Pregnancy

Chiropractic care if you're pregnant? ABSOLUTELY! Keeping your spine free from the vertebral subluxation complex is one of the best things you can do if you are pregnant. Pregnant women should see a chiropractor more than anyone else.
Your doctor of chiropractic will examine your spinal column for misalignments (called vertebral subluxation) causing spine and nerve stress. These subluxations damage the nervous system and affect the workings of the entire body. If subluxations are present, the chiropractor will correct them with a gentle chiropractic spinal adjustment in order to release the spinal stress. Without subluxations the body will function better, have higher resistance to disease and express more wholeness (health) than a body with uncorrected subluxations. That is the essential message of chiropractic.
All this is extremely important for the pregnant woman who needs to have her body as healthy and strong as possible in order to handle the rigors of pregnancy and childbirth. Chiropractic care will help ensure that the reproductive and other systems so essential for a healthy pregnancy receive a nerve supply from the spinal column without interference. The slightest interference to the nerve supply could adversely affect the mother and the developing fetus.
Another excellent reason for seeing a chiropractor during pregnancy is that it is a drugless health care system. Drugs, whether prescription or over-the-counter, can harm the growing fetus.
There are so many things pregnant women worry about: staying pregnant, carrying the baby to full term, morning sickness, the baby developing normally, backaches, leg pain and if their labour will be safe and (hopefully) easy. Over the past 100 years chiropractic care has proven to help pregnant women by helping to maintain pregnancy, control vomiting during pregnancy, deliver full-term infants with ease and produce healthier infants.
Questions & answers regarding chiropractic & pregnancy:
   1. Is chiropractic safe in pregnancy?
      Chiropractic is very safe and very sensible for both mother and baby.
   2. Is it difficult to receive a chiropractic adjustment when pregnant?
      Not at all. Chiropractors are trained in adjusting the spines of pregnant women and many chiropractic adjusting tables have special modifications and pillows for the pregnant figure.
   3. How late in pregnancy is it possible to get an adjustment?
      Patients have received adjustments even during labour, as that is when movement/shifting happens in the mother's pelvic area.
   4. Can spinal care help postpartum depression?
      For years chiropractic's beneficial effects on emotional stress and personality have been noted. At least one journal has quoted a doctor as saying that "postpartum depression is a rarity in patients receiving chiropractic care".
   5. Can back pain be helped with chiropractic?
      Chiropractic is not a treatment or therapy for back or spinal pain. However, with chiropractic spinal adjustments the body will be better able to heal its back and spinal pain, as well as many other health problems. Studies have shown a significant decrease in back and labour pains in mothers receiving chiropractic care.
   6. Do I have to have a problem in pregnancy to see a chiropractor? Not at all. Chiropractic should be used as preventive maintenance. Periodic spinal checkups during pregnancy should be as common as periodic weight checkups.
   7. Can my baby receive chiropractic?
      Infants a few hours old have been given spinal checkups and adjustments, if needed. 

The goal of a chiropractor is always to help the patient experience positive changes in their lives by realizing their optimum potential.  A pregnant woman brings with her the greatest potential of all, the potential to create life.  Through helping optimize her health you are helping optimize the health of a new child in the future.  It may be hard for some people to see how chiropractic can have such a dramatic effect on a future life but it can happen in any number of ways.
First, one must understand what it is a chiropractor does.  Our job is to find areas where the spine is interfering with the function of the nervous system it surrounds and protects.  This can happen by tiny misalignments or distortions of the spine or improper motion.  This spinal interference is called a subluxation.  Any interference with the spinal cord or nerves branching off it affects the function of their target cells or organs (efferent nerves) or affects the relay of information from the body to the brain (afferent nerves).  This interference may be noticed by your body and result in pain, but more often it goes unnoticed as only one in ten cells has the ability to create the response of pain.  The nervous system controls all functions, in every part of the body so interfering with it can affect any part of the body, and lead to disturbance of almost any bodily function.  Chiropractic adjustments restore proper function and alignment to the spine thus restoring proper nervous system function and addressing the underlying cause of the problem, not just the symptom.  Optimizing health through chiropractic can also involve advice on nutrition and exercise as well as giving information on any areas that affect overall health so that patients can make informed decisions on their health.  Most chiropractors have pregnant patients but may offer different services focused on different objectives.  Some choose to focus only on the relief of musculoskeletal symptoms while others choose to focus on improving overall health as well.  We focus on the latter and in doing so can optimize both the mother’s and the baby’s health in a number of ways.

Mental Health
Pregnancy is an exciting time for the parents and the people around them.  It can also be a stressful time, especially for the mother.  She is now responsible for the health and well being of a future human being.  We have only begun to discover the far reaching effects that our mind and emotions can have on the function of the systems in our body.  As an example, stress can affect blood pressure, cortisol secretion, emotions, etc.  In the delicate period of pregnancy we know these types of changes resulting from stress must affect the developing fetus in some way but we do not know exactly what those effects are.  Through the research of Candace Pert in the field of psychoneuroimmunology we know that our emotions have a profound affect on the function of our body’s cells and are expressed to those cells via neuropeptides8.  This means that intense emotional states may also have an effect on the developing fetus.  Pain is an example of an emotional state and can also create a stress response.  One study indicates that 28% of pregnant women get low back pain by the 7th month7.  Chiropractic adjustments have been proven time and time again to be the safest and most effective way to ease the stress on the spine that results in the emotion of pain7,10.  One study found 75% of pregnant women got relief of their presenting complaint by visiting a chiropractor7.  This stress on the spine is unavoidable as it is the result of spinal compensations for the extra weight being carried2.  Chiropractic is much more than pain relief, and with the established connections between the psyche, nervous system, and immune system it is very understandable how optimizing the function of the nervous system through chiropractic care can affect the emotional state of the patient as well as the function of the immune system.       

Physical Health
The mother’s body is the cocoon in which the baby must develop from two cells into being trillions of cells organized into all of the systems needed to sustain life.  It is obvious that the healthier the environment provided by the mother, the healthier the child.  One of the most important factors in this process is the supply of adequate nutrients from the mother to the child.  Vitamins and minerals along with the proper nutrients form the building blocks from which all cells will develop.  Proper nutrition begins before conception with the intake of pre-natal vitamins and folic acid.  During pregnancy iron intake must be 800mg/day to supply the excess hemoglobin needed to maintain 50% higher blood volume than normal.  400micrograms per day (twice the normal amount) of folic acid is essential for nucleotide synthesis, chromosome development, and prevention of spina bifida.  Calcium is needed in high quantities for bone and teeth development, especially in the third trimester where 1200mg/day is recommended. Protein requirements increase by 16 grams per day since the amino acids they provide are the cornerstones of cell development.  Vitamin B12 is important to avoid anemia.  Free fatty acids are required for fetal growth and also lactation.11  These essential fatty acids found in fatty fish such as salmon, or as supplements in flax seed oil or Udos oil are hugely important for proper nervous system development among a lot of other things.  These nutrients and minerals are best provided through the proper diet but can be ensured by taking pregnancy vitamins.  Water is also very important and dehydration is attained much easier so a minimum of 8 glasses of water should be consumed per day remembering that you can never drink too much of it.  A food to avoid, especially during pregnancy is tuna (especially canned) due to recent discovery of high mercury levels.  The FDA actually recomends no tuna intake for pregnant moms.    At the same time the fetus is developing, the mother’s body is undergoing changes to allow for this development and make the birth process easier as well.  By the tenth to twelfth week a hormone, Relaxin, is released which causes laxity of all ligaments in the body resulting in a more expandable birth canal for labor2.  This also accentuates the postural distortions caused by carrying the extra weight of pregnancy.  On average the women will gain a total of 25-35 lbs in total with 2-4lbs adding in the first trimester then one pound a week for the duration of the pregnancy.  This extra weight puts strain on the ligamentous holding structures and when coupled with relaxin it leads to spinal compensation.  The end result is stretched abdominal muscles, increased lumbar lordotic curve, overactive lumbar paraspinal muscles, distorted pelvic complex, and often a protrusion of the vertebral disc posteriorly2.  Exercises focused on strengthening weak or lengthened muscles and stretching tight, overworked muscles can be very important in maintaining proper muscle tone.  Maintenance of proper muscle tone serves to minimize structural changes and enable the body to perform everyday tasks without overtaxing any weakened structures.  The most important aspect to maintaining proper muscle tone is ensuring proper nerve supply as the nerves control the muscles, this is the role of the chiropractic adjustments.  Spinal compensation for pregnancy often leads to increased muscle tension guarding the compromised area which helps produce a pain response to make your body aware of the structural changes9.  This is especially noticeable in the pelvis and lower back.  The pelvic complex makes up the child’s home late in the pregnancy and any changes to surrounding muscle tone can affect the outcome of the pregnancy9,10.  Chiropractic adjustments, as mentioned previously, help restore proper structure and function to the area so it can best accommodate for the extra strain being placed on it without breaking down, while still providing the best home for the fetus7,9,10.

Birth Process
Now that the mom has provided the optimum environment for the development of the fetus it is time to begin the process of labor.  At this time excessive stresses are placed on the mother far beyond her previous limits.  This includes emotional stress as well as the physical stresses.  Proper exercise and chiropractic adjustments have helped ensure the body is at its optimal level and best able to cope with the process of giving birth.  It has been said that “problems during childbirth occur when there is a distortion of the bony pelvis and abnormal tone of the muscles of the mother’s pelvic floor”10.  As mentioned previously, abnormal muscle tone is often due to abnormal nerve activity which is often due to spine or pelvic misalignment so the three become unseparable.  It is no surprise that studies have shown that chiropractic patients have shorter labors as well as faster and easier deliveries with less problems1,4,7,9,10,11.  Before the day of birth the chiropractor can council the parents on their choices regarding the birth of their child.  This includes information on midwifery, water births, the process of labor, etc.  Another important component is helping the parents make a birth plan.  This is a written document given to the doctor before the women goes into labor.  It outlines their concerns and wishes regarding the use of drugs, birth positions, surgical interventions, etc.  This is a great way to ensure the birthing process unfolds with as few surprises as possible and the doctor knows what is expected of them as well.  One of the most valuable gifts the chiropractor has to offer the expecting mother involves the baby that has failed to turn into the vertex position.  This should occur around the seventh month and failure to do so results in a detrimental situation for the parents and child.  Breech births account for over 20% of cerebral palsy cases, 42% develop postural scoliosis, 20-25% get torticollis, and 50% have hip dislocations1,7.  Even worse is the fact that breech position usually results in birth through caesarian section which has its own side effects on both the newborn and mother.  Dr. Larry Webster has developed a technique used by many chiropractors to facilitate the baby turning into vertex position.  It is based on the principle that the sacrum is misaligned and causing reflexive hypertonicity of the pelvic floor muscles and round ligaments causing constraint on the uterus so that the baby can not turn head down.  The correction of this problem involves adjusting the sacrum in a specific direction and releasing the tension in what is believed to be the round ligament thus removing the constraining factors on the fetus1,13.  This technique is very effective and Dr. Webster has stated it to be over 90% effective in his practice13.  It is risk free and a much better alternative than forceful external turning or c-section.  It is true that many babies will turn on their own, but many will not, so it is very advantageous to have this risk free technique to be used when needed.  In our own clinical experience we have found the technique to be very effective, and have had one mother notice her child turn to vertex position 2 hours after the first adjustment.The chiropractor’s role does not end once the birth process begins.  It is becoming more common for women to ask a chiropractor to be at their child’s birth to both care for the mom and check the child’s spine for any signs of vertebral subluxation.  These can be  caused by the traumatic process of  the child being pulled through a small opening by it’s head, and occur even more frequently in traumatic births using forceps, vontuse, suction, etc.  There are also a few special circumstances that may arise during labor that chiropractors can help the parents deal with effectively.
The first such circumstance involves back labor.  This is acute back pain felt during the first or second stage of labor.  It is common complication that results in increased usage of pain medication, prolonged labor, and increased usage of mechanical and surgical interventions.  All of these are very serious interventions with their own side effects.  Often the fear of back labor leads to women requesting an epidural at the start of labor.  This has various effects including slowing down the process of labor as well as reducing the bodies release of endorphins.  Endorphins ease pain not only for the mother but are believed to be the sole source of pain relief for the baby.  Carol Phillips has described a plausible mechanism for back labor involving pressure on the sacral nerves caused by an occiput posterior presentation of the child.  She has developed a chiropractic procedure that can easily be taught to the women’s birth partner.  It involves gapping the pelvic joints to allow room for the pelvic muscles to turn the baby’s head into the correct position (occiput anterior)10.  Back labor is less common in women who were under chiropractic care during their pregnancy.  Another special situation where chiropractors can be of help during birth involves premature contractions.  Carol Phillips is also the pioneer for this chiropractic solution and describes how the position of the uterus can lead to premature contractions.  She singles out imbalances between the round and broad ligaments as the primary cause of this change in uterus position.  She has developed a procedure that can easily be performed by the chiropractor that eases the contractions by aligning the segments of the sacrum and thus restores balance to the round and broad ligaments11.  Both of the techniques she has established are backed by numerous case studies and decades of results.
Once the child enters the world the pregnancy is officially over and the woman becomes a mother.  The mother will be trying to achieve her pre-pregnancy figure as well as caring for her new child.  The chiropractor can still play an important role by giving information and advice on the benefits of breastfeeding, “spine friendly” diaper changing techniques, health strategies/risks, food introduction strategies to reduce allergies, accident prevention, etc.  The goal is for the parents to be making all decisions from an informed position rather than based on a lack of better information.  Most importantly, the mother’s long term health can be optimized by wellness chiropractic care to ensure optimal nervous system function in daily life.  As well, it remains important for the child to be checked by the chiropractor at certain developmental periods to ensure optimal health, development, and function12.  The life of a child involves many traumas, whether physical, chemical, or emotional, and each requires adaptation from a healthy body and nervous system in order to maintain its health potential.We think it is obvious that chiropractors have a lot to offer pregnant women both for themselves and their developing children.  The potential to impact their lives is phenomenal.  It can be through allowing a breech baby to turn, premature contractions or back labor to stop, proper development of the child, pain relief for the mom, or other assistance.  All of these serve to limit the reliance on drugs, surgeries, and other interventions while ensuring optimal expression of health by the mother and the baby.  This is an exciting adventure for the new parents and it can be a great and rewarding adventure for the chiropractor as well.

Both Drs Tim and Suzie Wood are registered chiropractors with special training in pediatrics and pregnancy.  They practice at Mission Family Chiropractic in Kelowna.  For more information the office can be reached at 250-712-0900.

REFERENCES
   1.Anrig-Howe C.  Scientific ramifications fro providing pre-natal and neonatal chiropractic care.  The American Chiropractor 1993; May/June: 20-23.
   2.Chalker H.  Spinal compensations of pregnancy.  The American chiropractor 1993; May/Jun: 23-26.
   3.Klougart N et al.  Infantile cholic treated by chiropractors: a prospective study of 316 cases.  JMPT 1989; 12(4): 281-287.
   4.Levinson D.  Chiropractic care and exercise: a winning formula for a healthy pregnancy.  The American Chiropractor 1995; Sep/Oct: 10-39.
   5.McMullen M.  Spinal stabilization and exercises for the child bearing year.  Journal of Clinical Chiropractic Pediatrics 1998;  3(1): 217-223.
   6.Nordsteen J et al.  The short term effect of spinal manipulation in the treatment of infantile cholic: a randomized controlled trial with a blinded observer.  JMPT 1999; 22(8): 517-522.
   7.Peacock L.  Conference notes: International Chiropractic Pediatric Association Fellowship Certification Module 4- Pregnancy.  May 20-21, 2000.
   8.Pert C.  Conference: Chiropractic Awareness Council Annual Convention- Molecules of Emotion.  April 12, 2000.
   9.Phillips C.  An effective drug-free approach to premature contractions.  ICA Review 1998; Oct: 77-81.
  10.Phillips C.  Back labor: A possible solution for a painful situation.  ICA Review 1997; Jul/Aug: 51-55.
  11.Plaugher G, Anrig C.  Pediatric Chiropractic. Baltimore: Williams and Wilkins; 1998.
  12.Warner S, Warner T.  The importance of beginning chiropractic care at birth.  Today’s Chiropractic 1997; May/Jun: 42-47.
  13.Webster L.  Video- Webster In-Utero Constraint Technique.