A Prospective, Longitudinal Health Outcomes Study of Pregnant Women and Children Undergoing Subluxation Based Chiropractic Care

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A Prospective, Longitudinal Health Outcomes Study
of Pregnant Women and Children Undergoing
Subluxation Based Chiropractic Care

• Matthew McCoy, DC, MPH
• Pamela Stone, DC, CACCP
• Christie Kwon, MS, DC
• Maggie Ashworth, DC
• Brandi Ancrum, MPH
• IRAPS 2011

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Introduction

• The primary focus of chiropractic care is the
  location, analysis and correction of vertebral
  subluxations.
• Vertebral subluxations may cause muscular and
  ligamentous imbalance, interfere with
  neurological function and inhibit the optimal
  functioning of the body.

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The Webster Technique

• Developed by Dr. Larry Webster in 1978
• Misalignments of the sacrum cause contraction of
  pelvic muscles and ligaments, and increase
  external forces on intrauterine pressure.
• Any malposition of the baby may indicate the
  presence of sacral subluxation and therefore
  intrauterine constraint.

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The Webster Technique

• The adjustment relieves musculoskeletal causes of
  intrauterine constraint, allowing the baby to
  adjust to the most natural and comfortable
  position.
• High reported success rate of the baby turning to
  the normal vertex position in expectant mothers
  presenting breech, transverse, and posterior.

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Fetal Presentations

• Cephalic
• Posterior

• Transverse
• Breech

www.webmd.com
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Cesarean Sections

• Common reasons include malpresentation, emergency
  complications, and patient preference.
• CDC National Center for Health Statistics
  reported a 31.8 C-section rate nationwide
  (2007).
• A 2003 CDC study demonstrated the rate of
  cesarean delivery was 27.5 nationwide, and 23.5
  for low-risk women. The repeat rate of C-section
  was 89.4 and 88.7 overall and in low-risk
  women, respectively.

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Research

• RA Pistolese1
• 2002 survey of ICPA member chiropractors
• 112 surveys returned from 1047 ICPA members (11)
• 82 success rate in relieving intrauterine
  constraint using Webster Technique.
• Author suggests possible benefit in avoiding the
  costs and/or risks of external cephalic version,
  cesarean section, or vaginal trial of breech,
  associated with fetal malpresentation.

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Research

• J Alcantara , L Mullin2
• Retrospective study of 30 patients in one
  chiropractic office
• Avg age 30.93 years (age range 20-46 years)
• Avg gestation 34.4 weeks (range 29-39 weeks)
• Avg number of visits 3.7 (range 1-9 visits)
  over 8.6 days (range 2-28 days)
• Fetal malposition/malpresentation consisted of
• Facial position 1
• Transverse position 4
• Posterior lie position 11
• Breech position 14
• All pregnancies corrected after using Webster
  Technique, verified by ultrasound.  

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Research

• D Drobbin, C Welsh3
• Case study of a 41 year old pregnant female
  presenting with breech fetus at 36 weeks.
• Webster chiropractic adjustments and manual
  trigger point therapy were used.
• After 5 adjustments, the fetal position turned
  from breech to vertex.
• Findings noted via pre- and post-ultrasonography
  and Leopold's Maneuver.

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Research

• Thomas JC 4
• Case study of a 28-year-old woman presenting with
  a breech fetus at 34 weeks.
• Evidence of intrauterine constraint from
  sacroiliac subluxation and trigger points of the
  round ligament were found.
• Post-adjustment evaluation demonstrated removal
  of the sacroiliac subluxation, relaxation of the
  trigger points along the round ligament, and a
  cephalic presentation of the fetus.

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Hypotheses

• Through reduction of vertebral subluxation,
  chiropractic care will alleviate complications
  affecting quality of life for the pregnant woman
  and the developing child.
• Adjustments of pregnant women decrease
  intrauterine constraint, restore pelvic balance
  and function, and prevent breech births and
  reduce cesarean deliveries.
• This study explores the safety and efficacy of
  Webster Technique in chiropractic care for
  pregnant women.

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Methods

• A retrospective study of 78 pregnancies in 77
  subjects, to assess the outcomes of regular
  subluxation-based chiropractic care on
  childbirth.
• Chiropractic adjustments, including Webster
  Technique, were delivered based on specific
  analysis to reduce vertebral subluxations.
• All care took place at a private chiropractic
  clinic in Kennesaw, Georgia.

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Methods

• Key data points
• Time in gestation period when chiropractic care
  commenced
• Method of delivery of any previous births
• Number of adjustments delivered
• Whether the fetus originally presented in a
  breech, posterior, or transverse presentation,
  and if it turned to vertex
• The type of delivery

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Results

• No pregnant female patients of the practice were
  excluded.
• There was no control group available for this
  outcomes study.
• All patients included in this study were pregnant
  at the beginning of chiropractic care or became
  pregnant during care.
• Twenty-one of seventy-eight women were under
  chiropractic care prior to pregnancy.

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Results

• Sixty-two subjects continued chiropractic care
  throughout the duration of their pregnancy,
  regardless of presentation.
• Forty-four women had previously delivered
  children.
• Three subjects were able to have successful
  vaginal births after c-section (VBAC).
• No reports of adverse outcomes among the women
  or the children in this analysis.

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Delivery Outcomes
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Results

• Thirteen breech, transverse, or posterior
  presentations were encountered.
• Avg number of adjustments 16.46 (range 2-46).
• Three women became pregnant after the start of
  care.
• Seven patients began care in the third trimester
  of pregnancy (28 weeks or later).

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Results

• All but one of the fetuses that had been in
  breech presentation turned following chiropractic
  care (92.3).
• Adjustments beginning at 37 weeks of gestation
  failed to turn this one fetus, which was also
  delivered surgically.
• 76.9 of originally breech fetuses were delivered
  vaginally

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Outcomes of Breech Presentation
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Discussion

• The majority of the participants presented a
  vertex fetus at the time of parturition, and were
  therefore able to deliver vaginally.
• At the time of delivery, seventy-seven of the
  seventy-eight pregnancies under care had vertex
  presentations.
• Only one breech fetus failed to turn - though
  care did not begin until after 37 weeks
  gestation.
• 67.6 of women in this retrospective study
  delivered vaginally.

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Conclusion

• Specific chiropractic analysis and adjustment of
  the sacrum, employing the Webster Technique, was
  safe and beneficial during pregnancy in this
  practice based setting.
• Chiropractic adjustments, including Webster
  Technique, may be used to detect imbalance and
  optimize pelvic biomechanics.

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Conclusion

• It is suggested that reduction and/or removal of
  interference to the nervous system via
  subluxation correction optimizes conditions for
  both the mother and baby.
• Continued studies of the safety and efficacy of
  chiropractic in general, and Webster Technique
  specifically, are encouraged.

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Next Steps

• Plans to launch a related prospective study are
  underway by the researchers of the study.
• Further explore the safety and efficacy of
  Webster Technique in chiropractic care for
  pregnant women.
• Aim to increase the sample size of available data.

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Acknowledgements

• Life University Office of Sponsored Research and
  Scholarly Activity
• Dr. Matthew McCoy
• Dr. Pamela Stone
• Ms. Maggie Ashworth

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References

• Pistolese RA. The Webster Technique a
  chiropractic technique with obstetric
  implications. J Man Phys Ther. 2002
  Jul-Aug25(6)E1-9.
• Alcantara J, Mullin L. Patients with malposition
  and malpresentation pregnancies cared for with
  the Webster In-Utero Constraint Technique a
  retrospective analysis. WFC and FCER Biennial
  Research Conference 2005 Jun 16-18 Sydney, AU.
• Drobbin D, Welsh C. Chiropractic care of a
  pregnant patient presenting with intrauterine
  constraint using the Webster In-Utero Constraint
  Technique a retrospective case study. J Ped Mat
  Fam Health. 200921-3.
• Thomas JC. The Webster Technique in a 28 year old
  woman with breech presentation subluxation. J
  Vert Sublux Res. 2008 Apr 71-3.
• Images from http//www.webmd.com/baby/healthtool-f
  etal-positions-slideshow