Feb. 18, 2002 -- Shawn Kelley delivered her first son, Evan, prematurely at 32 weeks. It looked like she was headed down the same path with her second baby when she started having contractions at 22 weeks. That is, until she tried an unconventional treatment that seems to be working.
Kelley started seeing a chiropractor, and within a few sessions of gentle manipulations the baby had moved up. She was no longer experiencing severe back pain and her obstetrician gave her the green light to cease bed rest and resume normal activity.
"It's amazing," says Kelley, of Minnetonka, Minn., who is now 33 weeks pregnant with her second baby . "I'll go in, she does some adjustments, and within an hour or two, everything opens up. The baby moves up, I don't feel as much pressure, and the back pain goes away." What's more, she says, she has been able to avoid more bed rest or drugs to stop pre-term labor.
Kelley has joined the growing ranks of Americans -- pregnant women included -- seeking alternatives to traditional Western medicine. Chiropractic care appears to offer many women relief from the back, leg, and pelvic aches and pains common during pregnancy.
"The best use of chiropractic, in general, has to do with musculoskeletal problems, and, in pregnancy, a lot of women have problems that are caused by the uterus being off center," says Mary Hammond-Tooke, a certified nurse-midwife at The Maternity Center in Bethesda, Md. "The uterus is pulling out in front and not well-balanced in back."
Add to that the hormonal changes that soften joints -- and even the strain of balancing another child on one hip -- and an expectant mom can be in for some major body stressors. "Chiropractors who are comfortable with pregnant ladies -- and not all of them are -- do just a wonderful job helping these ladies to be much more comfortable or pain free," says Hammond-Tooke.
More Popular Than Ever
Chiropractic is one of the most popular alternative medicine therapies, ranking fourth after relaxation techniques, herbs, and massage, according to a recent survey by David Eisenberg, MD, of Harvard University and Beth Israel Deaconess Medical Center in Boston. About 22 million Americans visited a chiropractor last year, according to Jerome McAndrews, national spokesman for the American Chiropractic Association, although there are no statistics on how many of those are pregnant women.
Chiropractic care involves diagnosing spinal misalignments and correcting them by using the hands to manipulate, or adjust, the spine, joints, and muscles. With pregnant women, chiropractors typically use gentler pressure than the more forceful manipulations that can be done on other adults. Many chiropractors who treat pregnant women use special cushions or a special table with a section that drops away to leave room for the belly.
"When women are pregnant, you can almost blow on them to make the adjustment because of the ligament laxity [due to hormones]," says Carol Phillips, a chiropractor in Richfield, Minn., whose practice deals almost exclusively with pregnancy. "You just put your hands in the right position to allow the muscles to make the adjustment."
Among the most common pregnancy ailments that chiropractors treat are headaches; lower- and upper-back pain; sacroiliac (hip and low back) pain, which starts in the lower back and often radiates down the leg; pubic-bone pain; and rib misplacement, says Sheilagh Weymouth, a chiropractor in New York City who treats many pregnant women.
"Many of these discomforts are really a combination of the hormonal changes, where the ligaments are relaxing, and biomechanical changes, which result from [a] very fast increase in weight that isn't evenly distributed, which causes the joints to become misaligned," says Weymouth. "By alleviating the source of the misalignment, you alleviate the symptoms."
Many pregnant women visit chiropractors, such as Weymouth, not only for specific symptoms, but to improve overall health and prevent potential discomfort. She'll typically see these women once a month during the first trimester, then every two or three weeks until the last month or so, then once a week when the most discomforts may occur.
Julia Murphy, of New York City, was seeing Weymouth before she got pregnant and continued throughout her pregnancy. "I feel like I had a completely trouble-free pregnancy, and I'm 39, so it's not like I'm some young gymnast," says Murphy, who delivered her 10-pound baby at home.
"I didn't have any morning sickness, edema, sciatica (shooting pains down the leg from a pinched nerve), or any of the things people seem to get a lot," says Murphy. "I had just a little bit of lower-back achiness toward the end. But, my whole body was really in balance and functioning as this unencumbered symphony of hormones and ongoing adaptation to the pregnancy, in part, because of Sheilagh's care."
Some published research and clinical experience reported by chiropractors even show success in turning breech babies and reducing labor pain with chiropractic treatments.
Phillips says she has turned hundreds of breech babies, and in only two cases did the women require a cesarean section, but only because a more serious problem existed. Larry Webster, the chiropractor who devised the method, claims a 90% success rate. A study compiling data from hundreds of doctors whose patients underwent the technique is nearing completion.
"There's an easy way to position the mother to relax the muscles and the baby will back up, turn its head around and then come on down," says Phillips, who is Kelley's chiropractor and also a doula. "It's a positioning, not an adjustment. You position the mother to use her body mechanics to relax the pelvic-floor muscle." She says it takes one to three tries, and she teaches the position to partners, midwives, and doulas.
Bones of Contention
While referrals to chiropractors are common among midwives, the use of chiropractic on pregnant women mostly raises eyebrows in the traditional obstetric community, which, like most doctors, has little or no training in alternative medicine. Obstetricians are also skeptical because of a lack of convincing medical research.
Chiropractic, denounced for years by the medical community as quackery, gained standing in 1994 when the U.S. Agency for Health-Care Policy and Research endorsed chiropractic manipulation -- over surgery and acupuncture -- as one of the few effective treatments for some forms of low-back pain.
But questions and controversy have remained, heightened recently by two studies in The New England Journal of Medicine. One indicated that spinal manipulation eases back pain no better than physical therapy; the other debunked common claims by chiropractors that spinal adjustments ease symptoms of asthma in children.
"I'm certainly aware of the evidence of its use in acute back pain, but I have not seen specific data on pregnancy ... or when it would be used," says Ronald Chez, MD, professor of obstetrics and gynecology at University of South Florida. Instead,Chez refers some patients with back pain to orthopaedic or pain specialists, who may use injections of corticosteroids to decrease inflammation, stretching exercises, or heat therapy.
Some doctors also worry about the potential danger of applying too much pressure. "Pregnancy hormones loosen the ligaments in the low back and pelvis to prepare for delivery, so twisting on them more can often increase back pain," says James Dillard,MD, DC,a doctor at Columbia Presbyterian Medical Center in New York , and a chiropractor.
"A practitioner who treats many pregnant women may be well-qualified to help pregnant women with back pain, but some gentle stretching, massage, and appropriate exercise can probably take care of most of these ladies' back pain," Dillard says.
But others, such as Hammond-Tooke, insist that chiropractic treatments are safe for pregnant women and say that other alternatives may not be as effective or desirable.
"Massage can be helpful if it's a muscle that's spasming, but it's not going to do anything if the problem is the sciatic nerve being compressed by vertebrae being out of alignment," says Hammond-Tooke. "Exercise can be very helpful in mild cases, so we always recommend pelvic rocks and cat backs. But it's not always enough."
Weymouth adds that there is no evidence any pregnant woman has ever been harmed from chiropractic treatments. "In my opinion, a chiropractor will never institute more force than is necessary to move any joint, be it [that of] a child, a geriatric, a 40-year-old robust male, or a pregnant woman."
Still, she recommends seeking a chiropractor who is experienced at treating pregnant women. "I'd look for a chiropractor the same way you'd look for the right medical doctor, dentist, or car mechanic -- ask around," says Weymouth. She says women might try calling a local birthing center for a referral, even if they aren't planning to use a midwife for their delivery.
Phillips also suggests finding chiropractors with postgraduate training in treating pregnant women. The International Chiropractors Association (ICA) pediatrics council now offers a postgraduate specialty in pediatrics, which includes prenatal training. Other postgraduate seminars in pregnancy also are available to chiropractors.
"I'd ask if they've had specialized training beyond what they've had in chiropractors' school and whether they treat pregnant women all the time," says Phillips, who teaches postgraduate seminars in obstetrics. "There are many chiropractors specializing in women and children." But she says to avoid high-volume practices, those treating 50-100 patients per day, because treating pregnant women takes more time.
To see whether a chiropractor with pediatric training has an office in your area, call the International Chiropractic Association Council on Chiropractic Pediatrics at (800) 423-4690. The American Chiropractic Association, at (800) 986-4636, also can provide local referrals but does not identify chiropractors with specific training in pregnancy.
The cost of chiropractic services -- which often is at least partially covered by health plans -- varies by region and is highest in the East and lowest in the Midwest. The initial consultation and exam typically costs about $65-90, and subsequent visits cost about $45-50, according to Anthony Rosner, director of research and education at the Foundation for Chiropractic Education and Research.