Monday, November 12, 2018

DC's in the Delivery Room

Chiropractors in the delivery room?
By Dr. Karen Gardner , D.C.
When the phone rang at 5:30 in the morning on October 12, I knew that Carol had gone into labor.  We had been talking several times a day for the past week discussing all of the physical changes she was experiencing and comparing them to my own childbirth experience.  Carol and I have known each other since the 6th grade and she has been a loyal patient of mine since we opened our practice in Pennsylvania in October 1996.  She has a firm grasp of chiropractic and always keeps her appointments.  It was no surprise to me, that after years of trying to get pregnant, she was able to once under regular chiropractic care. She had suggested months earlier that it might be nice to have her chiropractor at the hospital to check her baby as soon as it was born and to check her periodically during labor.  I, of course, said no problem.  I had been asked that very same question dozens of times in my growing practice of pregnant women.  Many women came to the office actually in early labor on their way home from the midwife or on their way to the hospital just to make sure their nervous systems were functioning at 100%.  But, at the last minute, most women did not ask me to adjust them while in active labor for a variety of reasons that are personal to each woman.   You can imagine my surprise when Carol called me BEFORE she called her OB/GYN. 

I was so excited I didn’t know what to do first.  I knew we had some time before real labor started.  She was getting adjusted weekly throughout her pregnancy and I knew from experience that regular chiropractic care reduces labor time so I didn’t want to take any chances. 

I hate hospitals.  I hate the smell.  I hate the bureaucracy.  I hate the white coats.  I hate the instruments.  I hate the drugs.  I hate the egos.  I have to admit, I was a little nervous crossing the river to a state where I was not licensed to practice chiropractic; to enter a hospital where I probably was not welcome.  But I thought to myself, no one needs a chiropractor right now more than my friend Carol and it’s time to step out of my comfort zone.  After all this was not about me.

At first I introduced myself to the nursing staff as a “friend”.  Then, I read Carol’s birth plan.  I was on it.  She specifically requested in writing that I, her chiropractor, be present to adjust her spine as I felt necessary and to be able to check the baby as soon as it was born for subluxations.  Once I wiped the tears from my eyes, I made sure everyone in that hospital knew that I WAS A CHIROPRACTOR!  

Carol’s labor progressed very well.  The nurses were so surprised at how quickly things were moving along.  I wasn’t.  I was getting very irritated with the medical “team” who kept trying to intervene in such a natural, beautiful process.  Fetal monitors, suggestion of enemas (yes, they still do that to laboring women), not allowing any food for the mother, forcing the mom into the lithotomy position, checking the cervix for dilatation every hour or so (in my opinion, checking the cervix was the most painful part of labor) and not honoring many of Carol’s and her husband’s wishes were just a few of the things that irritated me. 

Carol was left alone to labor without any “medical” support or encouragement.  For a first time mom, the need to know that everything is normal and OK is very important.  Feeling abandoned by the people you are depending on to make sure everything goes as it is supposed to is a horrible feeling.   If her husband and I were not there she would have been completely alone.  Carol later told me that I helped her deal with her fear of labor.  “She made me comfortable with it”, she said.  The medical team came on an hourly basis with a new proposal for more torture.  I said no to everything.  Carol and her husband were certainly not in a position to make decisions.  They were faced with a magnificent life changing experience and the nurses wanted to know if they wanted their baby vaccinated against Hepatitis B.  PLEASE.  It took all of my strength not to strangle someone.  I had to constantly remind the nursing staff to please refer to the birth plan.  All of the parents’ wishes are in writing. 

I think all of this intervention was causing some stress and performance anxiety in Carol, because her labor completely stopped twice.  That was my cue.  I stopped rubbing away her back labor and adjusted her sacrum.  Instantly Carol moaned as her labor returned with a whopper of a contraction.  I’ll never forget her husband saying, “Karen did it, not me!”  On a second occasion her labor stopped once again, this time C2 was the culprit.  I adjusted her in a modified cervical chair as I sat on the edge of the whirlpool.  Again, labor resumed instantly.  As I was adjusting her in that awkward position, I thought to myself, I’m glad I’m not being graded on technique.   When I talked to Carol about writing this article she said,”The most amazing thing was when you adjusted me when labor stopped and it started up again immediately.  My husband still talks about that with his friends and family.  I know that chiropractic kept my body in communication with itself.”

 I continued to check and adjust Carol between contractions as necessary until she was in transition.  Most people would tell you to avoid laboring women while they’re in transition.  This is the MOST painful part of labor and consequently, a very emotional and irritable time for the mother.  My instincts told me to stay near and check her every ten minutes.  I don’t know why, but I did.  Her C2 would not stay put.  I checked and adjusted her constantly.  Her doctor checked her cervix and she was 8 cm. Dilated.  The doctor said that in about 2 hours you’ll probably start pushing.  I adjusted her again and Carol’s body innately started to push.  The nurses yelled at her to stop pushing.  I said, “Maybe her body knows more than we do.”  After 15 minutes of Carol being told not to push, her doctor came back and checked her cervix again and said she was ready to start pushing.  I believe she was ready when the whole pushing thing started 15 minutes earlier. 

I thought, great.  Here comes the big moment and I started to help Carol get on all fours to deliver.  The nurses looked at me as if I had 3 heads and started to break down the bed and assemble the stirrups.  I said, “What are you doing?”  I was then told Carol needed to lie on her back so that fetal monitor can be hooked up and so she can deliver the baby.  I again reminded them of the parents’ birth plan and this was something that was objected to specifically.  The response I received absolutely floored me.  The nurse told me, and I quote,” It’s not up to the parents; it’s up to the doctor.”  If Carol didn’t need me there I would’ve walked out. 

I believe that because Carol was placed in the position she was, she pushed for far longer than necessary.  Although she only pushed for 45 minutes to an hour, not very long when compared to a lot of other women, I feel that time could have been drastically reduced if she had been allowed to do what her body was telling her to do.  For instance, I pushed for only 17 minutes before my first child was born and only four minutes with my second.  I was allowed to deliver in whatever position my body decided was right for me. 

When Thomas finally entered this world and we all stopped crying, I checked him and his mom for subluxations.  I am proud to say that luckily, neither needed adjusting despite all of the intervention.  I think that was probably due to the previous chiropractic care Carol had received over the past 2 years and the adjustments she received while in labor. This whole miraculous process took only 9 hours.  For
a first time mom, that’s supposed to be unheard of.  Carol and I know that chiropractic care played a major role in her short labor time just as it did in mine.  Just as it did in the dozens of other women that I personally know who were under chiropractic care during their pregnancies. .   Carol said, in retrospect, “Dr. Karen checked me for breech and other things that may ultimately interfere with a good, healthy labor.  I was impressed as I thought Dr. Karen went above and beyond what other doctors did.”

When I left Carol and her husband to bond with their baby and got into my car I started to cry, not just because I witnessed the miracle of birth.  But, I cried because I was asked by my friend and patient to be there during such an intimate time in a person’s life.  What an honor it was for me to be a part of this miracle.  What a privilege it was for me to check a newborn baby for vertebral subluxations.  Carol and her Tommy, who is now 5 years old, continue to get adjusted every week.  Olivia, his 2 ½ year old sister gets adjusted, too.  I had the honor to attend that birth as well.  This beautiful birth was attended by a midwife, but that’s a story for another article.  How wonderful to know that these children, like my own, will grow up having chiropractic care being a part of their normal, everyday life. 

Because chiropractic care has been shown to reduce labor time, reduce the need for pain medications, change a breech or transverse presentation to vertex, change a posterior presentation to anterior, reduce the need for other interventions and even induce labor when it has stopped, I feel an experienced pregnancy chiropractor should be in the delivery room or at least be waiting outside to be called upon as needed.  If a doctor of chiropractic can check the new born for the damaging effects of a vertebral subluxation (misplaced spinal bone that causes a disruption of the central and peripheral nervous systems by “pinching” off nerve supply), a leading cause of  S.I.D.S., think of the advantages that child would have.  The possibilities are endless.

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, November 5, 2018

Pregnancy Care 101

When I was in chiropractic school I remember the shear terror I felt when I had to adjust my first pregnant woman.  I was in 8th quarter.   I wasn’t given any information on the special needs of an expectant mother.  There was no book; there were no classes, there was nothing.  I thought to myself, “I wish I were in 12th quarter already so I can learn this stuff in pediatrics”.  Well, THAT was a huge disappointment.  Oh sure, we had a mini-lecture on Webster’s technique but that was it.  In my Ob/Gyn class I was taught how to perform a pap-smear and a breast exam (on a mannequin, no less).  I was NEVER taught how to adjust and actually care for a pregnant patient.  Were you?  That’s when it all started for me.  I decided to consciously make an effort to learn all that I could about pregnancy chiropractic care.  I figured if there wasn’t any info out there for me, I had to go get it.  Carpe Diem! 

After I complied all of this information over more than a decade of working with local midwives, doulas, Ob/Gyns, pregnant women and their families I felt I had to share this knowledge so that more women could benefit from the magic of a chiropractic adjustment.  After all, when can you positively impact two lives with the power of one chiropractic adjustment, except during pregnancy? 

So doc, I want to share with you some information that I have discovered over the years to be extremely helpful in working with pregnant women.  Let’s start with the basics.

It seems the #1 reason women see a chiropractor during pregnancy is for low back pain; especially pain over the SI joints.  When women are pregnant, they usually, for the first time, hesitate in popping pills for every little thing.  Chiropractic is logical next step for many pregnant women.  There are basically 4 main reasons why low back is so prevalent during pregnancy. 

  1. The Hormone Relaxin makes ALL ligaments lax and causes instability and changes walking gait and standing posture.
  2. Increase weight gain causes increased lumbar lordosis which can cause facet jamming and change in center of gravity.
  3. Weakened abdominal muscles
  4. Pubic bone misalignment.

Now, a pregnant spine is different than a non-pregnant one.  First of all, we need to accommodate for mom’s ever-changing figure.  A tilt up pelvic piece or pregnancy cushions work best.  I avoid tables with a drop out piece because this actually is VERY uncomfortable for a pregnant woman with an already hyperlordotic spine.  I speak from personal experience as well as from feedback I have received from dozens and dozens of pregnant practice members. 

When we adjust an expectant mother, we generally see her more frequently than a practice member who isn’t pregnant.  That hormone Relaxin makes it very difficult for mom to hold her adjustments. 

We must not forget the importance of the pubic bone when caring for the mother-to-be.  That is SO IMPORTANT during pregnancy.  The majority of mom’s weight gain occurs right over the front of her pelvis, it makes sense to be certain this is in proper alignment, doesn’t it?  If you learn nothing else from this article, please remember the importance of the pubic symphysis during pregnancy…especially if the baby is Breech. 

Some things to consider when working with the mother-to-be:

·      Have intake forms that specify pregnancy related concerns.   We have forms that ask about complaints before pregnancy and those that just appeared during pregnancy.  Why?  If a woman never had headaches before being pregnant, it is a clue that they may be due to an increase in estrogen which means look at L3.   If she’s past 28 weeks and complaining of headaches that she never experienced before, it could be pre-eclampsia which means check  T1 and T10- T12 and her blood pressure. 
·      Obviously NO x-rays ever on a pregnant woman.  Even with the abdomen shielded, DO NOT X-RAY a pregnant woman’s cervical spine.  It’s the x-ray exposure to the thyroid that causes the problems during pregnancy and in upper cervical films one cannot shield the thyroid. 
·      Don’t use bilateral scales… #1 NO pregnant woman wants to be weighed EVER!   #2 the position of the baby can give you an erroneous reading
·      I recommend omitting side posture during pregnancy; especially in the later months because of the slight risk of abrupting the placenta in susceptible women  as well as the pubic bone dysfunction I see in countless women who are adjusted this way during pregnancy.  I also recommend that if the doc is pregnant herself that she does not use side posture to adjust her patients because of the instability of her own pelvis. 

Basically, the rule of thumb is to decrease your force and avoid gross twisting motions, postpone x-rays and you should be OK.

I’m sharing this information with you because I hope it will help you become more interested and confident in caring for pregnant women and if you already do care for pregnant women, I hope some of this information will help to enhance your results. 

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

Thursday, November 1, 2018

5 neuro complaints of pregnancy

The Five Common Neurological Complaints of Pregnancy

By Dr. Karen Gardner

For many years I have helped literally hundreds of pregnant women with everything from breech presentations to carpal tunnel syndrome. I have encountered basically five common neurological complaints that frequent this part of our population.  In my experience, chiropractic care is the best choice for each and every one of these conditions.   

The five complaints defined

·      Meralgia Paresthetica Compression of the lateral femoral cutaneous nerve as it passes beneath the inguinal ligament.   Pain and paresthesias are seen in the lateral aspect of the upper thigh. 
o   During pregnancy:
 Meralgia Paresthetica is most likely due to the abdominal weight gain in pregnancy . (Compresses the inguinal ligament) 
o   Case management:
 L3 is almost always involved as are the trochanters.  They almost always rotate anteriorly on side of symptomotology.  Tight belts and waistbands will exacerbate and even cause symptoms. 

·      Sciatic neuralgia: 3 mechanisms can cause inflammation of the sciatic nerve.  
·         Vertebrogenic:  Compression of the lumbar plexus from lumbar subluxation.
·         Myogenic: Spastic or flaccid piriformis muscle.
·         Discogenic: Bulging disc
o   During pregnancy
Because the sciatic nerve passes over, under or
through the piriformis muscle, instability of the sacroiliac joint can cause sciatic neuralgia.  Various hormones of pregnancy often causes this instability  and can lead to  either a spastic or flaccid piriformis muscle which almost always irritates the sciatic nerve.  The positioning of the fetus itself can also be a factor. 
o   Case Management
The best way to address sciatica is to first determine which of the causes you are dealing with.  After uncovering that, your correction protocol is easy to discern based on the techniques you use in your office.  Since every technique handles sciatic neuropathy in different ways, use the techniques you have already had success with when dealing with sciatica making minor modifications as needed. 
·      Headaches:  As chiropractors, we know that the cause of many headaches, including tension, sinus, and some types of migraines, can be traced to subluxations in the cervical vertebrae.
o   During pregnancy
Headaches are very common especially in the first trimester and are usually due to hormonal changes.  High surges of estrogen cause migraine type headaches.  If a woman has never experienced headaches on a regular basis before pregnancy, expect them to be related to hormones.  A loss of cervical curve (as a result of lumbar Hyperlordosis) can be a component as well. 
o   Case management
 It is important to check L3/L4 and sacrum when hormone headaches are suspected.    If headaches are persistent after 28 weeks of gestation, they could be related to pre-eclampsia or toxemia of pregnancy.  Check for high  blood pressure and swollen ankles.  If these are present recommend that she see her midwife or Dr. immediately. 

·      Carpal Tunnel Syndrome:   Often caused by lower cervical subluxations.   Also repetitive strain and overuse causes problems with the tensor retinaculum.
o   During pregnancy
 Symptoms appear as the pregnancy progresses. It is not uncommon for the extra retention of water to cause these symptoms
o   Case management: .  Check lower cervicals.  Keep in mind that if CTS is being caused by water retention, it should dissipate after childbirth.  If it gets worse after childbirth it most probably because of Nursing Mother’s Neck. ™   Be sure to check the clavicles, shoulders, elbows and wrists for fixations.  .  
·      Bells Palsy   It is defined in Taber’s Cylopedic Medical Dictionary - 16th Edition as an idiopathic unilateral facial paralysis with sudden onset. 
o   During pregnancy The following are presumed mechanisms that may cause Bell ’s palsy :
a.    Swelling of the facial nerve due to hormonal changes and increased fluid retention during pregnancy
b.    Subluxation especially in the atlanto-occipital region.
c.    Subluxation of the TMJ
Note: Personally, I believe these instances can cause compression of the facial nerve as it passes through the temporal bone. 
o   Case management:
Most often Bell’s palsy occurs in the 3rd trimester or post partum (more common in my experience) and responds very favorably to chiropractic adjustments.  Be sure to check the TMJ, atlas, occiput and sacrum.

What can you do to help women with these conditions?

 Reassure mom that she’s not broken.  Often women have a misconception that there is something wrong.  She may say “My neighbor had 9 kids and never had a problem like this.”  To this I say, “Remember when you fell off a horse when you were 11?  That is why you are having the trouble you are having today.   This problem has been there since your fall, you just never noticed it until your tummy started to grow and changed everything about your pelvis and lower back.  Once the baby is born you will start to feel a lot better but we still have a lot of work to do get you back in shape for the next baby.  HA HA.”

Sometimes humor helps; sometimes you’ll get a dirty look.  So, use your best judgment in each case.  Most importantly, give your practice member hope that she found someone who can help her.  Many times, you will be the last resort.  Be sure she saved the best for last. 

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