Chiropractic Care and Pregnancy: Helping a Woman's Body to Adjust!
Bartholomew Family Chiropractic 2415 N. Triphammer Rd. Ithaca, Ny
Saying that a woman's body changes during pregnancy is somewhat like saying that the Tour de France is a bike ride.  The demands on a pregnant woman's body require that she be able to constantly adapt to changes in her internal and external environments, both physical and physiological.  A healthy nervous system is integral to this process, since it governs and controls these adaptive processes.  Regular chiropractic care can help to make a pregnancy as comfortable as possible and also promotes an environment where the body can adapt to the unavoidable stresses of the pregnancy experience.

About 60% of women experience back pain during pregnancy.  Women are turning to chiropractic care in increasing numbers (click here, here, and here for articles), due in part to research that indicates that chiropractic adjustment may ease low back pain associated with pregnancy.  In 2006, Dr. Anthony Lisi published a retrospective case series of seventeen pregnant patient with low back pain, sixteen of whom experienced clinically important improvement in their symptoms after chiropractic care (click here for the abstract).  Similarly, Stuber and Smith published a literature review in 2008 that showed positive results for resolution of low back pain in pregnant women  using chiropractic care (click here for the abstract).  A more comprehensive narrative review was published in 2007 by Cara Borggren (click here for the PDF).  

While relief of low back pain during pregnancy is a great benefit of chiropractic care, a more important one may be reduction of intrauterine constraint via chiropractic adjustment.  Intrauterine constraint is defined as any force outside of the developing baby that obstructs its normal movement.  Intrauterine constraint is correlated with such conditions as craniostenosis, congential hip deformity, and breech presentation (click here and here).  The Webster Technique, a specific chiropractic technique developed in 1978 by Dr. Larry Webster, can be used to relieve musculoskeletal conditions that can result in intrauterine constraint.  A survey of 112 chiropractors using the Webster technique indicated a high rate of success in relieving the musculoskeletal causes of intrauterine constraint.  Of these 112 surveys, 102 (92%) resulted in resolution of the breech presentation, while 10 (9%) remained unresolved (click here to download the PDF).  Several individual case studies have also demonstrated positive outcomes by ultrasound analysis (click here and here for abstracts)   

In the US, more than 80% of infants with breech presentation are delivered by C-section.  Chiropractic adjustment may help women by empowering their bodies to reposition the baby into a vertex position, allowing for a vaginal birth and thereby avoiding major abdominal surgery and the resultant recovery.  If your baby is breech, or if you know someone in this situation, please consider a chiropractic check of the spine and pelvis for indicators of intrauterine constraint. A simple, gentle, specific chiropractic adjustment might make the difference between a natural birth experience and major surgery.  

Lastly, a study by Dr. Joan Fallon entitled "The Effect of Chiropractic Treatment on Pregnancy and Labor:  A Comprehensive Study (Proceedings of the World Federation of Chiropractic, 1991: 24-31) showed a 24% reduction in labor time for first-time moms under chiropractic care, and a 39% reduction in labor time for women under chiropractic care who had given birth previously.  This promising study confirms what chiropractors, midwives, and doulas have seen for years - that chiropractic care can ease labor and reduce its duration. 

The evidence clearly suggests that chiropractic care can help to make pregnancy more comfortable.  If you'd like to experience this yourself, get started by coming in to Bartholomew Family Chiropractic to get your spine assessed today!

Anti-D injections are offered to all pregnant woman who have a rhesus-negative (RhD-negative) blood group to prevent the possibility of the blood disorder RhD haemolytic disease of the newborn.

Understanding the medical terms and the details of this disorder and it´s prevention can seem rather complicated. But, as with any medical recommendation made during pregnancy, having plenty of information allows you a greater degree of clarity and confidence in your health choices and the decisions that you make. Below I look at some of the most frequently asked questions relating to this topic.

What are rhesus negative and rhesus positive blood types and how are they important to my pregnancy?

There are two main systems used for categorising human blood: the ABO and the Rhesus (Rh) system. Individuals who are Rhesus (Rh) positive have a particular protein (RhD antigen) attached to their red blood cells whereas individuals who are Rhesus negative do not. There is a higher probability that you are RhD positive -approximately 85% of Caucasians are RhD positive and only 15% are RhD negative (lower still in other ethnic groups). Whether or not you are Rh positive or negative depends on the 2 rhesus genes you inherited from your parents (we receive 1 gene from each parent that may be either positive or negative). If you are RhD negative and pregnant, there is a chance that your baby could be RhD positive. In a first pregnancy, 60% of Rhesus negative mothers will have an RhD positive child. When this occurs there is the possibility for complications.

What can happen if I have a different rhesus blood group to my baby?

Having a different rhesus blood group to your baby is only a potential problem if you are RhD negative and your baby is RhD positive. This is because your baby´s red blood cells have the RhD antigen attached to them whereas yours do not. If small amounts of your baby´s blood mixes with yours during pregnancy, your immune system may perceive this difference in blood types as a threat, producing antibodies that will ´fight´ against your baby´s blood. This process is called sensitisation or alloimmunisation, and once your body has made these antibodies they cannot be removed. It is important to note that this process is unlikely to affect your current baby, but instead becomes a problem if you have subsequent babies that are RhD positive. This is because the process of producing antibodies takes time. The initial antibodies you produce in your first pregnancy (IgM) cannot cross the placenta but the subsequent antibodies produced in later pregnancies (IgG) can.

If I am RhD negative with an RhD positive baby, how likely am I to produce antibodies against my baby´s blood?

The most likely times you would produce antibodies is when an exchange of blood between you and your baby is most likely: at delivery, after abortion or after an invasive procedure. In a 2006 review of RhD testing, the authors state that without preventative treatment,

5-15% of RhD negative pregnant women will develop antibodies at delivery; 3-6% after spontaneous abortion; and 2-5% during amniocentesis. If no ´high risk´ situations occur prior to delivery , without treatment 1-2% of RhD negative pregnant women will produce antibodies before birth due to haemorrhages of their baby´s blood (SAFE WP6, University of Warwick 2006).

What is Rh D haemolytic disease of the newborn?

If your body has produced antibodies to fight the antigens on your baby´s red blood cells a blood disorder called RhD haemolytic disease of the newborn (sometimes called Rhesus disease or Rh disease) can result. It is important to realise that if you have produced antibodies, this will not necessarily lead to haemolytic disease of the newborn. If it does, it can be life-threatening, manifesting as anaemia, jaundice, heart or liver problems, or mental retardation. Before any preventative treatment had been developed haemolytic disease of the newborn affected 1% of babies in second pregnancies born to RhD negative women in England and Wales (SAFE WP6, University of Warwick 2006)

What are Anti-D injections and when are they recommended?

Anti-D injections are given to pregnant women who are RhD negative as a means of preventing antibodies from forming. The injections are derived from donor human blood and are tested for hepatitis C and B, parovirus B19 and HIV. The active substance in these injections is human anti-D immunoglobulin and other ingredients can include human albumin, glycine and sodium chloride. Fortunately since 2001 anti-D injections no longer contain thiomersal which is mercury derived. In 2008 the National Institute for Health and Clinical Excellence (NICE) published guidelines recommending that that one dose of anti-D be administered between weeks 28 and 30 of gestation.

Are the anti-D injections safe?

Anti-D injections have been used for approximately 40 years and have been considered to be safe. However because anti-D injections are derived from human plasma there continues to be a risk that viruses can be transmitted to pregnant women receiving them. This occured in the 1970´s in Ireland and could potentially occur again with diseases for which there are no tests available. In regards to the other ingredients in anti-D injections, drug manufacturer Pfizer states that sodium chloride safety in pregnancy has not been established. UK Government -based web information include the following side effects of anti-D injections of unknown frequency: allergic or anaphylactic, urticaria, tightness of the chest, wheezing, breathing difficulties or shock, chills, faster heart rate, fever, general feeling of being unwell, headaches, injection site problems such as pain or tenderness, lowered blood pressure, may affect the results for certain tests, nausea, skin problems, vomiting.

Will I need the anti-D injection?

Rh D haemolytic disease of the newborn is only relevant to RhD negative pregnant women because of the chance that they may have an RhD positive baby. If you are RhD negative and are certain of paternity, then a paternal blood test can be conducted. If both you and your partner are RhD negative then it is not possible for your baby to be RhD positive and you will not need to have anti-D injections. There is also non-routine testing that has developed called non-invasive prenatal diagnosis (NIPD) where your baby´s RhD status is assessed. The accuracy of this testing has been reported as between 94.8% -100%.

References and sources:

Szcepura A, Oispenko L, Freeman K. A new fetal RHD genotyping test: Costs and benefits of mass testing to target antenatal anti-D prophylaxis in England and Wales. BMC Pregnancy and Childbirth 2011; 11(5): 1-8.

A Curious Case of Anti-D Antibody Titer. Hensley JG, CNM, Coughlin KP, Klein LL. J Midwifery Womens Health 2009;54:497-502.

Determination of RhD Zygosity: Comparison of a Double Amplification Refractory Mutation System Approach and a Multiplex Real-Time Quantative PCR Approach. Chiu RW, Murphy MF, Fidler C, Zee BC, Wainscoat JS, Dennis YM. Clin Chem 2001;47(4):667-72.

A Case of Pregnancy with Rhesus Antibody and Bicornate Uterus- A Favourable Outcome: A Case Report. Acharya S, Ahmed S. Cases J 2010;3(3):50.

A Review of Evidence on Non-invasive Prenatal Diagnosis (NIPD): Tests for Fetal RHD Genotype.

Initial Report on NIPD Evidence Base: Prepared by Socio-Economic Group, University of Warwick for Work package 6, SAFE Network of Excellence. SAFE WP6, University of Warwick 2006.

Australian Red Cross http://manualtransfusioncomau.ozstaging.com/Pregnancy-and-anti-D/Frequently-asked-questions/Anti-D-product-FAQs.aspx

NHS Anti-D Information: NHS Side Effects Anti-D Injections

Pfizer sodium chloride: http://www.medsafe.govt.nz/profs/datasheet/s/SodiumChlorideinjPfizer.pdf

In the April 11, 2011, issue of the scientific periodical, the Journal of Pediatric, Maternal & Family Health, is a documented case study showing chiropractic helping a pregnant woman with a breech presentation pregnancy.  A breech presentation is when the fetus is not in the proper head-down position as the delivery date is approaching.

According to the study, a  breech presentation is created by "intrauterine constraint" which the authors describe as, "as any force external to the developing fetus that obstructs the normal movement of the fetus."

The study reports that, in the United
States, 86 percent of infants with breech presentation are delivered by cesarean which increases risks to the mother and the baby.

In this case, a 25-year-old woman went to a chiropractic office 31 weeks into her pregnancy. She was referred to the chiropractor by her obstetrician who had recently performed an ultrasound which confirmed the breech position. She was hoping to avoid a c-section birth.

A chiropractic examination was performed using the procedures of the "Webster Technique". The Webster Technique is a specialized analysis and procedure developed by the late Dr. Larry Webster who was affectionately known as the "grandfather of chiropractic pediatrics". A determination was made that this woman fit the protocol, and so the chiropractor applied the Webster Technique.

Within four hours of the first Webster Technique adjustment, the woman reported feeling "a lot of movement". The woman commented that she felt the fetus had shifted from a breech position to the transverse position. After her second chiropractic visit, the woman had a prenatal visit at which the obstetrician confirmed that the fetus had turned to the proper vertex position. The study noted that the woman continued to receive chiropractic adjustments for resolution of low back pain until delivery. She eventually had an uncomplicated vaginal delivery.