Anthony Espinosa, Chiropractic Intern
“It’s almost time!” A common phrase said with excitement to many of our pregnant
patients who are well into their 3 rd trimester. We proudly have a strong interest in prenatal
care and as members of the International Chiropractic Pediatric Association (ICPA) as well as
being certified in Webster Technique, our doctors are respectively trained to treat pregnant
women with tummies of all sizes! Utilizing our belly down pregnancy pillows and pregnant
friendly chiropractic tables, which carefully accommodate for the size of the patient’s
abdomen. Throughout the course of care, our doctors may apply the Webster Technique along with soft tissue therapy and diversified spinal manipulative techniques (with significantly less force when required) to safely…and I repeat…safely treat women who are suffering from associated musculoskeletal complaints, such as pregnancy induced low back pain, or are simply investing in their wellness to encourage a healthy pregnancy and unremarkable labor/delivery.
It is quite safe to perform spinal manipulative therapy (SMT or adjustments) on a
pregnant patient. However, it is taken into account that other conditions may arise during a
patient’s course of gestation, indicating that chiropractic care is not suitable. These may
include and are not limited to vaginal bleeding, ectopic pregnancy, sudden onset of pelvic pain, severe cramping, placenta previa, placenta abruption, ruptured amniotic membranes, and toxemia of pregnancy (preeclampsia). With a thorough history and physical exam, our doctors will recognize such circumstances and understand when referral is appropriate. With that being said, there is currently NO significant evidence showing contraindications or adverse effects of chiropractic care during normal pregnancy. In fact, not only is there literature dating back several decades of the chiropractic profession documenting the efficacy of SMT being used during pregnancy; literature within the osteopathic profession provides evidence of osteopathic manipulative therapy (OMT) being utilized during pregnancy and labor since the early 1900’s to improve labor and delivery outcomes.
When adjusting our pregnant patients, our doctors always seek to make sure that mom
and baby are as comfortable as possible, not only for relaxation but also for safety of the little one inside. The more relaxed the patient is with proper positioning, the less force required to deliver the adjustment. As mentioned before, prone pregnancy pillows are commonly used and our chiropractic tables include a thoracic piece that can be lowered, allowing ample room for the patient’s growing abdomen. This is beneficial during prone adjustments, as our doctors oftentimes use the drop portion of the table to effectively treat any common pelvic joint fixations. Side posture adjustments are also regularly performed to clear up any joint fixations of the lumbar spine and/or pelvis. Although, in this side lying position, modifications in patient positioning and technique delivery are consistently made in order to avoid any unnecessary abdominal compression. In addition, during pregnancy there is an increased release of the hormone relaxin, which increases ligament laxity throughout the spine and pelvis. This often makes SMT relatively effortless, while applying the gentlest of movements to harmlessly and successfully deliver the chiropractic adjustment. Here’s what you can expect from a treatment plan:
Symptomatic – patients experiencing any type of musculoskeletal complaint = 1-2x per week until resolved
Asymptomatic – patients coming in for pregnancy wellness = 2x per month until 34 weeks, then once a week until delivery
Chiropractic adjustments to enhance optimal fetal positioning (Webster Technique) = Daily for a week!
Now let’s take a look at some more research! In the United States, a survey conducted
by the National Board of Chiropractic Examiners estimated that approximately two-thirds of all chiropractors provide care to pregnant patients. According to Allaire et al. (2000) and Bayles (2007), both studies done among nurse-midwives showed that they referred 50% of pregnant patients who were experiencing musculoskeletal symptoms, nausea, and vomiting to a chiropractor. A case series by Lisi (2006), evaluated chiropractic spinal manipulation for
pregnancy related low back pain; 94% of the patients reported significant improvement in low back pain symptoms, with no harmful effects announced in any of the cases. Another study conducted by Murphy et al. (2009) on pregnant women with low back pain had favorable results with 73% of patients experiencing clinically significant improvement in disability and 82% experiencing clinically significant improvement in pain. Overall, 73% of the patients in this study described their improvement as “excellent” or “good”.
Patient preference, comfort, and safety are our primary concerns during care; not only
for our pregnant patients but for all of our patients here at Washington Park Chiropractic. As
members of the medical community, we always want what is best for the health and wellness
of our patients. So whether you are 8 weeks into your first trimester or a rocking 36 weeks
pregnant, we want you to know that chiropractic care is your friend and most importantly, we
the WPC Family are here and ready to help! “It’s time!”
References
Allaire, A. D., Moos, M. K., & Wells, S. R. (2000). Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midwives. Obstetrics & Gynecology, 95(1), 19-23.
Bayles, B. P. (2007). Herbal and other complementary medicine use by Texas midwives. Journal of Midwifery & Women's Health, 52(5), 473-478.
Borggren, C. L. (2007). Pregnancy and chiropractic: a narrative review of the literature. Journal of chiropractic medicine, 6(2), 70-74.
Lisi, A. J. (2006). Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. Journal of Midwifery & Women's Health, 51(1), e7-e10.
Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009). Outcome of pregnancy-related lumbopelvic pain treated according to a diagnosis-based decision rule: a prospective observational cohort study. Journal of Manipulative and Physiological Therapeutics, 32(8), 616-624.
Ramasubramaniam, S., Muliira, R. S., Seshan, V., Noronha, J., & Raman, S. (2012). Chiropractic care in women's health: a midwifery perspective. African Journal of Midwifery and Women's Health, 6(2), 98-101.
Stuber, K. J., & Smith, D. L. (2008). Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence. Journal of manipulative and physiological therapeutics, 31(6), 447-454.