CHIROPRACTIC AND PREGNANCY:

Did you know that chiropractic care is perfectly safe for pregnant women? It is. As a matter of fact, for tens of thousands of woman throughout the U.S., it is an INTEGRAL part of the pregnancy and birthing process. Boston Spine Clinics, especially Dr. John Haberstroh has treated many pregnant women over the years in a safe and gentle way. Let's find out how and why . . .

Female Changes During Pregnancy
As any woman who has been pregnant knows, there are a great number of changes that occur to the female body during pregnancy. Some very obvious such as the growing fetus inside the womb and others not so obvious.

• The female body releases a hormone called "Relaxin." As the name inplies, Relaxin, relaxes the muscles and ligaments in a woman's body, specifically in the pelvic rim. This allows the pelvis to stretch and open up to accomodate the growing fetus and later, for the actual act of childbirth. The downside to this aspect of physiology is that it allows her joints to fall out of place more easily. Chiropractic adjustments are particlularly effective in keeping a pregnant woman properly aligned.
• With increased weight gain comes increased stress and weighted pull on the spine and pelvic muscles and bone structure. Noted also in pregnancy are increased stress and subluxations in the Sacro-Illiac joints (SI joints). The thoracic and lumbar curves are often affected by increased weight gain and relaxation of the ligaments in the lumbo-sacral area and this can lead to increased pain and discomfort.

See Studin M, "Maternity and Pediatric Care in Chiropractic," The American Chiropractor, Vol. 32, #2.

Chiropractic Treatment During Pregnancy
Chiropractors are leaders in the safe, drugless, gentle approach to relieving pain and stress during pregnancy. Again, a woman undergoes dramatic muscular, ligamentous and spinal/pelvic stresses and pain during pregnancy. Relief is realized through a number of procedures:

• Gentle spinal/pelvic adjustments: I've adjusted dozens of pregnant women over the years including the mother of my first two, right up to the day she delivered. Adjustments are often still done manually by a DC, but due to the high amounts of relaxin in the woman's blood stream, less force is required to effect an adjustment and thus, pregnant women usually adjust easily. There are other methods such as Activator which I will also use in exceptionally sensitive women. We know that a properly aligned spine and pelvis will not only decrease the pain sensation a woman feels but the chiropractic adjustments generally keep the various pelvic tissues and overall biomechanics of the L-S spine functioning normally which will lead to less complications at birth.
• Stretches: Enables spinal/pelvic muscles to maintain the spine and body in a normal position and it helps keep the mother-to-be active and her joints mobile.
• Exercises: Similar to stretches. We often recommend water aerobics at the local YMCA. Trust me, it's worth it. Zero G environment is simply idea for a pregnant woman. Walking is always a good endeavor and largly under-rated.
• Soft Tissue massage: We utilize a series of trigger point therapy and leg/low back/pelvis massage to alleviate pain and contracture issues.
• Dietary/Lifestyle Counseling: The usual caveats are reiterated such as no smoking, no drugs, no alcohol, and keep junk food to an absolute minimum. We also stress to women to stay away from soft drinks, especially diet sodas. *See our Health Discussion on sodas. Also, we ask that women bleeching their hair to stop during pregnancy. As a general sidebar to this same discussion: we urge pregnant women in advance, to start thinking about breast feeding their children immediately after birth. Breast feeding, in addition to other benefits, confers adult quality immunity to the newborn. That's right; every antibody the mother ever created for every bacteria she ever encountered in her life is conferred to the child upon breast feeding for at least three months. **I refer you to our Children's page and the Robert Mendelsohn books I recommend on that page: www.becomehealthnow.com . (See also Berg G., Hammer M., et.al., "Low Back Pain During Pregnancy," J of Am Coll of Obstet & Gyn, Vol. 71 (1), p 71-75, 1988;  Fallon, J. "Textbook on Chiropractic & Pregnancy," ICA Press, 1994;  Cohen, K, "Chiropractic Treatment of the Musculoskeletal System During Pregnancy," JACA, 5/97.)
• Proper Biomechanics and Posture: The enormous weight gain in a pregnant woman is the single most obvious factor that she experiences. However, the fatigue from the extra weight and pain can lead to poor posture,  slouching and other less than optimal postures. Chiropractors emphasize to their pregnant patients the need to maintain proper postural hygiene during the entire pregnancy. This would include keeping the head straight up and the ears centered over the shoulders, keeping the shoulders back, keeping the knees bent slightly to reduce low back stress, keeping a stance widened while standing and keeping weight evenly distributed on each foot.
• Birthing: You will typically find many wholistic/chiropractically oriented women utilizing mid-wives for the act of birthing these days. We have seen a welcome revival of what used to be a typical situation in early American, that of a mid-wife assisted birth and a minimum of medical intervention. One reasonable compromise that we recommend is to have a baby in a so-called "birthing room" at a hospital with a mid-wife assisting. The medical resources that may be needed in an emergency are there but they don't have to be used if not needed. I did it with my first two and it worked out wonderfully.

See also, Murphy DR, Hurwitz EL, McGovern EE, "Outcome of Pregnancy-Related Lumbopelvic Pain Treated According to a Diagnosis-Based Decision Rule: A Prospective Observational Cohort Study," JMPT, Vol. 32 (8), Oct. 2009. *ACC Award Winning Paper showing Chiropractic care as a viable option for women with PRLP.

See also, Miller JE, Miller L, Sulesund AK, Yevtushenko A, "Contribution of Chiropractic Therapy to Resolving Suboptimal Breastfeeding: A Case Series of 114 Infants," JMPT, Vol. 32 (8), Oct. 2009.

What about Complications During Pregnancy?
There are a number of odd complications that occur during pregnancy and childbirth. We'll mention a few here. Bear in mind, that a strong, well nourished, well adjusted (chiropractically speaking) body with a very positive attitude will undoubtedly minimize many of these issues.

• Bell's Palsy: This unusual neurological condition involves the 7th Cranial Nerve. It manifests as a sudden onset of a usually painless loss of facial muscle function on one side of the face. These oddities would include lowering the eyebrows, closing of the eye and/or drooping of the lips. There is the possibility of loosing taste in the anterior 2/3 of the tongue. The 7th Cranial Nerve nucleus originates in the lower brain stem. While not directly affected by manipulative reductions like Cranial V would be, manipulative reductions in the upper cervical spine(just below the brain stem), can occasionally "afferentiate" a neurological cascade of events in the brain stem. Interestingly, this can re-calibrate the nerve nucleus and add neurological impulse to what is considerred a "lower motor neuron" problem. A full discussion of this is beyond the scope of this brief WEB page, but suffice it to say adjustments can help this odd, self limiting neurological condition.
• Lumbo-plexus injury: The actual full title is "parturitional lumbosacral plexus injury." According to Ropper, et. al. (Principles of Neurology, 7th Ed., McGraw-Hill, 2001), this neurological event takes place in 1 in every 2000 deliveries. It is usually unilateral (one sided) and is manifest by pain in the thigh and leg and symptoms and signs of involvement show in the superior gluteal and sciatic nerves. It is believed to be due to pressure of the fetal head on the sacral plexi. It is a limited plexopathy usually occuring after a difficult vaginal delivery and results also in impaired sensation. Protrusion of an intervertebral disc may also complicate the issue. Again, chiropractic manipulative reductions can help alleviate or even prevent this condition.
• Anemia: One of the very common complications is anemia which comes in two varieties; a) dilutional anemia-this is an increase in blood in the pregnant woman's body. The body occasionally overcompensates and produces too much blood. b) iron deficiency-this is the more well know and commoner of the two. This is just what it says, there is not enough iron in a woman's blood stream. Iron supplements and iron rich foods can easily remedy this variant. For dilutional anemia, we recommend the woman visit her GYN promptly.
• High Blood Pressure: Also known as "hypertension," this variant occurs in only about 8% of pregnancies. Generally, hypertension starts near delivery and usually spontaneously resolves.
• Pre-Eclampsia: Is characterized by a combination of high blood pressure, protein in the urine and increased swelling in the legs and feet. About 6-8% of women experience this and 90% of those are first time mothers. We recommend a trained mid-wife be present and the pregnant woman be removed to a birthing room at a hospital just in case more vigorous intervention is needed. Again, like most of the listed complications, they resolved quickly upon delivery.
• Ecalmpsia: This is the far more serious sequelae of pre-ecalmpsia. Major symptoms of this include seizures and coma. Diagnosis of both pre-ecalmpisa and eclampisa therefore, is crucial. Again we recommend the availability of medical intervention if necessary.
• Headaches: A very common and easily treatable complication nearly always caused by muscle tension and biomechanical stresses. This is one of the areas that chiropractic is particularly effective in reducing through manipulation of the cervical spine.
• Ectopic Pregnancy: Happens when a fertilized egg implants itself outside of the uterus. Two variants exist: a) Tubal-when the egg settles into one of the fallopian tubes and b) Ovarian: happens when the fertilized egg remains in the ovary. These situations require medical intervention and are usually ascertained BEFORE the day of birth. Spontaneous abortion is often the end result of these situations.

Summation: As we stated above, chiropractic care during pregnancy is very common and utilized by thousands of women across the country every month. I have been treating pregnant women since I graduated from chiropractic college and I can tell you it is extrememly safe, effective and works wonderfully in relieving the aches and pains most pregnant women experience during the nine months they carry their child.

Dr. John Haberstroh is a Boston chiropractor and Somerville Chiropractor in Massachusetts

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