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PREGNANCY STUDIESWomen who receive epidurals to ease labor pains may be increasing discomfort
for their newborns, according to a study published in Pediatrics. The study says
that epidural's can cause fevers in mothers during childbirth, which, in turn,
causes doctors to test newborns for blood and tissue infections (sepsis), and to
treat the newborns with antibiotics. Of babies born to 1,047 women, 34 % needed
an evaluation for sepsis, as compared to less than 10 % of babies born to
mothers who had no epidural. Newborns whose mothers had received an epidural
were four times as likely to be treated with antibiotics because doctors
were concerned about the possibility of sepsis. However, babies of women who
received an epidural were not more likely to actually have infections, which was
very rare in both groups. A retrospective review of 100 consecutive pregnancies, involving 94 women
receiving prenatal care at a rural western New York family practice, was
conducted. Back pain was spontaneously reported to the physician by 23 women in
23 pregnancies. Eleven of the 23 women met diagnostic criteria for sacroiliac
subluxation. These criteria include absence of lumbar spine and hip pathology,
pain in the sacral region, asymmetrical movement of the posterior superior iliac
spines upon forward flexion, a positive pelvic compression test and asymmetry of
the anterior superior iliac spines. A cohort of 11 women meeting criteria for
sacroiliac subluxation was treated with rotational manipulation of the
sacroiliac joints. After manipulative therapy, 10 of the 11 women (91%) had
relief of pain and no longer exhibited signs of sacroiliac subluxation. A cohort of 200 consecutive women attending an antenatal clinic were followed
throughout pregnancy with repeated measurements of back pain and possible
determinants by questionnaires and physical examinations. Seventy-six percent
reported back pain at some time during pregnancy. Sixty-one percent reported
onset during the present pregnancy. Back pain during pregnancy is a common
complaint. The 30% with the highest pain score reported great difficulties with
normal activities. The back pain started early in pregnancy and increased over
time. Young women had more pain than older women. Back pain starting during
pregnancy may be a special entity and may have another origin than back pain not
related to pregnancy. Manipulation keeps the segments of the pregnant woman's structure freely and
normally movable. It permits a constant free flow of all body fluids and a
normal venous supply to control function. During the second 6 weeks of pregnancy
the growing fetus and expanding uterus often settle in the hollow of the sacrum
and relief of nausea may be achieved. Manipulation results in an easier
pregnancy and an easier delivery. The postpartum return of the mother to
prepartum health is also expedited by manipulation. Manipulation has a part in
the prevention and cure of toxemia's. It can be demonstrated that chiropractic care significantly reduces the mean
labor time. Primagravidae subjects receiving chiropractic care averaged 24%
shorter labor times, and multiparous subjects receiving chiropractic care
averaged 39% shorter labor times versus control subjects. 84% of patients receiving spinal manipulative therapy reported relief of back
pain during pregnancy. There was significantly less likelihood of back labor
when spinal manipulative therapy was administered during pregnancy. Regular adjustments can make pregnancy less stressful and delivery less
uncomfortable. Chiropractic treatment can continue safely until the day of
delivery. The most common reason for severe low back pain was dysfunction of the
sacroiliac joints. Physically strenuous work and previous low back pain were
factors associated with an increased risk of developing low back pain and
sacroiliac dysfunction during pregnancy. In a study of 500 women during labor, 352 experienced pain in the lumbar area
during labor, an incidence of 70.4%. One of the most interesting findings of the
study was the association of back pain during labor and fetal presentation.
Application of pressure to the lumbar area to inhibit lumbar pain reduced the
need for major narcotic pain medication and minor tranquilizing medication. Any late second stage labor position that denies posterior sacral rotation
(the popular semi-recumbent position places the laboring woman squarely on her
sacral apex) denies the mother and fetus crucial sagittal pelvic outlet diameter
and jams the sacral tip up to 4 cm into the pelvic outlet. Even after vaginal
births, 4.6% of term neonates suffer unexplained brain bleeds and up to 10%
suffer neonatal encephalopathy. These pathologies may possibly be avoided by
decreasing distortion of fetal skulls, from pelvic misalignment, at delivery. A prospective, controlled trial of 427 primiparae compared the outcome of
labor in women randomly allocated to squatting (218) or conventional
semi-recumbent (209) management. The squatting group had significantly fewer
forceps deliveries (9% vs. 16%) and significantly shorter second stages (median
length of pushing 31 vs. 45 min.) than the semi-recumbent group. Adoption of upright positions resulted in a higher rate of intact perineum's.
There was a clinically apparent reduction of forceps deliveries in the upright
group, which influenced midwives' attitudes. Moving the parturient from
recumbent to upright positions was often perceived to be beneficial when there
was slow progress. The standing or squatting position of delivery provides the fewest problems
for both the mother and baby.
Gardosi J; Hutson N; Randomised, controlled trial of squatting in the second
stage of labour. Lancet 1989; 2(8654): 74-7 / Medline ID: 89294852 In 1976, Dr. Lewis E. Mehl conducted a careful matched study of 1,046 home
births vs. 1,046 hospital births. The outcomes, summarized below, were very
shocking to those who had previously believed hospitals to be the safest places
for birth to occur. As the statistics below show, the home birth group had a
much safer outcome.
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© 1996-2003 Craig M. Anderson, D.C.
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