June 24, 2015
Volume 17, Issue 13
Midwifery Today E-News
“Chiropractic Use in Pregnancy”
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In This Week’s Issue



Quote of the Week

To live in this world, you must be able to do three things: to love what is mortal; to hold it against your bones knowing your own life depends on it; and, when the time comes to let it go, to let it go.

Mary Oliver, American poet


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The Art of Midwifery

Chiropractors and midwives alike share a genuine respect for the process of natural birthing, encouraging the mother to follow her intuition for guidance throughout the process. Managing labor from within rather than through the use of external drugs and obstetrical procedures allows for safer and easier deliveries for both the mother and baby. When a mother is subjected to unnecessary interventions, not only is her well-being at risk, but many times her baby is also put at risk.

Jeanne Ohm, DC, excerpted from “Chiropractors and Midwives: A Look at the Webster Technique,” Sharing Midwifery Knowledge, Tricks of the Trade, Vol. IV, a Midwifery Today book
View table of contents / Order the book


ALL BIRTH PRACTITIONERS: The techniques you’ve perfected over months and years of practice are valuable lessons for others to learn. Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.


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Editor’s Corner

Teso Safe Motherhood Project in Uganda

[Editor’s note: This issue’s guest editor is Marion Toepke McLean.]

What exactly is the work I have been doing in Uganda?

Teso Safe Motherhood Project is part of a world-wide effort to reduce maternal mortality, which was initiated at a global women’s conference in Nairobi, Kenya, in 1987. At that time, it was noted that there was an enormous gap in maternal mortality between the rich and the poor, both between rich and poor countries and between the rich and the poor within each country.

Maternal mortality is hard to measure accurately, and as many organizations began to study the issue to try to reduce these deaths to save the lives of these mamas, the first thing that happened is that they discovered more deaths—deaths that were not being reported, and the statistical rates in many places actually worsened!

Luckily, the Bill and Melinda Gates Foundation, along with the University of Washington, put their substantial resources into locating data on maternal mortality that had previously not been included. (They included a Chinese language search engine, for example.) Using the sources that were of good research quality, they produced figures showing that indeed, maternal mortality has been dropping throughout the many years of the Safe Motherhood effort. Current statistics show that the number of maternal deaths is now half of what it was in 1987, even though the world’s population and number of births have increased. The UN and related agencies have reviewed and accepted the new values.

For the past six weeks, in the small city of Soroti, Teso district, I have worked with moms and babies. We have successfully nursed a couple sick babies into good health, encouraged moms, and helped make transport decisions when needed.

As I write this, Esther, a midwife at Teso, is currently preparing to register mothers for the antenatal clinic. She started here 10 years ago when the clinic began as a medical resource for the many IDP (internally displaced persons) camps which then surrounded Soroti after the incursions of the Lord’s Resistance Army (Joseph Kony) in 2003 followed by attacks by the Karamajong cattle raiders in 2004. She was a nursing assistant then; she was sent to nursing and to midwifery training by International Midwife Assistance and is now an experienced midwife. On day shift, two midwives are assigned to antenatal clinic and two to labor and delivery. Often we have several women admitted to treat malaria, for which an IV may be required. Malaria is a major cause of miscarriage, stillbirth and maternal mortality in Sub-Saharan Africa.

Antenatal care, provision of a trained attendant at delivery, treatment of infections and provision of family planning are all things that have been found to reduce maternal mortality, and so that is what we do at Teso Safe Motherhood.

— Marion Toepke McLean has been a midwife since 1971. She has mentored many midwives, and she has never missed writing for an issue of Midwifery Today since its very first issue in 1987.

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Conference Chatter

Join Debra Pascali-Bonaro and wonderful midwives and birthworkers from around the world for the International MotherBaby Childbirth Organization meeting on 20 October 2015 at Bad Wildbad, Germany, the day before our conference begins. More info here: IMBCI

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Featured Article

Utilizing Chiropractic for Optimal Pregnancy and Birth Outcomes

There have been many articles published regarding chiropractic as an effective form of holistic health care that can help optimize function and increase comfort during pregnancy, labor and the postpartum period. However, there remain misconceptions among midwives regarding when it is appropriate to utilize chiropractic in pregnancy. This article serves to further inform midwives of the appropriate use of chiropractic during pregnancy.

As a chiropractor that specializes in pregnancy and pediatric care, I am often asked when it is a good time to suggest that a woman see a chiropractor. In answering this question, I often discuss the different goals of chiropractic in pregnancy. These goals include alleviating pain and discomforts for a happier and more comfortable pregnancy, maximizing function of the pelvic joints allowing greater movement during pregnancy and opening during labor, encouraging optimal nerve function for coordinated and effective labor function and balancing pelvic bones and soft tissue structures to encourage optimal fetal positioning, thereby increasing optimal birth outcomes.

Chiropractic has been proven helpful for alleviating many pregnancy discomforts, including back pain, sciatic and symphysis pubis dysfunction (Lisi 2006; McMorland et al. 2010; Vireday 2008). When issues like these arise, many midwives have come to know that chiropractic can be helpful and so they refer accordingly. However, according to Lisi (2006), as few as 32% of women report symptoms to their prenatal provider, and only 25% of providers recommend treatment. This illustrates the importance for providers to understand the effectiveness of natural therapies, such as chiropractic, and to offer information and resources regardless of their client’s complaints. I have worked with a number of midwives both personally and professionally who provide their clients with a resource list at the beginning of care and briefly discuss the benefits associated with such resources with the goal toward increasing knowledge and understanding among women to help them achieve healthier and more comfortable pregnancies.

More importantly, chiropractic does not just alleviate unpleasant symptoms, but it also allows for increased function of the mother’s musculoskeletal and nervous systems. Spinal and pelvic misalignments and joint dysfunction—what chiropractors call subluxations—disrupt the normal position and motion of a joint, as well as increase strain and torsion of the muscles, tendons and ligaments of the pelvis and those ligaments attaching the uterus to the pelvis. Intrauterine constraint, or torsion of the uterus via these ligaments, is thought to be a major cause of fetal malposition and dystocia. This distortion can occur without the presence of pain. As a chiropractor, I have often been surprised at the level of distortion I have seen in some pregnant women who have no complaints of pain at all.

References:

  • Lisi, AJ. 2006. “Chiropractic Spinal Manipulation for Low Back Pain of Pregnancy: A Retrospective Case Series.” J Midwifery Wom Heal 51 (1): e7–10.
  • McMorland, G, et al. 2010. “Manipulation or Microdiskectomy for Sciatica? A Prospective Randomized Clinical Study.” J Manipulative Physiol Ther 33 (8): 576–84.
  • Vireday, P. 2008. “Symphysis Pubis Dysfunction.” Pathways to Family Wellness 16.

Joella Pettigrew
Excerpted from “Utilizing Chiropractic for Optimal Pregnancy and Birth Outcomes,” Midwifery Today, Issue 110
View table of contents / Order the back issue


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Read this editorial by Jan Tritten from the newest issue of Midwifery Today, Summer 2015:

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    Excerpt: Homebirth is safer for most mothers in many ways. For one, there are fewer interventions. The first intervention is stepping outside the door of your home and heading to the hospital.


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Birth Q&A

Q: Do you recommend chiropractic care in pregnancy? Why or Why not?

— Midwifery Today

A: Yes. I have never seen a chiropractor’s wife have a long labor.

— Elizabeth Wyson Smith

A: Even for a woman on a tight budget, just one appointment, close to birthing, can really help. It can help to make sure that everything is in a good position to move during the birth and to give the woman confidence about this, too. I found it very helpful before my recent birth and was glad as baby was breech and I was so happy to know that my pelvis wasn’t going to impede her descent in any way.

— Melanie Crocker-Hulse

A: Definitely! DCs can do wonders to the pelvis to facilitate labor. They are pretty good with other bothersome body parts, too! I’ve had overdue moms go into labor on the way home from a DC adjustment. I’ve had chiropractors come to a labor and turn a breech to head down halfway through labor! As people have said, chiropractors or their spouses typically have 3–5 hour labors! And they are never malpositioned! But even more important is taking every c-sectioned baby to the DC ASAP. They tend to get misaligned as they get pulled out.

— Marlene Waechter

A: I have attended births in which the mama was stalled for a long, long time at 10 cm, and then I adjusted her spine, she felt greatly relieved, and baby came soon … afterwards. She felt the shift immediately.

— Karen Ferreira

A: Chiropractic care can sometimes mean the difference between having a home or hospital birth. It can help facilitate labor, move breech, correct posterior and relieve sciatic pain, headaches, colds, flu, etc. I am a midwife who was trained by a homebirth chiropractor and I learned a lot about the benefits/importance of chiropractic care. It is best if the chiropractor is Webster-certified.

— Carol Gautschi

A: I definitely recommend it. It isn’t just about getting baby well-aligned in the pelvis; it also helps with an easier, faster labor.

— Anita Woods


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