Why Choose Chiropractic during Pregnancy

By: Brianna Busch, DC

Pregnancy care is a unique healthcare market, and chiropractic can be an excellent way to bring together both the father and mother with a focus on preparing the mother’s body for pregnancy and postpartum. A plethora of changes occur to the body in such a short amount of time, often leaving "mothers-to-be" (as well as “fathers-to-be”) flustered and bogged down with multiple questions and concerns. As a Chiropractor, my intention is to prepare the family with education, and promote musculoskeletal balance in the pregnant mother, being a continual base of knowledge and support for the family throughout the pregnancy experience. 

In a recent article by Weis et al, 2015, they looked at obstetric attitudes towards chiropractic care.2 Of the 91 completed survey participants, “forty percent of respondents referred at least some patients for chiropractic care each year, and 56% were interested in learning more about chiropractic care.”2 It is my goal through this introductory letter, and our future connections, to relay some of the indications, benefits, safety and contraindications for chiropractic care for your pre-pregnancy, mid-pregnancy, and postpartum patients.

​Summary of Benefits for Chiropractic Pregnancy Care
Most from the additional sourced information at the end of this blog

• Better pelvic alignment of the mother’s pelvis creating more space for the baby to grow and move comfortably. 4
• Improved biomechanics
• Improved sleep
• Improved quality of life
• Reduced pelvic and low back pain (along with a plethora of other musculoskeletal related injuries or dysfunctions)
• Exercise and activity prescription
• Nutrition and Supplement information
• Patient education leading to improved outcomes and coping strategies.
• Education and support given to mothers throughout the pregnancy journey (in a conservative and drug free manner) includes educating the patient on WHY they are having pain or dysfunction, HOW to fix the issues, and WHAT they can do actively to prevent/manage the issues. 
• An important step in the patient referral process for those with no red flags or contraindications, ultimately reducing healthcare dollars.

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Safety and Contraindications

In the study by Stuber, Wynd et Weis, 2012, they concluded from their systematic review that “there are only a few reported cases of adverse events following spinal manipulation during pregnancy and the postpartum period identified in the literature. While improved reporting of such events is required in the future, it may be that such injuries are relatively rare.”8

There are still modifications in chiropractic treatments that should occur when treating this group of patients, some of which include:
1. Low force adjustments, as relaxin plays a factor throughout pregnancy and during postpartum.9
2. Avoiding pressure on the abdomen.9
3.  Provision of uterine support when recumbent, along with decreased hip flexion during manual therapy.9
However, this is by no means an exhaustive list.

Some contraindications to exercise during pregnancy, found in the article by Davies et al., 20037 are listed below. 

“…Contraindications to Exercise in Pregnancy
Absolute Contraindications
Ruptured membranes
Preterm labour
Hypertensive disorders of pregnancy
Incompetent cervix
Growth restricted fetus
High order multiple gestation (≥ triplets)
Placenta previa after 28th week
Persistent 2nd or 3rd trimester bleeding
Uncontrolled Type I diabetes, thyroid disease, or other serious cardiovascular, respiratory, or systemic disorder

Relative Contraindications
Previous spontaneous abortion
Previous preterm birth
Mild/moderate cardiovascular disorder
Mild/moderate respiratory disorder
Anemia (Hb <100g/L)
Malnutrition or eating disorder
Twin pregnancy after 28th week
Other significant medical conditions
Note: Reprinted and modified with permission from the Canadian Society for Exercise Physiology…”

More in Depth Information on Pregnancy Related Benefits of Chiropractic Care

Pregnancy causes a drastic change in body biomechanics, as the stomach is increasingly protruding in an anterior direction, causing an increased tendency for hyperlordosis of the lumbar spine.5 It has been reported that “…approximately 20% of pregnant women experienc[e] pelvic girdle pain, and 50% to 85% experienc[e] low back pain[,]”5 and “…up to 40% of patients report musculoskeletal pain during the 18 months after delivery…”6 The increased lordosis can have undesirable effects on the pregnant woman including lumbar and pelvic pain.5 It is increasingly important to manage the rapidly changing biomechanics of a pregnant mother as she gets further along in her pregnancy.

Chiropractic can be a conservative means of healthcare by which a woman can be followed from prior to her pregnancy, throughout the pregnancy, and postpartum. Musculoskeletal issues are effectively looked after through the use of chiropractic, without the use of medications, some of which are potentially contraindicated or risky for pregnant women. Since “[p]regnancy-related LBP contributes substantially to health care costs[,]”6 chiropractic should be an initial source of referral once more ominous conditions have been ruled out.

“A 2012 study compared standard obstetric care alone to standard obstetric care combined with chiropractic care including spinal manipulation, education, and exercise”5 based on the biopsychosocial model of care.6 “The authors found that a multimodal approach resulted in greater decreases in pain and dysfunction both subjectively and objectively in pregnant patients with low back or pelvic pain.6 Patients in the multimodal care group also reported greater improvement in their quality of life, with the greatest improvements seen in their sleep patterns.”5 The authors “…conclude[d] that a multimodal approach to musculoskeletal LBP/PP that is instituted in the late second and early third trimesters of pregnancy benefits patients above and beyond standard obstetrics provider care.”6

Chiropractic can be a useful tool in creating an inviting environment for health education. As chiropractors commonly see their patients more frequently than medical doctors or other health providers, we are an excellent source of reassurance to the mother-to-be as she experiences her ever-changing body. For example, a mother may be having sacroiliac related pain, but mistakenly think and worry that it is in relation to her uterus, placenta, or an issue with the baby.5 Being primary health practitioners, chiropractors are trained to assess for potential red flags or conditions that need referral to another health care provider, while providing their expertise in the musculoskeletal system.5

We know the body does not heal overnight, and that is why chiropractic care is so important even before a woman enters into pregnancy. Not only is a mother going to have a plethora of changes to her body in a short amount of time, once post-partum rolls around, she has to shift her body mechanics as her body changes back to its original size. Through early assessment, treatment, and education, chiropractors can understand a woman’s musculoskeletal-based deficiencies before she gets pregnant, regardless of symptoms. Both active and passive care, with proper education, can empower these patients to make necessary changes to multiple areas of their health, including but not limited to posture, exercise, nutrition, sleep, and stress. I place great focus on these types of education and active care when treating my patients. If a patient can understand what is causing dysfunction, and understand the tools required to fix it, not only do they feel empowered in their healthcare, but they are able to take that education with them throughout their lives, understanding how to make better choices in their daily living that they may not otherwise have known.

Keeping the mother involved in an active exercise plan similar to the frequency and duration of exercise she implemented before becoming pregnant is another focus of mine when treating pregnant mothers. Often these patients are nervous that exercise will hurt the baby, when in fact, if the pregnancy is not one of complicated origin, it is recommended.7 Both sedentary and non-sedentary pregnant patients alike, are encouraged to become involved in programs aimed to improve strength and aerobic capacity.7 Postpartum is also an important time to focus on pelvic floor exercises, as these have potential to “…reduce the risk of future urinary incontinence.”7

Focus on education and reassurance to the “mother-to-be” about the benefits of exercise and movement, and the power their body holds to adapt to their ever-changing environment (in this case a pregnancy) is crucial. Patient education is vital to improving outcomes and coping strategies.6 A happy healthy mom is the first step to a happy and healthy baby.

References

2. Weis CA, Stuber K, Barrett J, Greco A, Kipershlak A, Glenn T, Desjardins R, Nash J, Busse J. Attitudes toward chiropractic: a survey of Canadian obstetricians. J Evid Based Complementary Altern Med. 2015 Sep 8.

3. International Chiropractic Pediatric Association: Establishing and advancing the chiropractic family wellness lifestyle. [Internet]. ICPA 2015 [cited 2015]. Available from: http://icpa4kids.com

4. Ohm J. Great Expectations with Jeanne Ohm, D.C., F.I.C.P.A., [unpublished lecture notes]. 2015. Lecture given 2015 October 10-11.
5. Oswald C, Higgins CC, Assimakopoulos D. Optimizing pain relief during pregnancy using manual therapy. Canadian Family Physician. 2013, Aug. 59: 841-2.

6. George JW, Skaggs CD, Thompson PA, Nelson DM, Gavard JA, Gross GA. A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. American Journal of Obstetrics & Gynecology. 2013, Apr. 295.e1-7.

7. Davies GAL, Wolfe LA, Mottola MF, MacKinnon C.  Joint SOG/CSEP clinical practice guideline: exercise in pregnancy and the postpartum period. 2003. Can. J. Appl. Physiol. 28(3): 329-41.

8. Stuber KJ, Wynd S, Weis CA. Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature. Chiropractic & Manual Therapies. 2012. 20:8 doi:10.1186/2045-709X-20-8


9. Browning MC. Low back and pelvic girld pain of pregnancy: recommendations for diagnosis and clinical management. Journal of Clinical Chiropractic Pediatrics. 2010, Dec. 11(2): 775-9