Have an Easier Pregnancy (and Birth!) with Chiropractic Care

Have an Easier Pregnancy (and Birth!) with Chiropractic Care

Adriana Lozada: Hello, Mighty Parent or Parent-To-Be. I hope you’re having a wonderful week. I want to welcome you to Birthful. I’m Adriana Lozada and I am grateful you are here. 

We’re in the midst of our Movement and Body Wellness in Pregnancy series, and really this series wouldn’t be complete without sharing the wonders of chiropractic care for when you need help with your alignment or are having any of the supposedly “common” pregnancy aches like sciatica pain, back pain, even carpal tunnel pain, and really any pain that is showing up as your body shifts during pregnancy. Just because they are really common doesn’t mean you can’t do something about it, and chiropractic care can be extremely helpful. So yes, chiropractic for pain… But what you might not know is that all that alignment can also allow your baby to get into a better position— even if they are breech or posterior, as you’ll hear in our conversation. So definitely chiropractic is a great tool that you can use if you need it, or even just for regular balancing. 

Joining me in this conversation is the wonderful Dr. Elliot Berlin, who is an award-winning pregnancy-focused chiropractor, childbirth educator, and he’s even a labor doula. He also hosts the Informed Pregnancy podcast, which is one piece of his “Informed Pregnancy Project.” In that project, he focuses on using different forms of media to compile and deliver unbiased information about pregnancy and childbirth. 

Aside from the podcast, he’s produced a couple of documentaries which we are going to talk about a little bit toward the end of the episode, so make sure you stick around for that. 

Also, if you’ve ever been on the fence about chiropractic care, I gotta say, Dr. Berlin’s explanation about how chiropractic care works is the best explanation I’ve ever heard, so I hope you enjoy it as much as I did.

You’re listening to Birthful. Here to inform your intuition. 

Adriana: Dr. Berlin, welcome!

Elliot Berlin: Thank you very much for having me.

Adriana: It is so fantastic, all the things that you do— like, I wanna talk to you about so many things! We’ll focus on chiropractic, but, y’know, films, the podcast, it’s, it’s all about giving people those choices so that they can have the best birth experience, however they define it, right?

Elliot: Exactly. I… y’know, I got into holistic healthcare by accident and I got into maternity care by bigger accident! And, I come from a very medical background myself, and so I was surprised when I started working in the prenatal world. I was surprised by how many people plan for a specific type of journey, and then all of a sudden, it comes time for the big moment and it goes wildly different than they expect. I just saw it happen over and over and over again and started to, sort of, y’know, get a better sense from them of what happened. Where did it go differently than they had planned and expected?

And doing a little bit of research, and I realized the way we do childbirth today is so radically different than the way it used to be. And I don’t think people are up-to-date on the information, and so there are a lot of big surprises when they get to the end. And I just really started by writing some articles to try to help open eyes and minds and get people to think and do a little more research and planning early on.

And articles slowly turned into podcasts and documentaries, and so I’m really just trying to stand on the rooftop and shout out any way that I can. And it— more than anything, it’s about informed choice. People should be able to have information about the pros and cons of all the options that are before them and be able to make a choice. And whatever choice they make, I support it, but it should generally be supported by anybody around them and it’s, number one, hard to get the information to make an informed choice. And when you do make an informed choice, it’s often hard to find support for the choices you’ve made. So that’s become a bit of a passion of mine!

Adriana: And mine too, right? And I totally appreciate what you do, because it’s that we’ve been sort of led down a path of “This is how birth is,” but when you actually sit down and look at it and are mindful about it, you realize, “Wait a second…” Which is what the path that you just described— “Wait a second, this is not going… Something’s off here. Why aren’t things working out?” So I find that it does require so much early preparation ahead of time, in order to even have a chance of being able to have that voice during their birth.

Elliot: Yeah. It’s interesting, because my observation is that birth goes best when you’re not thinking about it. And so it’s a delicate balance between having enough information and making enough choices to be empowered and sort of steer the way things go for you… but not so much that that’s all you’re thinking about while you’re in labor. It’s a tough balance.

Adriana: And I think, from my point of view, I always talk about the preparation you do ahead of time so that everything’s set up in a way that you have that supportive team that knows what you want, that already you’ve thought about your choices and have some “What if”s. And you prepare all the things behind the scenes and way ahead of time so that then you can have an environment where you don’t think.

Elliot: Exactly, yeah.

Adriana: Yeah. So I truly appreciate your films and your podcast and all the information you provide to help parents on their journeys.

Elliot: Thank you!

Adriana: Let’s talk specifically then about chiropractic care during pregnancy. What are the benefits? 

Elliot: Well, the benefits of chiropractic care, in general, relate to structure and function. So the body— looking specifically at the spine— you’ve got a whole bunch of vertebrae and they have dual purpose. One purpose is to protect the central nervous system, including the skull and spine and pelvis. They’re protecting the brain and spinal cord. But at the same time, they are designed to give you some mobility to be able to move in lots of unique ways, and those objectives sort of compete with each other. In a perfect world, if we wanted to protect the brain and spinal cord, we’d make this really rigid structure that doesn’t have any mobility. And if we wanted to give you a lot of mobility, then we’d have the exact opposite. So it’s a very complex structure— the spine, and at the top, the cranium, at the bottom, the pelvis— a very complex structure trying to accomplish two competing goals. And sometimes it doesn’t go just right. 

And the musculoskeletal system has two parts. There’s the soft tissues— the muscles and the tendons and the ligaments. And then there’s the bony tissues, which are the bones of the spine itself. And they interact. So if the muscles become stiff or tight or rigid, then it’s going to have an effect on the overall function of the musculoskeletal system and the joints. Wherever you have two bones come together, there should be movement around that joint: not too much (which is protected by the ligaments) and not too little.

If a joint becomes restricted, it doesn’t move anymore, then you start to have problems build up around that joint— one of which is the nerve that it’s supposed to be protecting. Fluid starts to build up around that nerve, and compress the nerve. So it’s a complicated system in today’s day and age; with the things that we do with our bodies, certainly it requires some maintenance. If we can keep those muscles from getting too tight, stiff, achy, restrictive, and we can keep the joints moving nicely, then we can better protect the central nervous system, which affects and controls and coordinates all functions of the body. But also we can keep you healthy, y’know, in a non-achy, stiff, painful sort of way.

So that’s general chiropractic— very, very powerful in what it can do, because, again, those nerves which we’re safeguarding control everything that takes place in the body. When it comes to pregnancy, we put that already complex system under even more strain. The growth of the body during the pregnancy, the shift in center of gravity (out and down), and it’s quite a dramatic growth for a lot of people! A lot of patients who gain 40 or 50 pounds, and that’s not even taking into account labor and delivery! 

So through chiropractic, where it’s important for most people, during pregnancy, with the added strain going on, it’s even more important to keep that system well-maintained. And indeed most people come in originally to our office for things that are more musculoskeletal— like back pain, low back pain, hip pain, sciatic pain, sometimes neck and shoulder pain, or what feels like carpal tunnel syndrome or actual carpal tunnel syndrome— and those are all fairly easy for us to correct, to improve, with maintenance of the muscles and joints of the spine and pelvis.

Adriana: And all of those are very common during pregnancy! All those aches.

Elliot: Yeah, they’re very common, that they sort of have been accepted as normal. But I wouldn’t call them “normal”— I would just call them “common.” And for the most part, they’re very treatable! Sciatica, which is I think the number one thing that we see— pain in the low back or sort of hip/buttock region that sometimes radiates down a little bit and sometimes doesn’t, down the leg— is the number one thing that we see in the office. Usually? Two to four visits, it’s gone and doesn’t come back. But oftentimes people come in in their ninth month where they just can’t even walk anymore. Sometimes we’ll put them in an office chair to wheel them down the hall because they literally can’t walk. And they’ve been struggling with this getting worse for 3-4-5 months already. And after the first visit, they can walk out, and by the second or third visit, they’re pain-free. And, I don’t… can’t remember the last day that went by where somebody didn’t say, “I can’t believe I didn’t find out about this earlier.” So it’s powerful. It’s simple. It’s relatively inexpensive, compared to most medical visits, and it’s widely available. Chiropractors are popping up all over the place!

Adriana: Yeah, more and more covered by insurance is, I think, the other reason why it’s becoming more and more popular.

Elliot: Yeah, so a lot of insurance networks are seeing the benefit in holistic care: keeping people healthy from the outset, and avoiding the more expensive, y’know, recovery care, when things go wrong.

Adriana: So we talked about more of those pains, and nerve pains, and achy pelvises… But what about: Can it have some benefits in terms of how you can sleep better? 

Elliot: Yes and no. I think the most common issue that comes up for sleep— and there’s several— but the most common is towards the third trimester where people are basically limited to sleeping on one side or the other, or alternating between two sides, and especially for moms who where stomach sleepers are back sleepers before the pregnancy, that can become pretty uncomfortable.

But for anybody, the combination of having all that pressure on your hip, compounded by the weight gain, those muscles around the hip joints start to get pretty stiff and achy at nighttime, and really can wake you up with some pain. And usually you’d roll over onto the other side, but then sometimes in an hour or two, that side’s in pain, so you roll back to the other side. With some massage around those muscles of the hip, we can usually make that achiness go away, that pain go away, at least for a few days at a time initially, and then for a week or two at a time once it really… we get through the layers of tightness that have been built up over the years before the pregnancy. So in that way, we could make it more comfortable. 

Sometimes, sleeping on your side creates neck/shoulder/rib issues— y’know, if that arm is kind of stretched down underneath you and your head is resting on it, it can create neck issues for people, again, who are not typically side sleepers. If you… Let’s say, you’re sleeping on your left side without enough pillow support, your head will be tilted to the left and those muscles on the right side of your neck start to get stiff all night trying to pull your neck back to neutral. You could wake up in the morning with a pretty stiff neck, sometimes so stiff and painful that you can’t even turn your neck in a way that’s not even really safe to drive! So for all those things, we can certainly help. 

In my case, we use a combination. I went to both massage therapy school and chiropractic school. I studied them separately, because it fascinated me how interactive they are. And I felt like just chiropractic by itself is addressing just the skeletal side of the musculoskeletal system. And just massage by itself is addressing the muscular side, the soft tissues. But together, they’re very synergistic, they’re more powerful, in a “one plus one equals three” kind of way. And so we use both in our office, and for all of those sleep issues, we have really good success at getting our moms comfortable through the pregnancy, even to 40 weeks and beyond.

Adriana: Yeah. And you’ve gone even one further by adding some craniosacral work to your modalities!

Elliot: Yeah, I do a little bit of cranio when I’m out at birth. We have cranial psychotherapists on the team who do intensive craniosacral therapy. We use it a lot for the babies after birth— incredibly powerful for babies, but it’s very powerful for adults too. Even when I get cranio myself— especially after I’ve been at a long birth, a couple of sleepless nights— I would say 15 minutes or so into the session, I fall into a very deep, relaxed state, where I’m not really even aware. And an hour later, I’ll just wake up feeling like I slept for two nights! Very powerful, refreshing, calming to the nervous system— it’s a great modality.

Adriana: I wanna ask you about the impact of the chiropractic care that you get during pregnancy, if there’s any benefits for birth?

Elliot: That’s a great question! The way I ended up starting to go to birth and then ultimately becoming a doula, is because I got a phone call from a midwife on a Sunday afternoon. I was in the pet store hoping not to buy a dog for my kids, and I was saved by the midwife! And she called because we do a lot of breech work in the office (which I’ll address in a second). And she said, “You get so many of those breech babies to turn! I’m stuck with a mom in labor. She’s at seven centimeters, and she’s been at seven centimeters for seven hours, and the baby’s posterior. The skull is against the spine. Can you do something to get the skull not to be against the spine? Can you get this baby to rotate a little bit and drop down into the pelvis and bring this baby home?” 

And I had no idea— because I had never been asked that question, and I had never, never tried to do that before. So before I tell you how that story ends, I’ll tell you what we do for breech. Towards the end of pregnancy, y’know, at birth, there’s only about 3-4% of babies are breech. In the middle of the pregnancy, about half the babies are breech. They move around a lot, but towards 32 weeks, roughly 90% of the babies are already head down, so only 10% breech, or 10 out of 100. And then by birth, only 3-4 out of 100 are breached. So somewhere between 32-33 weeks when people know that they still have a breech baby, they realize they’re running out of time for that baby to turn, and they’re 50% or less as every week goes by, a chance of the baby getting into the ideal position. And there are so few doctors left or midwives left who are proficient at delivering breech babies vaginally, that they really run down to just having the option of cesarean.

One of the films that we talked about earlier, it’s called Heads Up: The Disappearing Art of Vaginal Breech Delivery, and in the film, we discuss why the art is disappearing and make the case that it shouldn’t be disappearing— people should still have the option for it! And you could see more about that at headsupfilm.com, the home of that film online.

Adriana: Mhm!

Elliot: So, chiropractically, what we do for breech babies, it’s not all that different than what we do throughout the pregnancy. There is no “breech turning” technique with chiropractic, but the concept is based on Larry Webster’s work, a chiropractor from the 1970s. And he was really not even working on breech; he was working on understanding “the pelvic paradox.” Why do some babies— very small babies in a very large pelvis— get stuck on the way out? They just won’t drop down. And sometimes these very large babies in this very tiny pelvis squeeze right out with no problem. How do you reconcile that? How do you figure?

And there’s a whole field in medicine of pelvimetry where we measure… use different techniques to measure the size of the pelvic inlet and outlet and the size of the baby and see if we think the baby (that size baby) will fit through that size pelvis. And if we don’t think it’ll fit, we call fetal-pelvic disproportion, and oftentimes the recommendation is to not even try, and just schedule a cesarean. But through experience we see that unless the baby is very abnormally large, that we can’t tell— with all the modern pelvimetry, we can’t tell— if a baby’s going to make it through, unless we try.

Adriana: Right, ’cause the baby’s head molds, baby rotates and moves around, and so the pelvis too switches positions and can create space in different ways.

Elliot: Exactly. Pelvimetry is just looking at structure, but not function. A static image doesn’t tell you how much molding that head can do or how much expanding that pelvis can do. And when you add function to the equation, it makes a lot of sense that a baby and a pelvis that are both functional, even if it was a large baby and a smaller pelvis, the combination of the molding of that head and the structure of that pelvis will let it pass. Whereas even a baby that’s not very big, if the head is very rigid, and a pelvis is large and it’s very rigid and they’re not lined up just perfectly, neither one’s gonna give, and it’ll be hard for that head to get through that pelvis. 

So that’s what Larry Webster was looking at and he came up with techniques, a chiropractic technique that’s now called the “Webster Technique,” for improving the function of that pelvis. That’s what chiropractors do. We improve the function of the musculoskeletal system. It’s not really doing anything to the baby specifically. We’re doing what we do to people in general, in this case, the women at the end of pregnancy— which is checking the pelvis for restrictions where the sacrum (the foundation of the spine) meets the other bones. And if it’s moving well, we just leave it alone. And if it’s stuck, we adjust it. We restore motion there. And the same thing with the pelvic ligaments— if the round ligaments that connect the uterus to the pubic bone are stiff and restrictive, we stretch them and loosen them up. We open them to make more functional space. And the goal is to improve the functionality so that birth goes better.

But what he found was, when he was doing the technique on women who had breech babies, frequently, the baby would get into the ideal position soon after the adjustment. And so that’s what we do still today, from the chiropractic technique, when somebody comes in with a breech baby, we restore function to their low back hips and pelvis with chiropractic adjustments. What I added to that is, with my massage background, doing the same thing for the soft tissues, for the muscles and the tendons, using deep tissue massage techniques to release the muscles of the pelvis. In particular, the quadratus lumborum at the lower part of the back, the piriformis muscles deep underneath the gluteal muscles, when they’re tight, they squeeze the whole pelvis close. So we loosen them up and open the pelvis. And in the front, the hip flexor tendons that kind of come down under the baby, and when they’re tight, they kind of push in on the baby and lift. And of course we don’t want that, certainly not leading up to pregnancy and not during birth! So, we use that technique, and together with Chinese medicine, most— y’know, two-thirds or more of our babies that come in breech— ultimately end up in a head down position poised for the ideal birth position. 

So the midwife Alex was asking me, she said, “If you can do that— if you can affect the position for breech— can you affect the position right now in labor, for this rotated baby that’s not breech, but posterior?” I didn’t know. I said I was willing to give it a try! And after a couple of hours of working away at it together with this mom in the throes of labor, we all felt that baby just rotate and clunk down and within an hour, that baby was born. And that was the beginning of it.

And then I would get called a couple of weeks later to another birth, and then another birth. And eventually somebody said, “Hey, you went to my friend Becky’s birth and did massage, and she said it was great. Can you come to my birth and do massage?” And I said, “Well, Becky’s baby was stuck and that’s why I did massage.” And she said, “Well, why do I have to wait for something to go wrong?” And I didn’t really have an answer for that… so I attended that birth as well. And it was just really wonderful to be there, helping give her some physical relief and something else to focus on to get out of her head a bit, really just magical.

And because of that, I started attending birth just as a bodyworker, doing massage and chiropractic and reflexology and acupressure and counterpressure. And once I was going to that many births in that role, then I also did doula training and became a doula, as did my wife, who’s a pre- and postnatal psychologist. So we trained as doulas together and we both go to birth. So our kids are very, very aware of the human cervix and the dilation process!

Adriana: What a fabulous story of how you guys ended up where you are right now— that’s fantastic! And I was joking earlier, before we started recording, that I was like, “We need to clone you!”— like, everybody needs to have a Dr. Berlin at their births.

Elliot: Oh, thank you!

Adriana: Yeah!

Elliot: I would love to be cloned. I could use a couple more of me to juggle all the things that I’m trying to juggle. But just to finish up your question that got us started on this— how does chiropractic, sort of, prepare you, or what does it do for you leading up to or during birth— from a musculoskeletal perspective, again, we look at/I look at having a baby, delivering a baby, it’s kind of like squeezing this big basketball through a small rubber band. And if the basketball isn’t too inflated and can smoosh in a little bit, and that rubber band is pretty elastic and stretchy, you’ll get a big basketball through a small rubber band. But if that basketball is very rigid and over-inflated, and that rubberband is really, uh, rigid and not stretchy at all, it’s gonna be a tough squeeze. 

So in all of our labor preparation work, whether the baby’s head up or head down doesn’t really matter. And when I’m called to a birth that I wasn’t supposed to be at, or if I’m at a birth that I was supposed to be at, what happens is we use chiropractic and massage techniques to constantly release and improve the function of the low back hips and pelvis to make that rubber band as elastic and stretchy as it can be, as it’s supposed to be. And then as that baby tries to kind of wiggle down and come through— rotate and come out— there’s less resistance, better function. And the goal is to make it a smoother, more comfortable experience for both the mother and the baby.

Adriana: Because the better position baby is in and the more flexible that mom is, then the quicker, really, and easier that it’ll be!

Elliot: Exactly!

Adriana: And I like your analogy, that usually I’m used to hearing the rubber band analogy specifically towards the cervix, but you’re not talking about the cervix. The cervix is going to do its own thing. You’re talking about, sort of, the pelvic bowl—

Elliot: Yes, exactly.

Adriana: —as a band, and that’s a great way of visualizing it as well.

Elliot: Yeah. I mean, that’s literally what it feels like, from when you’re working on the muscles and bones of the pelvis. It feels like a rubber band together. They make this rubber band with a lot of movable pieces, and we’re just making it more and more stretchy and elastic and functional.

Adriana: So when is there an ideal time for people to go see a chiropractor? Is there, y’know, an ideal number of sessions? Is there a point where it’s too late?

Elliot: I don’t think it’s ever too late. I’ve started working with people who are breech after 40 weeks and still had success in getting those babies to turn. Y’know, every day that goes by with breech, the odds will go down because the baby’s bigger and the fluid starts to go down and whatnot. But just in terms of chiropractic for pregnancy, we start preconception to set the stage. There’s some things that we can work on before you’re pregnant, deep in the psoas (abdominal core) that we can’t work on once there’s a baby in there. So there’s some preconception work that’d be helpful.

But there’s no time that’s, I think, too early or too late. Ideally, by the end of the first trimester, we’ll get to look and see how things are. And if things look great, then we don’t see you too often— sometimes once a month. If there’s more built-up tension and dysfunction, then occasionally it’ll be a series of visits right up front (three or four visits close together over a two week period of time) and then twice a month for the bulk of the pregnancy. But for labor preparation, we typically start by 33 or 34 weeks at the latest. 

And, again, depending on what we’re working with— somebody who’s got a lot of experience really using their body hard, athletes who do a lot of running or dance or gymnastics or spinning or Pilates, those kinds of things— they’re great, but they leave you with an “athletic pelvis” that’s a bit more rigid than we we normally like to see. So we use our techniques to leave that strength there that you’ve built up, but to release excess tension and make sure that you still have function and your body doesn’t resist the baby coming down.

Adriana: That sounds fantastic. So, a random question: What do you think about Kegels then?

Elliot: Kegels is a tough question. And I think it’s an individual basis. In our office, we have someone who’s a pelvic floor specialist, different than what I do, and usually she’ll evaluate people and help them find exercises that will give them strength in the right places without overdoing it. And so I kind of leave that expertise to her. But, I think sometimes Kegels can be helpful. And sometimes there’s other exercises that could be more helpful, but it’s sort of an individual basis. There’s no one thing that’s right for everybody.

Adriana: It makes sense. And I want listeners out there to run it through their critical fact… critical thinking, because there’s different childbirth education classes that go, “You do Kegels, Kegels, Kegels,” and it may or may not be what you need.

Elliot: Right. Yeah, it’s just… Everybody’s an individual. Even for what I do specifically, some people are gonna be better candidates and some people are not quite as good of a candidate. We certainly don’t do the same thing with every person who comes in.

Adriana: What about postpartum? Is there a good time to come in afterwards, to check up after all that?

Elliot: Well, a lot of times people will ask when they can come back. If I’m at the birth, I’ll sometimes adjust mom and the baby. I’ll check the baby’s spine within an hour after they have the baby, sometimes even sooner. I’ve adjusted babies that are just four minutes old! In terms of when you can come back to the office from a vaginal birth, you can go back as early as three or four days if you need to. Or, after a cesarean birth, 10-14 days if you need to. We end up a little bit limited in exactly what we can do, but there’s still a lot we can do.

Adriana: Can you explain what a newborn adjustment is like? Because for somebody who hasn’t had chiropractor, or has had chiropractic but not seen a baby be adjusted, you think of, y’know, a little bit more forceful and cracking, and they might be a little apprehensive about that for babies… which is not what it is.

Elliot: Right. No, for newborns, y’know, they don’t have any of the scar tissue built up that we have built up. They don’t have a rigid muscular system built up. We really just almost touch each vertebra of the spine really gently to see that it has give— that when you touch it, it moves away from you. That’s what we’re looking for, the mobility, the function that it’s supposed to have. On a baby, when a vertebra doesn’t move away from you, you can use a very gentle technique called “sustained contact,” where all we’re doing is really holding that vertebra, one finger on the vertebra, in the right line of correction, with a little bit of force going to where it should be.

Y’know, vertebrae have a whole range of motion where it’s okay for them to be, but when they get stuck, they get stuck just outside that range of motion on adults— because there’s so much rigidity and resistance built into those structures, you kind of have to take it to the end of where it’ll move, y’know, where just that resistance point and give it a little thrust to get past it. But on babies, you don’t have to do that. You literally just hold your finger there, in the right correction with a very, very gentle touching pressure, and after sometimes 30 seconds, a minute or two minutes, it’ll just slide right back where it’s supposed to go. 

We regularly have people come in where the baby will only breastfeed on one side and not the other side, or bottle feed on one side, but y’know, in one position but not the other position. And oftentimes all it is, is a vertebra that’s pinched on that side. And so it’s uncomfortable for them to lay on that side. And as soon as we adjust them instantly (like magic!) they can now comfortably feed on both sides. 

So sometimes it’s not that simple. There’s a lot of other things that can come on with the feeding issues or lactation issues, but that’s how powerful it is when we just hold that vertebra and the line of correction and it releases, then the baby becomes comfortable on either side.

Adriana: And it’s the beauty of babies that they’re so resilient and pliable. Also, it’s so new! I find that any holistic therapy that you do tends to be very easy, very simple for babies, which is wonderful.

Elliot: Yeah.

Adriana: Is there anything else about chiropractic that we should address? 

Elliot: One note I would say is for us, even though we focus on pre- and postnatal, we take care of the whole family. Transitions are stressful. And when your body’s under stress, things stiffen up, tighten up, and it can create a cycle where that stiffness then creates nerve pressure and nerve pressure creates pain or achiness or more stiffness.

And at a time that’s already stressful, the last thing you need is for your body to start giving away. So during those transitions, stress is not always bad. Stress can be very good. But transitions are notably stressful. So, we like to take care of the whole family: mom and her partner and the babies, and even sometimes the caregivers.

Adriana: Do you find that once you start with chiropractic care, you have to keep going forever?

Elliot: That’s a question we get a lot. I, you know, it’s not like we’ve unlocked something that makes you now needy for chiropractic care. I think that when you feel mediocre and you get adjusted a few times and you feel great, and then go back to your regular life. And sit in front of your computer or, even taking care of babies, you know, everything for babies is “down.” When we see people during pregnancy, most commonly the issues are in the low back and hips. When we see people postpartum, most commonly the issues are neck and upper back. We call ’em “mommy neck” and “mommy back”— I’m feeding the baby, bathing the baby, changing the baby, dressing the baby, it’s all down low.

So, I think that once you feel how good you could feel, you probably want to keep doing that. But you know, if you stop, it’s not like you’re going to fall apart, you just end up back where you were before, and probably slowly sliding into a less functional place as you were before the chiropractic. So, y’know, just like your cars, like, just ’cause I did an oil change, do I have to always do oil changes? You have to do them anyway. If you want something to last, you gotta take care of it.

Adriana: You needed mobility. If you wanna be able to, like, walk when you’re older, you need to keep moving, right?

Elliot: Yeah. And whatever it is that you do in life that affects your body, having kids is gonna affect it a lot more. They require a lot.

Adriana: Absolutely. So, we talked about the Heads Up film, which is specifically about the disappearing art of breech. And I’ve got to tell you, I personally, I did not— I had ended up with a version, an external version that worked.

Elliot: Oh!

Adriana: That was my only option at that point— it was, y’know, that or a cesarean. And so I did that, and fortunately it worked and she stayed head down for four more weeks… went past 41 weeks and I had a vaginal birth!

Elliot: Oh, wow! Great.

Adriana: Yeah. So I am a believer of having to do what you need to do when you need to do it. But it would be great if that wasn’t so. Why is it that breech is disappearing?

Elliot: Every step of the way with breech, there’s decisions to make: y’know, do you want to do holistic, natural things to try to get the baby to turn, like chiropractic or acupuncture or massage or hypnosis or positional exercises? What are the pros and what are the cons? When do you even start being concerned about it? When do you care? Why is the baby breech? There are different factors that nobody really ever addresses. And what type of breech? They’re not all the same too— y’know, “breech” generally is referring to any baby that’s not head down, but there’s frank breech, complete breech, sometimes babies are transverse, sometimes they’re one or two feet down. And there are differences… there are nuances between the different types of breech. If the holistic things don’t work or you didn’t try… there’s the medical option for the external version like you did, which also has pros and cons, and they’re not the same for everybody as we talked about before.

Some people— if it’s your third baby and the baby’s small and you have a lot of amniotic fluid and your placenta’s out of the way— you probably have a very, very, very good chance that that baby will turn. It probably won’t even be that intense and it’ll be quick. But the problem is the baby may not stay head down once they get it head down. 

If you’ve got a… if your first baby’s deeply wedged in the pelvis, butt down, almost, y’know, eight cubic centimeters of fluid, not a whole lot of fluid and a large baby… you’re probably better off buying a Powerball ticket than getting that baby to turn. But they could still turn. The odds are just a lot smaller. There are some risks involved, but I think they’re oftentimes blown out of proportion, which is not good. it would be just as bad to not mention them at all, that you need to know that there are risks. 

And so what’s lacking is somebody stepping forward and saying, “Here are all your options. Here are the pros and cons of each option”— the realistic pros and cons of each option, not just in general, but for you specifically. “Which ones do you want to do and which ones don’t you want to do?”

And the ultimate option is if you’ve tried everything else in your baby’s still breech, “Do you want to have a cesarean? Here are the pros and cons,” or “Do you want to have a vaginal birth? Here are the pros and cons.” And you can’t listen to a podcast and know that because it has to be specific to you. What specific position is your baby? What baby number is for you? Have you had a vaginal birth before? How big is your baby? What position is the head in? Are you confident? Are you comfortable? Do you have a provider who has a lot of experience delivering breech babies? That’s important too. 

So, y’know, the film just sort of talks about the fact that this art is disappearing before our very eyes— choice is being taken away from people before their very eyes. In some cases, it’s very obvious that a woman and a baby are great, great candidates for vaginal breech birth, and in some cases it’s obvious that they’re not very good candidates for breech birth, but for everybody, the option is disappearing quickly. And the movie talks about the history of how it came to be the current protocol. The guideline from the American College of Obstetricians and Gynecologist is to give a woman a choice, but they even note in that recommendation that most people will choose cesarean because there’s very few providers left who still have the skill. 

So we’re trying to change that. We’re trying to make sure that women know there’s a choice. We’re trying to make… trying to restore teaching of breech so that we won’t lose the option, so that there will be providers who have that skill for the women who want it. And the more people that watch and share that film, the better off we will be able to accomplish that goal. And right here in Southern California, we are making a lot of progress in that realm. Providers are watching it, and those who offer breech are making it more known. Hospitals that don’t offer breech are looking at the possibility for how they might be able to offer breech. And even residents who watch it— ’cause we’re invited to screen the film at hospitals like grand rounds— even residents who watch it are going out of the country to try to get training so that they can offer this option to their clients.

Adriana: That’s fantastic! Because I do find that the big crux in all of that is the fact that fewer providers have the skills to do it.

Elliot: We have no way to teach it is the problem, ’cause there’s so little volume. How are you gonna teach somebody to competently deliver breech babies when there’s only, y’know, any provider who does it, does one a month, or less?

Adriana: In Canada, they’ve been more recently making some good efforts into… bring it into… starting to teach it again.

Elliot: Yeah. In the United States, we reinstated a recommendation that breech delivery should be an option in 2006, but haven’t done anything to really re-teach it. Canada? They reinstated breech as an option in 2009 and made more of an effort to reteach it, but it’s still not robust. The option’s still hard to come by.

Adriana: Well, that’s fantastic that you’re making strides in South California.

Elliot: Yeah. And we’re trying… y’know, the film’s online, anybody can watch it at headsupfilm.com. On the international scene, there’s more effort being put into making sure we don’t lose the option completely.

Adriana: And not to forget your other film, Trial of Labor.

Elliot: Trial of Labor is different. It’s not so information-based; it’s more of a story. It’s a story that I see every day in the office. This is for women who are pregnant for the second or third time, who previously only had cesarean birth that they didn’t plan for, and now they’re on a journey to have a more empowered experience. They’re reflecting on their previous experiences. They’re kind of surrounding themselves. They’re looking for more information, they’re doing more research, and they’re surrounding themselves with empowering providers and on an empowering journey that so many women have been on.

Look, 1 in 3 babies are born by cesarean, and only a very small fraction of those are planned to be a cesarean. I think that cesarean section— one of the greatest innovations we have in modern medicine to safely be able to deliver a baby in just a couple minutes time— is great for people who need it or people who want it. There’s nothing greater than someone who truly needs a cesarean having access to a cesarean. But when we overuse it, it does more harm. Any medical technique is like that. If I do CPR on someone who has no pulse and no breathing, I’m a hero, even if I break all their ribs. If I do CPR on somebody who is just talking to me, I’m gonna go to jail for assault and battery. Same medical technique, wrong patient, dramatically different results. 

And so it’s clear that we do too many cesareans. We’re doing more harm than good. We don’t demonize cesarean, but we want to help people become empowered. If they don’t want to have a cesarean birth, you sort of have to work at it these days. And so these women are sharing their stories to help share with people who watch the viewer, some of the mistakes that they’ve made, and to try to help them avoid those mistakes—sort of a “How to have your second birth the first time around.”

Adriana: Fantastic. Thank you so, so much!

Elliot: Thank you for having me!

That was award-winning pregnancy-focused chiropractor, childbirth educator, labor doula, and host of The Informed Pregnancy podcast, Dr. Elliot Berlin. You can find Dr. Berlin on Instagram @doctorberlin.

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Birthful is created and produced by me, Adriana Lozada, with production assistance from Aysia Platte.

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