Post: Chiropractic Care during Pregnancy: What Expectant Mothers Need to Know

Pregnancy Pain is Widespread

Back pain affects almost 70% of pregnant women, with studies showing prevalence rates ranging from 50% to over 75%. The most common types are low back pain and pelvic girdle pain, which can significantly impact daily activities, work ability, and quality of life.

Pain typically begins in the second trimester, with prevalence increasing as pregnancy progresses—affecting 50% of women in the first trimester, 40-70% in the second trimester, and 70-80% in the third trimester.

For many women, this isn’t just a temporary inconvenience. Approximately half of women who develop low back pain during pregnancy continue to experience pain one year after childbirth, and 20% remain symptomatic three years postpartum.

Why Pregnancy Causes Musculoskeletal Pain

During pregnancy, multiple physiological changes contribute to discomfort:

1. Postural Changes: As the baby grows heavier, the centre of gravity shifts and posture adjusts, potentially leading to misaligned spine or joints.
2. Physical Adaptations: Changes include a protruding abdomen resulting in increased spinal curve (hyper lordosis) and pelvic changes as the body prepares for labour
   • Abdominal muscle separation: The rectus abdominis muscles may separate (diastasis recti), reducing core stability
   • Weight gain: The additional 11-16 kg of pregnancy weight increases stress on weight-bearing joints
3. Hormonal Influences: Pregnancy hormones increase joint laxity (Relaxin), which can affect spinal stability

When the pelvis is misaligned, it may reduce the room available for the developing baby, a condition called intrauterine constraint, which can also make it difficult for the baby to get into the best position for delivery. This reduced space can make it difficult for the baby to move into the optimal head-down position for delivery.

Intrauterine Constraint

Breech presentation (when the baby is positioned feet- or bottom-first instead of head-down) occurs in approximately 4% of pregnancies at term. While some babies remain breech for various reasons, pelvic misalignment and the resulting constraint may be contributing factors. Breech presentation often necessitates changes to the delivery plan, including the possibility of caesarean section, external cephalic version (manual turning of the baby), or specialized vaginal delivery techniques.

Addressing pelvic alignment during pregnancy may help improve the space available for foetal positioning, potentially reducing the risk of breech presentation and associated delivery complications.

What to Expect: Chiropractic Care during Pregnancy

Our Philosophy: Timing Treatment with Your Baby’s Development

At Five Dock Osteopathic and Chiropractic, we take a developmentally-informed approach to prenatal chiropractic care. Our treatment philosophy is guided by respect for the critical stages of foetal development and the unique physiological changes occurring throughout your pregnancy journey.

First Trimester (Weeks 1-13): No treatment

The first trimester, particularly the embryonic period (weeks 5-10), is the most critical window for organ development. During these weeks:

• The brain, spinal cord, and heart begin to form
• All major organ systems establish their foundation
• The embryo transforms into a foetus
• Most structural birth defects, if they occur, develop during this sensitive period

We believe in allowing this remarkable developmental process to unfold without intervention, providing your body the space it needs to focus entirely on creating the foundation for your growing baby.

Second Trimester (Weeks 14-27): Commencing Chiropractic Care

Our Approach: Gentle Support as Growth Accelerates

As you enter your second trimester—often called the “honeymoon period” of pregnancy—we begin active chiropractic care. This timing coincides with several important physiological factors:

Why We Begin Treatment Now:

1. Organ Development is Complete By week 14, all major organs have formed and continue to mature. Your baby is now focused on growth and refinement rather than initial structural development.
2. Relaxin Hormone Increases The hormone relaxin, which increases progressively throughout pregnancy, begins to significantly affect your joints and ligaments during the second trimester. Relaxin causes:

• Increased joint laxity throughout the body
• Loosening of pelvic ligaments in preparation for birth
• Reduced spinal stability
• Greater susceptibility to misalignment

3. Postural Changes Intensify As your baby grows from apple-sized (week 15) to cauliflower-sized (week 27), significant postural adaptations occur:

• Your centre of gravity shifts forward
• Lumbar lordosis (lower back curve) increases
• Pelvic tilt changes
• Weight gain accelerates (approximately 5-6kg during this trimester)

4. Musculoskeletal Discomfort Commonly Begins Most pregnant women begin experiencing back pain and pelvic discomfort during the second trimester, typically around week 20-22.

Our Second Trimester Care Includes:

• Gentle spinal adjustments adapted for pregnancy
• Pelvic alignment to optimize space for foetal growth
• Postural correction and ergonomic advice
• Monitoring of biomechanical changes
• Regular assessments as clinically indicated

We coincide our scheduling and treatment approach with these week-by-week changes, ensuring you receive the appropriate care.

Third Trimester (Weeks 28-40+): Optimizing for Birth

Our Approach: Comprehensive Preparation for Labour and Delivery

The third trimester is when chiropractic care becomes most crucial. During these final weeks, your baby is preparing for birth, and your body is undergoing rapid, weekly changes that significantly impact your musculoskeletal system.

Expected mothers begin to experience week-by-week Physiological Changes:

Weeks 28-32: Foundation for Birth Positioning

• Baby gains approximately 0.5kg per week
• Increased weight places greater stress on the pelvis and spine

Weeks 32-34: Critical Positioning Window

• 72% of babies show important bone development markers (distal femoral epiphysis) by week 33
• Optimal time for addressing breech presentation
• Pelvic alignment is crucial for allowing baby adequate room to turn
• Maximum relaxin levels increase pelvic instability

Weeks 34-37: Late Preterm Period

• Baby is considered “late preterm” and could survive if born
• Brain weighs only two-thirds of what it will at 39-40 weeks
• Continued lung maturation
• Optimal pelvic balance supports final foetal positioning
• Mother’s body prepares for labour with practice contractions

Weeks 37-40+: Final Preparation

• Baby is “early term” (37-38 weeks) then “full term” (39-40 weeks)
• Skull bones remain unfused for passage through birth canal
• Optimal pelvic alignment may facilitate easier labour
• Weekly changes in maternal posture and biomechanics
• Maximum physical stress on mother’s musculoskeletal system

The Role of Relaxin in the Third Trimester:

Relaxin hormone reaches its peak levels during the third trimester, causing:

• Maximum joint laxity in the pelvis
• Increased risk of sacroiliac joint dysfunction
• Greater potential for pelvic misalignment
• Enhanced ability to correct alignment with gentle adjustments

Our Third Trimester Care Focus:

• Pelvic alignment to optimize space for baby
• Support for optimal foetal positioning (head-down)
• Management of sacroiliac joint dysfunction
• Relief from increased lumbar lordosis and pelvic pressure
• Addressing round ligament pain
• Preparation for labour and delivery

Clinical assessment guides our care recommendations—your treatment plan is individualized based on your symptoms, biomechanical changes, baby’s positioning, and proximity to your due date.