Question: My baby was delivered vaginally with the help of forceps. His head looks normal, save for a small red mark on his temple, does he need to see a chiropractor? Will he have problems in the future directly related to being born with the help of forceps?

As new parents, you do everything in your power to make sure your baby is healthy. You went through 9 months of pregnancy taking in good nutrients and supplements and avoided the “baddies” (cigarettes, alcohol, caffeine, medications, etc). You may have taken some childbirth classes to prepare yourself for a great delivery, perhaps even a natural, drug-free delivery at that. You’ve read all the books and seen a million YouTube videos, but nothing really prepares you for childbirth. Sometimes, even when you have done everything right, things can go “wrong”.

–NOTE: I use quotations around the word “wrong” as I believe there is no such thing as a “wrong” birth or delivery. Every child makes their way into this world in their own way – some calm and quick, some arduous and dramatic.

Sadly, some newborns have unhealthy spines as a result of a constrained or stressful pregnancy or the labor and delivery itself.

One of my first discussions with any new patient, adult or child, is, “Tell me about your birth.” This is often met with wrinkled brows and followed by the question, “Why?” Especially with newborns, it is impossible to gain an understanding of their challenges without taking it back all the way to the beginning – including a thorough understanding of mom’s pregnancy (another topic for another day!).

The birth process can have lasting physical consequences for your baby.

How would you feel if your head had been tilted and crooked in a small space for several months, then your head was crammed into an even smaller space for hours to days? And if that wasn’t enough, imagine your head then being squeezed by contractions and then pulled and twisted out into the world. You might have some neck pain. Maybe even a headache.

The birth process, even in its most natural form, can be a source of spinal stress for an infant. If the birth history includes a caesarean section, ventouse or forcep intervention, my ears always perk up. The average amount of force used by the doctor during forcep delivery is between 30-45 pounds. Your average infant is around 7 pounds at birth. That’s up to 5 times their body weight! It should come as no surprise that it has been estimated that around 80% of infants examined shortly after birth were suffering from injury to the neck.

If your baby is not in obvious distress at birth, they often are given a clean bill of health and you are discharged from the hospital. However, slight damage to your baby’s spine may cause several problems that can creep up over their first days to months. These include:

• Colic
• Poor feeding
• Inability to settle/fussiness/easily startled
• Poor sleeping patterns
• Preference of feeding on one side only/tendency to face to one side
• Irritable lying on their back or stomach
• Flat head (plagiocephaly)
• Acid reflux/indigestion/unsettled bowel movements

Where does Chiropractic fit in?

Chiropractic uses gentle pressure to relieve irritation in your nervous system (brain, spinal cord and nerves). The spinal cord carries information throughout the body and is responsible for all bodily functions. This means that if bones in the spine are not moving properly, this can affect the rest of the body. Most chiropractors, including myself, believe that a baby’s spine should be checked for any possible nerve dysfunction or trauma shortly after birth.

I have the pleasure of witnessing the benefits of chiropractic on children daily in my office. The children under my care are calmer, catch fewer colds, sleep more soundly and thrive in their education. There is no substitute for a properly balanced and optimal functioning nervous system.

“With the birth process becoming more and more an intervening procedure…the chiropractic adjustment becomes even more important to the child’s future.” – Dr. Larry Webster of the International Chiropractic Pediatric Association

The quality of life for women with Symphysis Pubis Disorder (SPD) can be greatly diminished and can make pregnancy difficult and stressful. Although it is not life-threatening, it can be life-limiting!

The symptoms of SPD vary amongst women, but almost all women who do suffer from it have substantial pain at the front of the pelvis which often can feel like it is coming from inside. This area will be tender to touch, and any movement that requires lifting one leg at a time or parting the legs tends to be particularly painful.

If you are suffering from SPD, you are not alone. Over 30% of pregnant women suffer symphysis pubis pain and upwards of 70% report substantial pelvic pain during their pregnancies. Although this pubic pain decreases after delivery, many women find that, if left untreated, it can stick around for weeks to months – diminished, but still present.

If your pelvis is restricted in its movement, it can make it difficult for your baby to flip head down prior to delivery, resulting in a breach presentation. The Webster adjustment is specific for improving pelvic motion and helping to flip a breach baby. Research has demonstrated a success rate of between 70 and 82%.

In my office, I have treated hundreds of pregnant women, most with some degree of pelvic and/or symphysis pubis discomfort. Gentle adjustments to the pelvis that are modified for comfort during pregnancy, rehabilitative exercises and soft tissue work all play into a treatment plan for SPD. I also make recommendations on altering your movement and positions and, at times, may suggest a pelvic or maternity belt to help relieve some of the weight and pressure of your growing belly on your spine and pelvis. Chiropractic care is a natural, drug free and comfortable approach that is widely used during pregnancy. For more information, please refer to my website, drshaila.com, or to the International Chiropractic Pediatric Association site, icpa4kids.org.

Dear Baby: why are you making my back hurt!?

Back pain and posterior pelvic pain during pregnancy is related to a number of factors. Some women will experience lower back pain with the onset of pregnancy, while others may not feel these aches until the third trimester. More amazingly, there are some lucky women who will not feel pain at all (and don’t we love them for it!). So, for those of you who DO have pain, what causes it pain to occur?

Beginning in the first trimester, the pregnant women will start to produce a hormone known as ‘relaxin’. The effect of relaxin is to soften and loosen the ligaments of the pelvis in preparation for the delivery. Relaxin creates this “softening” of the ligaments by producing and remodeling collagen, increasing elasticity and the relaxation of all muscles, tendons and ligaments. Unfortunately, hormones cannot target ONLY the ligaments of the pelvis. The end result is a direct negative effect of the strength of your body’s collagen. Don’t fret- ligamentous laxity is NORMAL during pregnancy and is necessary for a natural delivery; however, it is a main cause of back pain during pregnancy.

In addition to the increasing production of relaxin, your uterus is growing and this causes a few things to occur. First, the growing fetus changes your center of gravity. This alters your posture and, thus, the “normal” position of your spine changes. Increased pressure is added to the spinal joints as your weight increases and your center of gravity shifts forward. With these changes, you are forced to change the way you act – the way you sit, stand, reach for your coffee mug in the morning, etc. This change in behavior causes new and often underused postural muscles to become increasingly active, which can cause seeming simple movements to lead to painful sprains and strains.  Additionally, to support your growing belly, your abdominal muscles are forced to expand. With this, these muscles lose some of their ability to keep the spine erect and stable. This lack of stability, added to the change in center of gravity, are what forces your posture to change, ultimately leading to those pregnancy aches and pains.

Wait, there’s more! As your baby grows, the weight of the fetus can put pressure on the nerves that lie in your pelvis. This can cause localized pain in the back, as well as shooting pains into the buttocks and down the legs. Pain below the knee is rare.

If this is not your first pregnancy, there are additional concerns regarding your back pain. If you experienced lower back pain with your previous pregnancies, the prevalence of back pain with additional pregnancies is increased and the onset of these symptoms tend to begin earlier. As well, additional children, especially young ones that require more physical attention, can lead to back pain as lifting, carrying, bathing and overall care for them becomes more strenuous on your back as you get bigger.

Dear Doctor: how can I manage my pain naturally and best support my baby?

1. Maintaining good posture in a STANDING position:

-Hold your head up straight with your chin pulled in. Do not tilt your head forward, backward, or sideways – your earlobes should be in line with the middle of your shoulders when looking at your side.

-Keep your shoulder blades back and your chest forward – imaging your shoulder blades are being pulled together and down your back.

-Keep your knees straight, but not locked!

-Pull your stomach in and up as much as possible! Do not tilt your pelvis forward or backward and keep your buttocks tucked in.

-Point your feet in the same direction, with your weight balanced evenly on both feet. The arches of your feet should be supported with low-heeled (but not flat!) shoes to decrease the stress on your back. Many women find custom orthotics a source of relied during pregnancy.

-Avoid standing in the same position for a long period of time. If you must stand for long periods, elevate one foot at a time by resting it on a foot stool. After several minutes, switch your feet to elevate the other foot. If standing in front of a counter or table, adjust the height of the table to a comfortable level.

2. Maintaining good posture in a SITTING position:

-Sit up with your back straight and your shoulders rolled back – your buttocks should contact the very back of the chair.

-Use a lumbar support/roll at the curve of your back!! I highly recommend this to support your seated posture, especially while pregnant!

-If you choose NOT to use a lumbar support, or are visiting somewhere and do not have the option, follow these guidelines:

-Sit at the end of your chair and slouch completely.

-Draw your body up and accentuate the curve of your back as far as possible – hold this position for a few seconds. Now, release this position slightly, I suggest 10 degrees), and you should be in a good sitting posture.

-Your body weight should be distributed evenly on both hips, do not to cross your legs or shift your weight from side to side, and place your feet flat on the floor. In this position, your knees and hips should be at right angles. If this is not the case, use a stool to prop your feet up, or, if your chair is adjustable, lower or raise your chair to find the best position.

-Try to avoid sitting in the same position for more than half an hour – take standing and stretching breaks frequently!

-When sitting in a chair that rotates or pivots, be conscious of rotating your entire body as a single unit – do not twist at the waist (what waist!?).

-When standing up from a seated position, move to the front edge of your chair and stand up by straightening your legs. Avoid bending forward at the waist.

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3. Exercise:

-Bird Dog Extensions: As I mentioned earlier, during your pregnancy your abdominal muscles become increasingly lax in order to accommodate the growing uterus. Your back muscles compensate by working much harder than normal. Lower back extensions, performed properly, are safe to perform during your pregnancy and act to strengthen your back muscles to handle their increasing role.

Get down on your hands and knees with an exercise mat underneath you for comfort. Keep your elbows slightly flexed and your back straight. Brace your abdominal muscles before attempting any movements to help support your spine. Extend your right arm out in front of you up to shoulder height. At the same time, extend your left leg out behind you up to hip height. Hold this position for 5 seconds and return to the starting position. Repeat 10-20 times, switching sides with each 5 second count.

-Pelvic Tilts: This exercise acts to strengthen abdominal muscles, which helps to relieve back pain and improve your posture. This exercise is best done on an exercise ball.

Sit on the ball with your feet shoulder-width apart and your feet flat on the floor. Contract your abdominal muscles (again, bracing as if you are about to be punched in the stomach!) and rotate your pelvis so that your tailbone is pointing towards the floor. Hold for 5 seconds, release and repeat 10-20 times. This is an important exercise to help with the delivery of your baby – if you require assistance to learn this exercise, seek out a personal trainer or spine care professional.

-Swimming/Water Exercises: Because water supports your body weight, swimming and prenatal water aerobics classes allow you to get a great full-body workout while relieving pressure from your back and other joints. Check with your local community centers for classes, or seek out advice from a personal trainer. Take a dip, float around in that maternity bathing suit, and enjoy the freedom from your additional weight for a short while!

-Cat Stretch: Your lower back is not the only cause of pain during pregnancy! As your breasts become fuller, the additional weight in the chest area can pull at your upper spine, creating painful, sometimes pinching, pressure. This stretch originated in yoga disciplines and helps to relieve upper back tension.

Get down on your hands and knees (again!) and keep your back straight. Gently drop your head down and round your back, while tilting your pelvis so that your tailbone is pointing towards your nose. Hold for 10 seconds, return to the starting position and repeat.

4. Chiropractic Care:

Chiropractors adjust misaligned joints, especially in the spine, to relieve stress on nerves and promote healing throughout the body. According to numerous scientific studies, chiropractic care is extremely effective in treating pregnancy-related back and posterior pelvic pain. One specific study published in the journal Obstetrics and Gynecology found that 70% of pregnant women receiving chiropractic care achieved long-term relief from pain.

Chiropractors often treat women throughout their pregnancies, right up until delivery! Your chiropractor will do a thorough assessment and convey a diagnosis and individualized treatment plan to you. Specific interventions used by chiropractors during a patient’s pregnancy include spinal or joint manipulation (chiropractic adjustments), joint mobilization, massage and other soft tissue relaxation techniques, exercise programs and education on ergonomics, posture, and body mechanics. Some chiropractors will also make recommendations with regards to self-management, lifestyle, changes in daily activity performance, as well as nutrition guidance.

5. Supportive devices:

Along with the lumbar support I recommended earlier, many pregnant women find relief in maternity support belts. These thick elastic bands are worn around the hips and under the belly. They act to cradle your belly and support your lax abdominal muscles. These can be especially useful if your job requirements include standing for long periods.

Maternity belts come in all shapes in sizes and can vary widely. You can purchase a belt through your chiropractor (many, especially those with a keen interest in treating pregnant patients, will have them on hand in their offices) or through the Canadian Memorial Chiropractic College’s book store and supply center.

Wishing you all an easy and pain-free pregnancy!

What is Otitis Media:

Otitis media (OM) is, most simply, inflammation of the middle ear. This type of inflammation often begins with infections (bacterial OR viral) that cause sore throats, colds, or other respiratory illnesses, and then spreads to the middle ear. The inflammation may occur with or without infection and can be acute or chronic.

Acute OM: This type of OM is rapid in onset and short in duration. It is typically associated with accumulation of fluid in the middle ear and shows signs or symptoms of an infection, including fever.

Chronic OM: This type of OM is defined by a persistent inflammation of the middle ear and typically lasts for at least one month. This distinguishes it from Acute OM, which usually lasts for a couple of weeks. Following an acute infection, the fluid (known as effusion) can stay in the middle ear for up to three months before draining, leading to chronic OM. This type of OM can cause ongoing damage to the middle ear and eardrum. It is not uncommon for Chronic OM to begin without symptoms – painless and absence of fever. Ear pressure or popping can be persistent for month and, sometimes, a loss of hearing can result.

What symptoms should I look for?

The main symptoms to be aware of are:

• Severe earache (due to the fluid buildup causing an increased pressure behind the eardrum)
• Fever – 100.4° or higher, most often
• Flu-like symptoms in children (vomiting and a lack of energy are most common)
• Slight deafness
• Infants may appear hot and irritable
• Infants and young children may pull or tug at their ear
• Loss of balance

Medical treatment:

OM is the most common reason for children to be prescribed medication, and it is usually the first line of treatment sought out by parents. Unfortunately, antibiotic treatment for OM is controversial. Systematic reviews of antibiotic treatment have concluded that there is only weak evidence that routine antibiotic treatment improves the course and outcomes of OM. Fewer than 20% of patients will slightly improve, and there will only be short-term benefits (from Canadian Family Physician, 2007).

Chiropractic treatment:

Your chiropractor will perform a through history and examination on your child. We always check for signs of infection and most chiropractors will check your child’s temperature and look into their ear with an otoscope, just like your pediatrician would do! The difference is that chiropractors do not prescribe antibiotics!

OM may occur without any infection – in fact, in most cases, the fluid that builds up in the middle ear is sterile and antibiotics are not necessary at all! It is not uncommon for restrictions to be present in the joints of the upper spine that can lead to inadequate draining of the ear and referral of pain from the muscles of the neck to the ear. Your chiropractor will examine all possible reasons for your child’s pain and treat them accordingly. A chiropractic evaluation is recommended by many medical pediatric text books in order to reduce the usage of antibiotics and to prevent recurrence of problem. Chiropractors use gentle upper neck manipulation, cranial adjusting and manual lymphatic drainage techniques to assist the fluid to drain from the ear and decrease the pressure and pain that your child feels. The majority of OM cases treated with spinal manipulation by chiropractors resolve in 10 days, most responding with fewer than 5 adjustments, and many requiring only 1 or 2 treatments. Acute cases show faster rates of improvement with chiropractic, and patients undergoing manipulation encounter fewer surgeries or recurrence of OM!

Next time your child, or one you know, has an ear infection, recommend chiropractic! It is both safe and effective to help your child without the use of harsh medications!

Colic is described as an unexplained, extreme fussiness, not related to eating, that occurs within the first 3 months of life. Typically, it begins at about 2-3 weeks of age and gradually declines by the third month. Episodes are more common in the late afternoon and evening hours. Colic is known to occur in 20-30% of infants and can be quite distressing for new parents.

Common characteristics:

-sudden onset of intense crying for no particular reason

-stomach bloating and flatulence

-irritability

-drawing of the legs upward toward the chest

-infant has no trouble eating or gaining weight

There is no known cause for colic, but it has been speculated to be associated with immaturity of the central nervous system, gastrointestinal intolerance to milk, and/or family distress. Formula-fed infants have not been found to be more prone to colic than breast-fed infants. The birthing process can be quite traumatic on your baby’s spine, bones and joints, especially if your delivery included a prolonged pushing stage, forceps or vacuum extraction, or other forms of assisted delivery. The resulting spinal misalignment can compromise the functioning of major systems in the body, which can lead to colic.

Management:

Typically, parents are reassured that they are handling their baby well and that the condition will resolve within a few months. Holding, rocking or patting the infant may be of some help. If the child feeds quickly, using a smaller nipple on the bottle can be tried. The use of a pacifier or feeding the child upright may help as well.

Medical Management:

The medical treatment of colic is openly acknowledged to be limited. In some cases, a colicky infant is given drugs, most commonly Dramamine and/or Donnatol and less commonly Simethicone or Methylpolysiloxane. The results of studies evaluating the use of these drugs have been questionable. In most trials, the use of these drugs has been no more effective than that of a placebo.

Chiropractic Management:

Your chiropractor will perform a full physical examination of your infant to determine the reason for the incessant crying. The infant should be checked for vertebral subluxations or restrictions, with particular attention to the upper neck and the mid-back. These subluxations or restrictions could conceivably occur anywhere along the spine, necessitating a thorough spinal examination.

Many new parents are wary of bringing their little baby to a chiropractor. In actuality, pediatric adjustments to your baby’s spine are gentle and use little force. These are not the same adjustments you may be used to receiving yourself! The use of gentle, prolonged pressure with the fingers on your child’s spine is the typical mode of pediatric adjustment.