1. 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

2. 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.

3. 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.

4. 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.

5. Cephalic Posterior Fetal Presentations Transverse Breech www.webmd.com

6. 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.

7. Research RA Pistolese 1 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.

8. Research J Alcantara, L Mullin 2 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.

9. Research D Drobbin, C Welsh 3 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.

10. 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.

11. 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.

12. 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.

13. 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

14. 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.

15. 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.

16. Delivery Outcomes

17. 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).

18. 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

19. Outcomes of Breech Presentation

20. 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.

21. 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.

22. 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.

23. 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.

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

25. References 1.Pistolese RA. The Webster Technique: a chiropractic technique with obstetric implications. J Man Phys Ther. 2002 Jul-Aug;25(6):E1-9. 2.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. 3.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. 2009;2:1-3. 4.Thomas JC. The Webster Technique in a 28 year old woman with breech presentation & subluxation. J Vert Sublux Res. 2008 Apr 7;1-3. Images from http://www.webmd.com/baby/healthtool-fetal-positions-slideshow