Friday, September 26, 2014



Chiropractic Care and the Game of Life
As with the game of chess, success in the game of life requires planning and preparation. Such success depends in large part on long-term health and well being. Chiropractic care is a key component of any winning strategy for supporting a happy and productive life.
In contrast to medical care, which focuses on symptoms and disease, chiropractic care focuses on your body’s innate ability to promote wellness. It may be necessary, at times, to utilize the medical model to treat specific problems, but obtaining wellness over years and decades depends on your body’s innate ability to heal itself. Chiropractic care facilitates these innate healing processes by aligning your spine. This, in turn, provides an environment in which nerve signals can flow freely from your brain to the rest of your body. This freely flowing exchange of information provides optimal functioning of all your body’s cells, tissues, and organs. The long-term result is enhanced health and well being, thanks to the assistance of chiropractic care.
In chess, checkmate occurs when a player’s king is under attack and has no safe place to go. The king is threatened and every possible escape route is blocked. Such an existential condition, an allegorical “no exit,” is known as checkmate.
In life, a person may be similarly threatened by a serious illness. For example, a person may receive a diagnosis for which there is no effective long-term treatment. Short-term, temporary solutions may be available, but these usually require enormous expenditures of resources, both financial and personal. Most often, when the temporary fix has run its course, the illness persists and the long-term outlook remains the same. Optimally, we would prefer to avoid such medical “checks” and avoid being faced with an untimely “checkmate.” As in chess, obtaining success with respect to our health and well being depends in large part on having a sound strategy in place.
Successful chess players think several moves ahead. High-level chess players such as grand masters have the ability to envision combinations involving ten or more future moves. Fortunately, being successful at the game of promoting personal health and well being is much less complicated. There are only a few elements involved in developing a strategy that works.
These elements are well known and include (1) regular, vigorous exercise; (2) a healthy diet1; (3) sufficient rest; and (4) a positive mental attitude. But despite being well known, only the minority of people actually implements these critical “moves.” The evidence for such lack of action may be seen in the United States, for example, where one-third of Americans are overweight and additional one-third are obese. Merely knowing something is not sufficient to obtain a result.
What is required is actual action.2 In terms of exercise, evidence-based guidelines agree that 30 minutes of vigorous exercise, done five days a week, will provide a sound foundation for health. Optimally, such exercise consists of both cardiovascular and strength training sessions, but the most important point is to do five 30-minute sessions per week. With respect to diet, all the evidence affirms that men, women, and children should follow specific calorie-intake guidelines.3For example, a moderately active man, aged 31-50, should consume, on average, 2500 calories per day. A moderately active woman, aged 31-50, should consume, on average, 2000 calories per day. A man intending to lose weight, and then maintain an ideal weight, should take in about 1800 calories per day. A woman intending to lose weight, and then maintain an ideal weight, should consume about 1600 calories per day. Regarding daily food intake, the most important rule to follow is to consume at least five portions of fresh fruits and vegetables per day. It is also important, on a daily basis, to eat foods from all the major food groups. In terms of rest, most people require seven to eight hours of sleep a night. This may not be possible every night, of course, but over time people need to obtain the right amount of rest for them. The criterion is simple: if you do not feel rested after a night’s sleep, then you did not obtain sufficient sleep. Obtaining sufficient rest is an often-neglected component of a well-rounded health and wellness strategy.
Our strategy for helping ensure our long-term health and wellness contains only a few components, and involves many less moves than does a winning chess strategy. It should be easy to put such a strategy into place. What is required is a commitment and dedication to ourselves, our families, and our loved ones.
1Voeghtly LM, et al: Cardiometabolic risk reduction in an intensive cardiovascular health program. Nutr Metab Cardiovasc Dis 23(7):662-669, 2013
2Carson V, et al: A cross-sectional study of the environment, physical activity, and screen time among young children and their parents. BMC Public Health 2014 Jan 21;14:61. doi: 10.1186/1471-2458-14-61
3Wang YC, et al: Reaching the healthy people goals for reducing childhood obesity: closing the energy gap. Am J Prev Med 42(5):437-444, 2012

Repairing an Injured Rotator Cuff

Repairing an Injured Rotator Cuff

Rotator Cuff Injuries and Chiropractic Care
Regular Chiropractic Care and Injury Rehabilitation
Recovery from injury can’t be rushed, but the rehabilitation process can be impeded or facilitated. In other words, sufficient time is required to allow for healing of damaged structures. Re-injury is possible if you attempt to return to full activity before healing is complete. In contrast, use of tested rehabilitative protocols help you prepare properly for return to full activity and may even help you to come back stronger.
Regular chiropractic care is an important component of injury rehabilitation. By helping ensure that your spinal column is well aligned, regular chiropractic care facilitates optimal functioning of all of your body’s systems. Mechanical loads are balanced so your spine, hips, legs, and arms work effectively, aiding in the recovery process. Spinal nerve irritation is reduced and removed, helping your internal organ systems do their job properly. As a result, oxygen and nutrition are delivered where they’re needed most. Regular chiropractic care supports your rehabilitation program and the healing process, helping you get back as quickly as possible to doing the things you want to do.
As we get older, rotator cuff injuries become more common, a result of the natural aging process. A similar mechanism operates in the discs separating the vertebras in your lower back. These cartilaginous structures lose water over time, becoming less flexible and more brittle as the decades roll by. In the case of the shoulder, the rotator cuff tendon is pulleyed to and fro as the arm swings forward and back and up and down. As the years pass, this constant motion may cause fraying in the rotator cuff tendon and inflammation in the muscles that comprise the rotator cuff. Eventually, partial or full thickness tears may develop in one or more of these musculotendinous units, causing pain and some loss of function. Importantly, conservative care may be all that’s needed to reduce pain and restore needed motion.
The shoulder joint is beautifully designed and a marvel of engineering. Its construction makes possible a full 360-degree arc of motion in both the sagittal and frontal planes. In other words, you can swing your arm in a complete circle from front-to-back and to-the-side-and-up-and-around. In the third, horizontal, plane, 180 degrees of motion is available. The overall combination of movements in three-dimensional space makes the shoulder joint the most freely movable joint in your body. However, as with all freedoms we enjoy in this life, there is a price. The shoulder joint’s great mobility is countered by its very limited stability.
The shoulder’s lack of stability needn’t concern us in our average day-to-day tasks. Protection to the joint is built-in by way of the rotator cuff muscles, which form a strong hood that envelops the intersection of the arm bone and shoulder blade. Falling on an outstretched arm may result in a dislocated shoulder, so we need to have some care in this regard.
If you’re a young athlete and have suffered a rotator cuff tear, surgery may be an appropriate option.1 But for the vast majority of people, especially for those over age 40, most rotator cuff injuries are chronic rather than acute and can be treated with rest and rehabilitative exercise. Again, if you’re a 60-year-old skier who has torn his or her rotator cuff in a downhill accident, surgery could be indicated. For the rest of us, rehabilitative exercise is the key.2,3
Four or five primary strength training exercises are involved in shoulder or rotator cuff rehabilitation. The three basic shoulder exercises are (1) seated overhead press, which trains all the shoulder girdle muscles simultaneously; (2) standing side [lateral] raise; and (3) seated or standing bent-over raise. The lateral raise specifically trains the middle deltoid muscle and the bent-over raise specifically trains the posterior deltoid muscle. Specific rotator cuff strength training exercises include internal rotation and external rotation on a flat bench using very light dumbbells. More painful injuries with greater loss of mobility may require (1) Codman pendulum exercises and (2) finger-walking (up a wall) to the front and to the side.
The goals of rotator cuff rehabilitation, as for any mechanical injury, include decreased inflammation, decreased pain, return to more full active range of motion, return to more full muscular strength, and restoration of function.
1 Plate JF, et al: Rotator cuff injuries in professional and recreational athletesJ Surg Orthop Adv 22(2):134-142, 2013
2 Escalmilla RF, et al: Optimal management of shoulder impingement syndrome. Open Access J Sports Med 5:13-24, 2014
3 McMahon PJ, et al: What Is the Prevalence of Senior-athlete Rotator Cuff Injuries and Are They Associated With Pain and Dysfunction? Clin Orthop Relat Res 2014 Mar 12. [Epub ahead of print]



The current science is called genetic control, which simply means control by genes. The new science, that I got involved with more than 40 years ago and is now becoming mainstream, is called epigenetic control. This little prefix epi turns the world upside down. Epi means above. So, epigenetic means control above the genes. We now know that we influence the activity of our genes by our actions, perceptions, beliefs and attitudes. In fact, epigenetic information can take a single gene blueprint and modify the readout of the gene to create more than 30,000 different proteins from the same blueprint. Basically, it says that the genes are plastic and variable and adjust to the environment.
For example, if a woman conceives a child but all of a sudden there’s violence in the environment, war breaks out and the world is not safe anymore, how’s the child going to respond? The same way the mother responds. Why is this important? When a mother is responding to a stressful situation, her fight or flight system is activated and her adrenal system becomes stimulated. This causes two fundamental things to happen. Number one, the blood vessels are squeezed in the gut, causing the blood to go to the arms and legs (because blood is energy), so that she can fight or run. The stress hormones also switch the blood vessels in the brain for this reason. In a stressful situation, you don’t depend on conscious reasoning and logic, which come from the forebrain. You depend on hindbrain reactivity and reflexes; that’s the fastest responder in a threatening situation. Well that’s cool for the mother, but, what about for the developing fetus? The stress hormones pass into the placenta and have the same effect, but with a different meaning when it affects the fetus. The fetus is in a very active growing state and it requires blood for nutrition and energy, so whichever organ tissues get more blood will develop faster.
The significance in all this is that the forebrain is consciousness and awareness; you can reduce the intelligence of a child by up to 50 percent by environmental stressors because of shunting the blood from the forebrain and developing a large hindbrain. Nature is creating the child to live in the same stressed environment that the parents perceive. The same fetus developing in a healthy, happy, harmonious environment creates a much healthier viscera, which enables growth and maintenance of the body for the rest of its life, as well as a much larger forebrain, which gives it more intelligence. So, the mother’s perception and attitude about the environment is translated into epigenetic control, which modifies the fetus to fit the world the mother perceives. Now, when I emphasize mother, of course, I have to emphasize father [as well]. Because if the father screws up, this also messes up the mother’s physiology. Both parents are actually genetic engineers.

Wednesday, September 24, 2014

Physical activity guidelines: How much exercise do you need?

For general good health, the 2008 Physical Activity Guidelines for Americans recommends that adults get a minimum of 2-1/2 hours per week of moderate-intensity aerobic activity. (37) Yet many people may need more than 2-1/2 hours of moderate intensity activity a week to stay at a stable weight. (37)
  • The Women’s Health Study, for example, followed 34,000 middle-aged women for 13 years to see just how much physical activity they needed to stay within 5 pounds of their weight at the start of the study. Researchers found that women who were in the normal weight range at the start of the study needed the equivalent of an hour a day of physical activity to stay at a steady weight.(43)
  • If you are exercising mainly to lose weight, 30 minutes or so a day may be effective in conjunction with a healthy diet. (44)
If you currently don’t exercise and aren’t very active during the day, any increase in exercise or physical activity is good for you.
  • Aerobic physical activity—any activity that causes a noticeable increase in your heart rate—is especially beneficial for disease prevention.
  • Some studies show that walking briskly for even one to two hours a week (15 to 20 minutes a day) starts to decrease the chances of having a heart attack or stroke, developing diabetes, or dying prematurely.
  • You can combine moderate and vigorous exercise over the course of the week, and it’s fine to break up your activity into smaller bursts as long as you sustain the activity for at least 10 minutes.
Exercise Intensity:
  • Moderate-intensity aerobic activity is any activity that causes a slight but noticeable increase in breathing and heart rate. One way to gauge moderate activity is with the “talk test”—exercising hard enough to break a sweat but not so hard you can’t comfortably carry on a conversation.
  • Vigorous-intensity aerobic activity causes more rapid breathing and a greater increase in heart rate, but you should still be able to carry on a conversation—with shorter sentences.
Here is a summary of the 2008 Physical Activity Guidelines for Americans. More information is available on the Physical Activity Guidelines for Americans website.
Children and adolescents should get at least 1 hour or more a day of physical activity in age-appropriate activities, spending most of that engaged in moderate- or vigorous–intensity aerobic activities. They should partake in vigorous-intensity aerobic activity on at least three days of the week, and include muscle-strengthening and bone strengthening activities on at least three days of the week.
Healthy adults should get a minimum of 2-1/2 hours per week of moderate-intensity aerobic activity, or a minimum of 1-1/4 hours per week of vigorous-intensity aerobic activity, or a combination of the two. That could mean a brisk walk for 30 minutes a day, five days a week; a high-intensity spinning class one day for 45 minutes, plus a half hour jog another day; or some other combination of moderate and vigorous activity. Doubling the amount of activity (5 hours moderate- or 2-1/2 hours vigorous-intensity aerobic activity) provides even more health benefits. Adults should also aim to do muscle-strengthening activities at least two days a week.
Healthy older Adults should follow the guidelines for healthy adults. Older adults who cannot meet the guidelines for healthy adults because of chronic conditions should be as physically active as their abilities and conditions allow. People who have chronic conditions such as arthritis and type 2 diabetes should talk to a healthcare provider about the amount and type of activity that is best. Physical activity can help people manage chronic conditions, as long as the activities that individuals choose match their fitness level and abilities. Even just an hour a week of activity has health benefits. Older adults who are at risk of falling should include activities that promote balance. (37)

Strength training for all ages

Studies have shown strength training to increase lean body mass, decrease fat mass, and increase resting metabolic rate (a measurement of the amount of calories burned per day) in adults. (5960) While strength training on its own typically does not lead to weight loss, (61) its beneficial effects on body composition may make it easier to manage one’s weight and ultimately reduce the risk of disease, by slowing the gain of fat—especially abdominal fat. (62)
  • Muscle is metabolically active tissue; it utilizes calories to work, repair, and refuel itself. Fat, on the other hand, doesn’t use as much energy. We slowly lose muscle as part of the natural aging process, which means that the amount of calories we need each day starts to decrease, and it becomes easier to gain weight.
  • Strength training regularly helps preserve lean muscle tissue and can even rebuild some that has been lost already.
  • Weight training has also been shown to help fight osteoporosis. For example, a study in postmenopausal women examined whether regular strength training and high-impact aerobics sessions would help prevent osteoporosis. Researchers found that the women who participated in at least two sessions a week for three years were able to preserve bone mineral density at the spine and hip; over the same time period, a sedentary control group showed bone mineral density losses of 2 to 8 percent. (63)
  • In older populations, resistance training can help maintain the ability to perform functional tasks such as walking, rising from a chair, climbing stairs, and even carrying one’s own groceries. An emerging area of research suggests that muscular strength and fitness may also be important to reducing the risk of chronic disease and mortality, but more research is needed. (64-68)
  • A systematic review of 8 studies examining the effects of weight-bearing and resistance-based exercises on the bone mineral density (BMD) in older men found resistance training to be an effective strategy for preventing osteoporosis in this population. Resistance training was found to have more positive effects on BMD than walking, which has a lower impact. (69)
The Physical Activity Guidelines for Americans recommends that muscle strengthening activities be done at least two days a week. (37) Different types of strength training activities are best for different age groups.
  • When talking about the benefits of exercise, keeping the heart and blood vessels healthy usually gets most of the attention. For many individuals, though, stretching and strength training exercises may be just as important.
  • Strength training, also known as resistance training, weight training, or muscle-strengthening activity, is one of the most beneficial components of a fitness program.
Children and Adolescents: Choose unstructured activities rather than weight lifting exercises. (37)
  •  Playing on playground equipment
  • Climbing trees
  • Playing tug-of-war
Active Adults: Weight training is a familiar example, but there are other options: (37)
  • Calisthenics that use body weight for resistance (such as push-ups, pull-ups, and sit-ups)
  • Carrying heavy loads
  • Heavy gardening (such as digging or hoeing)
Older Adults: The guidelines for older adults are similar to those for adults; older adults who have chronic conditions should consult with a health care provider to set their activity goals. (37) Muscle strengthening activities in this age group include the following:
  • Digging, lifting, and carrying as part of gardening
  • Carrying groceries
  • Some yoga and tai chi exercises
  • Strength exercises done as part of a rehab program or physical therapy

Flexibility training

Flexibility training or stretching exercise is another important part of overall fitness. It may help older adults preserve the range of motion they need to perform daily tasks and other physical activities. (7071)
  • The American Heart Association recommends that healthy adults engage in flexibility training two to three days per week, stretching major muscle and tendon groups. (60)
  • For older adults, the American Heart Association and American College of Sports Medicine recommend two days a week of flexibility training, in sessions at least 10 minutes long. (70) Older adults who are at risk of falling should also do exercises to improve their balance.


37. Physical Activity Guidelines for Americans, U.S.D.o.H.a.H. Services, Editor. 2008.

43. Lee, I.M., et al., Physical activity and weight gain prevention. JAMA, 2010. 303(12): p. 1173-9.

44. Jakicic, J.M., et al., Effect of exercise duration and intensity on weight loss in overweight, sedentary women: a randomized trial. JAMA, 2003. 290(10): p. 1323-30.

49. Sesso, H.D., R.S. Paffenbarger, Jr., and I.M. Lee, Physical activity and coronary heart disease in men: The Harvard Alumni Health Study. Circulation, 2000. 102(9): p. 975-80.

59. Hunter, G.R., J.P. McCarthy, and M.M. Bamman, Effects of resistance training on older adults. Sports Med, 2004. 34(5): p. 329-48.

60. Williams, M.A., et al., Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation, 2007. 116(5): p. 572-84.

61. Committee, P.A.G.A., Physical Activity Guidelines Advisory Committee Report. Washington, D.C.(2008).

62. Schmitz, K.H., et al., Strength training and adiposity in premenopausal women: strong, healthy, and empowered study. Am J Clin Nutr, 2007. 86(3): p. 566-72.

63. Engelke, K., et al., Exercise maintains bone density at spine and hip EFOPS: a 3-year longitudinal study in early postmenopausal women. Osteoporos Int, 2006. 17(1): p. 133-42.

64. Katzmarzyk, P.T. and C.L. Craig, Musculoskeletal fitness and risk of mortality.Med Sci Sports Exerc, 2002. 34(5): p. 740-4.

65. Gale, C.R., et al., Grip strength, body composition, and mortality. Int J Epidemiol2007. 36(1): p. 228-35.

66. Bohannon, R.W., Hand-grip dynamometry predicts future outcomes in aging adults. J Geriatr Phys Ther, 2008. 31(1): p. 3-10.

67. Ling, C.H., et al., Handgrip strength and mortality in the oldest old population: the Leiden 85-plus study. CMAJ, 2010. 182(5): p. 429-35.

68. Ruiz, J.R., et al., Association between muscular strength and mortality in men: prospective cohort study. BMJ, 2008. 337: p. a439.

69. Bolam, K.A., J.G. van Uffelen, and D.R. Taaffe, The effect of physical exercise on bone density in middle-aged and older men: A systematic review.Osteoporos Int, 2013.

70. Nelson, M.E., et al., Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation, 2007. 116(9): p. 1094-105. 

Pregnancy and Chiropractic

Pregnancy and Chiropractic

(NaturalNews) Are you currently pregnant or thinking about having a baby soon? If you answered yes to either question, hopefully you are also seeing a chiropractor. A woman's body goes through countless changes while pregnant, not only hormonally, but also posturally and bio-mechanically. Low back pain is almost imminent during pregnancy; chiropractic care offers a non-invasive, safe form of care to help alleviate pain and make having a baby easier.


When pregnant, your body goes through changes to prepare to carry and nourish your baby. Your center of gravity shifts forward as the baby grows, the pelvis tilts anteriorly causing the muscles in the lower back to become shortened and tightened, while the hamstrings and gluteal muscles become stretched and weakened. The curves in the cervical and lumbar regions are increased, placing extra stress in the lower back and neck. The round ligaments attach to the uterus, are stretched and placed under a lot of stress while pregnant, and can be the cause of significant amounts of pain while pregnant, both in the abdomen and lower back. The psoas, tensor fascia lata (TFL), quadratus lumborum, and piriformis muscles are also placed under new loads when pregnant, causing pain, tightness and imbalances. Hormonal changes throughout pregnancy cause ligaments to become looser, and therefore causing the joints to become less stable, especially the sacroiliac joints and pubic symphysis. Chiropractors use gentle, soft tissue techniques to help relax the tight ligaments and eliminate or reduce pain.

Safe pain relief

Diversified chiropractic adjustments are safe for mom and baby throughout the duration of the pregnancy. Special tables and pillows are used so pregnant women can lie in the prone (face down) position while being treated. Chiropractic adjustments help put motion into joints that are not moving as well as they should be; the same goes for the joint in the front of the pelvis, which is placed under an enormous amount of stress throughoutpregnancy. Symphysis dysfunction and diastasis can happen during pregnancy; referred pain from the broad and round ligaments can cause intense pain often mimicking diastasis. Soft tissue techniques can be applied to relax tension in the round ligaments. Wedge-shaped blocks can also be used to help the pelvis return to a normal position and ease pain. Chiropractic care offers a variety of safe forms for pain relief without the use of invasive procedures or prescription drugs. Chiropractic appointments should be scheduled at the same intervals as OB/GYN appointments, or more frequently if necessary.

Have a more pleasant pregnancy, the natural way

Women who receive chiropractic care report easier and faster deliveries. Many chiropractors are also specially trained in the Webster Breech Technique. This hands-on technique helps to reduce uterine torsion so the baby can turn itself into the proper position for a safe, less painful delivery. No one likes to be in pain; pain can also cause a great deal of anxiety and stress, neither of which are good for mom or baby. Getting adjusted regularly while pregnant can help ease or eliminate pain and make the process of having a baby much easier.

Learn more:

Thursday, September 11, 2014

Truth About Medical Interventions – C-Sections, Inductions, Epidurals

Truth About Medical Interventions – C-Sections, Inductions, Epidurals

C-Sections Instead of Breech Delivery

Routine cesarean section for breech presentation has been recommended over the last forty years. As a consequence, the rate of vaginal breech delivery has decreased sharply. In the United States, the rate of cesarean section for breech presentation rose from just 10 percent to nearly 80 percent in 15 years (1970-1985). On closer examination, however, it is clear that the association between breech presentation and perinatal mortality is due principally to the confounding variables of prematurity and congenital malformation. Traumatic injury and complications giving rise to birth asphyxia in a vaginal breech delivery are uncommon. The recommendations for routine cesarean section have therefore been made on the basis of imperfect data. The issue of vaginal delivery compared with abdominal delivery of the term breech pregnancy is currently being addressed in a worldwide multicenter randomized controlled trial (“The Term Breech Trial”). -MIDIRS 9:1, March 1999
Reasons for present cesarean rate
1. Dystocia or failure of labor to progress (31% of cesareans): pelvic opening too small for the baby; birth canal too small for the baby; contractions irregular or not intense enough to dilate the cervix.
2. Breech presentation (12% of cesareans): baby emerging feet first.
3. Repeat cesarean (31% of cesareans): mother has previously given birth by cesarean.
4. Fetal distress (5% of cesareans): baby is shown to have abnormal heartbeat pattern with fetal monitoring, and diagnosis is confirmed by fetal scalp blood pH testing.
5. Other (21%) of cesareans): maternal illness such as diabetes or heart disease, active herpes, or medical emergencies such as placenta previa or prolapsed cord.
Wrapped Cords
A study that looked at outcomes of pregnancies complicated by a multiple nuchal cord entanglement included 8,565 deliveries. A single loop of cord around the fetal neck at delivery was found in 2,191 deliveries, and more than one loop was found in 326 deliveries. Pregnancies with a multiple cord entanglement were more likely to have an abnormal cardiotocograph consisting of persistent variable deceleration in advanced labor. These infants were also more likely to have meconium, a low Apgar score at one minute, and a low umbilical artery pH of 7. There was no difference in the rate of cesarean sections, placental abruption and Apgar scores at five minutes between the two groups, and no stillbirths occurred in the cord entanglement group. The study concluded that with multiple nuchal cord entanglement there was no risk of adverse neonatal outcome, and that a multiple cord entanglement is not a contributing factor in intrapartum stillbirth, placental abruption or cesarean delivery. MIDIRS Dec. 1996
Prerequisites for a safe vaginal birth after a previous cesarean (VBAC):
Common management guidelines:
 1. Parents have discussed all the pros and cons of a VBAC with their doctor.
 2. The present pregnancy has no indications for recommending a cesarean section.
 3. A low transverse incision was used in the previous cesarean section.
 4. The mother is admitted to the hospital early in labor, so that her progress can be carefully monitored.
 5. Backup facilities for an immediate cesarean section are available.
Controversial Management Guidelines:
1. Some doctors will not permit a trial labor is the mother has previously had a cesarean section because of too small a pelvis.
 2. Some doctors won’t use drugs that stimulate labor if the mother has had a previous
 3. Some doctors don’t recommend regional anesthesia during a vaginal delivery after a
 cesarean because they believe it could mask rupture problems.
4. Some doctors recommend the routine use of low forceps to shorten labor if the woman
 has previously had a cesarean.
Patient choices suggested by the cesarean support groups:
• Allow the mother to forego any preoperative medication.
• Allow the mother to choose regional anesthesia so she can see the baby being born.
• Use epidural anesthesia if a qualified anesthesiologist is attending.
• Use a low transverse skin incision whenever possible for cosmetic reasons.
• Allow the father to remain with the mother in the delivery room.
• Allow the mother to have her arms free.
• Allow the mother to view the birth without a screen or with a mirror.
• Encourage the doctor to talk reassuringly with the parents during the operation.
• Allow the mother, if possible, or the father to hold the baby immediately after the birth.
• Have the initial routine pediatric exam done where the parents can watch.
• Delay weighing, measuring, and eye drops until after the initial bonding period.
• Allow for the mother, father and baby to remain together in the recovery room during first hour after birth.
• Allow the mother to nurse the baby as soon as the operation has been completed.
• Allow the mother to have full rooming in as soon as she wished.
• Allow mother to have a helper such as the husband or a friend to assist her in caring for the baby.
• Allow siblings to visit the mother and baby daily.
• With repeat cesareans, have preliminary laboratory test done on an outpatient basis so the mother does not have to be admitted until the day of the surgery.


 In one day’s time I received two calls asking about the relationship between the administration of pitocin and neurologically compromised infants at birth and my intuitive antennas went off. Pitocin is a synthetic version of oxytocin the naturally produced hormone in the laboring woman. It is preferably administered through IV. As with all drugs, it does not come without its side effects, the most common being increased blood pressure in both the mother and child. Even the American Academy of Pediatrics agrees that no drug has been tested as safe for the baby in utero.
Pitocin is used for either labor induction or labor enhancement (what an inappropriate use of that term!) The use of pitocin does not, however, duplicate the natural progression of labor. Pit induced labors have longer, harder and more painful uterine contractions. Additional reported risks of induction are:
For the mother: higher rate of complicated labors and deliveries, greater need for analgesics and anesthetics, postpartum hemorrhage and a higher rate of placental rupture and separation life-threatening to both the mother and baby.
For the baby: induction causes fetal distress, a higher rate of jaundice, a greater chance of a prematurity, low apgar scores at 5 minutes, permanent central nervous system or brain damage and fetal death.
In either induced or enhanced use of pitocin, the blood supply (therefore the oxygen source) to the uterus is greatly reduced. With naturally paced contractions, there is a time interval between contractions allowing for the baby to be fully oxygenated before the next contraction. In induced or stimulated labor, the contractions are closer together and last for a longer time thus shortening the interval where the baby receives its oxygen supply. Reduced oxygen could have life-long consequences on the baby’s brain. 1
It is the belief (not necessarily the practice) in the medical profession that induction should occur when the risk of continuing pregnancy presents a threat to the life of the mother or baby. These situations include: some severe diabetics, kidney disease, severe preclampsia, severe high blood pressure, kidney disease, and an overdue pregnancy where a danger to the fetus has been proven. If induction were carried out only when these conditions were present, at most, an estimate of 3% of births would be induced. 2
In reality though, due date paranoia remains the most common reason for induction and the consequent use of pitocin. Surprisingly, studies on the due date calculations revealed frightening evidence. Firstly, the due date varies significantly between first time pregnancies and subsequent pregnancies. 3 Also, maternal race has been shown to be a determining factor in gestation time. 4
Another variable to the accuracy of the due date is the recent dependence of ultrasound as a reliable criteria for infant size and gestational age. First trimester measurements have an error bar of ± 5 days, increasing to ± 8 days in the second trimester and are as high as ± 25 days in the third trimester!  
Bigger fetuses are assumed to be older and in studies where the ovulation date was known 70% of women who were classified as postdates were incorrectly dated. 6
Furthermore, studies on induction have shown that 30% of fetuses testing normal developed fetal distress when labor was electively induced and the cesarean rate was 15% versus 2% for spontaneous labor. 7
Using pitocin to enhance labor leads to an increase in epidurals, and therefore obstetric intervention during birth adding additional risks to both the mother and baby. (See ICPA Newsletter Jan/Feb, 1999). And finally, a controlled randomized study showed that the use of pitocin to stimulate labor was not as productive for the progression of labor as allowing mothers to change positions during labor by walking, sitting or standing. 8 Giving the mother back control of her body–what a novel idea and topic for a future newsletter.
As more and more interventions are added to the birth process, the cause of birth trauma is proportionately rising. It is our job as chiropractors to continue to educate mothers about the choices they have in birth and help reduce the devastating effects birth trauma is having on their babies’ delicate nervous systems. It is a huge job ahead of us, yet I know chiropractors have the passion and the means to make it happen!
Jeanne Ohm, D.C., F.I.C.P.A. – Originally Printed in: I.C.P.A. Newsletter January/February 2000
1. “A Good Birth, A Safe Birth” Diana Korte and Roberta Scaer
2. Caldeyro-Barcia R. “Some consequences of obstetrical interference. Birth Spring 1975; 2(2)
3. Mittendorf R, Williams MA, Berkey CS, Cotter PF. The Length of uncomplicated human gestation. Obstet Gynecol 1990; 75(6): 929-932
4. ibid
5. Otto C, Platt LD. Fetal growth and development. Obstet Gynecol Clin North Am 1991; 18(4) 907-931
6. Nichols CW. Postdate pregnancy. Part I. A literature review. J Nurse Midwifery. 1985; 30(4):222-39
7. Devoe LD, Sholl JS. Postdates pregnancy. Assessment of fetal risk and obstetric management. J Reprod Med 1983; 28(9); 576-580
8. Read JA, Miller FC, Paul RH. Randomized trial of ambulation versus oxytocin for labor enhancement: a preliminary report. Am J Obstet Gynecol. 1981;139 (6):669-72

Why Women Do Not Like The “Induction of Labor” Procedure
• Induced labor causes contractions to become far more painful than nature ever intended.
• Induced labor causes women who would not have chosen drugs for childbirth to ask for them.
• Induced labor puts the baby at risk of possible brain damage through oxygen deprivation.
• Induced labor puts the mother at risk of uterine rupture if she previously had a cesarean birth.
• Induced labor dramatically increases the risk of emergency cesarean birth.
• Induced labor causes a woman to lose control and confidence in the natural birth process.
• Induced labor causes a woman to be monitored excessively during childbirth.
• Induced labor increases a woman’s chance of hemorrhage, during the birth and afterwards.
• Induced labor causes a woman to be unable to complete hormonal staging.
• Induced labor forces a baby who is not ready and a body that is not ready to try to give birth.
• Induced labor by rupturing the membranes may cause a woman’s umbilical cord to collapse thereby increasing the likelihood of death to the baby.
• Induced labor by rupturing the membranes may encourage the baby to assume a position that may cause the mother more pain and a longer labor that would have been experienced otherwise.
• Induced labor causes lasting side effects in the mother of complete loss of sexual desire, prolonged severe postnatal depression, and reduced immune function. The use of Prostin, which is pig semen, is most certainly a reason for the woman’s loss of sexual desire reported regularly after childbirth.
• Drugs such as misoprostal, used for induction have not been proven safe.
• Induced labor may cause the baby to have lowered immune function, leading to allergies, asthma and brain seizures due to the effects of the animal hormone used to induce or force the labor, caused by the long after-life of this drug and due to the fact that many babies have been induced prematurely and their immune system is not fully developed yet.
• Induced birth may permanently damage the woman’s uterus causing her to be unable or unwilling to bear more children
Words with a Midwife
Q: How and why do you induce labor?
If and when the intrauterine environment becomes more hazardous for the baby than the outside, or to relieve maternal suffering–which on occasion the mother can only subjectively describe. -Phil Watters, OBGYN, Hobart, Tasmania Australia 
I feel odd responding to this question because I don’t induce labor. I am a direct-entry midwife in Kentucky. I have only been practicing independently for a year; however, I was trained by Mary Ann Watson, CPM, QE, a direct-entry midwife with over 18 years’ experience in homebirth. Her philosophy/protocols regarding induction questions are:
1. What if I never go into labor?
Women were designed to give birth. Gestation for each mother with each baby will occur at its own pace, just as labor progresses at its own pace. Just because the baby inside feels large enough to survive, it may need more time inside to develop a crucial system? No woman has ever been pregnant forever. Mary Ann continues weekly prenatal visits until the birth. As long as no complications arise, she does not risk out or induce women just because they are overdue.
2. What if my baby is too big?
Normal, healthy women do not grow babies they cannot birth. The species would have destroyed itself if this were true. Induction may also contribute to malpresentation. If the baby is allowed time to find a good birthing position, it will adapt to the pelvic inlet. Arbitrary induction may cause labor to begin before the baby is in a good position.
3. Should VBACs be induced?
Mary Ann’s practice prior to coming to Kentucky was primarily VBAC births. She has an excellent record of successful VBAC births. Her VBAC moms are not induced and do not have a greater complication or transport rate than her other clients.
4. What if the placenta stops functioning?
Normal, healthy placentas do not just stop functioning 14 days past the due date. I myself have had one client go either 3 or 5 weeks overdue (she was unsure of her dates). Mary Ann has had clients confirmed at 30 days or more overdue. Those babies were fine, and those placentas were healthy.
Some women do try to induce themselves with herbal preparations, castor oil, or some other home preparation. She firmly discourages this, for all the reasons above. Many of these induction attempts are not successful. One mother who was successful in inducing labor later regretted it. She had three productive, relatively short labors. This fourth, induced labor was long, slowly productive, and exhausting. She now discourages other women from trying to induce labor. 
Our philosophy that birth is a natural process and our desire to allow it to progress with no intervention that is not absolutely necessary begins with good prenatal care and with accepting that labor will begin when it is time. -Candy Hall, midwife

The Epidural Epidemic

Epidurals during birthing have become so routine, as mothers are being convinced that pain during labor is unnatural. Convinced that they should not endure pain during the birth process, mothers are set up to believe in a drug instead of their bodies’ own natural capabilities. Sixty four percent of certified nurse midwives reported concern over the increased number of their clients who desire epidural anesthesia, and a majority of certified nurse-midwives surveyed (53%) reported a negative attitude toward the increased use of epidurals. 1
We started including questions about births years ago on our children’s case history and 9 times out of 10, mothers will check off that they had a “natural childbirth” and in the next question, they check off that they had an epidural. In other words, if they delivered vaginally, and their eyes were open, they are being led to believe that they delivered naturally.
What is not being provided to the parents is the increased complications which are a result of epidural usage. The PDR2 cautions that “local anesthesia rapidly crosses the placenta…and when used for epidural blocks, anesthesia can cause varying degrees of maternal, fetal and neonatal toxicity.” It continues, “this toxicity can result in the following side effects: hypotension, urinary retention, fecal and urinary incontinence, paralysis of lower extremities, loss of feeling in the limbs headache, backache, septic meningitis, slowing of labor, increased need for forceps and vacuum deliveries, cranial nerve palsies, allergic reactions, respiratory depression, nausea, vomiting and seizures.” Many of these side effects result in multiple complications. For example, maternal hypotension causes bradycardia (decreased heart rate) in the fetus. This altered heart rate can lead to fetal distress and operative deliveries.3
This has led doctors to warn “a high concentration anesthetics and epinephrine should be avoided, as they may influence labor.”
Things to Know About Epidurals:
1. Causes longer labors with slower progress.5 6
2. Can cause fevers in mothers during childbirth. 7
3. Increase use of pitocin by as much as 3 ½ times, which causes slow and irregular contractions. 5 8
4. Increases use of antibiotics in your baby by as much as 4 times. 4
5. Increases use of forceps by as much 4½ – 20 times.5
6. Causes neonatal jaundice due to altered red blood cells. 9
7. Increases the incidence of birth trauma due to the use of mechanically assisted deliveries. 10 11
8. Causes adverse behavioral effects of the neonate. 12
In order to bring about a reversal in epidural usage, mothers must become educated not only on its potential side effects, but on their bodies’ own ability to give birth naturally. The overwhelming fear associated with birth has become a learned behavior in our culture. Fear causes additional muscular tension in the body, resulting in decreased blood supply to organs and therefore impaired uterine function. It is our privilege and obligation as Chiropractors to care for these women throughout their pregnancies, offering them encouragement and educating about choices for their upcoming experience. I have been told by many chiropractors (and have heard it in our own practice) how women look forward to their visit with us because we treat the process of pregnancy with respect, and we enhance the mothers confidence in her own innate abilities.
Jeanne Ohm, D.C., F.I.C.P.A. – Originally Printed in: I.C.P.A. Newsletter March/April 1999 By Randall Neustaedter OMD, LAc, CCH | Published 8/11/2004 | Diseases and Conditions: Prevention and Treating | Excerpt from Child Health Guide, North Atlantic Books, 2005
1. Graninger EM; McCool WP. Nurse-midwives’ use of and attitudes toward epidural analgesia. J Nurse Midwifery 1998; 43(4):250-61
2. 1996 Physicians Desk Reference
3. Stavrou C; Hofmeyr GJ; Boezaart AP. Prolonged fetal bradycardia during epidural analgesia. Incidence, timing and significance. S Afr Med J 1990; 77(2):66-8
4. Thompson TT; Thorp JM Jr; Mayer D; Kuller JA; Bowes WA Jr . Does epidural analgesia cause dystocia? J Clin Anesth 1998; 10(1):58-65
5. Studd JW; Crawford JS; Duignan NM; Rowbotham CJ; Hughes AO. The effect of lumbar epidural analgesia on the rate of cervical dilatation and the outcome of labour of spontaneous onset. Br J Obstet Gynaecol 1980; 87(11): 1015-21
6. Alexander JM; Lucas MJ; Ramin SM; McIntire DD; Leveno KJ. The course of labor with and without epidural analgesia. Am J Obstet Gynecol 1998; 178(3):516-20
7. Lieberman E, Lang JM, Frigoletto F Jr, Richardson DK, Ringer SA, Cohen A, Epidural analgesia, intrapartum fever and neonatal sepsis evaluation. Pediatrics 1997; 99(3): 415-9
8. McRae-Bergeron CE; Andrews CM; Lupe PJ. The effect of epidural analgesia on the second stage of labor. AANA J 1998; 66(2):177-82
9. Clark DA; Landaw SA. Bupivacaine alters red blood cell properties: a possible explanation for neonatal jaundice associated with maternal anesthesia. Pediatr Res 1985; 19(4):341-3
10.Town A. Latent spinal cord and brain stem injuries in newborn infants Develop Ed Child Neural 1969, 11; 54-68
11.Menticoglou SM; Perlman M; Manning FA; High cervical spinal cord injury in neonates delivered with forceps: report of 15 cases. Obstet Gynecol 1995; 86(4 Pt 1):589-94
12.Murray AD; Dolby RM; Nation RL; Thomas DB. Effects of epidural anesthesia on newborns and their mothers. Child Dev1981; 52(1):71-82