In-Utero Constraint Solutions

By working with the mom to relax the ligaments and adjust the pelvis, chiropractic care can help relieve in-utero constraint during pregnancy.

What causes in-utero constraint?

Dr. Gregg Rubinstein: There are quite a few different causes listed. Let’s actually talk a little bit about what in-utero constraint is because I would imagine a lot of our listeners might not actually know. When we look at the anatomy, the uterus if physically attached to the pelvis and sacrum by way of the uterosacral ligaments which are behind the uterus and then the round ligaments which are in the front. These form a way of stabilizing and suspending the uterus inside the mother in a way that keeps the baby almost kind of floating in this little sack.

During pregnancy, there is a lot of increased physical loads on the skeleton and the presence of the hormone relaxin in the soft tissues make it really easy for the sacrum and pelvic bones to start to shift out of their alignment and become what we call in chiropractic subluxated. There are other things where sometimes moms are put on extended bedrest which can contribute to sacral subluxations. Improper posture, even minor trauma, when these things occur the ligaments described above can get pulled and create undue tension on the uterus.

Then there are other factors. Typically, it’s more common in the first pregnancy because a lot of the abdominal musculature is new to this and hasn’t been stretched out. A small maternal size or just a petite woman, small uterus, uterine malformation, there can be occasions where there are uterine fibroids which occupy space inside of the uterus and that can create uterine constraint. A small maternal pelvis and then also even early engagement of the female head into the mother’s pelvis. There’s a lot of different things even an out of the ordinary large fetus can do that and multi fetal gestation where they are having twins or more, all those things can contribute to it including one of the most common ones that we address is the pelvic alignment issues and the muscle and ligament imbalances.

There’s a lot that goes on and initially the fetus has to distend the mother’s uterus and the abdominal wall during the first pregnancy. It’s much more common to see there. Usually the firstborn will experience more constraint and usually smaller than the second or third children usually by a couple hundred grams. In most cases it’s going to be altered structural alignment to the pelvis which is the most likely possibility and then there are a few other things that are a little bit more technical if there’s not enough amniotic fluid or other fetal anomalies such as hydrocephaly or anenecephaly. Those are least common. Really what we talked about initially is more about the alignment.

What effects does in-utero constraint have on the baby?

Dr. Gregg Rubinstein: The primary thing that we’re always concerned about with in-utero constraint is the increased utero tension can decrease the ability of the baby to move into a more desirable position for birth. Almost imagine if you were taking a balloon and you were pulling on two sides. The balloon is going to shorten and then it will become rigid in response to the pulling forces. That’s essentially the same thing that happens in the uterus essentially trapping the baby in whatever position it was in at the time the subluxation or the malalignment syndrome was presented. Until the pull of the uterus can be removed, the constraint will remain and the baby might not be able to force it’s way into the vertex position.

A lot of times we’ll see moms that are experiencing intrauterine constraint will often report a decrease in the baby’s movement or development of jerky tense movements indicating that the baby’s ability to move is constrained or restricted. By taking the time to really align the pelvis and eliminate the stress to the ligaments and muscles, then the baby can start to return to a more normal state of balance inside the pelvis and be able to really move around with the space in there as optimized. That’s really what we’re looking for at that optimal fetal position which leads to a more spacious, safer and easier birth.

How can chiropractors help alleviate and reduce in-utero constraint?

Dr. Gregg Rubinstein: Chiropractors can really work by employing that Webster Technique. We’ve talked about that in previous interviews. When the Webster Technique is initiated in the care of pregnant women, sacral subluxations that often can contribute to difficult labor which we call dystocia, it’s caused by inadequate uterine function which means that maybe we’re not getting proper nerve supply to the uterus so correction of the sacro subluxations will eliminate any pressure built up on the nerves that are going to that area and these sacral misalignments can contribute primarily to those causes of dystocia or a slowed down birth.

It’s really important to understand that working with the mom early through this is really what’s going to eliminate the uterine nerve interference, the pelvic misalignment and the tightening and the torsion of the specific pelvic muscles which can result in an aberrant affect on the uterus and maybe even prevent the baby from comfortably assuming the best possible birth position. By working with the mom and really leading her through this practice and using the relaxation techniques on the ligaments and the pelvic adjusting, usually it’s going to lead to a much better outcome and it’s been successful in close to 80% of the women that it’s been performed on.

Are there other natural ways to try to remove any constraint on the baby?

Dr. Gregg Rubinstein: To be honest with you I haven’t heard of too many natural ways. There’s a lot of things that the medical profession can do and sometimes they will use medication and muscle relaxers but I never like to see that done with a mom who is expecting because she shares the bloodstream there but there are people who do yoga and lying in certain positions which can be helpful. A lot of people have explored the avenue of acupuncture. I’ve heard that they get some good success there.

Chiropractic isn’t the only game in town but it is one of the most successful and most commonly used by the expecting mom. We do see that there are other things. I always recommend prenatal massage and prenatal yoga because it’s not any one thing. The more angles you attack a problem from, the better success you’re going to have. Decreasing the mom’s stress, meditation, that can also be helpful in relaxing the entire central nervous system. It isn’t just about chiropractic. There are a lot of different things we can do to really improve the outcomes and it’s not just coming from the chiropractic office.

There are many doulas that help and guide people through this and continue people on exercise. People think they have to stop exercising when they’re pregnant and that’s not necessarily true. There are very few instances where there’s a high risk that the women needs to not exercise at all. You just need to keep it under control and minimize the intensity. In closing, in wrapping that up, there are just so many different things that can be done and there are a lot of different things and again, ones that I like to use the most and will recommend along with our care is massage, acupuncture, meditation, breathing exercises, proper nutrition, anything you can do to mitigate stress.

How can in-utero constraint be prevented?

Dr. Gregg Rubinstein: Well, you need to know the risks involved. If you are very petite women, actually before you even become pregnant, they can do some studies, they can take an x-ray and measure the pelvic brim and kind of see those things. But you know most women don’t really hear about the Webster Technique until later in pregnancy but it’s still prudent for people to seek out the natural approach that restore the pelvic biomechanics and really optimize that natural function that the nerve system controls over the birthing process.

Once the woman’s free of pelvic and sacral subluxation, the nervous system functions in a way that’s significantly enhanced then the birth canal diameter can be maximized and decreasing your chance for a difficult labor and additional complications during delivery. Due to the gentle nature care of the Webster Technique, it’s going to be safe and those are the things that we really want to get out to people, making sure that they understand that it’s not just about getting adjusted but there is some homework for the mom to do as well.

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