Saturday, 8 December 2018

How to Find a Chiropractor in Pregnancy: Part Two


We have been discussing chiropractic care in pregnancy and how it can be helpful towards a more comfortable pregnancy and possibly a more efficient labor and birth.

Many people are interested in seeing a chiropractor, but some know nothing about how to find a good chiropractor for pregnancy.

Basically, all chiropractors receive some training in treating pregnant women, so you could see most chiropractors and get at least some help. However, some chiropractors are more highly trained in pregnancy than others and you are probably better off with those.

Your best bet is to find a chiropractor who is trained in the Webster Technique, which is a specific protocol that looks at the alignment of the sacrum and pelvis and the balancing of soft tissues (muscles, ligaments) around it:
The Webster technique is a specific chiropractic analysis and diversified adjustment. The goal of the adjustment is to reduce the effects of subluxation and/or SI [sacroiliac] joint dysfunction. In so doing neurobiomechanical function in the sacral/pelvic region is improved.
The Webster Technique is not just for pregnant people, but can be applied to any weight-bearing person. However, its focus on relieving restrictions in the pelvis and restoring balance to the soft tissues in the area may be particularly very useful for pregnancy.

Chiropractors who have extra training in working with pregnant people can be found in several ways. There are several chiropractic professional organizations, and they can be a good place to start your search. These organizations are similar in many ways, but may have differences of opinion on certain philosophies or treatments, etc.

International Chiropractic Pediatric Association

The International Chiropractic Pediatric Association (ICPA) has a list of chiropractors who specialize in working with kids and pregnant mothers, or who have completed a training course in Webster's Technique, which addresses the specific needs of the pregnant body.

You can find a pediatric chiropractor with the ICPA at http://icpa4kids.org/Find-a-Chiropractor/.

However, this is not a complete list of all the chiropractors who are certified in the Webster Technique. The chiropractors on this list are ones who have asked to be put on this referral list. There may well be other chiropractors in your area who have been trained in the Webster Technique but did not sign up for this list. You can call the ICPA and ask if there are others in your area trained in the Webster Technique.

According to the ICPA website, the ICPA has created a tiered level of training. The first level is "Webster-Certified," which means extra class time beyond the chiropractic degree specializing in the Webster Technique for pregnancy. It is often the starting point for even more advanced training.

The next level is Pediatric Certification, but there are several levels of this. Some program participants have the initials F.I.C.P.A after their names, and undergo 120 hours of continuing education. Other participants undergo an expanded program of 200 hours and have the initials, C.A.C.C.P., after their names. The highest level of training is the Pediatric Diplomate, which requires 400 hours of continuing education, and these chiropractors have the initials D.A.C.C.P. after their names.


International Chiropractic Association

The International Chiropractic Association (ICA) has a Council on Pediatric Chiropractics. Their focus is on treating children, but their definition of "pediatrics" includes in-utero babies so they treat pregnant women as well. Many of these ICA members have gone on to become Board Certified in chiropractic pediatrics in a 3-year post-graduate course of over 360 hours. These chiropractors have "D.I.C.C.P." after their names as well as "D.C." Look here for lists of those with a DICCP diploma.

The ICA also has a list of members who are trained chiropractors who are interested in and specialize in children, but who may or may not have the further training that a "DICCP" diplomate has. Some of the chiropractors on this list are in the process of working on the DICCP diplomate program but have not finished it yet. Regardless, they may be excellent possibilities as well.

In addition, the ICA can be reached at 1 (800) 423-4690 to ask for referrals in person. Ask for a pediatric chiropractor who knows the Webster Technique. 

Other Possible Sources

Not everyone who is certified in Webster's Technique is going to be on the ICA or ICPA lists, but they are good first places to start looking. If you can't find anyone in your area from these lists, it doesn't mean there is no one to help you. Keep looking; many women who initially think there is no one in their area who can help them do eventually find help. It just may not be from the above sources.

One of the best ways to find a Webster-certified chiropractor is to try calling your local homebirth midwives, childbirth educators, and doulas and asking for a recommendation. Often they are familiar with the healthcare professionals in the area that offer pregnancy-related services and can recommend the best ones to you, saving you a lot of time and trouble.

If you cannot find a chiropractor trained in the Webster Technique in your area, you could consider a chiropractor who has extensive experience with pregnant women. Even basic chiropractic care may help enough to make a difference in your comfort level. But if you have a choice, someone trained in the Webster technique is probably preferable. 

People in countries that don't have chiropractors may want to try an osteopath. Osteopaths also do body manipulation to help align the body and relieve restrictions, although not quite in the same way as chiropractors. However, not all osteopaths do manipulations anymore. You might need to find one who has had classical osteopath training.

In some areas, chiropractors can be hard to find. If all else fails, try cold-calling all the chiros and/or osteopaths in your area. Ask them:
  • If they have experience and training in treating pregnant women (and what that training might be)
  • How much of their practice is devoted to pregnant women and babies
  • What kind of special equipment they have for accommodating the growing belly of pregnant women
  • If they have been trained in either Webster Technique, the pelvic "diaphragmatic release," or any other technique which might be especially helpful to a pregnant person
  • If they have not been trained in any of these techniques and/or are not experienced with pregnant women, do they know of any chiropractors in the area who are?
Talk to them on the phone if you can and get an idea of how experienced they are and whether they "click" with you. If they sound good, consider trying them for one visit to see how things go. Some chiropractors will do a free consultation so you can visit their practice and check them out. Others might let you observe someone else's treatment (with the patient's permission) so you can see the techniques in action. Ask how many pregnant women the doctor usually sees. Ask for referrals from other patients. Call the midwives in your area and see if they have any experience with that chiropractor.

Remember, all chiropractors are not alike. Some use pretzel adjustments by twisting and turning the patient's body. Some use a drop table to give a little bit of extra force to the adjustment without having to push on the patient as hard. Some use an activator, a spring-loaded small tool that exerts less force for those who dislike traditional adjustments. Some do hands-on work so subtle it's hard to know they are doing anything. There are many, many techniques and styles out there.

Keep your "quackometer" on alert and don't be afraid to try a different chiropractor if one doesn't seem right to you, if the treatment seems unreasonable or ineffective to you, or if they seem too profit-driven. If one chiropractor doesn't work well for you, it doesn't mean that none will. Sometimes it's just a matter of finding the one that fits you and your needs.

If in the end you decide that chiropractic care is not for you, that is a perfectly legitimate choice as well. Many women go through pregnancy without chiropractic care and do just fine. But if you have lots of back pain, pelvic pain, or a history of falls and/or accidents, it may be worth searching a little harder to find the right chiropractor for your needs. 

My Chiropractic Search Story


Although I didn't really experience much significant back problems before pregnancy, once I was pregnant I began to have tremendous back pain, sciatica, and pubic symphysis pain, probably from a series of minor car accidents years before. My care providers shrugged my pain off as a normal part of pregnancy, but by the end of my second pregnancy I could hardly walk at times. This certainly didn't seem normal to me, so I decided to consider a chiropractor.

My search for a chiropractor was long and involved. At the time, there were no lists from the ICA or the ICPA to check, and the local chiros I consulted did not even know about the Webster Technique. I saw several different chiros or osteopaths (D.O.s) over the years, looking for some help. It took a long time to find the right one. 

The first chiro I tried was a sports specialist available through the local family doctor's office. Unfortunately, he was majorly fat-phobic and obviously disgusted by my body. He never physically evaluated my back or pelvis, and he never touched me. He told me that my back pain was because I wasn't getting enough exercise, and gave me some special exercises to do for the muscles in the area. I tried them; they didn't help. I gave up the idea of chiro care for several years.

In my third pregnancy, I stepped up the effort to find some help. None of the doctors or midwives I saw knew of anyone who knew the Webster Technique. I saw an osteopath who had never heard of the Webster Technique, told me my back and pelvis were fine despite all my pain, and was basically no help.

My prenatal yoga teacher in that pregnancy eventually mentioned a chiropractor who used a less forceful "Network" technique for adjustments and who specialized in sacrum pain. I decided that this was better than nothing and saw this chiro. These treatments did not really help much but he happened to know of a young chiropractor in the area who was in the process of getting her DICCP diplomate from the ICA, so he referred me to her.

Amazingly, this chiro had just learned the Webster Technique at a recent class session and was able to help me out. She was shocked at how badly my back and pelvis were out of alignment. My back and pubic symphysis pain improved greatly within an hour or two after treatment. Although we weren't trying to turn the baby with the adjustment, the baby turned from posterior to anterior within an hour after the adjustment, the first time any of my babies had been anterior in three pregnancies. I went on to have a few more appointments in that pregnancy to keep things aligned and fine tune everything. Two weeks later, my baby was born by VBAC, Vaginal Birth After Cesarean.

My third labor and birth was SO much easier than my first two. In my first pregnancy, I had pushed for 2 hours with a malpositioned baby, then had a cesarean. In my second pregnancy, I had pushed for 5 hours with a posterior baby, then had a cesarean. In this pregnancy, I pushed for 12 minutes and the baby was born. He was born so quickly the doctor didn't even make it to the birth; the nurse had to catch the baby. I attribute the relative ease of this birth to the chiropractic care and the fact that the baby had turned to anterior, unlike my previous babies. 

In my fourth pregnancy, I tried an ICPA-trained chiro who was located much closer to home because I was tired of the long drive to my usual chiropractor. The new chiro was perfectly nice and very competent, but she didn't "get" my body and was not able to give much relief. So even though this chiropractor knew the Webster Technique, was very well-trained and knowledgeable, and was certified through the ICPA, she wasn't the right chiropractor for me. 

At one point, I also tried a different osteopath, one with more "classical" manipulation training, and did not find those results as effective either. I eventually went back to a chiropractor trained by my original chiropractor, realizing that a long drive was well worth the trouble to get better results. He focused not only on my back/sacrum, but especially on my pubic symphysis and supporting ligaments because of my pain there, and we found that I tended to respond to that protocol best.

I gave birth to my ten-pound baby (a pound bigger than my cesarean babies) with just 24 minutes of pushing. I'm sure it was not all due to just chiropractic care, but I do believe that a lot of it was. I was glad I had persevered in my chiropractic search.

Summary

Finding a good chiropractor for pregnancy is not always easy. Just as not every OB or midwife is equally effective for everyone, it's important to find a chiropractor that "gets" your body, uses techniques that you find helpful, and is always respectful and responsive to your concerns.

Don't just stop at the first chiro you find, try it once, and then conclude that chiropractic care is not for you. Try out several different styles if you can. If you can't do that, get the advice of local midwives and doulas because they often know the very best people in the area to recommend. Their guidance can save you a lot of time and effort. Remember, just as with an OB or midwife, it's all about finding a provider who is compatible with you.

My own story shows the importance of searching for the practitioner who is right for you. The first chiros and osteopaths I tried were not able to help me. Had the ICA or ICPA lists been available then, my original pregnancy chiro would not have been listed because she was still in the process of training. An ICPA-trained chiro that I tried later looked great on paper but was not effective for me. The chiros I saw saw for the fourth pregnancy were not listed because neither of them is a DICCP diplomate ─ but they were trained by a DICCP diplomate and so were familiar with the techniques needed. The chiropractor that was the closest and most convenient to me did not turn out to be the best chiropractor for my body. It took quite a bit of "shopping around" to find a chiro that worked well for my needs, but in the end it was well worth the work.

There are no easy or quick answers to searching for a good chiropractor for pregnancy. If at first you don't find a Webster Technique chiropractor, keep trying. If the chiro you try at first doesn't seem able to help you or you don't get good results with them, be willing to try others. Good and bad chiros are all over; lists can be a good place to start your search but ultimately they don't tell you much about the quality of the chiropractors themselves.

Nothing substitutes for actually trying something and keeping the search up till you find one that really clicks with your needs.


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Wednesday, 5 December 2018

On Fatlicious Gift Giving 2018

Another year is ending; another holiday season is upon us! Every year, I try and keep track of all the cool fatlicious things that I see online so I can share and promote them with you at the end of the year. Sometimes, like with the Fatties Against Facism T-Shirt, the availability closes before I get around to putting out this Guide, but I can assure you that most of my favourite fat things of the year on still around for you to get your fat fingers on. This list doesn’t have any affiliate links; I do not get any kind of money or compensation from the items or companies on the list – it’s just fatlicious stuff you may want for yourself or someone you love. I also don’t promote stuff I cannot wear/use/etc for myself, so all of the clothes options will go up to at least 5x.

 

For the activist

“Fat is Enough” zine and pin pack from the Femme Folio

 

Thick Thigh Squad button from Archive Six

 

Fat Phobia Sticker from Siobhan Williams Art

 

Fatties Against Facism Flag from Fat Lib Ink

 

Loving Your Body Tote from Dietland

 

 

For those who love a little JOMO

Fat and Pretty TShirt from Miss Crime Scene

 

Fluff Goddess Sweatshirt from Fluff Goddess

 

Basics from Fat Girl Flow

 

Gorda, Nalgona, y Chingona T-Shirt from Nalgona Positive

 

 

For the stocking

Frosty Peach Glasses from Chubby Cartwheels

Babely Body Positive Pin from Taynee Tinsley

Adipose Issue: A Zine About Being Fat from Sparklebutch

SexFation Iemanjà Enamel Pin from Sexy Fation

Rainbow Sprinkle Ice Cream Sandwich Necklace from Plus Bklyn

Fattie Enamel Pin from Fat Mermaids

Polka Dot Pig Brooch from Fancy Lady Industries

 

For the coffee table

The Little Book of Big Babes from Rachelle Abellar

Still Breaking Normal by TaLynn Kel

 

For the home office

‘Glorify’ Fat Positive Card from Embroidery Is Vital

Adipositivity Project 2019 Calendar from Substantia Jones

Downward Dog Watercolour from Fat Feisty Femme

Tangelo from Dimmie

 

For the reader

Puddin’ by Julie Murphy

The Cooking Gene by Michael Twitty

Landwhale by Jess Baker

The Body is not An Apology by Sonya Renee Taylor

 

For the fatshionista

Willa Maxi Dress from SWAK

Long Tutu in Blush from Society+

Ombre Star Print Georgette Sash Tie Dress from eShakti

Pumpkin Marissa Pant from Premme

 

For your feet

Heavenly Soles High Leg Boots from SimplyBe

Sling Back Block Heel Shoe from Ashley Stewart

Marcelle Caged Heel Ankle Boot from Avenue

 

Previous fatlicious gift giving guides

Fatlicious Guide 2017

Fatlicious Guide 2016

Fatlicious Guide 2015

Fatlicious Guide 2014

Fatlicious Guide 2013

Fatlicious Guide 2012

Fatlicious Guide 2011

 

 



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Monday, 3 December 2018

What Is Internalized Fatphobia?

internalized fatphobiaIn my piece about weight stigma and airlines I mentioned internalized fatphobia. On Instagram, @samolotus asked “could you expound upon what internalized fatphobia is?” Yes. Yes I can.

Internalized fatphobia is a form of internalized oppression, which is basically when oppressed people buy into the message of their oppressors. In terms of fatphobia, it happens when fat people don’t believe that they deserve the same things or same treatment that thin people get.

Internalized fatphobia can sound something like “If I take up more than one seat on a plane then of course I should pay for two seats!” Often this is a (conscious or subconscious) way to gain a modicum of approval from oppressors – the hope being that they think “well, she may be fat, but at least she has the decency to be self-loathing,” and that this attitude will lead them to better treatment to these fatties who are willing to fight for their right to be second class citizens.

We live in a culture that rolls out fatshaming messages to us from infancy, so the fact that fat people suffer from internalized fatphobia isn’t exactly a galloping shock. It’s not our fault, it’s about discovering the ways in which we have internalized the stigmatizing and oppressive messages we’ve heard, and then rethinking them, and then deciding what to do about what we actually deserve. (For example, realizing that what is considered “a seat” by the airline is arbitrary, that we deserve to be transported from point a to point b for the same prices as the thin person beside us, and then maybe getting involved in some activism around that.)

I want to be clear that there are people who would argue that it isn’t internalized fatphobia, that they simply believe that, as fat people, they should be treated as second class citizens. Often their justification are that being fat is their fault, and/or that they could be thin if they wanted to, and/or that fat people existing is an inconvenience to thin people (and, for some reason, they believe that thin people’s feelings and desires should be centered and accommodated but it definitely isn’t because they’ve bought into a fatphobic society, because that would mean that they are dealing with internalized fatphobia…)

Regardless, I have no need to argue with fat people who think like this, they are allowed to believe whatever they want. What’s important to remember is that, first of all, their belief that they deserve to be oppressed is NOT a justification for oppressing other fat people. I’m happy for these people to have the option to pay twice as much for the same plane ride, but by no means does that mean that any other fat person should be required to. Moreover, if they are trying to visit their ideas on other fat people (ie: insisting that we don’t deserve space on a plane, or healthcare facilities that accommodate us, etc.) then we’re no longer talking about internalized fatphobia. At that point its just the same old, regular, garden variety, fatphobia that is harming others and should be fought.

As long as we live in a fatphobic society, there will be people who deal with internalized fatphobia, and some of those people will argue vehemently for their continued poor treatment. But you don’t have to be in that group, you can insist that you deserve to be treated with equality and respect. Because you do.

Did you appreciate this post? If you like the work I do, you can support my ability to do more of it with a one-time contribution or by becoming a member.

Like this blog?  Here’s more cool stuff:

Wellness for All Bodies ProgramA simple, step-by-step, super efficient guide to setting and reaching your health goals from a weight-neutral perspective.  This program can be used by individuals, or by groups, including as a workplace wellness program!
Price: $25.00 ($10 for DancesWithFat members – register on the member page)

Non-Members click here for all the details and to register!

Book and Dance Class Sale!  I’m on a journey to complete an IRONMAN triathlon, and I’m having a sale on all my books, DVDs, and digital downloads to help pay for it. You get books and dance classes, I get spandex clothes and bike parts. Everybody wins! If you want, you can check it out here!

Book Me!  I’d love to speak to your organization. You can get more information here or just e-mail me at ragen at danceswithfat dot org!

I’m (still!) training for an IRONMAN! You can follow my journey at www.IronFat.com or on Instagram.

Published by danceswithfat

Hi, I’m Ragen Chastain. Speaker, Writer, Dancer, Choreographer, Marathoner, Soon to be IRONMAN, Activist, Fat Person.



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Friday, 30 November 2018

Worst Holiday Diet Tips Ever

Guilt Free EatingThe “holiday season” means being bombarded with ridiculous diet advice (“The Holidays are Coming” being one third of the Dieting Axis of Evil along with “New Years Resolutions” and “Bikini Season is Coming”.)  Since you’re likely to have to deal with this whether you celebrate the holidays or not, in another DancesWithFat annual tradition I’ve compiled a list of so-called holiday diet tips from actual serious online articles, with thoughts on why we might be better off skipping each of them:

10 Diet Tips You’ve Never Heard Before!

You’ve totally heard these tips before. They didn’t work then, they don’t work now, they will never work.

Start Our Program Now and Get a Head Start on Your New Years Resolution

If you start earlier, you can fail at weight loss sooner while giving the diet industry (who are fully aware of the massive failure rate of their product) a boost on their fourth quarter earnings.  Or, you know, not.

Eat a Big Bowl of Fiber Cereal and Drink Lots of Water Before A Party to Avoid Snacking.

Spend the party in the bathroom with your friends awkwardly knocking and asking if you’re ok while you miss out on delicious snacks.

Buy Your Party Outfit a Month Early and a Size Too Small for Inspiration to Lose that Last 10 Pounds

Frantically search through your closet on party day for something, anything, that fits and is party appropriate, end up going to the party uncomfortable in an outfit that’s too small.

Save Your Calories For the Party by Eating Very Little During the Day

Show up at the party absolutely ravenous, bribe a cater waiter to get your hands on an entire tray of shrimp puffs, scarf them in the bathroom.

Make low-calorie egg nog with skim milk, egg substitutes, and artificial sweeteners.

Oh…I just…I can’t even…Just…  Ok, by the underpants rule you can totally make this beverage if you want and I will support you in drinking it – whether it just sounds good to you or it works or food allergies/sensitivities, whatever – as long as you support me in not drinking it.  Ever.

Only Eat Desserts that Are Truly a Sensual Experience for You

This author has a different relationship with food than I do…  I’m looking for desserts that taste good, not desserts that turn me on. I would change this to “only eat desserts that you want to, and that aren’t expired or poisonous.”

Don’t Taste The Food While You Cook – Those Calories Add Up

Serve your guests delicious-looking appetizers that taste like a salt lick, or like nothing at all, who knows?  If only there was a way to tell how the food tastes before we give it to other people…  The person who wrote this article obviously never watched Hell’s Kitchen or Chopped.

Choose Foods that Won’t Make You Feel Guilty the Next Day

Here’s the super secret trick to guilt-free eating:  Eat. Don’t feel guilty about it. Done.

Bring Fruits and Veggies to Parties and Work and Remind People About Their Weight Goals, They’ll Thank You!

They will not thank you.  They may, in fact, throat punch you. There’s nothing wrong with bringing fruits and veggies to the party, there may well be something wrong with being what Southerners call a “superior sumbitch,” and you may be able to avoid that by skipping the second part of this advice.  Instead consider “Bring fruits and veggies to parties and work and then shut up about it – find something more interesting to talk about than weight goals.”

Enjoy Fat Free Mock Versions of Your Favorite Holiday Foods, You’ll Never Miss the Full Fat Variety

I doubt that very much, and I do not think that the words “mock” and “food” should be put together, but of course that’s just me.

Divide Foods into Naughty and Nice

Use the holidays to ease yourself into a disordered relationship with food.

Don’t Read Articles About Holiday Diet Tips

You caught me, this one didn’t come from an article, it’s my advice – take it or leave it.

Did you appreciate this post? If you like the work I do, you can support my ability to do more of it with a one-time contribution or by becoming a member.

Portland Area Readers: I’m coming to Portland, OR! Join me for talks, dance, and yoga!

Like this blog?  Here’s more cool stuff:

Wellness for All Bodies ProgramA simple, step-by-step, super efficient guide to setting and reaching your health goals from a weight-neutral perspective.  This program can be used by individuals, or by groups, including as a workplace wellness program!
Price: $25.00 ($10 for DancesWithFat members – register on the member page)

Non-Members click here for all the details and to register!

Book and Dance Class Sale!  I’m on a journey to complete an IRONMAN triathlon, and I’m having a sale on all my books, DVDs, and digital downloads to help pay for it. You get books and dance classes, I get spandex clothes and bike parts. Everybody wins! If you want, you can check it out here!

Book Me!  I’d love to speak to your organization. You can get more information here or just e-mail me at !

I’m (still!) training for an IRONMAN! You can follow my journey at www.IronFat.com or on Instagram.



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Wednesday, 28 November 2018

Chiropractic Care in Pregnancy: Part One


Many people experience back and pelvic pain in pregnancy.

For some this is just a passing phenomenon, a little discomfort that goes along with the hormones of pregnancy relaxing the pelvis and helping it expand for the birth. Some mild back and joint discomfort is common in pregnancy and does not have to be a problem.

For others, however, back and joint pain becomes a significant and long-lasting problem that can become debilitating. Some find it difficult to turn over in bed, to get dressed in the morning, to walk any distance, or even to sit comfortably for long. Some are in constant pain from it; a few even end up using a walker or in a wheelchair, unable to walk without aid.

Fortunately, chiropractic care is often helpful in these cases. Many pregnant people report pain relief and more mobility with chiropractic care. Yet some are not sure about the wisdom of chiropractic care in pregnancy.

Here are some answers to the most common questions about chiropractic care for pregnancy, and help in finding a pregnancy chiropractor for those who want it.

Purpose of Chiropractic Care During Pregnancy


While many doctors say that back and pelvis pain is "normal" in pregnancy and there is nothing that can be done to help it, chiropractors do not believe that significant or long-lasting pain is "normal" at all, and they know from experience that much of it can be helped.

They believe pain occurs when the spine or pelvis are out of alignment or the muscles and soft tissues around them are unbalanced. This can present as back pain, pain in the buttocks that radiates down the leg (sciatica), pubic symphysis pain in the front of the pelvis, hip pain, tailbone (coccyx) pain, stabbing pains in the abdomen when the mother moves too quickly or sneezes (round ligament spasm), neck pain, difficulty walking, difficulty turning over or lifting one leg, difficulty getting in and out of cars, and sometimes shoulder or rib/side pain.

If you are experiencing this kind of pain in pregnancy, chiropractic care may help make pregnancy more comfortable. Chiropractors believe that chiropractic care can help pregnant people in several different ways:
  • By creating more room in the pelvis for baby to maneuver through
  • By improving nerve function so that contractions are more effective
  • By relieving imbalances or tensions in the ligaments and soft tissues supporting the uterus
The most basic component of chiropractic care is to make sure the bony passage around the baby (the pelvis) is as open and well-aligned as possible, creating the largest possible space for the baby to move through.

Many women who have had cesareans have been told that their "sacrum is too prominent" or "too flat," that their pubic arch is "too flat/narrow," that "there is a bone in the way," or simply that their "pelvis is too small/narrow" for a baby to maneuver through. However, after chiropractic care, many of these same women have gone on to give birth to bigger babies than their "stuck" cesarean babies, simply because the pelvic passage is now optimized and the baby has more room. It doesn't seem like such treatment would make much more space, but getting into good alignment can actually make enough difference to maximize the space and help make an easier birth.

Chiropractors also place great importance on good nerve function. They believe that a misaligned spine impedes nerve function. They believe that poor alignment can not only affect the body physically by making less room for the baby to get out, but also by causing ineffective, uncoordinated contractions because of poor nerve function. From his article on "The Safety of Chiropractic Care in Pregnancy," Dr. Jason Lindekugel (D.C.) writes:
Chiropractic manipulation seeks to balance the joints of the body in order to normalize nerve function...In restoring joint function, chiropractors are relieving nerve irritation which in turn relaxes muscles and the ligaments of the pelvis and uterus. So, proper nerve function is the goal, not just “cracking” joints.
Finally, chiropractors believe that by relieving any misalignments, they will create more space and improve nerve function, lessening the risk for dystocia (slow, unproductive labors) and hopefully resulting in safer, faster, and more effective labors and births.

Some people mistakenly think that chiropractors are practicing obstetrics and manually trying to turn babies into position. This is not true. Chiropractors are trying to create conditions to normalize the body's functions so the mother has the best possible chance at an effective labor and birth.

Effectiveness of Chiropractic Care in Pregnancy

But is seeing a chiropractor in pregnancy that helpful? What does the research say?

Traditionally, chiropractors have done research differently than mainstream medicine. They have  relied more on case reports and case series rather than gold-standard randomized studies. They often didn't use control groups because they were loathe to deny anyone care, especially in pregnancy. Even when mainstream studies were done, sample sizes tended to be small. So there are limits to many studies done in the past.

However, there are now a number of studies and reviews using more rigorous methodology that are reassuring. Here is a summary of a few.

A 2013 prospective randomized study in pregnant patients with low back and pelvic pain compared usual obstetric care with obstetric care plus additional chiropractic care. It found that those patients who received the additional chiropractic care improved significantly, while those who received just standard obstetric care did not improve at all.

A 2014 study found that the improvement from chiropractic care was long lasting. Nearly 90% of study participants were improved a year later. Several other studies (see references below) have also found significant improvement with chiropractic care in pregnancy, with few adverse events.

A 2012 Canadian review stated:
Massage therapy and chiropractic care, including spinal manipulation, are highly safe and effective evidence-based options for pregnant women suffering from mechanical low back and pelvic pain.
In 2015, the Cochrane Collaboration, a leader in evidence-based care, reviewed a series of studies on alternative care practices in pregnancy like acupuncture, craniosacral therapy, and osteomanipulation (basically chiropractic care). They found the quality of evidence "moderate," and that osteomanipulative therapy did significantly  reduce low back and pelvic pain in pregnancy. Furthermore, any adverse events were "minor and transient."

It should be noted that no matter what the research says, some people will never be comfortable trying chiropractic care, and that's okay. If chiropractic care is not for you, don't feel pressured into it. Women have been having babies for thousands of years without having chiropractic care. Most will do fine without it. However, if you are having lots of back pain or pelvic pain, you might want to reconsider it.

If you are still not sure, you might try exploring the possibility further without committing to it. Ask local midwives and doulas for recommendations of good pregnancy chiropractors, then call and ask if you can do a non-treatment consult about your case. Find out how the chiropractor makes room for the pregnancy belly during treatment and the techniques they might use. See if you can observe treatment during an appointment (if the patient gives permission). Often this is enough to reassure people that chiropractic care in pregnancy is reasonable and safe. However, whatever you decide, remember that it's always your choice.

When To See a Chiropractor and How Often

Photo credit: Garden State Chiropractic 
If you do decide to see a chiropractor in pregnancy, one common question is when to start seeing them and how often. Unfortunately, there is no simple answer to this. The answer totally varies from woman to woman, depending on each person's unique needs.

Ideally, people would start seeing a chiropractor before or between pregnancies so that any serious issues can be taken care of before the hormones of pregnancy start softening and loosening the ligaments, making it hard to maintain chiropractic adjustments. The more serious a person's issues, the smarter it would be to start care before pregnancy instead of waiting till after they are pregnant.

However, many people only start experiencing significant pain once they are already pregnant. Others may have limits on the amount of chiropractic visits that are covered under their insurance, or they have no chiropractic coverage and must pay cash. Therefore, many want to try and maximize the benefit of the visits by timing them carefully, and that may mean limiting them to pregnancy only, or even to the last third of pregnancy only.

The problem is that no two people's problems are alike, and there is no one prescription that fits all everyone's needs. The loosening hormones of pregnancy increase as pregnancy progresses, so generally speaking it's better to start treatment sooner than later. However, if you have only a few visits that are covered by insurance or you have limited ability to pay for them out-of-pocket, then you may want to save your visits for the third trimester. However, if you do this and you have really significant alignment issues, you also run the risk of not getting enough treatment to really fix the problem in time. So there is no one answer for every woman. It really depends on the unique circumstances of your particular situation. If you are in a significant amount of discomfort, that usually indicates a problem that should be addressed sooner than later.

Generally speaking, chiropractors prefer to see women before they become pregnant to start resolving any long-standing misalignment issues. Once you become pregnant, most chiropractors want to see you on the same approximate schedule that a doctor or midwife sees you, which is about once a month in the first 2 trimesters, bi-weekly in weeks 32-36, and every week after 36 weeks until the baby is born.

Now obviously, that's the ideal schedule. A lot depends on what's happening with the body. If a pregnant woman comes in as a new patient and has a lot of major alignment issues going on, most chiropractors are going to want to see her weekly (or more) until her alignment issues are better, and then they will go back to the standard schedule noted above.

Other women may not need to be seen even every month. If the chiropractor finds that there is nothing to adjust, then he/she should send you home and elongate the time between visits. Some lucky women find that their pain goes away after a couple of chiropractic treatments and then they're done and never need to go back.

On the other hand, some women need to visit more often than weekly. When treatment is first initiated, frequent visits are important to start retraining the body's muscles and ligaments to "remember" the new alignment consistently. So there may be a flurry of frequent visits in the beginning that slowly space out farther and farther as the woman's body adapts to the new patterns, and then visit frequency comes and goes, depending on the woman's needs. In women with a history of major alignment issues, it's not unusual for the woman to go back to seeing the chiropractor very frequently near the end of pregnancy because the ligaments are so loose by then that it's difficult to maintain any adjustments. It all depends on the needs of the woman and her comfort levels.

However, a chiropractor should not force you to buy a pre-packaged bundle of "x" amount of visits for "x" cost. Some doctors offer this as a way for patients to save money, but the package should be flexible so that if you didn't end up needing "x" amounts of visits, you wouldn't have to have them. Furthermore, a pre-defined schedule of visits cannot anticipate what your body will need and how it responds to treatment; for some people more frequent visits might be needed, while others may need much less. A "one size fits all" package is a sign you should seek out a different chiropractor instead.

Unfortunately, there are bad chiropractors/quacks out there, just as there are quack doctors. Because of this, some people reject all chiropractors altogether. But the reasonable response to quack doctors is not to ignore all medical advice and shun all doctors, but instead to find a better, reputable doctor, one whose treatment philosophy and methods align with your preferences.

The same goes for chiropractors. If you find a bad one, don't be afraid to leave and try another one. Get recommendations from other mothers or childbirth professionals to help guide you to the more reputable and helpful practitioners. Also, there are many different styles of chiropractic care and ways to adjust people. If you don't like one style, keep trying till you find a chiropractor that uses techniques you are comfortable with and seems to "get" your particular body needs. Listen to your instincts; if your intuition is saying that a particular chiropractor is not for you, then find a new one.

Fortunately, most chiropractors are legitimate professionals and are not just out to make a quick buck. They should evaluate your condition, suggest a plan of care, and then keep re-evaluating your need for visits based on how well you respond to treatments. Their care plan should be dynamic and changing in response to your own needs and comfort.

In short, there is no one pattern of visits that you "should" follow. Ideally, you should try to start chiropractic care before pregnancy, and then in pregnancy see the chiropractor monthly, then bi-weekly, then weekly in the last month. However, this schedule is not set in stone and should be adjusted to the unique needs of each person.

Summary

To summarize, the purpose of chiropractic care during pregnancy is to:
  • Keep the body well-aligned to make the maximum possible space available for baby to pass 
  • To optimize nerve function so that contractions can be effective and coordinated
  • To balance joints, ligaments, and muscles of the uterine supporting structures so baby has the best chance to assume the easiest possible position for being born 
In other words, chiropractic care during pregnancy may help pregnancy be more comfortable, and hopefully help labor and birth be easier for mother and baby. Although further research is needed, the research we have so far suggests that chiropractic care in pregnancy can be very helpful for low back and pelvic pain.



References

Chiropractic Care for Low Back and Pelvic Pain in Pregnancy

Cochrane Database Syst Rev. 2015 Sep 30;(9):CD001139. doi: 10.1002/14651858.CD001139.pub4. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Liddle SD, Pennick V. PMID: 26422811
"...There was moderate-quality evidence...from individual studies suggesting that osteomanipulative therapy significantly reduced low-back pain and functional disability, and acupuncture or craniosacral therapy improved pelvic pain more than usual prenatal care. Evidence from individual studies was largely of low quality (study design limitations, imprecision), and suggested that pain and functional disability, but not sick leave, were significantly reduced following a multi-modal intervention (manual therapy, exercise and education) for low-back and pelvic pain.When reported, adverse effects were minor and transient."
Am J Obstet Gynecol. 2013 Apr;208(4):295.e1-7. doi: 10.1016/j.ajog.2012.10.869. Epub 2012 Oct 23. A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. George JW, Skaggs CD, Thompson PA, Nelson DM, Gavard JA, Gross GA. PMID: 23123166
...We examined whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to reduce pain, impairment, and disability in the antepartum period.  STUDY DESIGN: A prospective, randomized trial of 169 women was conducted. Baseline evaluation occurred at 24-28 weeks' gestation, with follow-up at 33 weeks' gestation.... Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants. RESULTS: The MOM group demonstrated significant mean reductions in Numerical Rating Scale scores (5.8 ± 2.2 vs 2.9 ± 2.5; P < .001) and Quebec Disability Questionnaire scores (4.9 ± 2.2 vs 3.9 ± 2.4; P < .001) from baseline to follow-up evaluation. The group that received standard obstetric care demonstrated no significant improvements. CONCLUSION: A multimodal approach to low back and pelvic pain in mid pregnancy benefits patients more than standard obstetric care.
Chiropr Man Therap. 2014 Apr 1;22(1):15. doi: 10.1186/2045-709X-22-15. Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow-up. Peterson CK, Mühlemann D, Humphreys BK. PMID: 24690125
...RESULTS: 52% of 115 recruited patients 'improved' at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year...CONCLUSIONS: Most pregnant patients undergoing chiropractic treatment reported clinically relevant improvement at all time points. No single variable was strongly predictive of 'improvement' in the logistic regression model.
J Midwifery Womens Health. 2006 Jan-Feb;51(1):e7-10. Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. Lisi AJ. PMID: 16399602
...This retrospective case series was undertaken to describe the results of a group of pregnant women with low back pain who underwent chiropractic treatment including spinal manipulation. Seventeen cases met all inclusion criteria. The overall group average Numerical Rating Scale pain score decreased from 5.9 (range 2-10) at initial presentation to 1.5 (range 0-5) at termination of care. Sixteen of 17 (94.1%) cases demonstrated clinically important improvement. The average time to initial clinically important pain relief was 4.5 (range 0-13) days after initial presentation, and the average number of visits undergone up to that point was 1.8 (range 1-5). No adverse effects were reported in any of the 17 cases. The results suggest that chiropractic treatment was safe in these cases and support the hypothesis that it may be effective for reducing pain intensity.
J Chiropr Med. 2016 Jun;15(2):129-33. doi: 10.1016/j.jcm.2016.04.003. Epub 2016 May 25. Chiropractic Management of Pregnancy-Related Lumbopelvic Pain: A Case Study. Bernard M, Tuchin P. PMID: 27330515
...A pregnant 35-year-old woman experienced insidious moderate to severe pregnancy-related lumbopelvic pain and leg pain at 32 weeks' gestation. Pain limited her endurance capacity for walking and sitting. Clinical testing revealed a left sacroiliac joint functional disturbance and myofascial trigger points reproducing back and leg pain...The patient was treated with chiropractic spinal manipulation, soft tissue therapy, exercises, and ergonomic advice in 13 visits over 6 weeks. She consulted her obstetrician for her weekly obstetric visits. At the end of treatment, her low back pain reduced from 7 to 2 on a 0-10 numeric pain scale rating. Functional activities reported such as walking, sitting, and traveling comfortably in a car had improved. CONCLUSION: This patient with pregnancy-related lumbopelvic pain improved in pain and function after chiropractic treatment and usual obstetric management.
Further articles: http://icapediatrics.com/resources/articles/pregnancy-and-chiropractic/

Safety of Chiropractic Care, Attitudes Towards Chiropractic Care

JAMA. 2017 Apr 11;317(14):1451-1460. doi: 10.1001/jama.2017.3086. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige NM. PMID: 28399251
OBJECTIVE: To systematically review studies of the effectiveness and harms of SMT for acute (≤6 weeks) low back pain...Among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms. However, heterogeneity in study results was large.
Chiropr Man Therap. 2012 Mar 28;20:8. doi: 10.1186/2045-709X-20-8. Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature. Stuber KJ, Wynd S, Weis CA. PMID: 22455720
CONCLUSIONS: 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.
Can Fam Physician. 2013 Aug;59(8):841-2.Optimizing pain relief during pregnancy using manual therapy. Oswald C, Higgins CC, Assimakopoulos D. PMID: 23946024
...As pregnant women move into their second and third trimesters, their centres of mass shift anteriorly, causing an increase in lumbar lordosis, which causes low back and pelvic girdle pain. Increasing recent evidence attests to the effectiveness and safety of treating this pain using manual therapy. Massage therapy and chiropractic care, including spinal manipulation, are highly safe and effective evidence-based options for pregnant women suffering from mechanical low back and pelvic pain.
J Evid Based Complementary Altern Med. 2016 Apr;21(2):92-104. doi: 10.1177/2156587215604073. Epub 2015 Sep 8. Attitudes Toward Chiropractic: A Survey of Canadian Obstetricians. Weis CA, Stuber K, Barrett J, Greco A, Kipershlak A, Glenn T, Desjardins R, Nash J, Busse J. PMID: 26350243
We assessed the attitudes of Canadian obstetricians toward chiropractic with a 38-item cross-sectional survey...Overall, 30% of respondents held positive views toward chiropractic, 37% were neutral, and 33% reported negative views. Most (77%) reported that chiropractic care was effective for some musculoskeletal complaints, but 74% disagreed that chiropractic had a role in treatment of non-musculoskeletal conditions. Forty percent of respondents referred at least some patients for chiropractic care each year.... 


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