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Back Pain During Pregnancy

As your pregnancy advances and your uterus enlarges, you’re likely to feel some discomfort. Back pain is a common complaint.

But you don’t have to grin and accept back pain as a normal part of your pregnancy. You can take steps to stop the soreness. It’s a good idea to learn these techniques now, because you’ll probably need them again later when your back is bearing the strain of constantly lifting your 7- to 10-pound baby or your 20-pound toddler.

What causes back pain in pregnancy?

At least 50 percent of women experience back pain during pregnancy. Pregnant women are prone to backaches and back pain for a number of reasons:

Extra weight. The weight you gain during pregnancy is good for your baby, but it can be bad for your back.

Change in center of gravity. As your uterus grows, your center of gravity shifts forward. Gradually— and perhaps without notice—you begin to adjust your posture and the way you move. These compensations can lead to backaches and back pain.

Your hormones. During pregnancy, the hormone relaxin causes the ligaments between your pelvic bones to soften and your joints to loosen in preparation for your baby’s passage through your pelvis during birth. As the structures that support your pelvic organs become more pliant, you may feel considerable discomfort on either side of your lower back, often with walking, especially up and down stairs.

Back pain can occur at any time during pregnancy. For many women, it interferes with daily activities and the ability to get a good night’s sleep.

What can you do?

These self-care strategies can put your back on track:

Pay attention to your posture. The healthy posture that you learned before you were pregnant still applies in early pregnancy, before your uterus is above your bellybutton. Tuck your buttocks under, pull your shoulders back and downward, and stand straight and tall.

Later in pregnancy, as your uterus enlarges, you naturally pull your shoulders back farther to offset the weight of your uterus pulling you forward. This can actually cause back strain. Talk to your doctor about adjusting your posture to accommodate your growing belly.

Make adjustments when sitting or standing. Sit with your feet slightly elevated, and don’t cross your legs. Change position often, and avoid standing for long periods of time. If you must stand for a while, rest one foot on a low step stool.

Strategically place your pillows. Sleep on your side, with one or both knees bent. Place a pillow between your knees and another one under your abdomen. You may also find relief by placing a specially shaped total body pillow under your abdomen.

Avoid lifting heavy objects or children. When lifting a smaller object, don’t bend over at the waist. Instead, squat down, bend your knees and lift with your legs rather than your back. Try to avoid sudden reaching movements or stretching your arms high over your head.

Get the right gear.Wear supportive, low-heeled shoes and maternity pants with a low, supportive waistband. Or consider using a maternity support belt.

Try heat, cold or massage. Apply heat to your back. Try warm bath soaks, warm wet towels, a hot water bottle or a heating pad. Some women find relief by alternating ice packs with heat. A back massage also may help.

Stay fit. As long as your health care provider approves, an exercise program can keep your back strong and may actually relieve back pain. Some women enjoy swimming, and doctors highly recommend it—the body’s buoyancy in the water offers relief from the extra weight of pregnancy. You also might like walking or taking a prenatal exercise or yoga class. On your own, you can try an exercise called a pelvic tilt or cat stretch: Kneel on your hands and knees with your head in line with your back. Pull in your abdomen, arching your spine upward. Hold the position for several seconds, then relax your abdomen and back. Repeat three to five times, working gradually up to 10.

If these self-care steps aren’t working or your back pain is severe, talk to your health care provider. He or she may suggest a variety of approaches, such as special stretching exercises, that can alleviate pain without causing concern for your unborn baby.

Pain in your back may be a sign of a more serious problem if it’s severe and unrelenting or if it’s accompanied by other signs and symptoms. A low, dull backache may be a sign of labor or preterm labor. So, it’s best not to ignore your aching back.

Ultrasound in Pregnancy

Ultrasound: high-frequency sound waves that travel at 10 to 20 million cycles per second. The pattern of echo waves creates a picture of tissue and bone.

In 1987, UK radiologist H.D. Meire, who had been performing pregnancy scans for 20 years, commented, “The casual observer might be forgiven for wondering why the medical profession is now involved in the wholesale examination of pregnant patients with machines emanating vastly different powers of energy which is not proven to be harmless to obtain information which is not proven to be of any clinical value by operators who are not certified as competent to perform the operations”.

Routine prenatal ultrasound (RPU) actually detects only between 17 and 85 percent of the 1 in 50 babies who have major abnormalities at birth. RPU can identify a low-lying placenta (placenta previa). However, 19 of 20 women who have placenta previa detected on an early scan will be needlessly worried: the placenta will effectively move up without causing problems at the birth. Furthermore, detection of placenta previa by RPU has not been found to be safer than detection in labor.

The American College of Obstetricians has concluded that “in a population of women with low-risk pregnancies, neither a reduction in perinatal morbidity and mortality nor a lower rate of unnecessary interventions can be expected from routine diagnostic ultrasound. Thus ultrasound should be performed for specific indications in low-risk pregnancy.

Effects of ultrasound include cavitation, a process wherein the small pockets of gas that exist within mammalian tissue vibrate and then collapse. In this situation “…temperatures of many thousands of degrees Celsius in the gas create a wide range of chemical products, some of which are potentially toxic. These violent processes may be produced by microsecond pulses of the kind which are used in medical diagnosis.” (American Institute of Ultrasound Medicine Bioeffects Report 1988). The significance of cavitation in human tissue is unknown.

Studies have suggested that these effects are of real concern in living tissues:

Cell abnormalities caused by exposure to ultrasound were seen to persist for several generations.

In newborn rats (similar stage of development as human fetuses at four to five months in utero), ultrasound can damage the myelin that covers nerves.

Exposing mice to dosages typical of obstetric ultrasound cased a 22% reduction in the rate of cell division and doubling of the rate of aptosis (programmed cell death), in the cells of the small intestine.

Two long-term randomized controlled trials comparing exposed and unexposed childrens’ development at eight to nine years old found no measurable effect from ultrasound. However, the authors comment that intensities used today are many times higher than there were in 1979 and 1981.

– Excerpted from “Ultrasound Scans: Cause for Concern”

References:

American College of Obstetricians and Gynecologists (ACOG) Routine Ultrasound in Low-Risk Pregnancy. In:ACOG Practice Patterns- Evidence-Based Guidelines for Clinical Issues in Obstetrics and Gynecology. Number 5 August 1997

Association for Improvements in the Maternity services (AIMS)- AIMS UK. Ultrasound Unsound? AIMS Journal vol 5 no 1, spring 1993.

American Institute of Ultrasound Medicine Bioeffects Report 1988. J Ultrasound Medicine 7S1-S38. Sept 1988

Beech BL. Ultrasound- unsound? Talk at Mercy Hospital, Melbourne, April 1993

Brand IR, Kaminopetros P, Cave M et al. Specificity of antenatal ultrasound in the Yorkshire region: a prospective study of 2261 ultrasound detected anomalies. Br J Obstet Gynaecol 1994. Vol 101, no5. pp 392-397

Brookes, A. Women’s experience of routine prenatal ultrasound. Healthsharing Women: The newsletter of Healthsharing Women’s Health Resource Service. Vol 5, no’s 3 & 4. Dec 1994- March 1995.
Campbell JD et al Case-control study of prenatal ultrasonography in children with delayed speech. Can Med Ass J 1993 vol 149 no 10 pp1435-1440

Chan FY. Limitations of Ultrasound. Paper presented at Perinatal Society of Australia and New Zealand 1st Annual Congress, Freemantle 1997

Davies J et al. Randomised controlled trial of doppler ultrasound screening of placental perfusion in pregnancy. Lancet 1992;340:1299-1303

De Crespigny L, Dredge R. Which Tests for my Unborn Baby, Revised Edition. Oxford University Press, Melbourne 1996.

Ellisman MH, Palmer DE, Andre MP. Diagnostic levels of ultrasound may disrupt myelination. Experimental Neurology 1987 vol 98 no 1 pp78-92

Ewigman BG, Crane JP, Frigoletto FD et al. Effect of prenatal ultrasound screening on perinatal outcome.RADIUS study group. N Engl J Med . 1993 vol 329, no 12, pp821-7

Geerts JGM, Brand E, Theron B. Routine obstetric ultrasound in South Africa: cost and effect on perinatal outcome- a prospective randomised controlled trial. Br J Obstet Gynaecol 1996. Vol 103. pp501-507

Kieler H, Axelsson O, Nilsson S, Waldenstrom U. Comparison of ultrasonic measurement of biparietal diameter and last menstrual period as a predictor of day of delivery in women with regular 28 day cycles. Acta-Obstet-Gynecol-Scand, 1993 vol 75 no 5 pp 347-9
Kieler H, Axelsson O, Haguland B, et al. Routine ultrasound screening in pregnancy and the children’s subsequent handedness. Early Hum Dev 1998 , vol 50 no 2, pp233-245

Kieler H, Ahlsten G, Haguland B et al. Routine ultrasound screening in pregnancy and the children’s subsequent neorological development. Obstet Gynecol 1998 vol 91 5 (pt 1) pp750-6
Kieler H, Cnattingius S, Haglund B et al. Sinistrality- a side-effect of prenatal sonography: A comparative study of young men.Epidemiology 2001:12 (6):618-23

Luck CA. Value of routine ultrasound scanning at 19 weeks: a four year study of 8849 deliveries. BMJ 1992, vol 34, no 6840, pp1474-8

Liebeskind D, Bases R, Elequin F et al. Diagnostic ultrasound: effects on the DNA and growth patterns of animal cells. Radiology 1979 vol 131, no1, pp 177-184

Lorenz RP, Comstock CH, Bottoms SF, Marx SR. Randomised prospective trial comparing ultrasonography and pelvic examination for preterm labor surveillance. Am J Obstet Gynecol 1990 vol 162 no 6 pp 1603-1610

Marinac-Dabic D, Krulewitch CJ, Moore RM Jr. The safety of prenatal ultrasound exposure in human studies. Epidemiology 2002 May; 13(3 Suppl):S19-22

Meire HB. The safety of diagnostic ultrasound (commentary). Br J Obstet Gynaecol 1987 vol 94, pp1121-1122

MIDIRS. Informed Choice for professionals leaflet no 3. Ultrasound screening in the first half of pregnancy: is it useful for everyone? MIDIRS and the NHS centre for Reviews and Dissemination. 1996

Mole R. Possible hazards of imaging and Doppler ultrasound in obstetrics. Birth 1986 vol 13, pp329-37

Neilson JP.Ultrasound for fetal assessment in early pregnancy (Cochrane Review). In:The Cochrane Library, Issue 2, 2002. Oxford” Update Software

New Scientist Shadow of doubt 12 June 1999, p23
Newnham J, Evans SF, Michael CA et al. Effects of frequent ultrasound during pregnancy: a randomised controlled trial. Lancet 1993, vol 342, no 8876, pp887-91

Newnham JP et al. Doppler flow velocity wave form analysis in high risk pregnancies: a randomised controlled trial. Br J Obstet Gynaecol, 1991,vol 98 no 10, pp956-963

Oakley Ann The history of ultrasonography in obstetrics. Birth, 1986 vol 13, no 1, pp 8-13

Odent M. Where does handedness come from? Primal Health Research Quarterly 1998, vol 6 no 1.

Olsen O et al. Routine ultrasound dating has not been shown to be more accurate than the calendar method. Br J Obstet Gynaecol 1997, Vol 104 No 11 pp1221-2

Rothman, Barbara Katz. The Tentative Pregnancy: Amniocentesis and the Sexual Politics of Motherhood. (2nd ed) Pandora 1994
Saari-Kemppainen A, Karjalainen O, Ylostalo P et al. Ultrasound screening and perinatal mortality: controlled trial of systematic one-stage screening in pregnancy. The Helsinki ultrasound trial. Lancet 1990 vol 336, no 8712. pp 387-391

Salvesen KA, Bakketeig LS, Eik-nes SH et al. Routine ultrasonography in utero and school performance at age 8-9 years. Lancet 1992, vol 339 no 8785 pp 85-89

Salvesen KA, Vatten LJ, Eik-nes SH et al. Routine ultrasonography in utero and subsequent handedness and neurological development. BMJ 1993: vol 307 no 6897 pp159-64

Salvesen KA, Ein-nes SH et al. Ultrasound during pregnancy and subsequent childhood non-right handedness- a meta-analysis. Ultrasound Obstet Gynecol 1999; 13(4) 241-6.

Sparling JW, Seeds JW, Farran DC. The relationship of obstetric ultrasound to parent and infant behavior. Obstet Gynecol 1988 vol 72 no 6. pp 902-7

Senate Community Affairs Reference Committee. Rocking the Cradle- A Report into Childbirth Procedures. Commonwealth of Australia 1999

Stark CR, Orleans M, Havercamp AD et al. Short and long term risks after exposure to diagnostic ultrasound in utero. Obstet Gynecol, 1984, vol 63 pp 194-200

Taylor KJW A prudent approach to ultrasound imaging of the fetus and newborn. Birth 1990. Vol 17 no 4, pp218-223

Testart J, Thebalt A, Souderis E, Frydman R. Premature ovulation after ovarian ultrasonography. Br J Obstet Gynaecol, 1982, vol 89, no 9, pp 694-700

Thacker SB. Quality of controlled clinical trials. The case of imaging ultrasound in obstetrics: a review. Br J Obstet Gynaecol, 1985 vol 92, no 5, pp 437-444

Wagner M. Ultrasound; More harm than good? Mothering magazine Winter 1995

Watkins D. An alternative to termination of pregnancy. The Practitioner,1989, vol 233 no 1472,pp990, 992.

 

CHIROPRACTIC DURING PREGNANCY

About 90% of pregnant women experience back and/or low back pain, which is result of weight gain, changed of center of gravity and altered biomechanics during pregnancy. Many pregnant women have reported having sciatica along with low back pain, which shoots down behind their leg. Utilizing any type of medical invasive approach or pain killers is out of question, because it could affect safety of the baby.

It is very important to understand, pregnant woman’s spine and pelvis can be easily misaligned due to release of RELAXIN hormone. During pregnancy, the placenta produces a hormone called RELAXIN that helps your whole body, especially with you pelvis flexibility. While RELAXIN is preparing your body for delivery, its causing pain in the back and lower back. Those delicate nerve roots are being crushed by misaligned vertebra in the spine.

Chiropractic has been a gold standard in treating back and low back pain without medication or invasive procedures safely and effectively. Chiropractic care during pregnancy not only great in eliminating your back/low back pain, but also improve balance and alignment in your spine and pelvis. This can help your baby assume optimal birthing position and reduce the risk of having a breech baby.

EPIDURALS ARE USELESS

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The epidural is standard medical practice for patients with sciatic back pain. It’s an injection of corticosteroids that is given to improve movement and reduce pain. Although it’s a treatment that has been routinely given to patients for the past 50 years, researchers have only now discovered that the procedure is virtually useless. It has some short-term benefit, which can last for two to six weeks maximum, but the American Academy of Neurology says that it is no longer a recommended treatment.

The change of heart is based on a study of 300 patients with back pain, which found that the steroids offered no long-term benefits. There was no pain relief or improved movement after 24 hours, nor again at 3, 6, 12 month intervals. The only improvement was recorded between two and six weeks, and this was so insignificant that it was no better than that offered by painkillers such as bupivacaine. Overall, epidural injections didn’t help the patient in his day-to-day functioning, his need for surgery, or his long-term pain.

Source: Journal of American Medical Association, 2007;297:1757-8

The Epidural Epidemic

Epidurals during birthing have become so routine, as mothers are being convinced that pain during labor is unnatural. Convinced that they should not endure pain during the birth process, mothers are set up to believe in a drug instead of their bodies’ own natural capabilities. Sixty four percent of certified nurse midwives reported concern over the increased number of their clients who desire epidural anesthesia, and a majority of certified nurse-midwives surveyed (53%) reported a negative attitude toward the increased use of epidurals.

We started including questions about births years ago on our children’s case history and 9 times out of 10, mothers will check off that they had a “natural childbirth” and in the next question, they check off that they had an epidural. In other words, if they delivered vaginally, and their eyes were open, they are being led to believe that they delivered naturally.

What is not being provided to the parents is the increased complications which are a result of epidural usage. The PDR cautions that “local anesthesia rapidly crosses the placenta…and when used for epidural blocks, anesthesia can cause varying degrees of maternal, fetal and neonatal toxicity.” It continues, “this toxicity can result in the following side effects: hypotension, urinary retention, fecal and urinary incontinence, paralysis of lower extremities, loss of feeling in the limbs headache, backache, septic meningitis, slowing of labor, increased need for forceps and vacuum deliveries, cranial nerve palsies, allergic reactions, respiratory depression, nausea, vomiting and seizures.” Many of these side effects result in multiple complications. For example, maternal hypotension causes bradycardia (decreased heart rate) in the fetus. This altered heart rate can lead to fetal distress and operative deliveries. This has led doctors to warn “a high concentration anesthetics and epinephrine should be avoided, as they may influence labor.”

Things To Know About Epidurals:

Causes longer labors with slower progress.

Can cause fevers in mothers during childbirth.

Increase use of pitocin by as much as 3 ½ times, which causes slow and irregular contractions. Increases use of antibiotics in your baby by as much as 4 times.

Increases use of forceps by as much 4½ – 20 times.

Causes neonatal jaundice due to altered red blood cells.

Increases the incidence of birth trauma due to the use of mechanically assisted deliveries.
Causes adverse behavioral effects of the neonate.

In order to bring about a reversal in epidural usage, mothers must become educated not only on its potential side effects, but on their bodies’ own ability to give birth naturally. The overwhelming fear associated with birth has become a learned behavior in our culture. Fear causes additional muscular tension in the body, resulting in decreased blood supply to organs and therefore impaired uterine function. It is our privilege and obligation as Chiropractors to care for these women throughout their pregnancies, offering them encouragement and educating about choices for their upcoming experience. I have been told by many chiropractors (and have heard it in our own practice) how women look forward to their visit with us because we treat the process of pregnancy with respect, and we enhance the mothers confidence in her own innate abilities.

References:
Graninger EM; McCool WP. Nurse-midwives’ use of and attitudes toward epidural analgesia. J Nurse Midwifery 1998; 43(4):250-61
1996 Physicians Desk Reference
Stavrou C; Hofmeyr GJ; Boezaart AP. Prolonged fetal bradycardia during epidural analgesia. Incidence, timing and significance. S Afr Med J 1990; 77(2):66-8
Thompson TT; Thorp JM Jr; Mayer D; Kuller JA; Bowes WA Jr . Does epidural analgesia cause dystocia? J Clin Anesth 1998; 10(1):58-65
Studd JW; Crawford JS; Duignan NM; Rowbotham CJ; Hughes AO. The effect of lumbar epidural analgesia on the rate of cervical dilatation and the outcome of labour of spontaneous onset. Br J Obstet Gynaecol 1980; 87(11):1015-21
Alexander JM; Lucas MJ; Ramin SM; McIntire DD; Leveno KJ. The course of labor with and without epidural analgesia. Am J Obstet Gynecol 1998; 178(3):516-20
Lieberman E, Lang JM, Frigoletto F Jr, Richardson DK, Ringer SA, Cohen A, Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. Pediatrics 1997; 99(3): 415-9
McRae-Bergeron CE; Andrews CM; Lupe PJ. The effect of epidural analgesia on the second stage of labor. AANA J 1998; 66(2):177-82
Clark DA; Landaw SA. Bupivacaine alters red blood cell properties: a possible explanation for neonatal jaundice associated with maternal anesthesia. Pediatr Res 1985; 19(4):341-3
Town A. Latent spinal cord and brain stem injuries in newborn infants Develop Ed Child Neural 1969, 11; 54-68
Menticoglou SM; Perlman M; Manning FA; High cervical spinal cord injury in neonates delivered with forceps: report of 15 cases. Obstet Gynecol 1995; 86(4 Pt 1):589-94
Murray AD; Dolby RM; Nation RL; Thomas DB. Effects of epidural anesthesia on newborns and their mothers. Child Dev1981; 52(1):71-82

Resolution of Breech Presentation With Chiropractic Care

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.

Adjusting Infants? Certainly!

Most hospital births include unnecessary trauma. The routine procedures of technological birth (anesthesia, maternal position, a fearful environment) all contribute to increase in complications and often result in invasive, traumatic births. As we are seeing in the US, the startling rise in c-section deliveries is a good indication that these routing procedures are not leading to safer more natural births but rather to the practice of more invasive, unnatural procedures. Infant and maternal mortality rates are rising, not declining. Technology is not necessarily providing safer care.

A c-section delivery has as much, if not more, trauma than a vaginal birth. The pull force on the baby’s head and neck during the c-section may be considerably greater than a regular vaginal birth because the uterine muscles of the mother are not assisting the delivery process. Most moms who have had a c-section describe a pulling and tugging sensation as the baby was being taken out of the belly. This pulling (which sometimes even lifts the mother from the table) is the amount of force that is pulling on the baby’s fragile spine. Pulling, stretching, twisting the baby’s spine during delivery is known to cause nerve system stress. Mechanical devices such as forceps and vacuum contribute excessive stresses to the baby’s cranium, spine and nerve system.

It is my suggestion for you to find a Doctor of Chiropractic in your area who cares for infants. I believe all babies should be checked by a qualified chiropractor right after birth, especially s-section babies who may need additional cranial care. Also, for the future pregnancies, you may want to get under regular chiropractic care as well it will help restore normal biomechanical function to your pelvis throughout pregnancy and facilitate a safer, easier birth in the future.

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