Please, Hands Off!

By Ryan French, D.C.

The Importance of Having a Non-Invasive Birth Process
(Originally published in ICPA Jan-Feb 2002 Newsletter)

Most chiropractors encourage their pregnant patients to be well-informed and deal with the birth process with the least amount of interference possible. We do this because we care about the health of both the mother and the soon-to-be-born baby; and because it is congruent with the vitalistic philosophy that chiropractic is based upon. Moreover, scientific advancements are also showing why a non-interventionistic approach to birth is the healthier avenue to pursue.

Unfortunately for humanity, the medical ‘drugs and intervention’ approach to health does not seem to provide all of the answers as once was thought. I say ‘unfortunate’ because it is the philosophy of health to which the majority of persons in North America currently subscribe. In an effort to clarify the situation, patients should be told about the statistics that science has to offer. Research estimates that there are 2,216,000 adverse drug reactions per year in hospitalized patients. (1) That translates into approximately 185,000 reactions per month, or over 6,000 per day! And that’s just the ones that are actually reported. Properly prescribed drugs are also estimated as responsible for 106,000 fatalities per year, or approximately 300 deaths per day. (1) This ranks adverse drug reactions from properly prescribed drugs as between the 4th and 6th leading cause of death! And, this doesn’t even include human error, patients treated outside the hospital, nor reactions from over the counter drugs. The director of public health at Harvard estimates that iatrogenic injuries, that is, injuries caused by the doctor’s actions, result in 180,000 deaths per year; or approximately 500 every single day. (2)

When it comes to obstetric accidents, it is interesting to know that although obstetricians make up only 3% of all medical doctors, they account for 29% of all the costs and damages (3), and account for 30% of all claims of negligence against medical doctors. (4) This means that one-third of all mistakes made by doctors are made by those responsible for delivering our children. A 1993 review of literature by Marc Gottlieb determined that despite these statistics “birth trauma still remains an under-publicized and, therefore, under-treated problem.” (5) And when it comes to trauma from the birth process, we are generally talking about damage to the skull, spinal column, and brachial areas.

Knowing this information, it becomes clear why it is imperative for the chiropractor to assess for subluxation and tissue trauma in the newborn. Tissue trauma causes the release of prostaglandin E2, leukotriene B4, bradykinin, histamine and 5-hydroxytryptamine, (6) which sensitize and cause depolarization of local nociceptors, eliciting the perception of pain. Subluxation, due to the component of restricted joint mobility, involves a reduction of mechanoreceptive stimulation, (7) and sensitization of the nociceptors, possibly eliciting the perception of discomfort by the newborn. If this joint area remains immobilized for even a few weeks in a position of ‘comfort,’ “contractures will develop in the surrounding tissue and as a consequence, a normal range of joint motion will be impossible.” (8) Thus it is imperative that the newborn is checked as early as possible after delivery.

Furthermore, the study by Mitchell et al. on the anatomy of the upper cervical spine elevates the importance of upper cervical subluxation correction because of the direct physical attachment of the superficial muscle and ligaments to the spinal cord itself. In this study the authors describe “previously unrecorded attachments of the ligamentum nuchae to the cervical posterior spinal dura, and to posterolateral parts of the occipital bone.” (9) They discovered a fibroelastic ligamentous attachment running from the nuchal ligament to the spinal dura in the midline between the atlas and axis vertebra. This information is so important since the majority of subluxations from birth trauma tend to be in this upper cervical region.

This extremely brief commentary on the literature is in no way exhaustive of the research supporting these concepts. We as chiropractors owe it to our patients to elevate our level of certainty by owning the principles, understanding the science, and being able to deliver the service. In doing this we will move a step closer to our vision of mandatory chiropractic examination for every pregnant mother and newborn.

References:
1. Lazarou, Pomeranz, & Corey. Incidence of Adverse Drug Reactions in Hospitalized Patients. Journal of the American Medical Association, Apr 1998, Vol 279, No. 15, p 1200
2. Leape, L. Journal of the American Medical Association. Dec 1994, Vol 272, No. 23, p 1861
3. Medical Protection Society. Annual Report. London: MPS, 1989
4. Orr, CJB. Medico-legal aspects of obstetric and gynaecological practice. In: Bonnar J, ed. Recent Advances In Obstetrics and Gynacology. London: Churchill Livingstone, 1989
5. Gottlieb, M. Neglected Spinal Cord, Brain Stem and Musculoskeletal Injuries Stemming From Birth Trauma. Journal of Manipulative and Physiological Therapeutics. Vol 16, No 8, 1993
6. Casey, K. Nociceptors and their sensitization: An Overview. In: Willis W, ed. Hyperalgesia and Allodynia. New York: Raven Press, 1992, p849-857.
7. Lephart S. Re-establishing proprioception, kinaesthesia, joint position sense, and neuromuscular control in rehabilitation. In: Prentice W, ed. Rehabilitation Techniques in Sports Medicine. St. Louis: Mosby; 1994, p 118-137.
8. Norkin C, Levangie P. Joint Structure and Function: A Comprehensive Analysis. Philadelphia: F.A. Davis; 1992, p 87-120.
9. Mitchell B, et al. Attachments of the Ligamentum Nuchae to Cervical Posterior Spinal Dura and the Lateral Part of the Occipital Bone. Journal of Manipulative and Physiological Therapeutics. Vol 21, No. 3, Mar/Apr 1998

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