There is a disturbing trend in health care: the increase in the number of infants born dependent on opioid painkillers, like OxyContin, codeine and hydrocodone. These infants go through withdrawal after birth, with symptoms including diarrhea, restlessness, crying, even seizures.
It is called Neonatal Abstinence Syndrome. The U.S. Centers for Disease Control and Prevention estimates there were 4,682 cases of NAS in 2000, with that number shooting up to 13,539 cases by 2009. The problem does not just affect low-income parents. Dr. Mark Gaylord, a specialist in infant care at the University of Tennessee Medical Center, stated the problem cuts across all income levels and races.
Fueling this increase is the number of prescriptions for these drugs given to pregnant women. Nationally, about 21 percent of pregnant women using Medicaid are prescribed these medications. One state had a shockingly high 41 percent prescription rate.
Certainly, pregnancy is a time of great stress on the lower back, and it is understandable pregnant moms would want some relief. But to use strong, addictive painkilling medications as the first line of treatment — one of the most aggressive treatments with the greatest possibility of harm to mother and child — seems unethical.
This is especially true when far safer, more effective alternatives are available. I have treated many pregnant patients with manipulation, mostly for lower back pain, and most of these patients get substantial relief. Once they feel better, our goal is to get them off their pain medications as quickly as possible, for the safety of mother and baby.
Since the cause of the low back pain in pregnancy is structural — increased weight in the front and a “sway back” shape to the back — it only makes sense a structural-based treatment would offer the most relief. While there is little literature on the safety of manipulation for pregnant mothers, the overall safety profile of manipulation is excellent, especially when compared with painkillers. It has been used for centuries by manipulators, long before the chiropractic and osteopathic professions existed.
There is still resistance to the idea of using manipulation to treat pregnant women, but this resistance is based on fear and lack of knowledge about the safety record of the treatment. While the standard style of manual manipulation is effective and safe, there are gentler alternatives.
Many chiropractors use “drop tables.” These are tables with a breakaway function, where a section of the table can be cocked upwards about an inch, and it drops back with a thrust into the joint. The drop resistance can be set by the doctor, who can choose settings from a stiff setting, appropriate for a strong weight lifter, to a very gentle setting, often used for a pregnant patient.
Even gentler is a technique called instrument adjusting, where a handheld tool is used to deliver a rapid, very shallow thrust into the joint. Some of them are mechanized, so they can deliver a series of thrusts. The advantage of this approach is that very little force is needed because it is so fast.
Whatever style of manipulation is chosen, doctors of chiropractic are trained in treating pregnant women. Besides the fact they typically are uncomfortable and have a difficult time moving on the table, there are hormones that loosen up the structures of the pelvis to make birth easier. This requires the treatment be modified for their situation.
Please don’t rush to take painkillers if you are pregnant and in pain. Even less dangerous medications like Tylenol are not perfectly safe for the child — its use has been associated with hyperactivity.
Manipulation is an alternative that is so much safer and for most patients provides long-term relief.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at noonanchiropractic@gmail.com.