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Pregnancy: Issues and Answers
 Pregnancy and Chiropractic
Special approach for pregnancy
Most commonly asked questions
Chiropractic and Pregnancy Scientific Studies
Postural changes in Pregnancy
Pregnant Women May Not Be Getting Enough Omega-3
Birth Trauma and the importance of having your newborn checked
by your chiropractor
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So many women who received care
during pregnancy say to us: How in the
World do other women get through pregnancy
without [chiropractic] adjustments? –
Carol Phillips, DC
If you are pregnant one of the best things
you can do for yourself and your baby is to see a doctor of chiropractic.
Pregnant women are very prone to subluxations (spinal misalignments
causing nerve interference) because hormonal changes can cause relaxation
of ligaments
and increased spinal instability. This can result in pain, spinal imbalance,
weakness, fatigue and breech presentations. Chiropractic care provides so many
things a pregnant body needs: a flexible and balanced spine, hips and pelvis;
internal organs without postural stress and freedom from nerve stress – all
essential for a healthy pregnancy and delivery.
In short – along with a better diet; exercise and avoiding drugs,
alcohol and cigarettes – chiropractic care should be an essential
part of every pregnancy.
Chiropractic care through pregnancy is not only safe, it is essential.
We can look at the implications of subluxation from a bio mechanical,
hormonal and neurological standpoint. It is easy for all of us to see
postural changes through pregnancy-the center of gravity changes, the
weight of the baby places increased pressure on the spine and pelvis,
and towards the end of the pregnancy, changes are seen in gait pattern-the "waddle." What
we can't see, are the millions of different hormonal changes and chemical
reactions occurring both in the mother and the developing baby--all
of which are controlled and coordinated through the nervous system.
Adjustments result in easier pregnancy, significantly decreased mean
labor time, and assists new mothers back to prepartum health. In one
study, women receiving Chiropractic care through their first pregnancy
had 24% shorter labor times than the group not receiving Chiropractic,
and multiparous subjects reported 39% shorter labor times. This is a
thirty-nine percent difference, that's a massive difference. In addition,
84% of women report relief of back pain during pregnancy with Chiropractic
care. Because the sacroiliac joints of the pelvis function better, there
is significant less likelihood of back labor when receiving Chiropractic
care through pregnancy.
Body position during delivery is also critical. Any late second stage
labor position that denies postural sacral rotation denies the mother
and the baby critical pelvic outlet diameter and jams the tip of the
sacrum up to 4cm into the pelvic outlet. In other words, the popular
semi-recumbent position places the laboring woman on her back onto the
apex of the sacrum, which closes off the vital space needed for the baby
to get through the pelvic outlet.
This delivery position is the main reason why so many births are traumatic-labor
is stalled, the mom becomes fatigued and overwhelmed by pain, so the
utilization of epidurals, forceps, episiotomies, vacuum extraction and
cesarean increases. Just consider the analogy my husband uses-how hard
would it be to have a bowel movement while lying on your back? You're
right, very hard, and it may not happen. This is why squatting is the
preferred position-gravity works to help and the pelvic outlet can open
to a greater degree. Squatting during delivery results in decreased use
of forceps and a shorter second stage of labor than the semi-recumbent
position.
Greater complications during delivery result in greater neurological
insult to the newborn due to injury to the head and neck. Even after
vaginal births, 4.6% of term neonates suffer unexplained brain bleeds
and 10% suffer neonatal encephalopathy. Because so many children had
been injured with forceps deliveries, (facial nerve palsy, tearing
of cervical spine musculature) vacuum extraction was developed. Suction
cups are placed on the newborn's head, and the baby is literally sucked
out of the mother.
When utilized, 120 pounds of pressure goes through the baby's head and
neck. Decapitation occurs at 140 pounds of pressure, to give you an idea
of the high forces involved. Remember when you were a little girl or
boy and there was a new baby you were being introduced to? Our parents
always said, "Watch his head-you don't want to hurt him." We're
careful because the fontanels of the skull are so pliable, and the neck
and brain are fragile and unprotected. This is why so many babies sustain
injuries to their heads and neck during vacuum extraction-the force is
far greater than their little bodies can tolerate.
Adjustments to newborns contain only ounces of force. But that force
is directed into the spine to facilitate health and remove subluxations.
We adjust babies as soon after birth as possible, to alleviate subluxations
caused by in-utero constraint and the journey down through the birth
canal. There has been a lot in the media lately about children not needing
Chiropractic care, but there is no better way to get a head start in
life. As you all know, Chiropractic care is not a cure for anything-it
is a system of wellness to help us be who we're supposed to be. It is
not a cure for ear infections, for colic, for allergies, for asthma,
for frequent colds, nor for ADD/ADHD.
When we listen to mothers' stories of their pregnancy, labor and delivery,
the children who suffer the most from the above complaints, are the ones
who've had the greatest trouble with their births. Even relatively easy
deliveries can result in subluxations. That's why every child should
be checked, before problems with their health even develop. That's preventive
care in the truest sense-preventing subluxations in mothers to prevent
subluxations in their babies during childbirth. This is why every woman
needs Chiropractic through pregnancy-so that the arrival of their baby
is a "wonderful experience", as one of my patients told me,
after her son was born.
Regular chiropractic care is an integral part of the prenatal and postpartum
care during pregnancy. It helps keep mom feeling good and assists her
in coping with the physical stresses of an ever changing body.
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Neuromuscular and Biochemical Changes During Pregnancy
During pregnancy, most women experience a number of neuromuscular and
biochemical problems which respond favorably to gentle, safe, noninvasive
chiropractic care. These include:
o Release of the hormone relaxin causes muscle and ligament relaxation
o Allows joints to more easily misalign
o Increased weight gain
o Increased demand and fatigue on spinal and pelvic structures
Chiropractic Treatment of the Neuromuscular and Biochemical Problems
Doctors of chiropractic can alleviate the uncomfortable symptoms arising
from the muscular, ligamentous, and biomechanical stresses encountered
during pregnancy. We accomplish this through the use of a number of highly
specialized procedures and techniques:
GENTLE SPINAL ADJUSTIVE PROCEDURES - specifically designed for use in
the pregnant female
Assist in maintaining a spine free from vertebral misalignments and fixations
- optimizing spinal biomechanics
Keep pelvis and spine in correct position/posture reducing spinal and
pelvic stresses, which produce soft tissue pain
Keep tissues and biomechanics functioning optimally to minimize complications
during birth
THERAPEUTIC EXERCISES AND STRETCHES - safe for use during pregnancy
Keep spinal musculature strong, balanced, and pain-free
Enable spinal muscles to maintain the spine and body in a neutral, correct
posture
Keep mom active and mobile
SOFT TISSUE WORK - massage, trigger point work, soft tissue mobilization,
etc.
Keep muscles relaxed and flexible
Reduces bouts of muscle aches and pains
Reduces spinal stress
DIETARY AND NUTRITIONAL COUNSELING - unique to the pregnant mother
Prevent neural tube and other birth defects
Increase the chances for a healthy baby
Assist the mother in maintaining optimal energy levels keep mother happy
and healthy during stressful periods
GENERAL PREGNANCY INFORMATION - general info on pregnancy
Answer mother's questions
Improve mother's health
Optimize birthing process
Enhance baby's health
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Is Chiropractic Care Safe During Pregnancy? Chiropractic care during
pregnancy is safe for both mother and baby. Spinal adjustments are especially
gentle during pregnancy, as far less force is required to correct subluxations.
This is due to the increase in hormones causing significant muscle and
ligamentous relaxation. Special "adjustive" positions are also
used to provide comfort and safety for both mom and fetus.
How Often Should I Receive Chiropractic Care During My Pregnancy? The
frequency of care varies for a number of different reasons. Typically,
regular care during a non-complicated pregnancy will range from once
per week to once per month.
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Low Back Pain During Pregnancy In this study, researchers identified
the sacroiliac joints of the pelvis (frequently "adjusted" by
chiropractors) as being responsible for the majority of low back pain
cases in pregnancy. This is due to the significant number of hormonal
and biomechanical changes occurring in the pelvis during pregnancy. Researchers
found 7/10 women were helped by spinal manipulation in this study.
Bery G, Hammar M, Moller-Nielsen J et al. Obstet and Gynecol, 72:71-75,
1988.
TextBook on Chiropractic & Pregnancy
According to Dr. Fallon, author and internationally recognized "chiropractic
pediatrician", statistics from her office "have demonstrated
that chiropractic adjustments effectively reduce the average amount of
time spent in labor." Her data shows a nearly 25% reduction in the
average labor times in those receiving chiropractic care versus the generally
accepted average labor time - in those receiving chiropractic care versus
the generally accepted average labor time - in women who had given birth
in the past, there was a 33% reduction in average labor time.
Fallon J. International Chiropractic Association. 1994 - Arlington, Virginia.
Italian Study on Chiropractic & Pregnancy
Postpartum pain was relieved in 90 of 120 patients who received chiropractic
adjustments.
Chiropractic Use Grows Among Pregnant Women
A growing number of pregnant women are turning to holistic therapies,
including chiropractic. Researchers at Robert Wood Johnson Medical
School pooled data on 463 women who had recently given birth.
In total, 31.3% of subjects used at least one type of complementary
care during their pregnancies. Specifically, 5.2% visited a chiropractor;
2.8% had acupuncture or acupressure and 2.8% took vitamin supplements.
5.8% tried alternative techniques (biofeedback, meditation, yoga, tai
chi, mental healing, imagery, Reiki, therapeutic touch or polar, dance,
reflex, art and aroma therapies); 24.2% used natural therapies (teas,
herbs, oils and foods used for medicinal purposes).
Ranzini A, Allen A, Lai Y Use of complementary medicines and therapies
among obstetric patients Obstet Gynecol 2001; 97 (4 Suppl 1): S46
Most Nurse Midwives Recommend Chiropractic
Nurse-midwives frequently
refer patients to doctors of chiropractic, according to a survey of 82
certified nurse-midwives in North Carolina.
Altogether, a whopping 93.9% of midwives surveyed reported that they
recommended "complementary and alternative medicine" to patients
during the past year. However, only 57.3% encouraged more than 10%
of their patients to consider these approaches.
Overall, chiropractic was the third most popular referral, with 57.3%
of midwives surveyed recommending chiropractic to their patients. In
addition, midwives recommended herbal therapy (73.2%), massage therapy
(67.1%), accupressure (52.4%), mind-body interventions (48.8%), aromatherapy
(32.9%), homeopathy (30.5%), spiritual healing, (23.2%), acupuncture
(19.5%) and bioelectric or magnetic applications (14.6%).
Allaire AD, Moos MK, Wells SR Complementary and alternative medicine
in pregnancy: a survey of North Carolina certified nurse-midwives Obstet
Gynecol 2000 (Jan); 95 (1): 19-23
Women Seeking Natural Care in Pregnancy
A recent study at Woman and Infants' Hospital in Rhode Island reveals
that a significant number of pregnant women are using herbs and alternative
therapies. Out of the 240 women involved in the study, 9.1% said that
they used herbs some time during their pregnancy and 7.5% used herbs
on weekly basis. The most commonly used herbs included garlic, aloe,
chamomile, peppermint, ginger, Echinacea, pumpkin seeds and ginseng.
Thirteen percent of the women also reported that they used chiropractors
and other alternative therapies, such as aromatherapy, meditation,
relaxation, yoga, acupressure, therapeutic touch, homeopathy, acupuncture
and reflexology.
Gibson PS, Powrie R, Star J Herbal and alternative medicine use during
pregnancy: a cross-sectional survey Obstet Gynecol 2001; 97 (4 Suppl
1): S44-S45
More studies
A retrospective review of 100 consecutive pregnancies, involving 94
women receiving prenatal care at a rural western New York family practice,
was conducted. Back pain was spontaneously reported to the physician
by 23 women in 23 pregnancies. Eleven of the 23 women met diagnostic
criteria for sacroiliac subluxation. These criteria include absence of
lumbar spine and hip pathology, pain in the sacral region, asymmetrical
movement of the posterior superior iliac spines upon forward flexion,
a positive pelvic compression test and asymmetry of the anterior superior
iliac spines. A cohort of 11 women meeting criteria for sacroiliac subluxation
was treated with rotational manipulation of the sacroiliac joints. After
manipulative therapy, 10 of the 11 women (91%) had relief of pain and
no longer exhibited signs of sacroiliac subluxation.
Daly JM, Frame PS, Rapoza PA. Sacroiliac subluxation: a common treatable casue
of low back pain in pregnancy. Fam Prac Res J 1991;11(2):149-159 / Medline
ID: 91281476
A cohort of 200 consecutive women attending an antenatal clinic were followed
throughout pregnancy with repeated measurements of back pain and possible determinants
by questionnaires and physical examinations. Seventy-six percent reported back
pain at some time during pregnancy. Sixty-one percent reported onset during
the present pregnancy. Back pain during pregnancy is a common complaint. The
30% with the highest pain score reported great difficulties with normal activities.
The back pain started early in pregnancy and increased over time. Young women
had more pain than older women. Back pain starting during pregnancy may be
a special entity and may have another origin than back pain not related to
pregnancy.
Kristiansson P; Sv¨ardsudd K; von Schoultz B. Back pain during pregnancy:
a prospective study. Spine 1996; 21(6): 702-9 / Medline ID: 97037045
Manipulation keeps the segments of the pregnant woman's structure freely and
normally movable. It permits a constant free flow of all body fluids and a
normal venous supply to control function. During the second 6 weeks of pregnancy
the growing fetus and expanding uterus often settle in the hollow of the sacrum
and relief of nausea may be achieved. Manipulation results in an easier pregnancy
and an easier delivery. The postpartum return of the mother to prepartum health
is also expedited by manipulation. Manipulation has a part in the prevention
and cure of toxemia's.
Hampton D; What is the role of osteopathic manipulative therapy in obstetric
care? For normal patients? For patients with problems (e.g., toxemia of pregnancy)?",
J Am Osteopath Assoc 1974; 74(3):192-7. / Medline ID: 75041885
It can be demonstrated that chiropractic care significantly reduces the mean
labor time. Primagravidae subjects receiving chiropractic care averaged 24%
shorter labor times, and multiparous subjects receiving chiropractic care averaged
39% shorter labor times versus control subjects.
Fallon J; The effect of chiropractic treatment on pregnancy and labor: a comprehensive
study. Proceedings of the World Chiropractic Congress, 1991; 24-31
84% of patients receiving spinal manipulative therapy reported relief of back
pain during pregnancy. There was significantly less likelihood of back labor
when spinal manipulative therapy was administered during pregnancy.
Diakow PR, Gadsby TA, Gadsby JB, Gleddie JG, Leprich DJ, Scales AM. Back pain
during pregnancy and labor.. J Manipulative Physiol Ther 1991; 14(2):116-8
/ Medline ID: 91210683
Regular adjustments can make pregnancy less stressful and delivery less uncomfortable.
Chiropractic treatment can continue safely until the day of delivery.
Penna M; Pregnancy and chiropractic care. ACA J of Chiropr 1989; 26(11): 31-3
The most common reason for severe low back pain was dysfunction of the sacroiliac
joints. Physically strenuous work and previous low back pain were factors associated
with an increased risk of developing low back pain and sacroiliac dysfunction
during pregnancy.
Berg G; Hammar M; Möller-Nielsen J; Lindén U; Thorblad J; Low back
pain during pregnancy. Obstet Gynecol 1988; 71(1):71-5 / Medline ID: 88095676
In a study of 500 women during labor, 352 experienced pain in the lumbar area
during labor, an incidence of 70.4%. One of the most interesting findings of
the study was the association of back pain during labor and fetal presentation.
Application of pressure to the lumbar area to inhibit lumbar pain reduced the
need for major narcotic pain medication and minor tranquilizing medication.
Guthrie RA; Martin RH; Effect of pressure applied to the upper thoracic (placebo)
versus lumbar areas (osteopathic manipulative treatment) for inhibition of
lumbar myalgia during labor. J Am Osteopath Assoc 1982; 82(4):247-51 / Medline
ID: 83108347
Any late second stage labor position that denies posterior sacral rotation
(the popular semi-recumbent position places the laboring woman squarely on
her sacral apex) denies the mother and fetus crucial sagittal pelvic outlet
diameter and jams the sacral tip up to 4 cm into the pelvic outlet. Even after
vaginal births, 4.6% of term neonates suffer unexplained brain bleeds and up
to 10% suffer neonatal encephalopathy. These pathologies may possibly be avoided
by decreasing distortion of fetal skulls, from pelvic misalignment, at delivery.
Gastaldo TD; Labor Posture. Birth 1992; 19(4):230 / Medline ID: 93112208
A prospective, controlled trial of 427 primiparae compared the outcome of labor
in women randomly allocated to squatting (218) or conventional semi-recumbent
(209) management. The squatting group had significantly fewer forceps deliveries
(9% vs. 16%) and significantly shorter second stages (median length of pushing
31 vs. 45 min.) than the semi-recumbent group.
Gardosi J; Hutson N; Randomised, controlled trial of squatting in the second
stage of labour. Lancet 1989; 2(8654): 74-7 / Medline ID: 89294852
Adoption of upright positions resulted in a higher rate of intact perineum's.
There was a clinically apparent reduction of forceps deliveries in the upright
group, which influenced midwives' attitudes. Moving the parturient from recumbent
to upright positions was often perceived to be beneficial when there was slow
progress.
Gardosi J; Sylvester S; Alternative positions in the second stage of labour:
a randomized controlled trial. Br J Obstet Gynaecol 1989; 96(11): 1290-6 /
Medline ID: 90122686
The standing or squatting position of delivery provides the fewest problems
for both the mother and baby. Gardosi J; Hutson N; Randomised, controlled trial
of squatting in the second stage of labour. Lancet 1989; 2(8654): 74-7 / Medline
ID: 89294852
Borgatta L; Piening SL; Cohen WR; Association of episiotomy and delivery position
with deep perineal laceration during spontaneous delivery in nulliparous women.
Am J Obstet Gynecol 1989; 160(2): 294-7 / Medline ID: 89132656
Paciornik M; Commentary: arguments against episiotomy and in favor of squatting
for birth. Birth 1990; 17(2): 104-5 / Medline ID: 90303397
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By Shelly Girard, B.S., L.M.T., L.M., C.P.M.
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Postural Changes in Pregnancy
During the course of pregnancy, a woman's body undergoes innumerable
changes biochemically and structurally which can create postural strain
and neck and back pain. A brief look at the anatomy of the spine provides
insight as to why chiropractic adjustments can facilitate a healthier,
more comfortable pregnancy.
The vertebral column is a strong, flexible rod composed of a series of
bones called vertebrae which enclose a protect the spinal cord, support
the head, and serve as an attachment for the ribs and muscles of the
back. This "spine" is able to rotate and move anteriorly, posteriorily
and laterally. The vertebral column shows four normal curves, which increase
its strength, help maintain balance in the upright position, absorb shock,
and help protect the column from fracture.
The spinal cord, which courses down the center of this column conveys
sensory impulses from the peripheral nerves to the brain and conducts
impulse from the seat of the Central Nervous System, the brain, to all
of the peripheral nerves. When an electrical impulse is stimulated in
the brain, it travels a neural pathway in the spinal cord; dysfunction
of the joint can cause irritation to the surrounding tissue and create,
discomfort and/or pain.
Over the course of a forty week gestation, a mother's weight gain will
ideally reach somewhere between 30-40 lbs. This increase in weight can
create spinal misalignment and/or postural distortions, which in turn
affect nerves, muscles and mobility of joints. As the bulk of this weight
is deposited in the abdominal area, the mother's center of gravity shifts
forward. In order to compensate, the natural curves of the spine, particularly
in the lumbar region, become exaggerated causing "low back pain".
The hips may also expand laterally to help stabilize the body, putting
pressure on the sacroiliac joints. The hormones of pregnancy cause muscles,
ligaments, cartilage (such as the symphisis pubis), and even bones to "soften" and
become more pliable. Pelvic bones "slip" and can become more
easily displaced and/or fixated. In addition, certain round ligaments
attach to pelvis bones and then to the uterus as it enlarges with the
growth of the baby. When these ligaments are strained or torqued, as
with sudden movement or "rolling over", they can cause even
more discomfort for the pregnant mother.
Benefits of Prenatal Chiropractic Care
Chiropractic care can:
1. Correct vertebral misalignment and relieve pressure with gentle and
effective adjustments.
2. Help ensure that pelvic bones are properly aligned, facilitating a
quicker, easier delivery.
3. Re-establish the natural position and mobility of the joints.
4. Helps with overall balance of the Nervous system and improving the
bodies’ response to stresses.
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Omega-3 fat DHA is accumulated in fetal tissues, particularly the central
nervous system. However, because animal cells cannot form omega-3 fatty
acids, a fetus must obtain all of its omega-3 fatty acids from its mother’s
diet. A mother’s dietary intake and plasma concentrations of DHA
directly influence the DHA status of the developing fetus.
Studies have found that reduced brain and retinal DHA results in decreased
visual function and altered learning, behavior and neurotransmitter metabolism.
Further, newborns with higher levels of DHA display more mature electroencephalography
patterns.
DHA can be formed in the liver from acid -linolenic acid (ALA), a dietary
essential fatty acid. However, studies show that less than one to four
percent of dietary ALA is converted to DHA, indicating the potential
importance of dietary DHA in humans.
Moreover, when provided as ALA, the amount of ALA required for fetal-tissue
DHA accretion could be 25-fold higher than the requirement if provided
by DHA, and studies have shown that higher intakes of ALA do not increase
the concentrations of DHA in the blood lipids of infants or adults.
The effect of dietary trends, such as the decline of saturated fat intakes
from 18 to 20 percent of total energy to 11 percent of total energy over
the past three to four decades, and the decrease in meat consumption
in North America, on the intakes of omega-3 fatty acids is not known.
However, concentrations of DHA in breast milk have decreased by 50 percent
in Canada and Australia over the past 15 years, according to studies.
Further, one study found that the intakes of DHA among some Canadian
women during the third trimester of pregnancy appear to be below possible
needs for fetal and maternal tissue DHA accretion. Researchers say that
this raises the need for studies combining functional outcome measures
of infant neural development, dietary fat intake, and DHA. American Journal
Clinical Nutrition February 2003;77(2):473-8
Dr Carlson’s comments:
It has become increasingly clear that the benefits that DHA offers is
crucial to a childs development. Specific benefits include intelligence
development, visual acuity and for mom's prevention of premature deliveries.
Nearly all women would benefit from adding fish oil to their diets, before
and during their pregnancies. Surely there are some women who are regularly
eating fish and therefore already have enough DHA in their systems.
However, these same women will likely have a major increase in mercury
in their system, which has been well documented to cause a variety of
neurological birth defects. Even the conservative FDA warns that women
should avoid most fish during pregnancy. Quality fish oil is filtered
for mercury and other contaminants so it is safer then consuming fish
and is a great source for Omega 3 fatty acids DHA and EPA
This is one area where supplementation could benefit.
These articles are to educate parents about Birth Trauma and reasoning
behind the importance of having your child check for subluxations
This information comes from the
research compilations of Dr. Jeanne Ohm
The effects, frequency and overt damage of birth trauma is perhaps the
easiest way to understand why all children need to be checked for spinal
misalignments and cranial distortions.
Routine labor procedures such as inducing labor, pain medications, and
restrictive maternal positions lead to further complications and the
resultant use of forceful pulling and operative devices such as forceps,
vacuum extractions and c-sections.
Standard obstetric management includes grasping the infants head during
birth usually accompanied by some degree of pulling and rotation. Further
intervention including the application of obstetric devises creates an
environment where an even more serious injury is bound to happen.
Although the studies sited below mostly deal with the excessive trauma
caused by obstetrical, operative devices it is important to note this
comment by Dr. Abraham Towbin, medical researcher on spinal injury, He
says, 'the birth process, even under optimal, controlled conditions is
a traumatic potentially crippling event for the fetus.'
More Studies Needed
Neglected spinal cord, brain stem and musculoskeletal injuries stemming
from birth trauma Gottlieb MS.
J Manipulative Physiol Ther 1993 (Oct);16 (8):537-543
•
Birth trauma remains an under publicized and, therefore, an under treated
problem. There is a need for further documentation and especially more
studies directed toward prevention. In the meantime, manual treatment
of birth trauma injuries to the neuromusculoskeletal system could be
beneficial to many patients not now receiving such treatment, and it
is well within the means of current practice in chiropractic and manual
medicine.
Relationship between Trauma at Birth and Infant Digestive Disorders
X-ray symptomatology and differential diagnosis of functional obstruction
of the digestive tract in children induced by birth injuries of the
spine and spinal cord Michailov MK, Akberov RF. Radiol Diagn (Berl)
1989;30(6):669-674
•
Clinical, neurological and roentgenological complex investigations of
174 children with similar birth injuries revealed pathogenetic relations
between birth trauma of the spine, the medulla and the functional obturations
of the intestinal tract as pylorospasms, spastic-hypotonic dyskinesia
of the ileum and gastroesophageal reflux. Frequent complications were
aspiration pneumonia, reflux esophagitis, esophageal stenosis and the
development of intestinal invagination due to dysrhythmic iliac peristalsis.
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The relationship of craniosacral examination findings in grade school
children with developmental problems Upledger JE. J Am Osteopath Assoc
1978 (Jun);77 (10):760-776
•
This study correlates the positive relationship between obstetrically
complicated births, cranial motion disorders and learning disabilities.
Trauma to the Head and Neck Resulting in Multiple Disorders.
Orthopedic Medicine a New Approach to Vertebral Manipulation by R. Maigne
• Birth trauma to the cervical spine and cranium can result in
disorders such as: headaches, vestibular problems, auditory troubles,
visual disturbances, pharyngolaryngela disorders, vasomoter and secretion
dysfunction and psychic disturbances. Care to realign the neck achieves
excellent results with many of these dysfunctions.
Routine Positions in Labor Cause Unnecessary Birth Trauma
Labor posture Gastaldo TD. Birth 1992 Dec;19 (4):230
•
In vaginal births, 4.6% of term neonates suffer unexplained brain bleeds
and up to 10% suffer neonatal encephalopathy. These injuries may be avoided
by decreasing distortion of fetal skulls, from pelvic contracure at delivery.
The popular semi-recumbent position places the laboring woman squarely
on her sacral apex. This closes her pelvic opening and creates a undue
stress and difficulty in the baby's descent.
Operative Devices: Forceps and Vacuum Extraction:
Kinematic Imbalance Due to Suboccipital Strain in Newborns. Biedermann
H Manuelle Medizin 1992; 6:151-6
•
A significantly high portion of babies suffered birthing injuries due
to prolonged labor and use of extraction devices resulting in Kinematic
Imbalances due to Suboccipital Strain.
•
135 children younger than 24 months were all treated by specific "manipulation" of
suboccipital joints caused by: intrauterine malalignment, assisted births
(extraction side), prolonged labor, multiple fetuses, and higher trauma.
Suboccipital Strain in Newborns by Dr. Peter Fysh
•
The upper cervical spine and atlanto-occipital junction have been identified
in previous studies as being the cause of a diversity of clinical findings
affecting the newborn infant. This month we review a study by Biedermann
in which suboccipital strain is identified as causing a variety of signs
and symptoms in a group of 114 young infants. The study, published in
the Journal of Manual Medicine, not only identifies the signs and symptoms
of the suboccipital strain syndrome, but also highlights the effectiveness
of spinal adjustments in correcting the problem.
Forceps Combined with Rotation Causes Serious Complications
High cervical spinal cord injury in neonates delivered with forceps:
report of 15 cases Menticoglou SM, Perlman M, Manning FA. Obstet Gynecol.
1995 (Oct); 86 (4 ~ Pt 1): 589-594
•
High cervical spinal cord injury in neonates resulted as a serious complication
of forceps rotations of 90 degrees or more. The common feature in all
cases was a forceps cephalic delivery, almost always a rotation of 90
degrees or more from the occipitoposterior or occipitotransverse position.
High cervical spinal cord injury in neonates is a specific complication
of forceps rotation.
Forceps Causing Multiple Traumas and Even Death
Kielland's forceps: association with neonatal morbidity and mortality
Chiswick ML, James DK.
Br Med J 1979 Jan 6;1(6155):7-9
•
The neonatal mortality rate attributable to use of the forceps was 34.9
per 1000. The incidences of delayed onset of respiration (17.4%), birth
trauma (15.1%), and abnormal neurological behavior--namely, apathy or
irritability or both--(23.3%) significantly exceeded those in a matched
group of babies born spontaneously. Fetal asphyxia played a major part
in the etiology of neonatal complications.
•
Babies on whom Kielland's forceps were used, however, had a significantly
greater incidence of abnormal neurological behavior even in the absence
of fetal asphyxia (14.3%), and in all of these babies the abnormal behavior
was transient and did not necessitate admission to the special-care baby
unit
•
The results suggest the neonatal complications are caused by the forceps
and not related to the process of birth itself.
Forceps Related to Facial Paralysis
Facial nerve palsy in the newborn: incidence and outcome Falco NA, Eriksson
E.
Plast Reconstr Surg 1990 Jan;85(1):1-4
•
This study published in "Plastic Reconstructive Surgery" retrospectively
identifies and characterizes patients with facial palsy related to birth
trauma and describes the natural history of this disorder. This retrospective
study revealed that 91% of all children who had suffused with facial
paralysis were delivered with forceps. The incidence of additional birth
injuries also was substantially higher among affected subjects than among
the general population of newborns.
Fetal Skull Fractures from Vacuum Extraction Devices
•
The vacuum extractor is being increasingly advocated as the instrument
of first choice for assisted vaginal delivery. It is widely believed
that the vacuum cup will dislodge before causing serious fetal trauma.
The vacuum extractor exerts considerable traction force. Fetal skull
fracture can result, and its true incidence may be higher than expected,
considering that few neonates with normal neurological behavior undergo
skull x-ray.
Vacuum extraction: does duration predict scalp injury? Teng FY, Sayre
JW. Obstet Gynecol 1997 Feb;89(2):281-5
•
In only 134 vacuum extraction-assisted deliveries there were 28 infants
with scalp trauma, including 17 superficial lacerations, six large caputs,
and 12 cephalohematomata; one infant had subgaleal, subdural, and subarachnoid
hemorrhages. The proportion of injuries was greater for applications
exceeding 10 minutes (6 of 9) than for those 10 minutes or shorter (22
of 121, P < .01). Cosmetic scalp trauma occurred in 21% of our newborns
delivered by vacuum extraction and was more common after longer vacuum
applications, longer second stages, and paramedian cup placement.
Vacuum Extraction Increases Neurological Deficits in Children.
Craniocerebral birth trauma caused by vacuum extraction: a case of growing
skull fracture as a perinatal complication Papaefthymiou G, Oberbauer
R, Pendl G.
Childs Nerv Syst 1996 Feb;12(2):117-20
•
A case of growing skull fracture following birth trauma and caused by
vacuum extraction is reported in order to emphasize the incidence of
this peculiar head injury at the beginning of extrauterine life and to
point out its relation to possible neuropsychological disturbances that
may appear later in childhood. Delivery by vacuum extraction increases
the incidence of perinatal injuries and consequently the incidence of
neurological deficits in children. Neurosurgical repair is advocated
as the appropriate treatment, with the aim not only of cosmetically correcting
the lesion's typical subgaleal protuberance with cranioplasty, but also
of performing a water-tight closure of the dura, enabling the cerebral
cortex to "fill in" the intracerebral lesion. The surgical
technique and gross pathology of the lesion are described together with
radiological findings before and after surgery. Reports by other authors
are reviewed in an attempt to identify the conditioning factors and pathological
features of this traumatic injury to skull and brain in neonates and
infants. The literature on cranial fractures associated with intracerebral
lesions at this age shows a significant difference in recovery and outcome
from that after similar lesions in older children.
Spinal Cord Injury during Birth
Spinal-cord injuries during birth Byers RK; Dev Med Child Neurol 1975;
17(1):103-10
•
Recognized causative factors are traction on the infant's trunk during
breech delivery, rotational stresses applied to the spinal axis, traction
on the cord via the brachial plexus in shoulder dystocia, and hyperextension
of the fetal head in breech delivery or transverse presentation. Recognition
of these factors is the basis for prevention of this terrible accident.
Birth Trauma Has Lasting Psychological Effects
although almost addressing trauma to the nervous system when looking
at birth trauma, there is growing evidence that the traumas of birth
have lasting psychological effects.
"Although controversy can still be generated, especially among
persons who are not acquainted with contemporary findings, we should
not proceed arrogantly with the routine traumatization of our infants
at birth! Fortunately, an increasing number of therapists are being privately
trained to recognize and work to resolve prenatal/perinatal trauma, but
there could never be enough of them to do the work that is piling up.
It would take an army of therapists to keep up with endless production
line of trauma at birth! Their work could be--and should be--eliminated
with the prevention of unnecessary traumas of contemporary obstetrics.
But there is no end in sight at this time." Read entire article
Birth Trauma: A Modern Epidemic
"Birth today has become a technological experience where a natural
process has been replaced with artificial procedures and schedules. Without
the necessary support during pregnancy, women enter the birth process
with fear and are led to rely on drugs instead of their bodies’ own
natural strengths. These drugs weaken her body’s ability to function
and lead to even further interventions. The more interventions used in
birth, the greater the risk of injury to both the mother and baby.
References:
Kiminski HM, Stafl.A & Aiman J. The effect of epidural anesthesia
on the frequency of instrumental obstetric delivery. Obstet Gynecol 1987;
69 (5): 770-773
Birth injury and method of delivery Benedetti T. NEJM 1999 Vol 341,
No. 23
Content of care by independent midwives: assistance with pain in labor
and birth Sakala C. Soc Sci Med 1998; 26 (11): 1141-115
"
One expert medical researcher on spinal cord and brain stem injury tells
us, 'the birth process, even under optimal, controlled conditions is
a traumatic potentially crippling event for the fetus."
"Spinal cord and brain stem injuries often occur during the process
of birth but frequently escape diagnosis. Respiratory depression in the
neonate is a cardinal sign of much injury. In infants, there may be lasting
neurological defects reflecting the primary injury."
Latent spinal cord and brain stem injuries in newborn infants Towbin
A. Develop Med Child Neurol 1969; 11, 54-68
"
Routine procedures such as inducing labor, pain medications and restricted
maternal positions are known to cause greater difficulty in labor and
lead to further interventions."
Satin AJ., Hankins, GD. Induction of labor in postdate fetuses. Clin
Obste Gynecol 1989; 32 (2): 269-277
Arulkumaran S et al. Obstetric outcome of patients with a previous episode
of spurious labor. Am J Obstet Gynecol 1987; 157 (1): 17-20
Chestnut DH et al. The influence of continuous epidural bupivacaine
analgesia on the second stage of labor and method of delivery in nulliparous
women Anesthesiology 1987; 66: 774-780.
Gardosi J, Huston N & B-Lynch. Randomised, controlled trial of squatting
in the second stage of labour Lancet 1989; 2 (8654): 74-77.
"
Medical research on birth trauma tells us, 'Forceful pulling on the baby’s
neck particularly when combined with stretching of the spine- has been
considered the most important cause of infant spinal and brain stem injury.'
Towbin A. “Brain Damage in the Newborn and ts Neurological Sequels” 1998
Chapter 1: 138.
Adams C, et al. “Spinal cord birth injury: Value of computed tomographic
myelography,” 1998 Depts of pediatric neurology and radiology:
University of Toronto
Rossitch E, Oakes J. Perinatal spinal cord injury: clinical, radiographic
and pathologic features Pediatr Neurosurg 1992; 18: 149-152
A recent study published in the New England Journal of Medicine revealed
startling data. It reports: difficult labor itself and the method of
delivery may lead to brain injuries and deaths in babies.
Brain injuries were found in:
•
one out of every 664 infants delivered with forceps;
•
one out of every 860 deliveries by vacuum extraction and
•
one out of every 907 infants delivered by c-section.
Towner D et al. Effect of Mode of Delivery in Nulliparous Women on Neonatal
Intracranial Injury NEJM1999; Vol. 341, No. 23
Another published medical study reports: “mechanical stress imposed
by obstetric manipulation-even the application of standard orthodox procedures
may prove intolerable to the fetus. Difficult breathing in the newborn
is a classic indication of such injury”
It further states,” Survival of the newborn is governed mainly
by the integrity and function of the vital centers in the brain stem.
Yet paradoxically, the importance of injury at birth to the brain stem
and spinal cord are matters which have generally escaped lasting attention.”
Latent spinal cord and brain stem injuries in newborn infants Towbin
A. Develop Med Child Neurol 1969; 11, 54-68
Birth trauma causes spinal injury. The effect is lifelong impairment
Neglected spinal cord, brain stem and musculoskeletal injuries stemming
from birth trauma Gottlieb MS. J Manipulative Physiol Ther 1993 Oct;16
(8):537-43
(The excerpts listed above are taken from the text of the video, "Birth
Trauma: A Modern Epidemic" by Dr. Jeanne Ohm)
The Newborn Infant
by Peter Fysh
...Chiropractors should also play an important role in evaluation of
the newborn infant. It is just possible that an early chiropractic evaluation,
performed during the first month of life, may have a significant effect
on a child's ability to develop to its full potential -- both physically
and mentally. We are aware of the tremendous stresses which are placed
on the neck and head of a neonate during the birth process. These stresses
can result in a wide variety of problems, from subluxation of the upper
cervical spine to significant trauma to the brainstem. One of the first
tasks of a chiropractor, when examining a newborn infant, should be to
check the spine for signs of trauma induced by the birth process. Subluxation
of the atlas can be the cause of an infant who is irritable, who sleeps
for only short periods, also of one who feeds poorly because of irritability
in a particular feeding position or because of regurgitation...
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