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Implications for Malpositions and Cesareans
One of the most interesting side-effects of a misalignment of the pelvic bones is that anecdotally, it often seems associated with malpositions of the baby, including:
breech (feet or butt-first)
occiput posterior (head-down but facing the mother's stomach instead of her back)
asynclitic (head tilted to one side so that the parietal bones presents first instead of the crown)
compound (hand or arm by face)
All of these malpositions tend to cause more difficult labors, with greater pain and often great difficulty in dilation or descent of the baby. There is a high rate of operative intervention when malpositions are present, including lots of forceps in vaginal births, and many cesareans as well. In fact, research shows that only a small percentage of babies with persistent malpositions actually are born spontaneously and without interventions. (See the FAQ on Malpositions on this website for further information and references.)
As noted on the website of the Australian Osteopathic Association:
The descent of the baby through the pelvis is determined by factors such as ligament laxity, hormonal control, uterine contraction, gravity and position of the baby. If the mother's pelvis is mechanically unstable or is lacking mobility, it may interfere with the baby's passage through the birth canal.
Unfortunately, very few doctors in recent years have paid much attention to malpositions (except to do cesareans for breech). Only in the midwifery, osteopathic, and chiropractic communities have these positions received much attention, and then only recently. Interest is now just beginning to re-surface in the obstetric community, but is very limited in mainstream obstetric journals as of now.
There is little scientific data to show that pelvic misalignment is associated with malpositions because traditional medicine does not recognize misalignment as a problem or research it, nor do they take the idea of "pelvic misalignment" seriously. Really, they barely take the idea of non-breech malpositions seriously! Therefore, it cannot be stated from an evidence-based point of view that pelvic alignment is associated with fetal malpositions or difficult labors, or that re-aligning the pelvis would prevent malpositions, prevent cesareans, or lessen the incidence of difficult labors.
Obviously, research into this issue is very important, but quite unlikely to occur anytime soon. The funding and interest is simply not there in the traditional medical community. This lack of data does not prove or disprove the misalignment theory; it simply has not been researched in the traditional scientific manner. Chiropractors, on the other hand, have seen in their own practices for years that women with misaligned backs and pelvises tended to have more malpositioned babies. There are some limited case series studies on this available in chiropractic research journals, but even this is not very well-documented.
The first really significant work was done by Dr. Larry Webster, founder of the International Chiropractic Pediatric Association. He found that simply by realigning the pelvis and releasing the soft tissues, most breech babies turned head-down within a few treatments. It is important to emphasize that he did NOT manually turn the baby in any way, but simply realigned the mother's pelvis and 'released' the ligaments supporting the uterus. The baby then was not "constrained" anymore from assuming the best possible position, and so usually quickly turned vertex.
Dr. Webster taught this "Webster In-Utero Constraint Technique" to many other chiropractors. Success rates depend on the skill of the practitioner, but usually are documented at about 80% or more in turning the breech baby. This is much higher than the success rates for manually turning the baby with the often-rough procedure known as a "External Cephalic Version". ECV success rates generally run anywhere from 40-65% or so, whereas the Webster Technique successfully turns 80% or so, at least in the data available so far.
Thus, it seems likely that many cases of breech babies are quite probably associated with pelvic misalignment, and that treatment to re-align the pelvis may help many breech babies turn head-down. However, proof of this is limited to anecdotal evidence, lectures and articles from Dr. Webster, a few small case series, and surveys about chiropractors' experience with the Webster Technique. Not overwhelming evidence by any means, but all we have at this point. Yet it may be women's best bet in preventing malpositions and relieving pelvic pain.
The Webster Technique also has a variant that can be used with babies that are head-down but facing the wrong way (posterior). Although little formal data exists on this, anecdotally many women and midwives have reported this to be helpful for non-breech malpositions as well. Thus, it is quite likely that in many cases, pelvic misalignment is often accompanied by baby malposition of varying types, not just breech presentations, and treatment may help resolve such malpositions.
Anecdotal evidence also suggests that many women who have had past cesareans for non-progressive labor or "Cephalo-Pelvic Disproportion" (supposedly, baby too big or pelvis too small) actually may have had malpositioned babies. It's not that the baby was too big or the mom's pelvis too small, it's that the baby's position did not permit it to go through easily, causing it to get "stuck." These women (one of whom is Kmom!) often report that if they get regular chiropractic care in subsequent pregnancies, they frequently go on to have a Vaginal Birth After Cesarean because the baby malposition is prevented or is more easily resolved. They also regularly report that their pubic symphysis pain decreases significantly with treatment.
So although little concrete scientific data exists from mainstream studies (largely because it has not been studied), and although anecdotal evidence has to be treated with caution, women with misaligned pelvises often seem to experience pelvic pain/SPD, and possibly a higher rate of malpositioned babies. It seems logical (though unproven) that treatment to help re-align the pelvis may help lessen pelvic pain, and may also prevent or correct a fetal malposition.
Although not every women with SPD experiences a malpositioned baby, it does seem to be very common in this group. Since baby malpositions commonly lead to lots of interventions like epidurals and forceps that tend to worsen pubic pain and may even damage the pubic symphysis permanently, checking for misalignments and working carefully to avoid/treat baby malpositions may be important to avoiding long-term pain or permanent pubic symphysis damage. This is a fascinating area that is just beginning to be researched but has potentially far-reaching implications.
