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