One of the great opportunities we have as chiropractors is to see a variety of patients with many different conditions. I have had the opportunity to adjust people of all ages, ranging from a newborn to a very active and healthy 97-years-young patient.
An evolving practice specialty for chiropractors is the realm of prenatal care. Pregnant women are probably some of the best candidates for chiropractic care, as the physiological and postural changes of pregnancy wreak havoc on the spine. However, given the medical contraindications during pregnancy - drugs, surgery and therapy modalities being forbidden - little else is available to pacify a pregnant woman's complaints. We all know most patients seek care for pain, and pregnant women are no different. Sciatica, tension headache and carpal tunnel are very common, especially during the last trimester. Very often, these women are told they have no choice but to "deal with it" until childbirth. From a medical perspective, this is true - there is no drug to help these women.
However, chiropractic very easily fills this void with gentle, natural care that removes postural torsion and stress from the body - can you think of a better treatment? If it has not happened already, you can be sure that very soon, a pregnant woman will be coming through your door seeking care for complications of her pregnancy. There is a lot of new information on the treatment of the pregnant woman, and the rules for treating these patients have changed.
As this practice specialty has evolved, so has the understanding of how to treat the pregnant patient. The uterus is supported by eight ligaments in the lower abdomen. Torsion of the pelvis during pregnancy will stress these ligaments, producing pain for the mother that may complicate the pregnancy. A pregnant body is different, both chemically and biomechanically, from a nonpregnant body, and common diversified techniques are not always appropriate. The spine, and especially the pelvis, must be appropriately evaluated and treated to address these subluxations, for the safety of the mother and her child.
Special accommodations and specific techniques are required when examining a pregnant woman. Obviously, a pregnant woman cannot lie face down, so make sure you have a bench with a drop-away abdominal piece or a pelvic lift. If your bench cannot make these adjustments, there are cushions available to provide the right support. Do not try to adjust a pregnant woman face down without the proper table setup.
During pregnancy, the hormone relaxin kicks in to prepare the pelvic ring for childbirth. This makes adjusting much easier, but it also makes the patient more susceptible to subluxation. Using a higher-force technique can cause more problems than relief, so less force is the standard. Also, straight line-of-correction techniques should be used - Thompson, Activator or Nimmo.
Under no circumstances should a pregnant woman be adjusted side-posture. Current research demonstrates that this type of rotational motion may abrupt the placenta. Prenatal exercise and yoga classes are now not even teaching rotational-type motions for this same reason. If you are in the habit of performing a diversified side-posture roll, it is time to learn a new technique. Remember, a pregnant body is chemically and biomechanically different from a nonpregnant body, and the usual battery of techniques is not always appropriate.
The next big concern with pregnancy is taking X-rays. We all learned in school that you do not take pictures of the lumbar region during pregnancy, to prevent radiation exposure to the fetus. Most of us also have signs in our X-ray room reminding patients to advise us if they might be pregnant. New research has now shown that any radiation to the mother can negatively affect the baby. Radiographs of the neck specifically affect the thyroid, exposing the baby to secondary radiation. (There have also been studies showing that simple dental X-rays can affect the fetus.) Therefore, if you are dealing with a pregnant patient, the need for any X-ray must be weighed against the negative effect to the baby. If you use an upper-cervical technique that relies on radiographs for evaluation, you will need to pursue a different method of evaluation during the pregnancy.
To give a case example, I have a woman under my care, 30 weeks pregnant, who was struck by a car while standing in a parking lot. After orthopedic exam, I was confident that she had a fully torn lateral collateral ligament. I put her in a support brace and referred her to the local orthopedist for further evaluation. He needs to do diagnostic studies to confirm the diagnosis, but the OB will not authorize any X-ray or MRI of the knee until after birth due to the possible complications for the baby. My patient was told she will most likely need surgery for the knee, but will have to wait for any further testing or treatment until after childbirth. Exposure to radiation was deemed so serious that the OB directly told the patient she would have to deal with her knee issues (instability and pain) for the duration of her pregnancy, as diagnostic studies are contraindicated.
Prenatal care is a very rewarding field of practice. Because of the physical changes associated with pregnancy, women typically respond very quickly to conservative care. As always, it remains the doctor's responsibility to provide appropriate care in the best interest of the patient. When dealing with a pregnant patient, your responsibility extends to the baby as much as the mother, and you must make sure to do all you can in providing the best care possible.
- Bagnell, Karen. "The Bagnell Technique for Breech Presentation." For more information, visit www.pregnancychiropractic.com.
Click here for more information about Douglas R. Briggs, DC, Dipl. Ac. (IAMA), DAAPM, EMT.