Slide 4 The chiropractic role during pregnancyTwo philosophies about healthA natural process in crisisOhm’s Law: The three stresses that lead to dystociaWilliams Obstetrics definition of dystociaTechnique for the elimination of dystociaAt-Home RecommendationsAbout birth traumaRaising consciousness
Agenda
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Slide 5 The chiropractic role during pregnancy
Two philosophies about healthA natural process in crisisOhm’s Law: The three stresses that lead to dystociaWilliams Obstetrics definition of dystociaTechnique for the elimination of dystociaAt-Home RecommendationsAbout birth traumaRaising consciousness
Agenda
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Slide 6 The Chiropractic Role During Pregnancy
The Beginnings of the Family Wellness Lifestyle and the Chiropractic Role During Pregnancy
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Slide 7 The Chiropractic Role During Pregnancy
Chiropractors work with the body’s ability to adapt and function the way it is designed to.Chiropractic care in pregnancy is vital to the normal physiological function of both the mother and baby in pregnancy and birth.
Pregnancy and Birth as a Natural Process With Chiropractic Care Supporting this Process:
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Slide 8 The Chiropractic Role During Pregnancy
In the mother:
Prepares the pelvis for an easier pregnancy and birth by creating a state of balance in pelvic muscles and ligaments.Removes tension on the ligaments that support the uterus thus reducing torsion (intrauterine constraint) to the woman’s uterus.Removes interference to the mother’s vital nerve system which controls and co-ordinates all of her systems and functions.Allows for a safer easier birth for the mother decreasing the potential for intervention.
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Slide 9 The Chiropractic Role During Pregnancy
To the infant:
Removes interference to the mother’s nerve system allowing for better baby development.Allows the baby the room to develop without restrictions to its forming cranium, spine and other skeletal structures.Offers the baby the room to move into the best possible position for birth.With proper fetal positioning, there is a significant decrease in dystocia and the resulting birth trauma caused by intervention.
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Slide 10
The International Chiropractic Pediatric Association (ICPA)
Oldest and largest non-profit organization of its kindApolitical and independent from any other national organizationUnified in One Mission, One Purpose: The Chiropractic Family Wellness LifestyleWe fulfill our mission with research, training & education
Slide 11 The chiropractic role during pregnancyTwo philosophies about health
A natural process in crisisOhm’s Law: The three stresses that lead to dystociaWilliams Obstetrics definition of dystociaTechnique for the elimination of dystociaAt-Home RecommendationsAbout birth traumaRaising consciousness
Agenda
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Slide 12 Two Philosophies about Health
VITALISM
Perceives the human being as a whole person who tends towards wellness if there are no barriers to prevent it.
Traced back to 6,ooo yrs B.C.Was Predominate Healing for CenturiesChiropracticEinsteinian SciencePsycho-Neuro-Immunology (P.N.I.)
MECHANISM
Perceives the body as a complex machine you need to figure out, prone to constant breakdown. You tinker with it until it can’t be fixed anymore.
We are all part of the whole and the whole is bigger than the sum of its parts
Respect for the process
Above Down Inside Out
MECHANISM
Events are random –coincidence
Everything is measurable to a chemical/ proportional breakdown
Fear of the process/ unknown
Outside In Below Up
Recognizing the Perspective
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Slide 14 The chiropractic role during pregnancyTwo philosophies about healthA natural process in crisis
Ohm’s Law: The three stresses that lead to dystociaWilliams Obstetrics definition of dystociaTechnique for the elimination of dystociaAt-Home RecommendationsAbout birth traumaRaising consciousness
Agenda
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Slide 15
Slide 15
A Natural Process in Crisis
C-section rate at an all time highWomen now electing c-sectionsWomen fearing birthOB’s malpractice sky rocketingBirth/ midwifery centers closingMidwives being jailedPrematurity upBirth Trauma
**See ICAN website: www.ican-online.org**
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Slide 16 The chiropractic role during pregnancyTwo philosophies about healthA natural process in crisisOhm’s Law: The three stresses that lead to dystocia
Williams Obstetrics definition of dystociaTechnique for the elimination of dystociaAt-Home RecommendationsAbout birth traumaRaising consciousness
Agenda
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Slide 17 Ohm’s Law:Measuring The Potential Of Resistance To A Natural Birth:
The Three Stresses That Lead To Dystocia
1. Physiological/ Biomechanical Stresses
2. Emotional Stresses
3. Mechanistic/ Technological/ Medical Stresses
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Slide 18
Slide 18Slide 18
www.netterimages.com
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Slide 19
Slide 19Slide 19
Management of Suspected Fetal MacrosomiaMARK A. ZAMORSKI, M.D., M.H.S.A., and WENDY S. BIGGS, M.D. University of Michigan Medical School, Ann Arbor, Michigan
Fetal macrosomia, arbitrarily defined as a birth weight of more than 4,000 g (8 lb, 13 oz) complicates more than 10 percent of all pregnancies in the United States. It is associated with increased risks of cesarean section and trauma to the birth canal and the fetus. Fetal macrosomia is difficult to predict, and clinical and ultrasonographic estimates of fetalweight are prone to error. Elective cesarean section for suspected macrosomia results in a high number of unnecessary procedures, and early induction of labor to limit fetal growth may result in a substantial increase in the cesarean section rate because of failed inductions. ..
The medical literature confirms that prediction of fetal macrosomia is difficult. Ultrasound estimation of fetal weight adds little additional useful information.17,29
What clinicians really want to predict is not macrosomia, per se, but the serious complications that physicians mistakenly associate as occurring only with macrosomia, such as brachial plexus injury or shoulder dystocia. Such complications, however, are not determined by birth weight alone, but by a complex and poorly understood relationship between fetal and maternal anatomy and other factors.
Moreover, the vast majority of macrosomic infants who are delivered vaginally do very well, even if they experience shoulder dystocia.17 The weight estimate of the suspected macrosomic fetus should be recognized as uncertain. The patient's obstetric history, her progress during labor, the adequacy of her pelvis and other evidence suggestive of fetopelvic disproportion should be used in determining an intervention, such as cesarean section.
Failure to progress: lack of progressive cervical dilation or lack of fetal descent.
Most common indication for primary c sections. (50-60% of all sections)Over diagnosed in the US: Incorrect diagnosis, epidurals, fear of litigation, ob/gyn convenience. (25% of all sections occur with a diagnosis of dystocia at 3cm cervical dilation, when 4 cm is the accepted dilation for accurate diagnosis.)
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Slide 22 Q & A
Slide 22
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Slide 23 The chiropractic role during pregnancyTwo philosophies about healthA natural process in crisisOhm’s Law: The three stresses that lead to dystociaWilliams Obstetrics definition of dystocia
Technique for the elimination of dystociaAt-Home RecommendationsAbout birth traumaRaising consciousness
Agenda
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Slide 24
Slide 24
Dystocia Undefined
“Dystocia is very complex, and although its definition-abnormal progress in labor seems simple, there is no consensus as to what “abnormal progress” means.
Thus, it seems prudent to attempt a better understanding of normal labor in order to determine departures from normal.”
Chapter 18 Williams Obstetrics
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Slide 25 Dystocia (Chapter 18 of Williams Obstetrics Text)
1. Abnormalities of the expulsive forces— either uterine forces insufficiently strong or inappropriately coordinated to efface and dilate the cervix (uterine dysfunction), or inadequate voluntary muscle effort during the second stage of labor. (Power)
2. Abnormalities of the maternal bony pelvis– that is pelvic contraction (Passage)
3. Abnormalities of presentation, position, or development of the fetus (presented in chapter 19) (Passenger)
4. Abnormalities of the soft tissue of the reproductive tract that form an obstacle to fetal descent (presented in chapter 35)
Williams Obstetrics 21st Edition
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Slide 26 Dystocia (Chapter 18 of Williams Obstetrics Text)
1. Abnormalities of the expulsive forces— either uterine forces insufficiently strong or inappropriately coordinated to efface and dilate the cervix (uterine dysfunction), or inadequate voluntary muscle effort during the second stage of labor. (Power)
Williams Obstetrics 21st Edition
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Slide 27
Slide 27
1- Abnormalities of the expulsive forces
Uterine Dysfunction: uterine forces insufficiently strong or inappropriately coordinated to efface and dilate the cervix
Uterus: hollow muscular organ The function of the uterus is dependent on nerve innervations.
www.netterimages.com
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Slide 28
Slide 28
1- Abnormalities of the expulsive forces
Interference to the nerve system affects the function of muscles.The purpose of chiropractic is to reduce interference to the nerve system
Reason #1 for dystocia is functional condition with chiropractic considerations.
www.netterimages.com
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Slide 29
The nerve plexus to the uterus is composed of sympathetic and parasympathetic components.
Sympathetic innervations is from the lower thoracic sympathetic nerves.
Parasympathetic innervations is from S2 and S3 spinal nerves.
www.netterimages.com
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Slide 30 Dystocia (Chapter 18 of Williams Obstetrics Text)
2. Abnormalities of the maternal bony pelvis–that is pelvic contraction (Passage)
Williams Obstetrics 21st Edition
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Slide 31
Slide 31
2- Abnormalities of the maternal bony pelvis
Pelvic Contraction
Williams Obstetrics Text tells us:
"Any contraction of the pelvic diameters that diminish the capacity of the pelvis can create dystocia (difficulty) during labor."
They further state that the diameter of the woman's pelvis is decreased when the sacrum is displaced.
Williams Obstetrics 21st Edition
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Slide 32
Slide 32
2- Abnormalities of the maternal bony pelvis
Pelvic Contraction
Dr. Abraham Towbin, medical researcher on birth tells us that the bony pelvis may become "deformed" this way by trauma.
Chiropractors define this displacement/ deformation as spinal misalignment or subluxation primarily caused by the stress of trauma.
“Brain Damage in the Newborn and its Neurological Sequels”
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Slide 33 Dystocia (Chapter 18 of Williams Obstetrics Text)
3. Abnormalities of presentation, position, or development of the fetus (presented in chapter 19) (Passenger)
Williams Obstetrics 21st Edition
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Slide 34 A. Vertex B. Sinciput C. Brow D. FaceRight Occiput Anterior Right Occiput Posterior
Complete Breech Footling Breech Frank Breech Transverse
Images courtesy Williams Obstetrics
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Slide 35
Slide 35
Positioning?
What is the cause of malposition?
Imbalance in the muscles and torsion in the ligaments.
This leads to intrauterine constraint.
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Slide 36
Slide 36
Intrauterine Constraintdefined as any forces external to the developing fetus that obstruct the normal movement of the fetus. Im
Extends from an attachment posteriorlaterally to the supravaginal portion of the cervix
Inserts into the fascia over the second and third sacral vertebrae
www.netterimages.com
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Slide 40
Slide 40
The Round Ligaments
Arises from the fundus of the uterus
Proceeds inferolaterally to the labia major
Joins up with the inguinal ligament about halfway through its course.
www.netterimages.com
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Slide 41
Slide 41
The Uterosacral Ligaments
The uterosacral ligament prevents the uterus from displacing anterior and inferior. A sacral dysfuntion will transmit the torque force by the uterosacral ligament on to the uterus and shearing it out of its proper position, resulting in a restricting tension within the uterine wall.
Image courtesy Dr. Werner Michael Heller
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Slide 42
Slide 42
The Round Ligaments
The round ligament prevents the uterus from moving posterior, keeping it in a normal anterior position. Unilateral tension in the round ligament is thought to increase the total torque on the uterus as it is off center position is further enhanced. The tension of the uterine walls will further increase.
Image courtesy Dr. Werner Michael Heller
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Slide 43
Slide 43
www.netterimages.com
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Slide 44 The Webster Technique
The Webster Technique is a specific chiropractic analysis and
adjustment:
1. Reduces interference to the nerve system
2. Balances pelvic muscles and ligaments
3. Reduces torsion of the women’s uterus, (the cause of intrauterine constraint) and therefore allows the baby to get into the best possible position for birth.
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Slide 45
Slide 45
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Slide 46 Dystocia (Chapter 18 of Williams Obstetrics Text)
4. Abnormalities of the soft tissue of the reproductive tract that form an obstacle to fetal descent (presented in chapter 35)
Williams Obstetrics 21st Edition
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Slide 47 The Webster Technique: Results from a practice-based research program
There is a long tradition chiropractic on the care of the pregnant patient. The results of our study demonstrate a measure of effectiveness and safety of the Webster Technique in relieving the consequences of intrauterine constraint (i.e., malposition/ malpresentation). This presentation contributes to the knowledge base that pregnant patients may derive benefits from the Webster Technique.
Joel Alcantara, DC, Research Director, International Chiropractic Pediatric Association, Media, PA and Private Practice of Chiropractic, San Jose, CA and Jeanne Ohm, DC, Private Practice of Chiropractic, Media, PA and Executive Director, International Chiropractic Pediatric Association, Media, PA
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Slide 48 The Webster Technique: Results from a practice-based research programA total of 81 pregnant patients with various breech presentations were cared for by a total of 24 chiropractors. The patients previously received care such as the external cephalic version, slant board, acupuncture, moxabustion, homeopathy, crawling exercises, hip and pelvis movement and handstands.
So far, 63 patients gave birth to their child and we were able to see if the Webster Technique was successful. Overall, the Webster Technique is 69% effective with this preliminary data with the greatest changes observed in frank breech presentations.
Joel Alcantara, DC, Research Director, International Chiropractic Pediatric Association, Media, PA and Private Practice of Chiropractic, San Jose, CA and Jeanne Ohm, DC, Private Practice of Chiropractic, Media, PA and Executive Director, International Chiropractic Pediatric Association, Media, PA
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Slide 49 The chiropractic role during pregnancyTwo philosophies about healthA natural process in crisisOhm’s Law: The three stresses that lead to dystociaWilliams Obstetrics definition of dystociaTechnique for the elimination of dystocia
Slide 52 The chiropractic role during pregnancyTwo philosophies about healthA natural process in crisisOhm’s Law: The three stresses that lead to dystociaWilliams Obstetrics definition of dystociaTechnique for the elimination of dystociaAt-Home Recommendations
About birth traumaRaising consciousness
Agenda
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Slide 53 At Home Recommendations to Support
Chiropractic Prenatal Care
Postural Advice:
Have patient avoid one sided positions and repetitive motionsDo not carry older siblingsSitting techniques: rocking pelvis forward
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Slide 54 At Home Recommendations to Support
Chiropractic Prenatal Care
Specific Exercises:
Keep SI Joints mobile: figure eight motionYoga cat movement (pelvic rocks) KegelsRound ligament massage
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Slide 55 At Home Recommendations to Support
Chiropractic Prenatal Care
Stress Reduction:
Prenatal YogaSurround herself with images/ books/ stories/ people associated with natural birthing of natural birthing
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Slide 56 Emotional Stress, Technological Stress And The Significant Role Chiropractic Offers In Reducing These Stresses.
Addressing the emotional stresses:
finding a supportive team
Addressing the potential Technological stresses:
empowering the mother to trust and to choose.
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Slide 57 What Are The Common Bonds Between Midwives & Chiropractors?
Knowledge and trust in the body’s inner wisdomSkills and objectives to work with the body’s normal function and natural healing abilities.Support and commitment towards non-traumatic, non-invasive birthing procedures.
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Slide 58 The chiropractic role during pregnancyTwo philosophies about healthA natural process in crisisOhm’s Law: The three stresses that lead to dystociaWilliams Obstetrics definition of dystociaTechnique for the elimination of dystociaAt-Home RecommendationsAbout birth trauma
Raising consciousness
Agenda
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Slide 59 Birth TraumaPhysical, Chemical and Emotional Stress
"It has become appallingly obvious that our technology has exceeded our humanity."
-Albert Einstein
Photo courtesy Dr. Skip George
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Slide 60
Slide 60
VIDEOS
Birth Trauma Part I: The ProblemBirth Trauma Part II: The Solution
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Slide 61 Q & A
Slide 61
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Slide 62 The chiropractic role during pregnancyTwo philosophies about healthA natural process in crisisOhm’s Law: The three stresses that lead to dystociaWilliams Obstetrics definition of dystociaTechnique for the elimination of dystociaAt-Home RecommendationsAbout birth traumaRaising consciousness
Agenda
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Slide 63 Our deepest fear is not that we are inadequate, our deepest fear is that we are
powerful beyond measure.
It is our light, not darkness that most frightens us.
We ask our selves, “who am I to be brilliant, gorgeous, talented fabulous?”Actually, who are you not to be?
You are a child of God.
Your playing small doesn’t serve the world. There’s nothing enlightened about shrinking so that other people won’t feel insecure around you.
We were born to make manifest the glory of God that is within us.
It is not just in some of us; it is in every one and as we let our own light shine, we unconsciously give other people permission to do the same.
As we are liberated from our own fears, our presence automatically liberates others.
