Improvement in Quality of Life for Six Pregnant Patients Undergoing Chiropractic Care: The Promise of PROMIS

CASE SERIES

Improvement in Quality of Life for Six Pregnant Patients Undergoing Chiropractic Care: The Promise of PROMIS

Joel Alcantara, DC Bio & Jeanne Ohm, DC Bio

Journal of Pediatric, Maternal & Family Health - Chiropractic ~ Volume 2013 ~ Issue 1 ~ Pages 11-14

Abstract

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Introduction: The use of health-related quality of life (HRQoL) measures in chiropractic pregnant patients remains virtually non-existent.  In this paper pregnant patients are characterized showcasing the use of the NIH PROMIS program to determine baseline HRQoL measures.

Methods: In addition to describing sociodemographic and clinical data, patient-centered outcomes measures utilizing the PROMIS-29 Profile V1.0 are demonstrated.

Results:   Six pregnant patients (average age=33.33 years) with average parity at 0.33 and mean gestation of 20 weeks are described. Their primary caregivers were obstetrician/gynecologists, nurse-midwives and midwives. All were aware of concurrent chiropractic care. The patients presented with NMS complaints and for wellness care. The PROMIS scoring demonstrated the dynamic nature of the HRQoL domains in pregnant patients with improvements (i.e., fear/anxiety, pain interference and satisfaction with social roles) and decrements (i.e., physical functioning and sleep disturbance) in HRQoL domains.

Discussion:   Evidence-informed practice expects that some aspect of chiropractic patients’ HRQoL measures will have demonstrable improvements. The use of PROMIS within a chiropractic Practice Based Research Network (PBRN) offers promise in this regard.

Conclusion:  Pregnant patients attending chiropractic care within a PBRN are characterized using PROMIS HRQoL measures. The use of valid outcome measures to demonstrate chiropractic effectiveness should be further implemented in research and practice.

Keywords:  Chiropractic, Practice Based Research Network, pregnancy, Health-related quality of life, PROMIS

Breech Pregnancy Corrected with Chiropractic

A case study of a pregnant woman, whose fetus presented breech and was successfully turned with chiropractic care, was published in the Journal of Pediatric, Maternal & Family Health on December 4, 2012. The title of the case study was, Resolution of breech presentation after application of Webster Technique in a 35-year-old female: A case study. The 35-year-old pregnant woman was in the 30th week of her pregnancy. The woman’s doula (a labor coach or midwife) established that the fetus was in breech position. The woman was in good health and had been receiving chiropractic care for headaches and low back pain with good results for the previous two years. This was the woman’s second pregnancy, with her first child delivered vaginally. Previous studies have determined that breech presentations occur in 3 to 4 percent of all pregnancies, with the often resulting decision to birth by cesarean section rather than vaginally for the safety of mother and baby. Breech presentations often turn after the 35th week of pregnancy, but 87 percent of breech pregnancies are delivered by caesarian section. Though safety is argued as the case for a caesarian section, the rate of morbidity was 3.6 percent in a study of 2,088 women birthing with caesarian section. Fetal morbidity can also result from caesarian section with reports of fetal heart-rate abnormalities, spinal cord injuries, skull fractures, long bone fractures, genital injury, and respiratory problems. A chiropractic examination was performed, and postural abnormalities were found, as well as a decrease of lateral flexion of 5 degrees, and lumbar range of motion significantly decreased due to the pregnancy. Motion palpation found several spinal misalignments, and EMG scans and thermography correlated the determination that spinal subluxations were present in the patient. Chiropractic care began for the woman using Webster’s Technique—a technique that uses sacrum adjustments and trigger point release in the abdomen area to reestablish pelvic function which can allow the fetus to turn to the desired head-down birth position. After four adjustments in four weeks using Webster’s Technique, the fetus turned from the breech position to the normal birth position. A healthy female baby was delivered vaginally by the mother at a home birth. The use of the Chiropractic Webster’s Technique resolved a breech presentation, and a possible caesarean section into a normal, natural and healthy birthing experience.