Monday, March 4, 2013

Case History of Occiput Posterior Presentation at 31 weeks gestation

Over the years I have penned many case histories for various publications and continuing education courses I have taught.  Since so many doctors ask for advice in caring for pregnant women, I've decided to post some of my more interesting case histories (well, I think they're interesting.  My hope is that you will, too!) so that more doctors can read about various methods I have found in caring for moms to be.  As always, feel free to forward this info to your friends and colleagues and if you have any questions or comments about this or other cases, please fell free to post it here.  

Spoiler Alert:   
I've included a shameless plug at the end of this case study.  If the books I mention are of interest to you, use this coupon code BLOGBOOK to save 15% on one or both books.  Thanks!

Case History: 33 year old woman presents with headaches, low back pain and a posterior baby at 31 weeks gestation.

The patient is pregnant with her first child. 

Her main reason for coming to our office for care to is have her pelvis evaluated for its possible contribution to the current occiput posterior presentation of her baby. 

In the past, she has had headaches, low back pain, stomach trouble and neck pain prior to this pregnancy and is also currently complaining of the same. None of her current complaints, however, are interfering with her activities of daily living. She is currently under the care of a midwife for this pregnancy.   She does not have a history of any hernias, uterine fibroids, or ovarian cysts.  She had never had any abdominal surgeries.  Her midwife reports this patient’s uterus is normal and is free from any abnormalities that may be contributing to the posterior presentation of the baby. 

She did report that in the seventh grade she was fitted for a back brace to treat her severe scoliosis.  She wore the brace for 18 hours each day for three years.  She was unable to describe her degree of scoliosis or any details about the brace, however.  She was not able to obtain patient records from her physician who ordered the braced and cared for her during this three year period. 

She communicated the following accident history:
As a teenager (she did not give a specific age when asked) this patient was thrown from a horse, hit the ground and landed on her coccyx.  Again, no medical treatment was obtained for this injury.  At approximately 8 years of age she was involved in a “fender bender” type auto accident as a back seat passenger.  She was not wearing a seatbelt and reports that she did not experience any symptoms after the accident and therefore did not receive any medical care.  This patient also experienced a fairly serious fall down a flight of stairs at age as a young child at camp.  She could not remember how old she was at the time of the accident.  She reports that she fell on her tailbone repeatedly and describes it as the absolute worst pain of her life.    

This patient denies smoking.  She reportedly drinks one cup of coffee as well as one cup of tea per day.  She is taking pre-natal vitamins; iron (Flourodix) and Calcium (Citracel) as directed by her midwife.  Even though she is experiencing acid reflux and indigestion, none of these supplements appear to be causing digestive distress that is sometimes common with these particular supplements.  She reported being unaware if her amniotic fluid levels were within normal limits.  She admits to exercising regularly as well as eating a balanced diet.  She does not get at least eight hours of sleep per night due to her chronic insomnia. 

Physical Examination –

A thorough examination of her lumbar and cervical spine was conducted due to her complaints of headache, lower back pain, and posterior baby.   Postural evaluation revealed a lumbar hyperlordosis most likely due to her advanced stage of pregnancy.  She also presented with anterior weight bearing.  Despite her history of scoliosis, the remainder of her postural evaluation appeared to be within normal limits. 

Cervical active range of motion was within normal limits with no noted pain or discomfort.  Lumbar active range of motion was also within normal limits.   

Palpation revealed taut and tender fibers in the lumbo sacral region bilaterally from L3 through Coccyx.  Palpatory tenderness was noted at the Coccyx and Sacrum, also bilaterally.  Trigger points were noted in the upper trapezius muscles from C7 to T-5

Deep Tendon Reflexes:  Biceps (C5\C6):  left: normal;  right: normal. Brachioradialis (C5\C6):  left: normal;  right: normal. Triceps (C7\C8):  left: normal;  right: normal. Patellar (L2\L4):  left: normal;  right: normal. Hamstrings (L4\L5):  left: normal;  right: normal. Achilles (S1\S2):  left: normal;  right: normal. Cranial Nerve Exam:  Myotome evaluation revealed no weakness in the  upper and lower extremity. Dermatome evaluation revealed no altered sensation to pin prick in the  upper and lower extremity.

Spinal analysis using muscle testing uncovered the following misalignments:
Posterior coccyx on the right, superior pubic bone on the left, posterior L3 on the left, posterior T6 and T4, and C3 Body left.

Prone leg checks uncovered a left short leg of ¼ inch with a left cervical syndrome.  Therapy localization indicated a left posterior Atlas on the right.  Supine leg checks uncovered a right short leg of ¼ inch. 

Using Basic Sacral Occipital analysis, the patient was not found to be any Category. 

All cervical orthopedic tests were found to be within normal limits.  The lumbar orthopedic tests that are not contraindicated during pregnancy were also found to be within normal limits. 

A thermal spinal scan showed areas of severe thermal asymmetries in the upper cervical (specifically atlanto-occipital) and upper lumbar (specifically thoraco-lumbar) regions which correlates and supports the initial exam findings. 

Care Plan
Based upon the patient’s history of traumas, previous pregnancies, weeks gestation of current pregnancy and presenting symptoms, the following care plan has be recommended:

Specific Chiropractic spinal adjustments following the Bagnell Technique protocol three to four times weekly until baby turns to the anterior position.  Once the baby turns, one to two weekly adjustments is recommended until the birth of the baby.  A 6 week post-partum check up is also recommended to evaluate a continued need for care. 


This patient received her first chiropractic adjustment on May 26, 2009.  C3 was adjusted, manually, in the prone position as was T4 and T6.  L3 was adjusted using an instrument in the prone position as was a posterior right coccyx.  A superior right pubic bone was corrected in the supine position using a very light setting (2 rings) on the activator instrument. 

Re-evaluation and follow up

On June 3, 2009, the patient returned for her second adjustment and reported that the baby was in a breech presentation. A brief kinesiological exam revealed a C2 body left and a posterior right coccyx.  Both were adjusted in the prone position using an instrument.  A superior right pubic bone was corrected in the supine position using a very light setting (2 rings) on the activator instrument.  A follow up thermal scan showed the previous severe thermal asymmetries in the cervical area have improved and were described as mild to moderate in nature.  The thoraco-lumbar area still showed severe asymmetries however they were on the opposite side from the first scan. 

On June 11, 2009 she returned for her third adjustment, even though it was recommended that she be seen more frequently until the baby turns.  C7 and T1 were adjusted in the prone position.  Her sacrum and not her coccyx needed to be adjusted on this visit.  A P-L listing was adjusted in the prone position using an instrument.  In addition, an anteriorly rotated trochanter was found and adjusted on the right in the prone position using an instrument.  The patient reported that an ultrasound examination revealed that the baby had turned to the vertex position and that the baby was also in an occiput anterior position.


Prior to her third visit in our office, this patient was taking Homeopathic Pulsatilla (a dilution 6C) as recommended by her midwife.  Pulsatilla is a widely used homeopathic remedy derived from the vegetable kingdom, from the wind flower.  It is often referred to as “the” pregnancy remedy as is addresses many common complaints of pregnancy.  It also has some notable success in getting babies to turn head down.  The 6C dilution is an extremely mild dilution and in most, if not all, states in the U.S. it is available without a prescription.  The midwives we work with on a regular basis will often suggest Pulsatilla to their breech patients as they did the case discussed above.

Initially this patient came to our office because the baby was in an occiput posterior position.  This baby later turned from vertex to Breech as it will sometimes happen.  As expected, her pubic bone and coccyx were misaligned and needed to be adjusted regularly; even after the baby turned to the vertex position.  In fact, on every visit prior to delivery (eleven office visits in total) she needed her coccyx adjusted.  This misalignment was of no surprise given her history of trauma to this area of her pelvis. 

On August 2, 2009 – just three days after her last adjustment in this office, this patient was able to deliver her baby vaginally

Want to build, grow and perfect your Pregnancy Practice? Let's get on a call to discuss your strategy. The first call is on me! Schedule now

Dr. Karen, just wanted to say wow...I've learned so much and I'm only into the 2nd module. This is the stuff we need to know in everyday practice! I could listen to you all day long!        ~ Dr. Katie Gelesko Stull

Friday, February 22, 2013

Don't be an American "Idle"

Don’t be an American “Idle”
How to work at building your pregnancy practice

For a long time, my family has loyally watched American Idol.  We got hooked on the drama and excitement that followed these young talented people through their journey.  If you’ve never seen the show, it’s one “reality” show that was actually somewhat entertaining…in my opinion, anyway.  In case you’re wondering why I’m speaking in the past tense, it’s because we don’t watch the show any more.  I just can’t stand Nicki Minaj.  Sorry, she’s one of those you either like her or you don’t.  I don’t.  That being said, the premise of the show still remains the same and it taught me something very valuable that I use in my own practice on a regular basis and share with all of my coaching clients.  I want to share that with all of my readers as well.

As I was watching past seasons, I noticed a couple of key things. 

  1. The show is not called American “IDLE”. 
 These kids (yes , even though some of them are 26, they are kids to me) work their buns off to get ahead.  They spend hours upon hours in rehearsals, with their voice coaches, their publicists, and their fashion advisors….you name it they are putting in some serious time.  No idleness is allowed if you want to be an idol.

  1. Success doesn’t happen overnight. 
 I looked back on the first season of American Idol and remember Kelly Clarkson.  She was the first winner of the very first season and she is still doing GREAT!!!  She also is on tour, has several albums out, hit singles are everywhere, she consistently tops the charts, she has sung songs for movie soundtracks, was in a movie herself, makes personal appearances on talk shows etc., is on tour……the list can go on and on. 

Then we have Carrie Underwood, a more recent winner, who is doing unbelievable things in the world of country music.  She has won so many awards it’s hard to keep track of them all.  Even though they “made it” in two different music genres, they have a similar road to success and a similar way of maintaining that success.  They work at their success.  You’ll never hear them say “I won and now you have to buy my music”.  No way!!  They are on top of their game.  They apply themselves; they practice their art and promote it to the world. 

Did you get that last line?

They apply themselves; they practice their art and promote it to the world. 

Doc, how about you?  How much do you work?  I don’t mean how many hours a day do you adjust?  I mean how many hours do you spending working on practicing your art, and promoting and growing your pregnancy practice???  It is work, too.  Isn’t it? 

It’s not fun…all of the time.  It’s tedious, it can be boring, tiring and down right uncomfortable, right?  I totally agree.   

But…..if you don’t do it because you don’t like it, don’t have the time, don’t know how, (put your own excuse in here) you won’t grow, period!  No world class athlete got to where they are without doing the WORK.  I am pretty sure our Olympic track team isn’t excited about doing wind sprints or running the stadium stairs, but they do it to better themselves and prepare for the big race. 

Singers and actors also need to put in a lot of effort to succeed in their fields.  Even if someone was “discovered” and became an “overnight success” they have to work to maintain their success….by the way, most overnight successes take years to get discovered. 

So what does this mean to you?  It means you have to work at success.  What could you be doing to build your pregnancy practice right now?

·      Set up an outside talk
·        Child Birth classes
·        Mom’s groups
·        Obstetricians offices
·        Midwives offices
·      Do a screening
·        Baby store
·        Maternity store
·      Introduce yourself to area businesses.
·        Midwives
·        Doulas
·        Ob/Gyns
·        Massage therapists
·        Yoga studios that offer pre-natal yoga
·      Ask for a referral.
·        Other pregnant practice members
·        Midwives
·        Doulas
·        Ob/Gyns
·        Massage therapists
·      Write a press release
·        Send it to all forms of media, like radio and local TV; not just your newspapers

Of course you can do all of this.  Did you notice all of the above cost nothing to do? 

What’s stopping you?  Let’s imagine that your life depended on getting 3 new patients this week and every week for 3 months.   What would you do differently to grow your practice?  I know there are some things you are putting off, doc.  Stop it!  

Do those things now as if your life depended on it, because in the long run…it really does, doesn’t it? 

What would your life look like if you had 3 new patients a week every week?   Try it on for a while.  If it doesn’t work, change it.  If you hate doing it, delegate it.  If it works, do it until it stops working.  And above all, don’t be an American Idle.

Be sure to click this link to sign up for a free monthly newsletter dedicated to assisting principled chiropractors in building and enhancing a pregnancy care practice.

Want to build, grow and perfect your Pregnancy Practice? Let's get on a call to discuss your strategy. The first call is on me! Schedule now

Dr. Karen, just wanted to say wow...I've learned so much and I'm only into the 2nd module. This is the stuff we need to know in everyday practice! I could listen to you all day long!        ~ Dr. Katie Gelesko Stull

Tuesday, February 5, 2013

Pregnancy Meric Chart Fiasco Part II

I posted this blog back in November and wanted to repost it today.  Why?  Because the Pregnancy Meric Chart posters are no longer on backorder - yay!!  Infact, I have updated the coupon code mentioned in this blog so that it can be used for the remainder of this month.  Thanks everyone for your patience!  Here's the original Blog...

A few days ago, one of my dear friends and long time coaching client alerted me that an original digital copy of my copyrighted Pregnancy Meric Chart poster was posted on Facebook.  Soon I learned it was VIRAL. This was not good news.  Copyright laws were being broken.  People could get into a lot of trouble.  The poster that I created after many long hours of work was "out there" for anyone to steal.  YIKES

I asked all the doctors, whom I could trace down, to please, please remove this from their pages.  I felt that the initial posting that started the whole "spread" was not malevolent.  Doctors just wanted to share the information with their patients and page fans.  All of the doctors whom I contacted took it down.  All of the doctors except for one.  This doctor didn't want to take it down and asked that I allow her to keep it on her page with a link so other people could order it.   So I did.  What happened next was not expected...

Now These posters are on back order. (Not anymore....I finally have them in my hands!)  Now more chiropractors than ever have this tool to reach out to their communities to teach about the MANY, MANY benefits of SAFE, NATURAL  pre-natal chiropractic care.  Thanks Dr. Who shall remain anonymous, for your graciousness in helping to spread the word!  

The link to order is here

The same exact poster is also available in handout form and are not on back order.  These are printed in black ink on yellow paper.  Here is the link for them.

Want to build, grow and perfect your Pregnancy Practice? Let's get on a call to discuss your strategy. The first call is on me! Schedule now

Dr. Karen, just wanted to say wow...I've learned so much and I'm only into the 2nd module. This is the stuff we need to know in everyday practice! I could listen to you all day long!        ~ Dr. Katie Gelesko Stull

Tuesday, January 29, 2013

More Pregnancy Q&A

Last month I started posting questions that I receive on a regular basis from chiropractors worldwide concerning pregnancy and chiropractic.  This month I will do the same as so many of you have emailed me privately or through Facebook or LinkedIn to tell me how much you have enjoyed it so far.  Please don't be shy if you'd like to ask a question or comment on one that I'll be posting here.  Be sure to also join my LinkedIn Group Pregnancy Chiropractic.  It's a group where docs from all over are asking and answering questions as it pertains to natural, prenatal chiropractic care.  I hope to see you there.   

So, without further adieu here's the Q&A...and it doesn't come from a doctor, it comes from one of the dozens of mothers-to-be who e-mail me every week. I feel her question is vitally important to moms and their chiropractors, so I decided to share it with all of you reading today

Hi there,

I will be 38 weeks pregnant with boy/girl twins Monday, 7/18 & have been referred to your website by Gail Tully from the spinning babies website. I am presently seeing a chiropractor who studied under Dr. Webster & have been receiving acupuncture as well as craniosacral & myfacial release massage at his office. He is doing symphysis pubis adjustments, but Baby A is still in the breech position. She flipped at 30 weeks & I believe is still in the complete breech position, bottom side closest to my pelvis. Baby B is head down, but not as low as Baby A, so my dr. believes that Baby A will engage 1st & thereby cause us to have a c-section.

We are holding off as long as we can as we have studied the Hypnobirthing technique & hired a doula for what we hoped would be a completely natural, drug-free birth. I am hoping that perhaps someone on your staff & my chiropractor or myself can work together to see if his techniques will be successful in getting Baby A to flip for us. The acupuncturist is working on both my kidney & bladder chi's as they were deficient just after she flipped. (a problem I also faced prior to becoming pregnant)

Anything you can do or recommend would be so greatly appreciated as our dr. has asked us to schedule a c-section for week 41 just in case. I'm not feeling like either baby has engaged yet, however I am fearful that this might be the last week I can try any manuevers due to space issues for the babies. I truly appreciate you taking the time to read this e- mail & am hopeful that Gail's recommendation will be exactly what I need to accomplish our intentions.

Have a most wonderful day!

Pam & Mark C.

Hi Pam,

Thanks so much for contacting me. I appreciate your thoughtful e-mail. It is not unusual for one twin to be breech and the other vertex. For reasons of space in-utero, it makes perfect sense. Most often once the first baby is delivered, the second flips head down and is delivered shortly after the first. This may also happen in your you stated depending on who engages first. But we have had cases where the twins have turned both in our office and in other docs' offices. It's a lot less likely because of the physical crowding, but our technique has worked on twins.

You are doing wonderful things by getting adjusted, pubic bone adjustments are vital. Craniosacral, myofascial release and acupuncture are also excellent! Congratulations on choosing such healthy and natural care for you and your babies. You may want to discuss the homeopathic remedy called pulsatilla with your chiro. It has been known to make a "stubborn" baby a little more cooperative. I have recommended it for several of my practice members with great success. But, since you are not my patient, I can't recommend it you for obvious reasons, but I do recommend that you discuss it with your doctors.
I recommend that your chiro e-mail me to get some information regarding my techniqueAlso be sure to forward the following link to an article I wrote for Today's chiropractic magazine. This article should give your doc the basics of what we do. It may offer some new info that could be implemented to help you out.
Please don't hesitate to let me know if I can be of further service to you. Good Luck with everything. I hope this information is helpful to you. Until next time....

Love & Gratitude

Dr. Karen Gardner 

Want to build, grow and perfect your Pregnancy Practice? Let's get on a call to discuss your strategy. The first call is on me! Schedule now

Dr. Karen, just wanted to say wow...I've learned so much and I'm only into the 2nd module. This is the stuff we need to know in everyday practice! I could listen to you all day long!        ~ Dr. Katie Gelesko Stull

Monday, January 7, 2013

Most Frequently Asked Questions about Pregnancy and Chiropractic


Starting today, I am posting some of the emails and questions that I receive from chiropractors who are sprinkled all over the planet.  I think there are a lot of doctors out there with the same questions, so why not spread the info far and wide?  If you have a question about pregnancy and chiropractic, you may find your answer here.  If you don't find the answer here,  feel free to reply to this blog or send me a private e-mail at and be sure to put BLOG Q&A in the subject header so I can make your email my top priority.  

Here's the first Q&A:

 Hi Dr. Karen,
I have a question regarding childbirth educators and doulas. I live in a large town for North Dakota, but as for midwifery and doulas, there's not much information. How do I find out who and where they are? I'm assuming word of mouth - they're not listed on MANA or anything. Also, for childbirth educators through our local hospital, how do I approach them - or shouldn't I?? Also, should I be sending anything to pediatricians with my focus being on family wellness???

Thanks so much for your time, Karen. I truly appreciate and I really hope I have the opportunity to meet you someday!!

Dr. Tiffany

Hi Dr. Tiffany,

I really admire your enthusiasm! You are going to be a huge success, I can tell.

As far as locating people in your area, try the internet. Do a search for Midwives and doulas in your town and others nearby. There is an association called DONA (Doulas of North America) look that up and see who is in your area.

Once you find some doulas, ask them which midwives and OBs they like to work with. They'll have a good idea of who has a more natural approach and open to working with a chiropractor. There's a letter in my marketing manual that you can send out to introduce yourself, so use that to get the word out.

As far as building a family practice, instead of asking the medically trained pediatricians, ask your practice members. If you are going to adjust pregnant women, they will have families in 9 months or less. Instant doubling of your practice! Make sense?

However, if there is a really cool pediatrician in your area who is open to alternatives to drugs, by all means reach out.

Keep up the great work! I am really proud of you. Be careful not to spread yourself too thin though, OK?

Love & Gratitude

Dr. Karen

Want to build, grow and perfect your Pregnancy Practice? Let's get on a call to discuss your strategy. The first call is on me! Schedule now

Dr. Karen, just wanted to say wow...I've learned so much and I'm only into the 2nd module. This is the stuff we need to know in everyday practice! I could listen to you all day long!        ~ Dr. Katie Gelesko Stull