www.icpa4kids.org; www.isischiropractic.co.uk/chiropractic_pregnancy.html.

[19] Berg G, Hammer M et al. “Lower Back Pain During Pregnancy and Labour.” Obstetrics and Gynaecology. (1988) 71: 701-775.

[20] Diakow P, Gladsby T et al. “Back Pain During Pregnancy and Labour.” Journal of Manipulative and Physiological Therapeutics. (1991) 14: 116-118.

[21] Fallon J. “The Effect of Chiropractic Treatment on Pregnancy and Labour: A Comprehensive Study.” Proceedings of the World Federation of Chiropractic. (1991) 24-31.

[22] Wang SM, Dezinno P et al. “Low back pain during pregnancy: prevalence, risk factors, and outcomes.” Obstet Gynecol July 2004;104(1):65-70. Source: www.toyourhealth.com/mpacms/tyh/article.php?id=573

[23] You can find a list of Webster certified practitioners on www.icpa4kids.org.

[24] Rosenberg S. (2008) Natural Pregnancy, Natural Baby – Natural Remedies for Pregnancy, Birth and Post-Partum Discomforts. USA: Xlibris Corp.

[Versions of this article were printed in the Winter 2008 ICPA Pathways Magazine; and January and March 2009 Canadian Chiropractor Magazines]