Despite great technology, the United States has an infant mortality rate like that of a third world nation.  The procedure intensive approach to childbirth in the U.S. is believed to be a significant contributing factor.  A survey of 1,573 pregnant women reported significant interventions such as “regional analgesia (76%), ruptured membranes (65%), forceful pushing (75%), and cesarean sections (32%). The U.S. rate of cesarean sections in 2005 was the fourth highest among 25 countries. The epidural has many negative features. When used in labor it extends the length of time from 5 to 7 hrs, causes a raised temperature greater than 100.4 degrees C in 15-30% of infants and mothers, and produces a very sleepy baby at birth, irritable and with increased crying for 3 weeks.”

The statistics from research published this year highlight this tragedy:

·  In 1960 the U.S. ranked 12^th among other nations in infant mortality

·  By 2005 the U.S. infant mortality rate had fallen to 30^th  

·  In 2007,  31% of U.S. births were by cesarean section

·  Preterm births in the U.S. have also risen to 36%
Countries using fewer drugs and fewer invasive procedures like Finland and Sweden have the lowest infant mortality rates of industrialized countries.

Academy of breastfeeding medicine founder’s lecture 2009: Maternity care re-evaluated.

Breastfeed Med. 2010 Feb;5:3-8.

Klaus M, Klaus P.
Department of Pediatrics, University of California, San Francisco, USA. phyllisklaus@sbcglobal.net

In the 1990s a rising tide of medical, surgical, and instrumental interventions served to make childbirth almost treated like a disease. This report supports a different approach to childbirth. A case and discussions of induction are presented. A national survey of 1,573 pregnant women throughout the United States was collected. Although most U.S. childbearing women are low risk, childbirth is “procedure intensive.” Women reported significant interventions such as regional analgesia (76%), ruptured membranes (65%), forceful pushing (75%), and cesarean sections (32%). The U.S. rate of cesarean sections in 2005 was the fourth highest among 25 countries. The epidural has many negative features. When used in labor it extends the length of time from 5 to 7 h, causes a raised temperature greater than 100.4 degrees C in 15-30% of infants and mothers, and produces a very sleepy baby at birth, irritable and with increased crying for 3 weeks. The three hormones that relieve pain are turned off by the epidural or a cesarean section. Maternal and infant mortality was doubled as a result of cesarean section. After cesarean sections, subsequent pregnancies have types of abnormal attachments of the placenta to the uterus. British physicians recommend normal birth, defined as labor that starts on its own and uses no analgesia, no inductions, no interventions, no epidurals, and no cesarean sections. The doula’s presence decreases labor length, significantly decreases cesarean sections, means less use of pain medicine, and gives greater breastfeeding rates.

Annual summary of vital statistics: 2007.

Pediatrics. 2010 Jan;125(1):4-15. Epub 2009 Dec 21.

Heron M, Sutton PD, Xu J, Ventura SJ, Strobino DM, Guyer B.
Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA. mheron@cdc.gov

The number of births in the United States increased between 2006 and 2007 (preliminary estimate of 4,317,119) and is the highest ever recorded. Birth rates increased among all age groups (15 to 44 years); the increase among teenagers is contrary to a long-term pattern of decline during 1991-2005. The total fertility rate increased 1% in 2007 to 2122.5 births per 1000 women. This rate was above replacement level for the second consecutive year. The proportion of all births to unmarried women increased to 39.7% in 2007, up from 38.5% in 2006, with increases noted for all race and Hispanic-origin groups and within each age group of 15 years and older. In 2007, 31.8% of all births occurred by cesarean delivery, up 2% from 2006. Increases in cesarean delivery were noted for most age groups and for non-Hispanic white, non-Hispanic black, and Hispanic women. Multiple-birth rates, which rose rapidly over the last several decades, did not increase during 2005-2006. The 2007 preterm birth rate was 12.7%, a decline of 1% from 2006. The low-birth-weight rate also declined in 2007 to 8.2%. The infant mortality rate was 6.77 infant deaths per 1000 live births in 2007, which is not significantly different from the 2006 rate. Non-Hispanic black infants continued to have much higher rates than non-Hispanic white and Hispanic infants. States in the southeastern United States had the highest infant and fetal mortality rates. The United States continues to rank poorly in international comparisons of infant mortality. Life expectancy at birth reached a record high of 77.9 years in 2007. Crude death rates for children aged 1 to 19 years decreased by 2.5% between 2006 and 2007. Unintentional injuries and homicide were the first and second leading causes of death, respectively, accounting for 53.7% of all deaths to children and adolescents in 2007.

Behind international rankings of infant mortality: how the United States compares with Europe.

NCHS Data Brief. 2009 Nov;(23):1-8.

MacDorman MF, Mathews TJ.
Centers for Disease Control and Prevention National Center for Health Statistics 3311 Toledo Road, Hyattsville, Maryland 20782, USA.

Infant mortality is an important indicator of the health of a nation, and the recent stagnation (since 2000) in the U.S. infant mortality rate has generated concern among researchers and policy makers. The percentage of preterm births in the United States has risen 36% since 1984 (1). In this report we compare infant mortality rates between the United States and Europe. We also compare two factors that determine the infant mortality rate-gestational age-specific infant mortality rates and the percentage of preterm births. U.S. data are from the Linked Birth/Infant Death Data Set (2,3), and European data for 2004 are from the recently published European Perinatal Health Report (4). We also examine requirements for reporting a live birth among countries to assess the possible effect of reporting differences on infant mortality data. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

The challenge of infant mortality: have we reached a plateau?

Public Health Rep. 2009 Sep-Oct;124(5):670-81.

MacDorman MF, Mathews TJ.
Reproductive Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Rd., Room 7318, Hyattsville, MD 20782, USA. mfm1@cdc.gov

OBJECTIVES: Infant mortality is a major indicator of the health of a nation. We analyzed recent patterns and trends in U.S. infant mortality, with an emphasis on two of the greatest challenges: (1) persistent racial and ethnic disparities and (2) the impact of preterm and low birthweight delivery.

METHODS: Data from the national linked birth/infant death datasets were used to compute infant mortality rates per 100,000 live births by cause of death (COD), and per 1,000 live births for all other variables. Infant mortality rates and other measures of infant health were analyzed and compared. Leading and preterm-related CODs, and international comparisons of infant mortality rates were also examined.

RESULTS: Despite the rapid decline in infant mortality during the 20th century, the U.S. infant mortality rate did not decline from 2000 to 2005, and declined only marginally in 2006. Racial and ethnic disparities in infant mortality have persisted and increased, as have the percentages of preterm and low birthweight deliveries. After decades of improvement, the infant mortality rate for very low birthweight infants remained unchanged from 2000 to 2005. Infant mortality rates from congenital malformations and sudden infant death syndrome declined; however, rates for preterm-related CODs increased. The U.S. international ranking in infant mortality fell from 12th place in 1960 to 30th place in 2005.

CONCLUSIONS: Infant mortality is a complex and multifactorial problem that has proved resistant to intervention efforts. Continued increases in preterm and low birthweight delivery present major challenges to further improvement in the infant mortality rate.

ChiroACCESS Article: http://www.chiroaccess.com/Articles/The-Deplorable-US-Infant-Mortality-Rate.aspx?id=0000155

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

The article was written by the combined efforts of the ChiroACCESS editorial staff and published on April 26, 2010

 Recent research reported in the Journal of Pediatric, Maternal & Family Health – Chiropractic reveals that chiropractic may play an important role in helping pregnant women with breech presentations deliver normally in such situations.

 The research is the first to report on the use of a hand held instrument to administer a specialized chiropractic technique developed for “In Utero Constraint”, a leading cause of breech presentations.

 ”Every day more clinical research is showing that chiropractic care can play a crucial role during pregnancy, labour and delivery” stated Dr. Drew Rubin, the author of the study. “Research showing that the Webster Technique can affect a breech presentation so that more aggressive interventions such as C-sections can be potentially avoided is growing. This study is the first to use a hand held adjusting instrument to perform Webster’s Technique” added Dr. Rubin.

 Despite widespread education and efforts to curb birthing interventions such as caesarean sections, their use remains high and concern amongst health care advocates is growing. The concern centers around the use of high risk interventions for “convenience” of the doctor or mother without taking into consideration the long term effects of a traumatic birth on the child.

 ”Some expectant mothers are hesitant to undergo chiropractic care for fear it might harm the baby” stated Dr. Matthew McCoy a researcher, public health expert and editor of the journal that published the study. “But the data shows this is simply not the case and chiropractic has been shown to be safe and effective during pregnancy. The findings from Dr. Rubin’s study add further options for the way pregnant women are adjusted” added McCoy.

 As pointed out in the paper, a hand held adjusting instrument was used to perform one part of the adjustment known as Webster’s Technique. The instrument produces a very light impulse that helps “reset” the spinal or pelvic joints. According to chiropractic specialists, distortions of the spine and pelvis either cause or add to the problem of “In Utero Constraint”, possibly causing breech pregnancies. Spinal and pelvic distortions, termed subluxations by chiropractors, result in structural and neurological interference to the spine and nerve system. It is this interference that may affect the birth process and chiropractors correct or reduce this interference, correct the imbalance and allow the fetus to turn in preparation for the birth process.

 ”The goal is for the mother to be checked prior to the time of delivery so that these problems can be corrected beforehand and a difficult labor avoided” remarked Dr. Rubin adding “While these are only three cases, coupled with numerous other case studies and some larger clinical studies, our hope is that is shows health care providers that chiropractors can play a very beneficial role in the management of pregnant patients.”

 All three mothers in this study were managed utilizing the Webster Technique and after 2-4 Webster Technique adjustments, the babies turned from a frank breech position to a vertex, head-down position.

 Dr. Rubin calls for more research on the role of chiropractic care in pregnancy and delivery.

 For more information on Webster technique and chiropractic care in pregnancy, contact Dr. Stacey Rosenberg at Gibsons Chiropractic (604) 886-7080 or your local family chiropractor. To find a listing of Webster Technique certified practitioners in your area, visit www.icpa4kids.com.

Chiropractic Table Modification for Pregnancy

Short answer – yes! Chiropractic techniques need to be modified for comfort and to accommodate the growing belly. Additionally, certain techniques should be avoided so you should see a chiropractor trained in the techniques that address in utero constraint or mal-presentations, who will check for misalignment of the pelvic bones, pubic bones, misalignment of the sacrum and vertebrae, and spasm of the ligaments that support the uterus and help hold the pelvis together (such as Webster Technique or Bagnell Pregnancy Technique).*

How can visiting a Chiropractor be beneficial to a pregnant woman?

Labour Helper Technique

Chiropractic care during pregnancy helps with the typical pregnancy backache, it ensures the pelvis is working and moving properly prior to and during labour. 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. Chiropractic care throughout pregnancy restores balance to your pelvic muscles and ligaments and therefore leads to safer and easier deliveries for you and your baby. Additionally, the chiropractic adjustment removes interference to the nervous system allowing your uterus to function at its maximum potential. Published studies have indicated that chiropractic care does in fact reduce labour time. 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 (pain medication). In one study, women receiving chiropractic care through their first pregnancy had twenty-four per cent shorter labour times [than average] 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 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 during labour) and dystocia when receiving chiropractic care through pregnancy. Chiropractic care has also been shown to increase breast milk production and breastfeeding comfort.

What common aliments do you see most when working with pregnant women?

The preventative check-ups, typical pregnancy backache, lower ribcage discomfort, pubic bone discomfort, upper back ache from increased breast size, breech presentation, in utero constraint, and delayed maturity (past due date).

At what age can children start seeing a Chiropractor?

My children were both checked within one hour of delivery. And even with their natural, non-invasive, midwife-delivered births, both had small misalignments in the upper neck area. Studies show that infants showed signs of nervous system injury and birth trauma in up to 40% of natural, non-traumatic births. A German physician (M.D.) found upper cervical (neck) misalignments and dysfunction in over 90% of neonates (newborns).

“The birth process and eager hands pulling and twisting can put a great deal of pressure on the spinal nerves and muscles of the infant’s neck (up to eighty pounds in some studies). In a difficult delivery, damage to the delicate tissues of the spine may occur, especially when vacuum extraction or forceps are used. While forceps injuries may be less common today, vacuum extraction can do just as much damage—up to 120 pounds of pressure goes through the baby’s head and neck to literally suck the baby out of the mother (decapitation can occur at 140 pounds of pressure, to give you an idea of the high forces involved).

Changing diapers may also place undue stress on the baby’s mid-back (thoracic spine). Raising the infant’s legs with one hand to place the diaper underneath can cause repetitive stress to these spinal joints. Spinal problems can also occur as a result of the frequent falls suffered by young infants in the first months of life. A fall from a bed, a sudden stop in an automobile, or any significant unsupported movement of the head and neck in an infant can induce excessive movement in the spine causing subluxations. At the other end of the spine, the act of learning to walk, and the number of simple falls encountered in this way, can induce trauma to the lower spinal segments and to the large sacroiliac joints of the pelvis.”*

NB: Adjustments for children and babies are safe and take into account the delicate nature of the pediatric spine. The amount of pressure used to check and adjust a child’s spine is very small, approximately the same as you would use to check a tomato for ripeness.

How could seeing a Chiropractor be beneficial to a child?

Unless a child has an obvious problem, it can be difficult for parents to recognize when a child has spinal subluxations (misalignments causing nerve interference). There are some signs, however, which parents may look for which can be an indicator of an infant with a spinal problem including: the child’s head consistently being tilted to one side; restricted head or neck motion to one side; disturbed sleeping patterns where the child sleeps for only an hour or two at a time; feeding difficulties in the young infant, for example, the infant may have difficulty nursing at the breast on one particular side; and the presence of any of the symptoms of ill-health mentioned previously. Nerve interference from subluxations is implicated in many common childhood health problems such as: sucking dysfunction, colic, irritability, reflux, unexplained crying, recurrent ear infections, frequent colds, headaches, asthma, lack of appetite, poor digestion, constipation , stomach aches, so called ‘growing pains ‘, back aches, bed-wetting , poor general health, and fatigue.*

*(From Natural Pregnancy, Natural Baby – Natural Remedies for Pregnancy, Birth and Post-Partum Discomforts)

[This article was originally posted in the October-November 2008 edition of Coastparents.ca Online Newsletter Parent Profile of Dr. Rosenberg]