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.
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!
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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
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