Drs. Tania Howard & Marissa Wallie
Family Chiropractors
530 College Parkway, Suite F
Annapolis, MD 21401
401-349-2727

The Chiropractor-Midwife Relationship
by Dr. Tania Messina Howard
This article was originally published in the August 2001 edition of The Chiropediatric Times

Imagine this: Pregnant women under chiropractic care, some for a breech version technique, some for pregnancy-related symptoms, but all to ensure that their neuromusculoskeletal systems are functioning at 100% to most effectively grow and deliver their babies. Then, imagine those babies coming into the world through the hands of a midwife, slowly, gently and quietly. To complete this dreamlike scenario, imagine those newborns getting checked for subluxations, to ensure that they are starting their life as nature intended, without interference.

For me, this dream is a reality. For the past three years I have served on the Board at Special Beginnings Birth and Women's Center in Annapolis, Maryland. Having had my daughter Julia at Special Beginnings and her older sister Francesca at the Baltimore Birth Center, I was a huge fan of this type of healthcare delivery system. As an Advisory Board member, my role is to promote midwifery for women's primary care as well as for perinatal care, and to assist the Center in creating policies and procedures that make it the success it is today. My relationship with the Center, both as a patient and as a Board member, have led to a more professional relationship as the consulting chiropractor.

Nurse midwives who staff the Center are regularly informed of the benefits of chiropractic care to the prenatal woman and newborn, who then educate their clients during the routine prenatal visits. Additionally, I offer lectures at the Center, our community hospital and my office on related topics. Our office receives 6 - 8 referrals per month from the Birth Center, requesting that their clients be evaluated chiropractically. Whether their entry into chiropractic was stimulated by a breech pregnancy or low back pain, it is always recommended that they continue to be checked as their pregnancy progresses to optimize both the integrity of the pelvis for the remainder of the pregnancy and delivery, but more importantly to ensure that the innervation to the related organs and tissues is functioning optimally. Of course, we bring the patients back postnatally to check them and their babies if we haven't already done so.

It is not unusual for my patients to request that I attend their births, and in the past year I have participated in 12 or 13. My official role is that of a support person; there is always a midwife or obstetrician attending. However, excepting checking for cervical dilation, monitoring fetal heart rate and the actual delivery, I have been the primary caregiver in most of the cases. Getting a full spine adjustment is essential in the early stages of labor to ensure optimum nerve function for the task at hand. As labor becomes more active, sacral adjustments are an extremely effective pain management modality. During a recent hospital birth of one of my patients who was delivering with an OB, I was called out of the room by a midwife to assist with a patient who was doing her best to avoid an epidural. Then, to my surprise, I say another patient in the hallway who was getting ready to deliver, and I was able to adjust her before she began pushing. An unusually busy but very satisfying day nonetheless.

Pregnant patients also find their way to my office through several area obstetricians who distribute a "Pregnancy and Chiropractic" handout with their usual literature. Regardless of the referral source, we immediately begin educating our patients on the importance of having their newborns checked. Without exception, I have had the privilege of checking and adjusting, as necessary, all of these children.

As a result of my relationship with this particular birth center, I have been invited to serve on the national advisory board of the American College of Nurse Midwives. I hope to encourage similar relationships at birth centers around the country, though you can help by contacting midwives in your area (check the yellow pages or www.midwife.org) and forming relationships such as I have. The following are some strategies for gaining recognition in the prenatal community:

• First and foremost, be confident in your abilities to detect and correct subluxations in pregnant women and children. Minimally, study texts on pediatrics, and optimally, work on getting a postgraduate certification.
  
 
• Talk to mothers and pregnant patients in your office, and find out which midwives and OB's in the area are supportive of natural childbirth. Ask if you may use their name in a letter of introduction to those practitioners, and follow that up with a visit to their office to introduce yourself.
  
 
• Seek out Doulas and Bradley childbirth instructors in your area. Both of these professions strongly support natural childbirth and are happy to have a like-minded doctor with whom to consult.
  
 
• Be prepared to discuss Webster's Breech Turning Technique with these practitioners. The gold standard for a breech baby today is a scheduled Cesarean section. Few, if any, obstetricians will attempt an external cephalic version, a traumatic and risky procedure to turn breech presentations. Patients in this situation are often desperate to avoid a C-section. If you can offer a viable alternative, this will be a great source of referrals.
  
 
• Ask if you can include a handout about the benefits of chiropractic care in the office's prenatal information packet. Even if the practitioners don't refer directly, patients will often self-refer if the information is available to them.
  
 
• Offer to lecture to prenatal exercise or yoga classes. These are often offered through health clubs and hospitals.
 

Through these and other efforts such as those set forth by the likes of Drs. Teri and Stu Warner and the WCA, I believe we CAN make a difference, one spine at a time.

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