Chiropractic Evaiuation and Management of the Pregnant Patient:
An Update from Recent Literature by Lindsey Zerdecki and Steven Passmore
P
regnancy should be a time
of joy for the expectant
mother. However, it's also
a virtually unparalleled period of rapid
change in one's morphology. The stresses
placed on a human's anatomy and physi-
ology result in compensatory altered bio-
mechanics and gait to perform even the
'k^M^M\ n^ost basic activities of daily living. These
| | _ 0 _ ^ changes to an individual often result in
the onset of a myriad of musculoskeletal
issues that can develop during pregnancy.
This article details the current expla-
nations of these changes as well as the
potential role of chiropractic therapy for
the pregnant woman.
Low Back Pain and Physiologic
Changes in the Pregnant Patient
Low back pain is a common complaint
of the pregnant woman (Ritchie 2003).
Research has demonstrated that between
50% and 80% ofpregnant patients report low
back pain (Skaggs et al. 2004), the majority
when the mother is between 20 and 40 weeks
pregnant (Kristiansson, Svrdsudd and von
Schoultz 1996).
An estimated 25% of women with low
back pain during pregnancy have a severity
of pain categorized as temporarily disabling
(Borg-Stein, Dugan and Gruber 2005). A
portion of this back pain can be attributed
to the release ofthe hormones progesterone,
estrogen and relaxin during the beginning
stages ofpregnancy (Borg-Stein, Dugan and
Gruber 2005). These hormones primarily
cause decreased muscle tone, changes in con-
nective tissue integrity, retention of water
and laxity of ligaments. Ligamentous laxity
(looseness ofthe ligaments) in the pelvis can
cause hypermobility ofthe pubic symphysis
or the sacroiliac joints, thus affecting lumbar
spine stability (Bogduk 1997). This laxity,
along with changes in posture, may be the
main components of low back pain in the
pregnant population. Postural changes in the
pregnant patient include: increased lumbar
lordosis (leading to shortened lumbar muscu-
lature), increased sacral base angle, increased
extremity pronation, possible transient rever-
Autumn 2008
sal ofthe cervical lordosis, a shift ofthe plumb it will pull the pelvis toward it (Anony-
line posteriorly and a change in the sacro- mous 2003).
coccygeal angle (Benizzi DiMarco 2003).
These changes in posture cause an increased Beyond Low Back Painthe Role of
load on the posterior aspects ofthe vertebral the Chiropractor in the Evaluation
column including the zygapophyseal joints; and Management of the
intervertebral discs; supraspinous, intraspi- Pregnant Patient
nous and intertransverse ligaments along Besides low back pain, other conditions
with the ligamentum flavum and muscles that occur during pregnancy are within
including the deep spinal muscles; the erec- a chiropractic scope of practice for man-
tors; the psoas and the muscles ofthe pelvis. agement or evaluation. These include peri-
(Editor's Note: For a better understanding of pheral nerve entrapments, headaches, tran-
the psoas in relation to pregnancy, see "Birth- sient osteoporosis or osteonecrosis and pubic
ing Fear: The Iliopsoas Muscle," Midwifery Today,pain. Common nerve entrapments at the
Issue 74.) In addition, anterior structures are carpal tunnel (median nerve) and the inguinal
not spared; stretching of the anterior longi- region (lateral femoral cutaneous nerve) lead
tudinal ligament also occurs, yielding spinal to carpal tunnel symptoms or meralgia pares-
instability (Ibid). thetica (numbness in the outer thigh) respec-
Although lumbar disc herniations are tively (Borg-Stein, Dugan and Gruber 2005).
uncommon in pregnant women, they do Nerve entrapments during pregnancy can be
appear in approximately one of 10,000 attributed to hormonal changes causing pos-
cases of lumbosacral pain during preg- sible edema around a nerve, compression or
nancy (LaBan et al. 1995). Weight gain, traction to the nerve itself Edema around the
coupled with the previously mentioned extensor pollicus brevis and abductor pollicus
hormonal and postural changes, alters bio- longus can cause DeQuervain's syndrome
mechanics, which may contribute to disc (stenosing tenosynovitis) (Ibid).
herniations. Weight gain further increases The pregnant patient also may present
loads on the joints ofthe lumbar spine. A with headache. Melhado, Macial and Guer-
weight gain of 20%, which is adequate, reiro (2007) found that the majority ofwomen
increases the load on the zygapophyseal with headaches during pregnancy presented
joints by as much as 100% (Ritchie 2003). with migraine headaches, which the women
The morphology and biomechanical strain had prior to conception. Most disappeared
on a pregnant woman are not unlike that by the second or third trimester (Melhado,
of the man with a pendulous protuber- Macial and Guerreiro 2007).
ant abdomen or "beer belly." Differences Although rare, transient osteoporosis
between the two would be, most notably, of the femoroacetabular joint can develop
the slow onset of weight in males and the during pregnancy. This condition presents
lack of hormonally-induced ligamentous with weight-bearing hip pain, usually in
laxity. An empirical comparison of these the third trimester (Borg-Stein, Dugan and
populations in terms of lordosis, stability Gruber 2005). The etiology for this condition
and response to intervention needs fur- is unknown (Ritchie 2003). A possibility of
ther study. osteonecrosis ofthe femoral head also exists.
Another contribution to low back pain Causes for the condition are unknown, but
in pregnant women is anterior pelvic rota- some theorize that the higher cortisol levels
tion and subsequent muscle hypertonicity, combined with increased stress of the joint
because pelvic rotation leads to increased from weight gain may be responsible (Cheng,
lumbar lordosis (Borg-Stein, Dugan and Burssens and Mulier 1982). Another hypoth-
Gruber 2005). Asymmetrically taut ham- esis is that the higher levels of estrogen and
strings may also affect pelvic rotation. If progesterone along with increased intraos-
one side is more hypertonic than the other seous pressure may contribute to the devel-
Midwifery Today www.midwiferytoday.com
opment of osteonecrosis of the femoral head for women who want a natural birth, and it of the patient's pain. Chiropractors need to
(Hungerford and Lennox 1985). increases the risk for both mother and baby change the way in which they adjust pregnant
Pubic pain also is commonly seen in of other complications from pain-relieving patients, to accommodate patient comfort. In
pregnant women. Various conditions may drugs and instruments. a case series study by Lisi (2006), chiroprac-
be the cause of this pubic pain including: Pregnant women who are clinically tic care including advice on body mechan-
increased motion due to ligamentous laxity, depressed in the early parts of pregnancy ics, exercise instruction, myofascial release,
osteitis pubis or a rupture of the symphysis also have an increased risk of developing pre- joint mobilization and manipulation was
pubis. All of these conditions are consid- eclampsia (Kurki et al. 2000). In addition, the determined to help alleviate low back pain
ered self-limiting, with rare exceptions, in risk of bleeding during gestation, prematu- in 94.1% of the cases examined. The average
which case care may be warranted (Borg- rity(< 37 weeks), low Apgar scores, neonatal decrease in pain, as indicated by a numerical
Stein, Dugan and Gruber 2005). One must unit admissions, neonatal growth retardation, rating scale (NRS) changed from 5.9 to 1.5,
consider the totality of symptoms to deter- elevated fetal heart rate and low birth weight which exceeds a minimally clinically impor-
mine whether causality may be temporally, (<2500 g) also are associated with maternal tant difference. Patients noted this improve-
anatomically or physiologically attributed depression (Preti et al. 2000; Steer et al. 1992; ment after only an average of 1.8 visits to their
to pregnancy, because a patient's complaint Allister et al. 2001; Chung et al. 2001; Zax, chiropractor. No reports indicated adverse
may not be related to tbe pregnancy at all, SamerofF and Babigian 1997). According side efFects from the treatments (Lisi 2006).
but from a previous co-morbid condition to the National Center for Health Statistics This suggests that not only is chiropractic
(Anonymous 2003). Thorough evaluation (NCHS), nearly half of all infant deaths are care effective, but it is also safe.
and frequent re-evaluation of a patient is related to low birth weight (National Vital
essential to avoid failing to diagnose and Contraindications to
Statistics Report 2004).
manage a patient appropriately. Chiropractic Intervention
Women with depression also are less
According to Benizzi DiMarco (2003) there

Table 1 are contraindications to adjusting a pregnant
Depression, Pain and Pregnancy
woman (Table 1). If any of these conditions
The associations between pain and depres- Contraindications to chiropractic
are noticed by or reported to a chiropractor,
sion have been studied extensively. Pain is care of the pregnant patient:
rapid referral to an obstetrician/gynecolo-
found to be strongly associated with anxiety Highriskof miscarriage
gist would be clinically warranted (Benizzi
as well as with depressive disorders (Von Vaginal bleeding
DiMarco 2003). In addition, common
Korff and Simon 1996). One study found Imminent birth
Sudden onset of pelvic pain physical modalities (ultrasound, electrical
a relationship between the severity of the Ovarian cysts
stimulation, diathermy, etc.) are contrain-
pain, the duration/frequency of the pain Bowel obstruction
dicated over the abdomen, low back and
and the gross number of pains (Fishbain et Placenta previa
pelvic girdle in the pregnant patient (Borg-
al. 1997). The extent to wbich pain inter- Fibroids
Stein, Dugan and Gruber 2005). Aside
feres with daily activity is correlated with Placenta abruptio
Ectopic pregnancy from cryotherapy, which can be used on a
an increase in the likelihood and severity of Toxemia
patient with acute low back pain, chiroprac-
depression (Von Korff and Simon 1996). As Trauma
tors should focus on joint manipulation, soft
discussed previously, pregnant women may Adapted from Benizzi Dimarco (2003) tissue mobilization and prescriptive exercise
spend nine months or longer with several
(Anonymous 2003).
different pain presentations, ranging from likely to take care of themselves and are more
morning sickness to postoperative pain fol- likely to engage in self-destructive behav- Appropriate Treatment for
lowing cesarean delivery. Such pains are likely iorincluding using cigarettes, drugs and the Pregnant Patient
to interfere with daily activities (25%), thus alcohol, to show poor weight gain and to be When applying joint manipulation to a preg-
pregnant women may have a higher likeli- less likely to seek prenatal care or use prenatal nant patient, a chiropractor may alter the deliv-
hood than non pregnant women of develop- vitamins (Allister et al. 2001; Zuckerman et ery of treatment to maximize patient comfort.
ing depression. Depression among pregnant al. 1989; Bonari et al. 2004). Clearly, mother Due to the ligamentous laxity brought about
women ranges from 10-25%. Not aU cases are and baby may experience many complications during pregnancy, low velocity, low ampli-
due to pain, but as with any case of depression, when depression is involved. If chiropractic tude mobilization/manipulation such as flex-
pain may play a role (Wisner et al. 2000). therapy can help decrease pain, that reduc- ion-distraction, may be substituted for high
Why is this important? Depression in tion in pain may reduce or decrease associ- velocity low amplitude delivery. For patient
a gravid woman can lead to efFects on the ated depression. comfort, the chiropractor can use pregnancy
developing fetus and also may affect the pillows or a table where the abdominal area
woman's labor. Chung et al. (2001) showed Effective Treatment Based on lowers, while the patient is prone. Other
that women with depression late in the preg- Peer-Reviewed Research alterations in the delivery of care for com-
nancy were more likely to receive epidural Although chiropractic care cannot alter the fort may incorporate instrument-assisted
analgesia and have operative deliveries (cesar- physiological endocrine changes related to delivery (Activator, Graston Technique),
ean section and instrument-assisted vaginal pregnancy, it may make those nine months
delivery). This presents an obvious problem more comfortable by helping to relieve some Continued on page 67

www.midwiferytoday.com Midwifery Today Autumn 2008

in my hest interest. Instead of complaining
or lecturing, she worked with the situation.
Throughout the entire experience, she was
upheat and reassuring.
In the two weeks that followed, Polly
and Eric stayed with uscooking, clean-
ing, caring and advisingas Mark and I
learned how to hecome parents. Polly wore
many hats during this time: doula, nurse,
hahysitter, lactation consultant. Grandma. A
thousand times I asked her, "Is this normal?
Is this supposed to happen?" As long as she
said yes, which she always did, I knew that
everything was fine.
From the moment she arrived, our daugh-
ter has opened new horizons for us all, and on
that Fehruary evening she confirmed things
that I could only hope were true. That having
a hahy isn't a physical impossihility, after all.
That drugs and interventions aren't always
necessary, despite what a doctor recommends,
and that childhirth doesn't always have to
he managed or expedited. Perhaps most
important of all, I got to witness firsthand
the power that is Mother Nature. I, like PoUy,
had trusted in hirth.
^^ Paulina (Polly) Gandy Perez received her
S i ^ nursing degree from Texas Woman's Uni-
versity. She is president of CFE, Inc., of Johnson,
Vermont. She consults with hospitals, universi-
ties and corporations on health care-related
issues. She also has authored numerous articles
and books. Polly has four grandchildren.
Jamie D. Perez is a full-time mother and
freelance writer in Los Angeles, California.
Chiropractic Evaluation and Management
Continued from page 29
special tahles (knee-chest), or treatment of
the patient in a seated position or decuhitus
(reclining) position, instead of prone.
In regard to flexion-distraction, the chi-
ropractor can position the patient in the lateral
decuhitus posture and use the lateral flexion
component of the tahle to distract the spine.
If a course of care doesn't improve pain, the
patient may he referred to her primary care
physician or ohstetrician/gynecologist. As
with any patient-clinician relationship, open
discussion and good communication with
the other memhers of the health care team
are essential (Anonymous 2003).
Another technique commonly used hy
chiropractors is the Wehster Technique. The
Wehster Technique is hased on the theoretical
www.miclwiferytoday.com
principle thatjoint manipulation and soft tissue
mohilization may alleviate musculoskeletal
intrauterine constraints on fetal positioning if
a hreech presentation is suspected (Pistolese
2002). While this technique has not heen
scrutinized or supported hy randomized
clinical control trials, some women try this
and other forms of complementary and
alternative medicine techniques in an attempt
to avoid a cesarean (Founds 2005). According
to preliminary results of a practice-hased
study done hy the International Chiropractic
Pdiatrie Association (ICPA), the Wehster
Technique was found to he 69% effective,
although further research is needed in this
area (Alcantara and Ohm 2008).
A Final Note
In summary, the pregnant patient may
suffer from a variety of conditions that are
manageahle through chiropractic interven-
tion. Today's practicing chiropractor must
have a thorough awareness of the presentation,
common diagnoses and appropriate delivery
of treatment (which may require alterations
of traditional techniques) to deUver optimal
care to their pregnant patients.
To hetter comprehend the impact of joint
manipulation and chiropractic care on preg-
nancy, more research is needed regarding
appropriate treatment scheduling, mecha-
nisms that descrihe intervention and quan-
titative outcome measures. This research
is needed to further add to the chiroprac-
tors', other health practitioners' and patients'
understanding of the hreadth and limita-
tions of chiropractic care for the pregnant
patient.
The doctor of chiropractic is responsihle
for remaining proactive in the quest for ongo-
ing research and continuing education on this
topic. Through education and assertiveness,
the chiropractic profession can maximize its
ahility to deliver the highest quality of health
care possihle, while empowering the patient
to make healthy lifestyle choices to provide a
safe environment for her unhorn child.
aZci L'ndsey Zerdecki, DC, BS, is a chiropractor
^ S ^ in Williamsport, Pennsylvania. Dr. Zerdecki
is a member of the International Chiropractic Pdi-
atrie Association (ICPA) and is currently working
on her Chiropractic Pdiatrie Certification.
Steven R. Passmore, DC, MS, is a kinesiology
PhD candidate at McMaster University and Veter-
ans Affairs WNY Healthcare System chiropractor.
Midwifery Today
Dr. Passmore is supported by fellowships from the
Foundation for Chiropractic Education and Research
(FCER), and New York Chiropractic College.
References:
1. Alcantara, J., and J. Ohm. 2008. The Webster Technique:
Results from a practice-based research program. ECU Annual
Convention, Brussels.
2. Allister, L., etal. 2001. The effects of maternal depression
on fetal heart rate response to vibroacoustic stimulation.
Dev Neuropsychol 20 (3): 639-51.
3. Anonymous. 2003. When to Adjust: Chiropractic and
Pregnancy. J Am Chiro Assoc 8-16.
4. Benizzi DiMarco, Diane. 2003 Nov. The Female Patient:
Enhancing and Broadening the Chiropractic Encounter
with Pregnant and Postpartum Patients. J Am Chiro
Assoc 18-24.
5. Bogduk, N. 1997. Clinical Anatomy of the LumbarSpine
and Sacrum. 3rd ed. New York: Churchill Livingston.
6. Bonari, L., et al. 2004. Perinatal Risks of Untreated
Depression During Pregnancy. Can] Psychiatry i9{n):
726-35.
7. Borg-Stein, J., S. Dugan and 3. Gruber. 2005. Musculo-
skeletal Aspects of Pregnancy. Am J Phys Med Rehabil
84 (3): 180-92.
8. Cheng, N., A. Burssens and J.C. Mulier. 1982. Pregnancy
and post-pregnancy avascular necrosis of the femoral
head. Arch Orthop Trauma Surg 100 (3): 199-210.
9. Chung, T.K., et al. 2001. Antepartum depressive symp-
tomatology is associated with adverse obstetric and
neonatal outcomes. Psychosom Med 63 (5): 830-34.
10. Hungerford, D.S., and D.W. Lennox. 1985. The Importance
of increased intraosseous pressure in the development
of osteonecrosis of the femoral head: implications for
treatment. Orthop Clin North Am 16 (4): 635-54.
11. Fishbain, D., et al. 1997. Chronic Pain-Associated Depres-
sion: Antecedent or Consequence of Chronic Pain? A
Review. Clin J Pain 13(2): 116-37.
12. Founds, S.A. 2005. Maternal posture for cephalic version
of breech presentation: a review of the evidence. Birth
32(2): 137-44.
13. Kristiansson, P., K. Svrdsudd and B. von Schoultz. 1996.
Back Pain during Pregnancy: A Prospective Study. Spine
21 (6): 702-09.
14. Kurki, T., et al. 2000. Depression and anxiety in early
pregnancy and risk for preeclampsia. 0/Jstet Gyneeol 95
(4): 487-90.
15. LaBan, M.M., e t a l . 1995. Magnetic Resonance Imaging
of the Lumbar Herniated Disc during Pregnancy. Am J
Phys Med Rehabil 74 (1): 59-61.
16. Lisi, Anthony. 2006. Chiropractic Spinal Manipulation
for Low Back Pain of Pregnancy: A Retrospective Case
Series. J Midwifery Women's Health 51 (1): e7-10.
17. Melhado, E.M., J.A. Maciel, Jr., and C.A. Guerreiro. 2007.
Headache during gestation: evaluation of 1101 women.
Can J Heurol Sei 34(2): 187-92.
18. National Vital Statistics Report. National Center for
Health Statistics. 2004.
19. Pistolese, R.A. 2002. The Webster Technique: a chiropractic
technique with obstetric implications. J Manipulative
Physiol Ther 2^6): El-9.
20. Preti, A., et al. 2000. Obstetric complications in patients
with depressiona population-based case-control study.
J Affect Disord 61 (1-2): 101-06.
21. Ritchie, J. 2003. Orthopedic Considerations during
Pregnancy. Clin Obstet Gyneeol 46 (2): 456-66.
22. Skaggs, C., et al. 2004. Documentation and Classifi-
cation of Musculoskeletal Pain in Pregnancy. J Chiro
Educ 18: 83-84.
23. Steer, R.A, etal. 1992. Self-reported depression and negative
pregnancy outcomes. J Clin Epidemiol 45 (10): 1093-99.
24. Von Korff, M., and G. Simon. 1996. The relationship
between pain and depression. Br J Psychiatry 30:
101-08.
25. Wisner, K.L., et al. 2000. Risk-benefit decision making
for treatment of depression during pregnancy. Am J
Psychiatry 157 (12): 1933-40.
26. Zax, M., A.J. Sameroff and H.M. Babigian. 1977. Birth
outcomes in the offspring of mentally disordered women.
Autumn 2008
 Am J Orthopsychiatry 47 (2): 218-30.
27. Zuckerman, B., et al. 1989. Depressive symptoms during
pregnancy: relationship to poor health behaviors. Am
J Obstet Gynecol 160 (5 pt. 1): 1107-11.
Naturopathic Modalities
Continued from page 36
sahexaenoic acid (DHA) content. Studies
show that this not only prevents postpartum
depression and premature rupture of mem-
branes (PROM) by strengthening amniotic
membranes, but also enhances fetal brain
development. If the woman has no history
of miscarriage, one cup oiRubus ideaus tea
per day is introduced at 20 weeks.
The third trimester involves preparing
for labor and birth, as well as preventing
issues that may arise from an overloaded
metabolic and hepatobiliary system. Clients
who have been through a previous detoxifi-
cation programfindthis stage of pregnancy
far less demanding. Mother's Cordial, a
botanical formulation dating back from the
1920s in the American naturopathic tradi-
tion, is taken at 36 weeks. The formula is
adjusted every two weeks to support the
normal softening of the cervix. NDs will
often perform a weekly pre-birth acupunc-
ture protocol, beginning at 36 weeks. These
protocols result in fewer post-dates, fewer
SROMs and fewer transfers of care. The
emotional and spiritual health of clients is
taken into account, especially because they
become emotionally vulnerable and spiritu-
ally receptive towards the end of gestation.
NDs are trained in lifestyle counseling and
classical homeopathy. These modalities give
clients tools to improve their health and out-
look more effectively by providing insight
into areas where different attitudes can help
and psychological relief as a result of a suc-
cessful homeopathic prescription.
Naturopathic Support
during Labor and Birth
Some naturopathic physicians attend births
either as part of the birth team or as a perina-
tal ND. Naturopathic physicians honor the
historical and present role of the midwife
as well as the great benefits of a drug-free
labor and gentle birth for both women and
their babies. Throughout a woman's labor, the
ND's role is to observe closely and to work
with the woman's body as she labors in her
own way, with her own wisdom and strength.
By understanding that both mind and body
work together in an unmedicated labor to
68 Autumn 2008
create an important state where the woman Conclusion
has a unique and deep focus within herself NDs are bilingual medical practitioners
to birth her baby, naturopathic physicians who are fluent in both Western and com-
and midwives are able to support women plementary medicine. NDs are grateful that
as they do the hard work of labor. NDs are the midwifery model is gaining widespread
also able to observe subtle changes in the acceptance. In some urban settings, due to
woman's state and provide positive support, undersupply and over-demand, thousands
remove obstacles to progress and employ cus- of women are turned away from midwifery
tomized treatments, such as acupuncture for services. Six out often women in Ontario are
pain relief or homeopathy and botanicals to unable to obtain midwifery services. Together
address fears, discomforts and pain. In this naturopathic physicians and midwives can
way NDs are able to help women overcome ensure optimum health for families.
and avoid many of the issues commonly seen
in obstetrical care today that result in stalled i Lisa Doran, BSc, ND, is a licensed natu-
labor, failure to progress or very long second ^ ^ ^ ropathic doctor in private practice in
stage labors. Toronto, Ontario, with a special interest in wom-
en's and children's health. Lisa is the founder of
Naturopathic Support at Birth and the Association of Perinatal Naturopathic Doc-
Immediate Postpartum tors, past teacher of obstetrics at the Canadian
Positive birth experiences that arise from College of Naturopathic Medicine, and attends
optimal preconception health, prenatal births as a doula and naturopathic doctor.
health and careful and informed prenatal Nora Jane Pope, BA, ND, practices naturo-
decision-making regarding care provid- pathic medicine in Toronto. She uses clinical
ers, birth team and place of birth, pro- nutrition, herbal medicine (Western, Chinese and
vide for a positive immediate postpartum Ayurvedic), acupuncture, classical homeopathy
period where mother and infant are able to and counseling. She has a special interest in drug-
have their needs met completely. Mother herb interactions, pediatrics, neurology, fertility,
and infant are able to bond appropriately; pregnancy, homebirth and women's health.
breastfeeding can be initiated immediately;
skin-to-skin contact is maintained for a long When Homeopathy Works Too Well
period and both mother and infant feel Continued from page 40
aware and awake to meet each other and and I went to the bathroom. While I was in
share in the ecstatic mind-body-spirit expe- there, the phone rang again and Lorenzo said
riences of the first gaze and the first loving on the machine, "The baby's here."
touch. Many women who have experienced Seven-and-a-half pound Christopher
a midwifery-led birth, in which they were Leonardo was born at 11:01 pm. When
unmedicated, will describe the experience Aide said that he was coming, Lorenzo
as a rite of passage and an important step tried to call and had to drop the phone to
in their transformation to the demands of catch his son.
motherhood. Lorenzo was calm on my arrival nine
They feel confident as mothers, able to minutes later, although he hadn't even wit-
make decisions for their infants, able to nego- nessed the births of his other two sons. He'd
tiate the normal postpartum challenges of covered the baby with the blankets I had
little sleep, recovery from labor and birth, out and suctioned some mucus with the
hormonal changes and learning to breastfeed bulb syringe.
and care for their infants. It is a shame this Only a little over one and a half hours
experience is taken from so many women. had elapsed from a tight 4 cm to birth.
Naturopathic physicians are able to sup- Two more births enhanced by the grace
port and protect this immediate postpartum of homeopathy.
period by assisting with perineal healing, pro-
viding support for breastfeeding initiation ^^^'^^ Diane is the mother of four children and
and challenges, and using homeopathy, nutri- grandmother of two. She has had an indepen-
tion and botanical medicine to assist with dent midwifery practice for over 20 years. Diane
maternal recovery. NDs have many tools at has two books of birth stories published and
hand to help the postpartum woman and is at work on the third. Homeopathy is one of
her infant achieve a smooth transition from her passions, www.inspiringbirthstories.com
womb to birth and beyond. She welcomes comments.
Midwifery Today WWW. midwif erytoday.com