Chiropractic Care in Pregnancy Reduces Risk of Difficult Birth

By: Dr. Kimberly Nelson

As baby grows, mom’s weight progressively increases and her body experiences continual postural adaptations that create a neuro-biomechanical need for chiropractic care. These changes can place a taxing demand on the spine and pelvic muscles, ligaments and joints and thus increasing the chances of misalignment in vertebrae and the sacrum.

Chiropractic care has been shown to reduce each of these three causes of difficult birth. When mom presents with rotation of the sacrum, anatomically, the rotation of the sacrum will create tension or even torsion of the uterus. The uterus has three associated ligaments:

1. Uterosacral ligaments
2. Round ligaments
3. Broad ligaments

The uterosacral ligaments attach from the cervix to the sacrum. The round ligaments attach on the sides of the uterus run between the layers of the broad ligaments and attach to the labia majora. The broad ligaments attach to the sides of the uterus to the pelvic floor and lateral walls of the pelvis.

So when there is rotation in mom’s sacrum, there is tightening and torsion of these ligaments contributing to the tension placed on the uterus. The tightness and torsion within the uterus is what affects the passenger, or baby. If the uterus doesn’t allow for a favorable environment for baby to travel head down and/or rotate properly through the vaginal canal, baby’s optimal birthing position is compromised and can lead to breech or OP presentations.

The Three P’s of Childbirth

According to William’s Obstetrics there are three reasons for difficult birth (dystocia):

1. Power
2. Passage
3. Passenger

Power means there are abnormalities of the expulsive force. The uterine forces are either insufficiently strong or they are inappropriately coordinated to efface and dilate the cervix. Or there is inadequate voluntary muscle effort during the second stage of labor.

Passage means there are abnormalities of the maternal bony pelvis. An example given by William’s Obstetrics is the decrease in pelvic diameter when the sacrum is displaced.

Passenger means there are abnormalities of presentation, positioning or development of baby.

Power

The power is affected because the parasympathetic nerves, the one responsible for rest and digest, are the nerves found in the back and sacrum. If there is a misalignment in the sacrum, it creates a “kink”, inhibiting this nervous system. The uterus contains innervations from both sympathetic (responsible for fight or flight) and parasympathetic nerves, so if the parasympathetic nerves are inhibited then the uterus is primarily receiving input from the sympathetic nerves.

With the uterus thinking it’s in a fight or flight mode, there become abnormalities of the expulsive forces. By adjusting the sacrum and stimulating the parasympathetic nerves found at the sacral level, the uterus can return to a more relaxed state that is optimal for regular uterine contraction patterns.

Passage and Passenger

The pelvis is made up of three bones: the sacral bone and a right and left iliac bone that come together to form the pubic symphysis in the front of the pelvis. When perfectly aligned, the birthing canal is a nice circle and the sacrum is able to move/open as baby makes their way down the birthing canal. But the passage is affected if any of the three pelvic bones are slightly misaligned on each other. It not only creates dysfunction within the affected joints, possible interference of the surrounding nerves, torsion within the surrounding ligaments and muscles – but also changes the bony structure of the pelvic outlet. Instead of being a perfect circle, it might become oval and/or limit the sacral range of motion not allowing it to fully move/open as baby makes its way down the birthing canal during delivery.

Chiropractic Techniques to get Mom Ready for Labor

Webster’s Technique is a chiropractic adjusting technique designed by chiropractor Larry Webster, founder of the International Chiropractic Pediatric Association (ICPA). Webster’s technique is a specific analysis and correction of the sacrum and sacroiliac joints to help balance the pelvic muscles and ligaments potentially improving the outcomes of labor. He initially used it to level pelvic imbalances for any population but started to notice the positive effects it had on pregnant patients. Webster’s technique is most popularly known for helping to correct breech positioning of baby in utero.

The ICPA started a Practice Based Research Network (PBRN) made up of a network of chiropractors participating in clinical and observational research to aid in the development of evidence-based chiropractic care for families. PBRN is defined by the ICPA as practitioners devoted principally to the care of patients and also affiliated with each other for the purpose of revealing the phenomena of clinical practice occurring in their communities. The research coming from the ICPA through PBRNs are showing the positive effects of the utilization of the Webster’s technique on pregnant women and even the benefits of chiropractic care on children.

The Use of the Patient Reported Outcomes Measurement Information System and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing the Webster Technique written by Alcantara, Nazarenko, Ohm and Alcantara was published January of this year in the Journal of Alternative and Complementary Medicine using information collected from a PBRN that was previously conducted. The results showed a high satisfaction following their chiropractic care. More specifically it showed an improvement in fatigue, pain and sleep.