Back Pain and Pregnancy

What Do You Want To Know?

2012-01-16T17:19:00.000-08:00

I have come to the point in this blog, where I realize that I have been having all of the fun. I get to write about whatever comes into my head, and whatever I feel you should want to know. But, that isn't particularly fair. You come and read my ramblings with no input whatsoever. One might call it a dictatorship!

Today it ends! You get to ask any questions you may have about pregnancy, chiropractic, babies, nutrition...you name it and I'll answer it. Just post your question in the comment section and my next post will be answers.
Pick my brain and I'll tell you what I know (and if I don't know, I'll tell you
where you can find out).
Deal? Good!

What is SI or Sacroiliac Joint Dysfunction?

2012-01-05T08:44:00.000-08:00

SI pain is definitely the most common complaint that I have from pregnant women. Hormones (primarily relaxin) are the all too familiar culprit! Often SI pain begins during pregnancy and becomes a recurrent problem with subsequent pregnancies. However, chiropractic care during pregnancy can reduce the likelihood of SI joint dysfunction occurring and most certainly can help alleviate the pain associated with it.

First off, let’s look at the sacroiliac joint.

At the lower end of the spine, just below the lumbar spine lies the sacrum. The sacrum is a triangular shaped bone that is actually formed by the fusion of several vertebrae during development. The sacroiliac (SI) joint sits between the sacrum and the iliac bone (thus the name “sacroiliac” joint). You can see these joints from the outside as two small dimples on each side of the lower back at the belt line.
The SI joint is held together by several large, very strong ligaments. Because the pelvis is a ring, these ligaments work somewhat like the hoops that hold a barrel together
The SI joint hardly moves in adults. During the end of pregnancy as delivery nears, the hormones that are produced cause the joint to relax. This allows the pelvis to be more flexible so that birth can occur more easily. Multiple pregnancies seem to increase the amount of arthritis that forms in the joint later in life

Taken from this great site http://www.orthogate.org/patient-education/lumbar-spine/sacroiliac-joint-dysfunction.html

What are the symptoms of SI pain or dysfunction?

Symptoms include:

Localized pain on the left or right side of your lower back. The pain is an intermittent to constant ache but sometimes occasional to frequent sharp pain. (Really specific, I know)
The sharp pain occurs especially with certain movements (even as minimal as shifting your weight). It can be so acute that many patients are not able to perform basic daily activities like turning over in bed, bending over to put on shoes or brush teeth, or getting in and out of the car.
The sharp pain usually stays local or travels into the buttock but can travel as far as the back of the thigh or around to the front. It does not travel into or past the back of the knee.
The pain may be worse upon rising from sitting or lying down and decrease after walking for a few minutes.
There is often tenderness when palpating the SI joint itself and spasm of the gluteal (buttock) musculature.

How does SI dysfunction differ from sciatic pain?

They are very similar. In fact they are so similar that many medical doctors mistake SI dysfunction for sciatica. However there are two important distinctions:

SI pain will not go into or past the knee, while sciatica often does.
The ache of SI pain is primarily in the SI joint itself and the sharp pain always shoots from the SI joint while sciatic pain can begin higher up in the low back (lumbar spine) or in the muscles of the buttock with no tenderness of the SI joint.

The treatment for each is quite different, so it is important to get an accurate diagnosis so that you get the proper treatment.

How is SI different from PSD?

SI pain is localized in the back of the pelvis while PSD is in the front of the pelvis. All three joints (two SI joints and one pubic symphysis joint) make up the pelvic ring and need to be able to separate during the birth process to allow the baby to pass through the birth canal (assuming a vaginal delivery). Therefore, all three joints will be affected by the hormone relaxin and can become hypermobile (too much movement) during pregnancy that results in pain.

Tips to reduce SI or pubic symphysis pain

There are two things to consider to reduce SI or pubic symphysis pain:

Reduce stress on the joints.
- This is done by avoiding certain activities and postures. For example, don’t do anything that causes the knee to cross the midline or puts more pressure on one side of the body than the other. Here are some examples:
- Don’t cross your leg when sitting (keep both feet on the floor)
- Don’t stand with one hip sticking out to the side (keep equal weight on each leg)
- Don’t vacuum in the fencer’s (or lunge) stance (keep both feet next to each other, or better yet, have your husband vacuum instead!)
- Sleep with a pillow between your legs
- Don’t slump when sitting nor sit in a semi-reclined position (sit straight up or lie completely down)
- When rolling over in bed keep your knees locked together
- When getting in and out of your car keep your knees together (get in by backing in and then swinging your legs into the car)
- Avoid bending forward, especially for sustained periods, without supporting yourself with your arm (for example, after brushing your teeth support your weight on the counter as your lean forward to rinse)
- Avoid walking up and down hills
Reduce the mobility of the joints.
- This is most easily accomplished by wearing a sacroiliac belt. I personally like the Serola brand the best, but there are many good ones out there that work well with some being more comfortable than others. The key is to make sure the belt goes around the SI joints (rather than a belly support band that is worn higher up).

Guest Blogging

2011-11-14T21:34:00.001-08:00

Today I am guest blogging over at Enjoy Birth a great blog about pregnancy. I really like the emphasis placed on empowering mothers and enjoying this wonderful time of life. Please visit and leave a comment!
Dr. Richards

How to pick the right doctors for your pregnancy.

2011-10-27T08:00:00.000-07:00

Ask around.

Odds are that you have a friend or two who thinks their doctor is great. Talk to childbirth teachers, your general practitioner, or your chiropractor. If you are already seeing a gynecologist, find out if they practice obstetrics as well.

Do you like where your doctor has hospital rights?

When my wife had our first baby, she delivered at a large area hospital. We both disliked the “move 'em in, move 'em out” mentality. So despite a great OB, she switched to a different practice for our next two. She delivered in a smaller hospital where we felt we got a lot more individual attention. However, everyone values different things.

Some things to think about:

Does my hospital have a high level neonatal intensive care unit? Does my hospital have 24 hour anesthesiologists? Do I have an option for labor tubs or showers?

Does my doctor have similar views or respect mine?

What are your doctor’s views on natural childbirth? Inductions? Elective c-sections? Fetal monitoring? Episiotomy? Be sure to discuss these things with you doctor early on, so you are completely comfortable later. In the whirlwind of giving birth, you don’t want to find out you are on different pages.

Practice Size?

Do you like to see the same doctor every prenatal visit? Would you like more than one opinion? Do you mind waiting or rescheduling a visit if your solo practitioner is at the hospital? Does the practice include midwives?

Chiropractor?

Look for a chiropractor who has advanced education in pregnancy and pediatrics. This doesn’t mean that a general chiropractor can’t do a great job, but if you are starting out check out the American Pregnancy Association for a great recommendation.. Before making an appointment, call the office and ask if the practice sees a lot of pregnant women. Ask about the techniques used and if the doctor is certified in the Webster Technique.

It may seem like a lot of work to do at the beginning of your new adventure, but these tips will pay bid dividends in the end.

Any other good ideas? Leave a comment!

Swollen Feet in Pregnancy

2011-10-20T18:41:00.000-07:00

Swollen feet seem like an unfair jab toward the end of pregnancy. You have heartburn, you visit the bathroom multiple times each night, your baby is poking and prodding from the inside, you can’t get up without grunting, even your maternity clothes are looking too small, oh and by the way……….now your feet are too swollen to fit into the last vestige of your former wardrobe. (My wife’s words.)

Swollen feet and ankles are an annoyance for some and, for a few, very painful. Most of my pregnant patients ask about the swelling and a few have shown up in the winter wearing flip flops. So here goes:

What causes the swelling?

Edema is the medical term for an increase of fluid within the tissues of the body. In pregnancy, edema occurs because the volume of blood in the body doubles. (That extra volume of blood is needed to nourish your baby) This extra fluid needs to go somewhere, and gravity does its job. Now, there are a few more factors at play here. Increased weight gain and our friend relaxin (which allows the bones to more easily spread) complete the perfect storm.

What can you do?

Edema from pregnancy is temporary and it most cases fairly benign. That doesn’t mean it isn’t annoying, so, here are some things you can do to cope in the meantime:

Put your feet up periodically during the day. If you work at a computer, see if it is feasible to rest your feet on an adjacent chair.
Drink plenty of water and don’t cut down on salt. The body has a very delicate balance between sodium and water, and cutting down on either can actually make swelling worse.
Don’t cross your legs. Compressing blood flow will make the swelling worse.
Wear comfortable shoes. Sorry, no heels!
It is okay to wear your regular shoes (some women say that the compression actually eases the ache) but be warned, that once you take the shoes off…they aren’t going back on until the next morning.

If you feel more comfortable in a larger size, make sure the shoes are low heeled, and supportive. Go shoe shopping in the evening when your feet are the most swollen!
Do foot exercises. Scrunch your toes up for a count of five and then relax. Do heel lifts.
Make your husband rub your feet!

Your swelling should be a distant memory within a week or two after delivery. However, it is common for feet to stay a half size bigger after pregnancy.

*If you notice swelling in places other than your feet and ankles (especially in your face) or very sudden swelling, see your doctor immediately. This can be a sign of pre-eclampsia.

Is it Pubic Symphysis Disorder or round ligament pain?

2011-10-11T19:14:00.000-07:00

Pubic Symphysis Disorder (PSD or SPD) is a painful condition felt in the pubic area and is often mistaken for round ligament pain. Unfortunately not a lot of OBs will give much heed to PSD (or even round ligament pain) because they cannot do much about it. However, being able to distinguish the two will allow you to choose a more effective remedy in reducing your pain.

1. Where is the pain?

PSD: Almost always the pain is felt at the pubic symphysis joint—the bony part at the top of the pubic area—and will be very sore to the touch. The pain usually radiates down into the groin and will often also radiate out into the hip joints.

Round Ligament: The pain is usually felt in the lower abdomen and slightly off to one (or both) sides. It often radiates into the groin and/or around the sides to the flanks or hips.

2. What is the quality of the pain?

PSD: Sharp and intense. For some the pain feels like they are breaking open from the inside or their hip bones are grinding together. Oftentimes a clicking sound is heard when walking or moving.

Round Ligament: Also sharp and can be intense. Many times the pain happens suddenly.

3. When is the pain felt?

PSD: When standing, walking, shifting while sitting, and intensely when rolling over in bed. The pain continues even after stopping the movement.

Round Ligament: When performing sudden movements and usually diminishes if not goes away after a few seconds.

If you still aren't sure which it is here is a simple test: stand on one leg (please use your arms to support yourself when doing this).

PSD: You will experience increased pain or even an inability to stand on one leg (the other leg may give out). You will find it difficult with activities like walking up stairs, raising one leg to put on pants, or getting in/out of a car.

Round Ligament: You will experience minimal, if any, change in pain and should find it easy to stand on one leg.

Here is a side note: Sciatica and sacroiliac joint dysfunction (SIJD) are sometimes co-conditions of PSD. The presence of sciatica or SIJD does not rule out PSD, but it doesn’t guarantee it either.

6 Ways To Get The Most Out Of Your Fish Oils

2011-10-05T18:16:00.000-07:00

Take with meals or immediately after meals
Food triggers the release of enzymes (to digest the food) which will also work to break down the fish oil so they can be absorbed by the body. (An added bonus: You are less likely to have fishy burps!)
Take your fish oils with a fatty meal.
The fats in a meal will trigger the release of bile and fat-specific enzymes (called lipases). The bile breaks apart the globules of fat (like dish soap does to grease) and allows the enzymes to break down the fat molecules. Since fish oil is also fat, the process works on it as well.
Don’t take fish oils when eating oatmeal.
The fiber in the oatmeal absorbs the oil so it's not available for your body.
Take a high quality fish oil.
Take one that has been quality tested for low levels of mercury, lead, and arsenic, and have at least 60% omega-3 fatty acids. Better brands will always tell you fish species and location and are molecularly distilled to remove heavy metal toxins.

I recommend Nordic Naturals, Zone Labs Omega Fish Oil,and Carlson Lab Fish Oils. My family uses Nordic Naturals. It has a lemon or strawberry flavor that makes it palatable to the kids, and if you have an odd burp here or there, it tastes good. Nordic Naturals is also the official omega-3 of the American Pregnancy Association.
Don’t skimp on your fish oil
You should be consistently taking fish oil every day at a minimum dosage. Research states that pregnant women should be consuming a minimum of 300 mg of DHA a day (not total Omega-3s, which will be a higher amount).
Don’t think that the added DHA in your prenatal vitamin will cover you!
The DHA in prenatal vitamins has been broken down from its natural triglyceride form in order to be incorporated into a solid multivitamin. DHA in that form is not as bioavailable as it is in fish oils. As new research finds, you must take EPA with the DHA for it to work properly Link for more info

For more technical and indepth information visit my latest article here

Colic and Chiropractic

2011-10-02T21:45:00.000-07:00

Do you have a baby with colic? We had one, and it still sends shivers down my spine! He is a healthy well adjusted 10 year old now, but there was a time we called him our “incredible screaming machine”. Nothing else can pierce your very soul like a screaming, hurting child. You are desperate to help him and helpless at the same time.We tried all of the various medications (we didn’t know what else to do) and they each were relatively ineffective and we worried about side effects.

When our 3^rd son was born, he was set to rival number 1, but I was armed this time with a chiropractic degree and a lot of experience. We didn’t use drugs, I adjusted him a few times and gradually the screaming for hours on end diminished.

Colic is defined as unexplainable and uncontrollable crying in babies from 0 to 3 months old, more than three hours a day, more than three days a week for three weeks or more, usually in the afternoon and evening hours. In other words, no one really knows what causes it or what it really is. I think it is probably mostly gastroesophogeal reflux with a few other unknown conditions thrown in. (But that’s just my best educated guess!)

Colic is such a common condition of childhood that it is said to affect some 16% to 26% of children in their first year of life. Most parents are told that this is a harmless rite of passage for your baby, however the condition is stressful to both parents and baby alike. Parent-child interactions have been found to be less than optimal when a child has colic. Afflicted families experience more problems in their daily functioning than families without colicky infants.

If you visit your child’s pediatrician you will most likely be given simethicone drops, some form of an antacid, or a stronger drug like Prevacid. (We tried them all, and to no avail.) There are a couple of problems with this treatment.
1) No drug is without side effects (Adverse effects associated with these medications include drowsiness, constipation, and diarrhea, as well as more serious effects such as apnea, seizures, and coma.)

2) Randomized controlled clinical trials have found them to be ineffective!

At this point, you are probably crying right along with your baby…but don’t despair.

Chiropractic treatments have been found to reduce colic symptoms and severity. Here are 2 of the studies:

· A study conducted by N. Nilsson, interviewed parents of 132 infants with colic, found that 91% of the parents reported an improvement following an average of two to three patient visits and one week after initiating care.

· M. Klougart and colleagues described 316 infants suffering from colic receiving chiropractic care. Based on an analysis of diaries kept by their mothers and parent interviews, 94% percent of the patients benefited from chiropractic care.

This is great news for parents and babies. As a parent I saw, first-hand, the difference. As a chiropractor I have seen the difference in my patients again and again. Visit my office at w ww.abetterbrain.com

Ear pain? Call the chiropractor!

2011-09-23T14:30:00.000-07:00

If you have a young child you have probably been woken up in the night to find your wee one tugging on his ear. He hurts and you call your pediatrician who gets you in the next morning and starts your child on a course of antibiotics. Within a week your child feels great and you think nothing of it until it happens again.
Many parents are unaware of the variety of options available for the treatment of ear infections, the standard 10 day course of amoxicillin is looking less and less appealing. There is the hassle of medication, the recurrence of the ear infection, and the pain until the antibiotics work. More parents are choosing to call their chiropractor first!

Why Chiropractic for Ear Infections?
Quite simply…It works and it’s safe. Even the American Academy of Pediatrics recommends a watch-and-wait approach, because the evidence-based research about antibiotics is showing that not only are they ineffective at treating ear infections, but they will actually lead to repeated ear infections in your child. In fact a new study published by the American Medical Association showed that antibiotics have little impact on child ear infections. Here is more information

How Does It Work?
The chiropractic adjustment works by relaxing the neck muscles which allows the Eustachian tubes to drain properly. It rarely takes more than 1 visit. Studies have shown that regular chiropractic care can keep away recurring ear infections. Many children who have been told they needed tubes in their ears are able to avoid surgery, by visiting the chiropractor.

Is It Safe?
It is very safe. In fact, antibiotics have more serious side effects than the chiropractic adjustment including rashes, thrush, stomach aches, etc.As Tumaini Coker, MD says in In this article about antibiotics and ear infections. "Prescribing antibiotics early may help cure ear infections a little bit faster, but also raises the risk that children will suffer antibiotic-related side effects such as a rash or diarrhea," Coker said. "Parents and their children may value these different outcomes differently."

Aren’t Antibiotics Just Easier?
Many would say they are (if you can get your child to take them and you remember every single day). However, most ear infections are viral, not bacterial which means that antibiotics won’t help and can cause a lot of harm.

If antibiotics are used too often for things they can't treat — like colds, flu or other viral infections — they become less effective against the bacteria they're intended to treat. Not taking antibiotics exactly as prescribed also leads to problems. For example, if you take an antibiotic for only a few days — instead of the full course — the antibiotic may wipe out some but not all of the bacteria. The surviving bacteria become more resistant and can be spread to other people. When bacteria become resistant to first line treatments, the risk of complications and death is increased. In the United States alone, thousands of people die each year of antibiotic-resistant infections.

So next time, you are woken up in the middle of the night, speed dial your chiropractor instead of your pediatrician.
Visit me at www.abetterbrain.com

Wellness Care for Your Baby

2011-06-03T18:17:00.000-07:00

Recently, I've been asked a lot of questions about chiropractic care for babies, so I thought I'd post a little bit about what happens after the
"big event". Here is a great new study for expectant parents to read:

Two recent survey studies have shown chiropractic care for children is safe, gets results and offers children unexpected health benefits. One survey included data from doctors of chiropractic and the other survey collected data from parents of children under care.
The results of the doctors’ surveys showed that of the 812 clinical cases, 717 indicated experiencing an improvement with their presenting symptoms.

An overwhelming majority of the parents reported that their children’s problems improved with chiropractic care. After 10,249 visits from 1, 176 children, only 17 reported treatment associated aggravations described as soreness and stiffness after the adjustment, the child is “fussy” after the adjustment or a fever or spitting up. No serious complications were reported. “Wellness care” care was reported by 54% of the parents for their child’s visits. Parents of children with colic also found relief.

Both surveys revealed that children experienced added health benefits beyond what they came in for. The three most common additional benefits were: improved immune system function, improved sleep and improved moods in the children.

It’s easier to raise healthy children than to fix broken adults!
for more information about chiropractic care visit www.abetterbrain.com

Do You Want A Longer Labor???

2011-01-26T09:04:00.000-08:00

I have had a number of skeptics in the past few weeks ask me what good chiropractic really does in pregnancy.
I mentioned relief of pain without medication, less breach presentation, ease of movement, lower risk of complications, and was greeted with a "so-what" smile.
I mentioned that studies show, pregnant women who have chiropractic care have shorter labors.
That impressed every single skeptic I spoke with. Who would have thought?

Here's the data
A study done in 1990 showed that women who were under Chiropractic care throughout their pregnancies had reduced labor times. First time moms experienced 25% less time in labor and birth and moms with previous babies averaged 31% shorter labor times.

Not bad at all!

J. Fallon, “The Effect of Chiropractic Treatment on Pregnancy and Labor: A Comprehensive Study,” Abstract of the Proceedings of the 1991World Federation of Chiropractic, Nov./Dec. 1992, Journal of Manipulative and Physiological Therapeutics, Vol. 15, No. 9, p. 614.

For more information about chiropractic care visit www.abetterbrain.com

Although not strictly back pain related.....Importance of Fish Oil in Pregnancy

2010-01-27T19:02:00.000-08:00

Although fish oil or omega-3 fatty acids aren't strictly a back pain issue in pregnancy, I've decided to write a little bit about them because of the myriad questions I get about them and of their importance for the expectant mother.

Now for a little biology lesson:
We all know that an infant gets all of its nutrition from the mother during pregnancy. What a mother eats greatly is passed directly to the baby through the umbilical cord. We all know that it is important to get folic acid for spinal cord development, iron for blood supply, and calcium to help build those little bones. However, you may not know that omega-3 fatty acids are essential for brain development! Pretty important, huh?

If you want all the gory details, read on:
There are 2 important types of omega-3 fatty acids for brain development and enhancement: DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). These fats are long chain fatty acids that we must get from food. (Our bodies aren't able to make them.) When omega-3s are present, the brain is able to function better because it helps build the fatty sheath that surrounds a nerve (called myelin). Myelin speeds up nerve transmission and enables our brain to send more accurate and faster messages to the rest of the body.

*Omega-3 fatty acids make up 70% of a baby's brain and the only way for a baby to obtain these necessary nutrients is from its mother. How the baby's nervous system develops will depend greatly on how much Omega-3s the mother has during her pregnancy.
Now for all the questions I routinely get about fish oil....

Why can't I just eat more fish?
Well, you certainly can. We would all do well to replace meat products in our diet with fish. However, when you are pregnant you want to limit the amount of fish you eat. High levels of mercury in fish such as swordfish, mackerel, and some tunas could cause problems to your unborn baby (called heavy metal toxicity). Those fish should be avoided. According to the FDA only low-mercury fish should be eaten while pregnant and then not more than 2 times per week. However, even eating fish twice a week will not give you a sufficient amount of Omega-3s (it's not even enough for someone who is not pregnant!). So even if you eat fish, you should still supplement with a good omega-3 supplement.
Check out 6 easy tips to getting the most out of your fish oils.

How does my baby benefit from omega-3 fatty acids?
This is one of my favorites because it really amazes people. (It still amazes me!)

Stronger immune system
Better hand-eye coordination
Higher IQ
Fewer behavioral problems
Reduced risks of asthma

Additionally there are great benefits for the mother as well....

Less risk of postpartum depression
Reduced risk of breast cancer
Decreased chance of pre-term labor
Improved cardiovascular health

On the other hand, a deficiency in the omega-3 fats can adversely affect learning, behavior, and vision in infants

I thought omega-3s were only important during breastfeeding?

They are very important during breastfeeding, but they come into play long before the baby is born.
Throughout pregnancy, maternal fatty acid blood levels drop. This results from the growing infant’s need for the fatty acids to build developing brain tissue. This leaves the mother with depleted stores of essential fatty acids for her own nervous system health (her body will actually strip her own nerves of the fatty acid to provide it to her infant during pregnancy and while breastfeeding). When her system is depleted of these fatty acids, they are not easy to replenish.

As a result of this, with each pregnancy, omega-3 supplies in mother and, therefore, baby, are decreased. Mothers with low fatty acid levels have been shown to have higher levels of postpartum depression because of the difficulty the nerves have to pass accurate messages. Because of this, it becomes even more important for mom to supplement her omega-3 intake during pregnancy, particularly in the 3rd trimester when fetal brain development is most rapid.

There are so many types of fish oil out there, how do I know which one is best?

When looking for an omega-3 supplement, one needs to find pharmaceutical-grade. This denotes the highest level of purity attainable in these supplements avoiding damaging mercury and PCBs as much as possible. I personally recommend Nordic Naturals to my pregnant patients. I like them because they exceed industry standards, they are of the highest purity, they are used most often by researchers, and lastly, they taste good! (They are strawberry or lemon-flavored, so you don't get the "fishy burps" you often get with other products.)

More info about Nordic Naturals

For more information about fish oil research and references check out:
Latest fish oil research
Visit one of the natural pharmacies on the side bar to purchase.

Breech babies and the Webster Technique

2009-01-18T19:04:00.000-08:00

*Although my focus for this blog has been devoted to back pain and discomfort of pregnancy, I have received a number of questions about the Webster Technique and breech babies. To answer all of your questions most effectively I am going to dedicate this post to that topic.

Why is a breech baby a problem?

Did you know that MOST breech babies are delivered by c-section? Did you also know that the national c-section rate is over 30%? That means one in every three women who are pregnant will have a c-section. Is that OK with you? It shouldn't be.
Here's why I say that. . .

A woman is five to seven times more likely to die from a cesarean delivery than from a vaginal delivery.
A woman having a repeat C-section is twice as likely to die during delivery.
Twice as many women require rehospitalization after a C-section than after a vaginal birth.
Having a C-section means higher rates of infertility, ectopic pregnancy, and potentially severe placental problems in future pregnancies.
Babies born after an elective cesarean delivery (i.e., when labor has not yet begun) are four times more likely to develop persistent pulmonary hypertension, a potentially life-threatening condition.
Between one and two babies of every hundred delivered by C-section will be accidentally cut during the surgery.
The US is tied for second-to-last place with Hungary, Malta, Poland, and Slovakia for neonatal mortality in the industrialized world.
Babies born via C-section are at high risk for not receiving the benefits of breastfeeding.
The risk of death to a newborn delivered by C-section to a low-risk woman is 1.77 deaths to 1,000 live births.
The risk of death to a newborn delivered vaginally to a low-risk woman is only 0.62 per 1,000 live births.

"Cesarean Birth in a Culture of Fear" By Wendy Ponte
Mothering Magazine Issue 144, September/October 2007

What can be done about breech presentation?

Unfortunately, there is not a foolproof method to prevent or correct a breech position, but armed with a little information you can greatly reduce your risk of Cesarean section.

The Journal of Manipulative and Physiological Therapeutics reported in the July/August 2002 issue that mother's with a breech baby should begin chiropractic care at least by the 8th month (as the baby is unlikely to turn on its own after this time.)
The Webster Technique was effective in 82% of women in the same study.
Currently, the International Chiropractic Pediatric Association recommends that women receive chiropractic care throughout pregnancy to establish pelvic balance and optimize the room a baby has for development throughout pregnancy. With a balanced pelvis, babies have a greater chance of moving into the correct position for birth, and the crisis and worry associated with breech and posterior presentations may be avoided altogether. Optimal baby positioning at the time of birth also eliminates the potential for dystocia (difficult labor) and therefore results in easier and safer deliveries for both the mother and baby.

I hope this little bit of information is helpful in understanding breech presentation and why chiropractic care is important. To learn more about the Webster Technique see my previous post "Can You Turn Breech Babies?" For more information about my practice and my successes with the Webster Technique visit my website at Keystone Chiropractic.

Sciatica: A Real Pain In The Backside!

2008-11-15T17:53:00.000-08:00

Sciatica is another constant companion of many a pregnant woman. Like indigestion, edema, and constant urination, sciatica tends to show up in the 2nd trimester. And like its companions it tends to stick around until the baby is born. The good news is that sciatica can be sent on its way rather quickly and leave you alone to deal with the indigestion, edema, and constant urination.

What is sciatica?

Sciatica is an often misused term. Many people say they have sciatica if they have any lower back pain. However, sciatica occurs when the sciatic nerve (the largest nerve in the body and the one that innervates the majority of the lower body) becomes pinched or irritated.

Sciatic pain follows a particular path from the lower back or hips and runs down the leg generally ending near the knee. Sciatic pain is often described as a burning pain or a pins and needles sensation. Numbness and tingling can occur as well. Sciatic pain makes it incredibly painful for a person to sit, stand, bend, or really do anything other than lay on their back.

Why is sciatica so often associated with pregnancy?

Sciatica in pregnancy is common for 2 reasons.

Hormones: Our good friend relaxin is just doing his job and is allowing the pelvis to become hyper-mobile. (Read previous post on relaxin.) Unfortunately the sciatic nerve is attached in the pelvis and becomes irritated with all the unaccustomed movement.

Structure: As the baby grows, the uterus grows and puts pressure on the sciatic nerves and its surroundings. This weight is pulled forward, which increases the arch of the back and can lead to pressure on the sciatic nerve.

What can be done to ease the pain?

Sciatica can cause even the toughest to break into tears. It can be debilitating and miserable, but it doesn't have to last. Although it is tempting to stay in bed, not moving a muscle and praying to feel better, recent studies have shown that this is ineffective and can actually prolong the agony.
Getting up and moving while painful, will ultimately help the sciatic nerve.

Home remedies:

An ice pack applied for 10 minutes to the low back can help and is safe for pregnancy.
Sleep or lie down on your side with a pillow between your legs and one in the small of your back.
Try to stand as straight as possible and sit up straight.
Avoid standing or sitting for extended periods of time.
No heavy lifting.

Outside help:

Chiropractic is one of the best and safest treatments for sciatica. Using a gentle, low-force adjustment a chiropractor can free the sciatic nerve and allow normal impulses to return. A majority of women feel relief after the first treatment, and all but the rarest case are feeling fine by the 2nd or 3rd visit.

Some women find that acupuncture can really relieve the pain. It is believed to be safe for the baby and effective. Although it is great for pain relief, it does not correct the underlying structural problems causing sciatica, and it will return.

So, all you sciatica sufferers, get moving. Help your amazing body do its job without hurting you!

For more information about chiropractic visit www.abetterbrain.com

Can you turn breech babies?

2008-11-05T18:41:00.000-08:00

Recently I have been getting the same question over and over . . . .

"Dr. Richards can you turn a breech baby?" Because this question comes up with alarming frequency I thought I would address it here. (Although this is not strictly a back pain related topic.)
First of all chiropractors do not and should not "turn babies". Turning a baby is a terribly painful and brutal practice. While some OBs may try to turn a baby, it is generally not successful and carries inherent risks, such as rupture of the placenta, injury to the baby, and early labor.
Once again, chiropractors do not turn babies.
Some of the confusion may lie in the fact that chiropractors often use a technique called the Webster Technique which was once known as the "Webster's Breech Turning Technique" due to the high frequency of babies turning following the technique.

What is the Webster Technique and how does it work?
The Webster Technique corrects intrauterine constraint, which occurs when the proper shape of the uterus in constricted due to tight ligaments, rotated sacrum, or other external forces. When intrauterine constraint is present it can keep the fetus from attaining the proper head-down birthing position, which leads most often to a cesarean section. In fact 13% of all cesarean sections in the US are due to breech positioning.

Performance of the Webster Technique begins by analysis of the relationship of the bones of the pelvis. Upon finding a restriction, a light force chiropractic adjustment of the sacrum corrects the restriction. The chiropractor will then analyze abdominal muscle tension or spasm and work to relax this tightening.

Does the Webster Technique work?
The Journal of Manipulative and Physiological Therapeutics reported in the July/August 2002 issue an 82% success rate of babies turning head down when doctors of chiropractic used the Webster Technique. Further, the results from the study suggest that it may be beneficial to perform the Webster Technique as early as the 8th month of pregnancy when a woman has a breech presentation.

To summarize, if you have a breech baby and are concerned about the possibility of a cesarean, the Webster Technique is a safe and effective treatment. To find a chiropractor near you who is certified in the Webster Technique follow this link. Or visit my office at www.abetterbrain.com

Round Ligament Pain Relief

2008-10-28T16:54:00.000-07:00

Today we are going to talk about one of the major irritants and complaints of pregnancy . . . . round ligament pain. Round ligament pain can range from uncomfortable to down-right painful. Generally, the pain is referred to as a brief, sharp, stabbing pain or a long lasting dull pain centered in the abdomen. Usually, this condition starts in the second trimester of your pregnancy

Many pregnant women experience round ligament pain initially when suddenly getting up from the bed, from the chair, when rolling over in your bed, whenever you cough, or when you get out of the bath tub. Most times you will experience a short, stabbing feeling (most commonly on the right side) that will quickly resolve, however some woman experience chronic pain.

Why do women get round ligament pain?

The round ligaments attach the front section of the uterus to the groin, and like muscles they can contract and release. However, unlike muscles they function slowly. During pregnancy these ligaments stretch well beyond their "norm". They then become apt to seize up or contract.

If you make any movements like changing the position quickly, coughing or laughing, then the ligaments become stretched, making them to contract very quickly. This can cause you to experience the pain, but the pain only exists for a few seconds. Some women have chronically tight ligaments and will have continual aching and dull pain in the abdomen.

Reducing round ligament pain

Anything that stretches these ligaments slowly and gradually will help alleviate pain. Therefore:

Daily stretching exercises help a great deal. The most often prescribed exercise is performed by keeping your hands and knees on the floor, lowering the head to the floor and by placing the bottom in the air.

Apply heat to the area to relieve from the pain. A warm bath will also give you some relief.

If you know that you are going to sneeze, cough or laugh, slowly bend and flex your hips. This can greatly reduce the pull on these ligaments.

Lie on the opposite side to alleviate the pain. Lie on your left side with a pillow under your belly for proper support and place another one in between the legs.

If you are suffering from chronic round ligament pain or are having a them often, visit a chiropractor who can use a variety of ligament release techniques to get you out of pain.

The good news is that as your pregnancy progresses into the 3rd trimester, the pain usually decreases.

*Please note that if the pain exists more than few minutes, or is accompanied by any bleeding, chills, or nausea please t contact your doctor immediately.

For more information about chiropractic visit www.abetterbrain.com

What is relaxin?

2008-10-09T08:07:00.001-07:00

If you are pregnant you are well aware of the surge of hormones that has taken over your body. As soon as a woman is pregnant hormones flood through her body, often leading an expectant mother to wonder what happened to her former self. Many pregnant women tell me about feeling happy one minute and weeping the next. Others are plagued with acne, reflux, and low energy levels. This hormone flood may produce side effects that a mom could do without, but they all play a very important role in the development of your baby.

However, one, often maligned, hormone is very specifically important to the health of the pregnant woman. It is relaxin. Relaxin is a hormone produced during pregnancy that allows you to give birth! The way it works is complex, but generally it makes collagen breakdown happen at a much faster rate which causes the cervix and the pubic symphysis to soften and lengthen. It allows the baby to pass through the birth canal. This is a good thing for a pregnant woman.

Relaxin is a hormone that is always present in a woman's body, however during pregnancy, the hormone relaxin is present in 10 times its normal concentration. While relaxin is a great hormone in preparing for labor it can cause some unwanted side effects as well. Relaxin doesn't know the different between the pubis and any other joint in the body so it can lead to abnormal motion, which in turn leads to pain and inflammation. Most of this is mild and can be controlled with Tylenol. Some people are more affected by relaxin than others for reasons we don't entirely understand. Those who experience significant pain due to loosening joints can get relief with the practices listed here.

Upon delivery the raging hormones gradually go back into hibernation and loosey-goosey joints tighten up again. Relaxin has allowed the human body to do something that seems impossible. (Birthing a baby.) So let's hear it for relaxin. It gets a bad rap, but is your best friend come delivery day!

Why hasn't my OB recommended chiropractic care?

2008-09-23T06:08:00.000-07:00

There are a number of reasons that your obstetrician may not refer you to a chiropractor.

Although countless studies have shown the safety and efficacy of chiropractic, many MD's don't understand chiropractic. Historically chiropractic has been viewed as "alternative health care" and doctors were skeptical about sending patients to chiropractors. Many fallacies still abound about chiropractic, but the medical community at large is beginning to see the value in cooperative care.
Many MDs do not understand that the training involved in becoming a chiropractor is comparable to their own. They may not understand that a Doctor of Chiropractic is as skilled and as trained as any medical professional.

Subject	Chiropractic Schools		Medical Schools
	Hours	% of Total	Hours	% of Total
Anatomy	570	40	368	31
Biochemistry	150	11	120	10
Microbiology	120	8	120	10
Public Health	70	5	289	24
Pathology	205	14	162	14
Total Hours	1,420	100	1,200	100

Finally, many MDs don't know a chiropractor to refer their patients to! (To find a chiropractor specializing in pregnancy click here.)

You don’t need anyone’s approval to seek a chiropractic opinion about health issues affecting you and your child. Consulting another health care expert is always helpful in the decision-making process. Most chiropractors work closely with other practitioners who keep up with the latest research and understand the value of this natural, drug-free approach to better health.

Decreased Labor Time with Chiropractic Care

2008-09-15T15:40:00.000-07:00

Good news for those of you who have or fear long labors. Not only can chiropractic care ease symptoms during pregnancy, there is research that show it can ease delivery time and pain as well.
Research found that women who receive chiropractic care during pregnancy have approximately 6 fewer hours of labor than women who did not receive care.
According to a study by Irvin Hendryson, MD "visiting a chiropractor while being pregnant can help the expectent mother deliver the baby with more comfort." That's great news for mom and baby alike!

American Medical Association records released in 1987 during trial in U.S. District Court Northern Illinois Eastern Division, No. 76 C 3777

For online childbirth classes visit Click Here!

84% of Pregnant Women Get Back Pain Relief From Chiropractic

2008-09-08T07:00:00.000-07:00

Here is a little gem of a study for those of you contemplating chiropractic treatment for your back pain or sciatica.

In a recent study 84% of patients receiving chiropractic manipulation reported relief of back pain during pregnancy. There was significantly less likelihood of back labor when spinal manipulative therapy was administered during pregnancy. ("Back pain during pregnancy and labor". Diakow PR, et al. Journal of Manipulative and Physiologic Therapeutics, 1991: 14(2): 116-118.)

Not only does chiropractic treatment bring relief of symptoms it also reduces the chance of "back labor" which as many of you know can be rather painful. Chiropractic is safe and effective and can help you feel better now and keep you from pain later.

Understanding Pelvic Pain in Pregnancy

2008-09-02T11:51:00.000-07:00

One problem that many pregnant women complain about is pubic pain. Yet doctors and midwives often dismiss this pain as either 'inconsequential', 'unfixable', or 'just one of those pregnancy discomforts that have to be endured'. Occasionally, some uninformed doctors have even mistakenly told women that such pubic pain means that they would need an elective cesarean section in order not to permanently damage that area during birth, or as a result of prior damage to the area.

Yet none of this is true. Pubic pain in pregnancy is certainly not 'inconsequential'; Although many doctors and midwives do not know what causes it or how to fix it, many women are able to get improvement or relief with chiropractic treatment or osteopathic manipulation. It is not something that you 'just have to live with'. And although extra care should be taken during labor and birth in order to prevent trauma, it absolutely does NOT mean that you 'have' to have a cesarean!

For more information about chiropractic care visit www.abetterbrain.com

Although not every provider has a name for this condition, it is most commonly called Symphysis Pubis Dysfunction (or SPD), especially in Britain. Other names for it include: pubic shear (osteopathic term), symphyseal separation, pubic symphysis separation, separated symphysis, pelvic girdle relaxation of pregnancy, pelvic joint syndrome. In the United States it is most commonly referred to as Pubic Symphysis Disorder. (However, for the sake of this article we will use SPD.)

The symptoms of SPD vary from person to person, but almost all women who have it experience substantial pubic pain. Tenderness and pain down low in the front is common, but often this pain feels as if it's inside. The pubic area is generally very tender to the touch; many moms find it painful when the doctor or midwife pushes down on the pubic bone while measuring the uterus (fundal height).

If you are unsure about your pain being SPD or pelvic pain do this quick and easy test.

Any activity that involves lifting one leg at a time or parting the legs tends to be particularly painful. Lifting the leg to put on clothes, getting out of a car, bending over, sitting down or getting up, walking up stairs, standing on one leg, lifting heavy objects, and walking in general tend to be difficult at times. Many women report that moving or turning over in bed is especially excruciating.

Many movements become difficult when the pubic symphysis area is affected. Although the greatest pain is associated with movements of lifting one leg or parting the legs, some women experience a 'freezing', where they get up out of bed and find it hard to get their bodies moving right away--the hip bone seems stuck in place and won't move at first. Or they describe having to wait for it to 'pop into place' before being able to walk. The range of hip movement is usually affected, and abduction of the hips especially painful. Many women also report sciatica when pubic pain is present. SPD can also also be associated with bladder dysfunction, especially when going from lying down (or squatting) to a standing position. Some women also feel a 'clicking' when they walk or shift just 'so', or lots of pressure down low near the pubic area.

Many women with SPD also report very strong round ligament pain (pulling or tearing feelings in the abdomen when rolling over, moving suddenly, sneezing, coughing, getting up, etc.). Some chiropractors feel that round ligament pain can be an early symptom of SPD problems, and indicate the need for adjustments. Other providers consider round ligament pain normal, part of the body adjusting to the growing uterus. If experienced with pubic and/or low back pain, it probably is associated with the SPD.

Indeed, although pubic pain often does go away after pregnancy, many women find that it sticks around afterward, usually diminished but still present. If treatment to resolve any underlying causes is not done, long-term pain usually sticks around. Anecdotally, this often seems to be associated with long-term low back pain or reduced flexibility in the hips. Even worse, if the mother is mishandled during the birth, the pubic symphysis can separate even more or be permanently damaged. This is called Diastasis Symphysis Pubis.

Although the best idea may be to resolve chronic SPD pain through realigning the pelvis girdle and soft tissues, most women have some residual pubic and low back discomfort sticking around during pregnancy and the early postpartum weeks because of hormones. Therefore, tips for coping with pubic pain tend to be a focus of many SPD websites.

Many of the suggestions include:

Use a pillow between your legs when sleeping; body pillows are a great investment!
Use a pillow under your 'bump' (pregnancy tummy) when sleeping
Keep your legs and hips as parallel/symmetrical as possible when moving or turning in bed
Some women also find it helpful to have their partners stabilize their hips and hold them 'together' when rolling over in bed or otherwise adjusting position
Some women report a waterbed mattress to be helpful
Swimming may help relieve pressure on the joint
Keep your legs close together and move symmetrically
When standing, stand symmetrically, with your weight evenly distributed through both legs
Sit down to get dressed, especially when putting on underwear or pants
Avoid 'straddle' movements
Swing your legs together as a unit when getting in and out of cars; use plastics or something smooth and slippery (like a garbage bag) on the car seat to help you enter car backwards and then turn your legs as a unit
An ice pack may feel soothing and help reduce inflammation in the pubic area
Move slowly and without sudden movements

Visit a chiropractor who has experience treating pregnant women.

taken from Symphysis Pubis Dysfunction
by Pamela Vireday
ICPA Newsletter Jan-Feb 2003

Pelvic Pain in Pregnancy

2008-08-23T07:23:00.000-07:00

Pelvic pain during pregnancy is something that is often misunderstood by the medical community at large. The degree of pain is something that is often not addressed at all.
I became aware of the severity of pelvic pain when my wife was pregnant with our second child.

During the 2nd month of my wife’s pregnancy she began to complain about pain in her hips and pelvis when she rolled over in bed at night. She said it felt as if her bones were grinding together. I was a young, inexperienced student at that time and I told her I didn’t know how to help her.

She went to her OB multiple times over the next 3 months as the pain became debilitating. She walked as if she were an old woman, and used a wheelchair for situations that required a lot of movement. Her OB could only recommend Tylenol and told her she might want to try massage. Other than those suggestions she would just have to wait it out.

Now, my wife is not one to sit around and wait for anything, so she began her own research. She found a small blurb about something called Symphysis Pubic Disorder or SPD in a medical journal online; she then was able to find a support group for SPD in Great Britain. She emailed them and found out that this disorder is something that is just recently gaining attention in Great Britain and they sent her some literature. She was relieved when one of the first treatments mentioned was chiropractic care. (Did I mention I was a student and was somewhat MIA?)

My wife began chiropractic care and within a week was making great progress. Her pain levels went from a 10 to a 3 and she was able to tolerate the remainder of her pregnancy without too much discomfort. She moved like a different woman in a matter of weeks.

So now, thanks to my wife, I look like the hero when I tell pregnant women I know what is wrong with them and how to help them. She is the real hero.

Check back next week for details about SPD and its treatment, or email me directly at drrichards@abetterbrain.com.

New Office Space for Pregnant Moms

2008-08-21T09:17:00.000-07:00

CT - June, 1 2008 - Dr. Jason B Richards of Keystone Chiropractic is making a move to better serve his patients. He recently expanded his office space to be able to accommodate mothers with small children and pregnant women.

Dr. Richards expanded Keystone Chiropractic office space in response to what he saw as a chronic problem. "Mothers are caught in a difficult dilemma. Medical offices are open during the hours when mothers are the sole caregiver. Mothers have to decide if they will get a sitter, chase their kids around an office, or not get care.To ease this problem Dr. Richards’ new office includes a treatment room just for mothers with small children. The room has a window cutout into a playroom for children. Mothers can talk to and see their children and the children can play with toys or watch movies. This allows mothers to relax without worry. "My patients love it" says Dr. Richards.

Dr. Richards hopes that his additions to his practice will help mothers make some healthier choices in their lives. He hopes that making chiropractic care easier will allow moms to be able to take care of themselves as well as their households. "Moms do some heavy lifting, I'm just trying to lighten their load."

Keystone Chiropractic has been serving the Hamden/North Haven community for the past 4 years. Dr. Jason B Richards graduated Summa Cum Laud from University of Bridgeport Chiropractic College in 2003. He has advanced training in neurology and pregnancy.

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