Many years ago, if a mother was told that her unborn baby was in the wrong position (breech, transverse, face/brow) it was assumed that the safest course of action was a c-section. While there were other options such as "external cephalic version" by an obstetrician, there were risks involved that a c-section could avoid. This has resulted in over 30% of births ring by c-section, 20% of which are due to malpresentation. As the rate of c-sections has risen so has the rate of pregnancy-associated deaths(1,2).
In the 1970s, chiropractor, Dr. Larry Webster, found a connection between a sacral/pelvic misalignment and fetal malposition. The presence of this misalignment may cause ligament tension which could result in undue uterine tension making it more difficult for the fetus to move into optimal position for birth. He discovered a simple way to determine the presence of , and provide chiropractic care for this misalignment and resultant ligament tautness and in-utero constraint. The result of the procedure was that many babies were naturally able to assume the normal verge (head down) position(3).
In her article "The Webster Technique-A Chiropractic Analysis and Adjustment for Pregnant Women", Dr. Jeanne Ohm defines intrauterine constraint (or in-utero constraint) as a condition where fetal movement is restricted, resulting in potential adverse effects to its development throughout pregnancy. Furthermore, limited movement and space in the uterus can lead to malpresentation in various forms: breech, transverse, posterior as well as ascynlitic presentations(4). She goes on to discuss the labor difficulties that may result from intrauterine constraint including increased pain or dystocia (slow or difficult labor), the need for medical interventions as well as a more traumatic birth experience for both mother and baby.
To truly understand this cause and effect, picture a basketball net hanging from a ring. If the net is twisted the basketball can't get through. The net must be hanging evenly for the ball to easily pass. The same is true of the mother's uterus. The sacrum is one of the bones in the pelvic ring, like the ring in the basketball hoop. The uterine ligaments attach to this boney pelvic ring like the strings of the net. If a sacral misalignment has caused an uneven pull in the ligaments attached to the uterus, this may result in the uterus being tense. When this happens, the uterine wall becomes more rigid and the fetus has more difficulty moving. The result of which is called intrauterine constraint.
Here Dr. Ali is performing a specific sacral adjustment to help correct the sacral misalignment that was present using the Webster Technique. The pregnant patient comfortably gets to lie on her stomach during the adjustment with special pillows Dr. Ali uses.
What is the Webster Technique?
A simple Google search provides the following definition which was provided to the website "Spinning Babies" by Dr. Jeanne Ohm: "A chiropractic adjustment called the Webster Technique is a specific sacral adjustment to help facilitate the mother's pelvic alignment and nerve system function. This in turn balances pelvic muscles and ligaments, reduces torsion to the uterus and offers a greater potential for optimal fetal positioning." (5)
The Webster Technique is performed by a trained Doctor of Chiropractic. The doctor will determine which side of the pelvis has the sacral rotation by checking muscle tension through the leg muscles that attach to the pelvis. Then an adjustment to the sacrum will be performed to realign it in the pelvic ring.
Who Benefits from the Webster Technique?
The Webster Technique proves to be most beneficial when chiropractic care is sought early in the pregnancy, as this may decrease the need for medical intervention. If the fetus has unrestricted movement throughout the entire pregnancy then there is no need for external maneuvers or c-section deliveries.
External maneuvers, like External Cephalic Version or others, are risky with only about 58% success. (6) Interestingly, one of the signs of a failed version is "a uterus tense to palpation", (2) meaning that the uterus is tense or tight, which is exactly what the Webster Technique addresses. A much safer option, the Webster Technique, is not known to convey any risk to the fetus or the mother because it is not an obstetrical maneuver.(3) It has nothing to do with the actual baby itself and everything to do with the mother's pelvic function. By removing an existing misalignment the body begins to function properly allowing the fetus the opportunity to move more freely in to the proper position.
When Should Chiropractic Care Start?
A sacral misalignment is not a dislocation but basically what happens when a joint moves beyond what is a natural position or range. Regular chiropractic adjustments during each trimester may help to avoid any sacral misalignments at all, which means that the Webster Technique may never even be necessary as the uterus will remain symmetrical with no twists or tension.
However, even the most well-adjusted spine may have a sacral misalignment especially if the pregnant patient has a fall, performs repetitive movements, spends long periods of time sitting, need extended bed rest, or experiences any other outside force to their pelvis.
Here Dr. Ali is releasing tension on the round ligament to decrease the intra-uterine constraint. This allows more room for baby to get into the ideal birthing position.
The Webster Technique is Effective
In the past few years more than a dozen case studies have proven the effectiveness of the Webster Technique.(7) As such, more and more midwives and obstetricians are recognizing the value of the Webster Technique as a non-invasive approach to malpresentations and refer their patients to chiropractors trained in the Webster Technique.
In a 2010 survey (Mullin et al.) of 187 midwives from across the US, it was reported that 88% of respondents had referred patients to chiropractors and of those who had referred, 94% referred for fetal malposition.(8)
Lauren Feder, MD, in her book Natural Pregnancy states, "chiropractic preventative care is recommended during pregnancy, as it is known easing delivery. The Webster Technique relaxes the pelvic structures and ligaments in pregnant women with a success rate of 82% in turning babies from breech positions." (9) Dr. Judy Forrester, a prenatal chiropractor expert shares in the textbook, Pediatric Chiropractic, Dr. Webster reported having a successful version (head down position) in 97% of adverse in-utero presentations.(3)
When considering the fact that fact that the Webster Technique avoids any external force being applied to the uterus and more importantly the baby, it is by far the safest alternative potentially reducing likelihood of a C-section.
Here Dr. Ali is performing the Webster Technique and assessing her patient for sacral misalignments.
Here Dr. Ali is checking a 2 day old baby for spinal misalignments...being born is hard work!
Many mothers assume that a successful outcome from the Webster Technique means that their unborn baby suffered no ill effects. However, while in the unnatural, restricted position, the baby was under a great amount of pressure (for up to 8-12 weeks).
In-utero constraint may result in posture issues, jaw and lactation issues, hip dislocation, torticollis or club foot.
In addition to these obvious symptoms of in-utero constraint, birth strain may also result in misalignments and there exist silent signs of interference to the nervous system. If a baby shows any of these signs consider having their spine checked. These signs include: colic, reflux, constipation, positional discomfort, extended arching, difficulty sleeping, a weak immune system, respiratory issues, or digestive problems.
To learn more about the Webster Technique visit the American Pregnancy Association's website at americanpregnancy.org and search "Chiropractic Care During Pregnancy".
1. Answers Prove Elusive as C-setion rate rises; Rita Rubin, USA Today, January 7, 2008
2. Williams Obstetrics, 23rd Ed, McGraw Hill Companies, 2010
3. Anrig, CA and Plaugher, G. Pediatric Chiropractic. Baltimore: Lippincot, Williams & Wilkins; 2012
6. Obstet Gynecol. 2008 Nov; 112(5):1143-51. doi: 10.1097/AOG.0b013e31818b4ade.
8. Mullin, L. "Attitudes and Views on Chiropractic: A Survey of United States Midwives." Complementary Therapies in Clinical Practice 17.3 (2011): 135-140.
9. Feder, L. Natural Baby and Childcare. Long Island City: Hatherleigh Press, 2006