Authored by Dr. Jillian Skluzacek

During May, we celebrate Mother’s Day! Motherhood is a beautiful gift. Moms also endure a plethora of stresses beginning right at the start of pregnancy. Today, I would like to discuss a healthcare option that is available for these amazing women we call mothers...chiropractic care. 

Chiropractic is a healthcare profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. One of the most common and well-known therapeutic procedures performed by doctors of chiropractic is spinal manipulation or chiropractic adjustment. Manipulation, or adjustment of restricted joints and tissues, restores mobility, thereby alleviating pain and muscle tightness, allowing tissues to heal. 

Why would this treatment option be beneficial for mamas during pregnancy, postpartum and beyond? 

Prenatal Care
Let’s start with prenatal care. Pregnancy is a time of many physical, mental and hormonal changes. The mother’s body is constantly adapting and providing for the fetus. Baby inhabits the uterus, which is physically attached to the pelvis and sacrum via the utero-sacral ligaments, round ligaments and broad ligaments. As baby grows, so does the space they live in! This continual growth leads to increased physical loads on the skeleton and the connecting ligaments. Postural changes and an altered walking pattern occur which the spine must accommodate balance for(1). The mother’s body also begins to produce a hormone named relaxin that promotes ligament laxity (i.e. loosening) to prepare for childbirth. The combination of increased strain on the body and relaxin production can make the sacrum and pelvic bones become easily misaligned, which can stress the surrounding ligaments and muscles. 

These stresses lead to more than 75% of women experiencing pregnancy-related low back pain, pelvic pain or a combination of these(1). Unfortunately, pregnancy and postpartum women have fewer options regarding pain-relief. Many are searching for relief options that don’t or can’t include medications; chiropractic care is one of those options.
 
Chiropractic adjustments are an effective and safe treatment option to restore alignment and provide pregnant women pain relief and support. The Webster Technique is a chiropractic technique that is used for specific analysis and adjustment to optimize pelvic and sacral positioning throughout pregnancy(2). The goal of treatment is to place the body in its optimal position to promote healing and restore normal function. This then has been found to reduce tension and discomfort, improve mobility, decrease stress, and more. 

Many women seek prenatal chiropractic care not only for pain relief, but also for wellness care to prepare for birth. Sacral restriction may contribute to difficult labor for the mother (i.e. dystocia), caused by inadequate uterine function, pelvic contraction and baby mal-presentation. Correction of the sacral restriction with regular chiropractic care throughout pregnancy may have a positive effect of all of these causes of dystocia(3,4). 

Your chiropractor will determine how often visits are necessary based on a variety of factors such as severity of your current condition, the duration the adjustment is lasting, and what stage you are at in the pregnancy. Chiropractic care is generally safe throughout the 1st, 2nd and 3rd trimesters. I have personally treated women who have begun labor and are on the way to their birthing location! 

Common conditions associated with pregnancy that can benefit from chiropractic care includes, but is not limited to:

• Muscle and joint pain: low back, hip, neck, or upper back
• Sciatica
• Pubic symphysis and round ligament pain
• Restless Legs
• Insomnia
• Digestive Issues: nausea, heartburn or constipation
• Carpal Tunnel Syndrome

After Baby
After baby is born, the mother enters the postpartum stage. At this time, the mother’s body experiences a drastic shift in their body biomechanics. Her body that spent 9 months growing and changing, is now quickly adjusting to return to her pre-pregnancy state. She continues to be adapting with hormonal changes as well; the hormone relaxin we discussed earlier remains in mother’s system for 5-6 months following birth. She now has additional stresses and movements such as carrying baby and baby items, increased weight and breast size, feeding positioning, diaper changes and more. Remember, all of this is happening after she has just endured the fatiguing marathon of labor and birth. Moms are amazing!

Chiropractors commonly treat new moms with neck, pubic symphysis, upper, lower and mid-back pain. Adjustments to improve alignment will help her body recover more comfortably and combat these stresses. Addition of at-home exercises will help long-term stabilization of muscles. 

To keep it going - the stresses of motherhood then persist and continue to change throughout their child’s development. Chiropractors wish to support moms through all stages to function at their best so they can provide their best care to those they love. 


References

1. 5 Conditions Chiropractic Care Can Improve During Pregnancy by American Chiropractic Association
2. The Webster Technique: Definition, Application and Implications by Jeanne Ohm, D.C. & Joel Alcantara, D.C.
3. About the Webster Technique by ICPA
4. Optimal Positioning: Balancing the Pelvis for a Safer, Easier Birth by Jeanne Ohm, D.C.

Authored by Amy Daws, CMT, ShT

There have been so many new and expecting parents in my life lately! Many of my friends are becoming parents and I have seen an influx of bodywork clients who are pregnant or new parents in the last couple months. All this parentness has inspired me to write a post about how awesome bodywork can be during pregnancy and as a person enters the realm of parenthood. Medical professionals are increasingly recommending bodywork during pregnancy for pain, stress and anxiety relief. Although one massage during pregnancy is great, regular bodywork during pregnancy and throughout the time of parenthood can be a wonderful addition to any expecting or new parent's self-care routine.

For clients that are pregnant, massage can be a great way to relieve discomfort from the musculoskeletal changes that are inevitable during pregnancy. It is also a wonderful way to soothe anxiety or stress that comes with the current and expected changes to life. Bodywork is generally safe for pregnant individuals through the 1st, 2nd and 3rd trimester. High risk pregnancies can still benefit from bodywork, but be sure to let your practitioner know so that they can additionally modify the session. If you are not sure if bodywork is right for you it's always a good idea to check with your doctor first. 

Specific Symptoms that bodywork can address during pregnancy:

• Sciatic nerve pain
• Muscle and joint pain
• Stress and anxiety
• Swelling or edema in extremities
• Improve circulation

How is bodywork during pregnancy different than regular bodywork?

1) Focus of the session:
​In general, bodywork for pregnant clients is focused on relaxation and increasing comfort. A session can focus on addressing any of the common symptoms that arise during pregnancy: sciatica, muscle/joint pain, stress and anxiety, edema, and decreased circulation. Specific work can be done to relief muscle and joint pain, but there are certain areas of the body where deep digging is avoided because of the vulnerability of these areas. During pregnancy, the body releases relaxin, a hormone that allows for the bones and joints to shift to make room for the baby. Work in the hips and low back is more gentle. Greater care is taken when stretching to take into consideration that the joints and bones are more loose and easily manipulated. In Shiatsu, certain acupressure points are avoided as to not move the energy too forcefully downward. 

2) Positioning:
Special cushions are used to support the body during pregnancy. The cushions can be used to a certain point in the pregnancy (usually through the 1st trimester) to allow you to lay face down without pressure on the abdomen. The cushions can also be used to support you in laying on your side or in a semi-reclined position on the back. Getting a massage while laying on your side feels different than a regular massage, but still covers all the bases and allows for areas like the back, neck and shoulders to be worked on.

3) How often to come:
While one bodywork session during pregnancy is awesome, regular bodywork can have additional benefits and increase comfort for the parent and child.  According to an article in Parent's magazine:

"Studies from the Touch Research Institute at the University of Miami suggest that moms-to-be who get a weekly massage have lower levels of the stress hormone cortisol and higher levels of the feel-good hormones serotonin and dopamine. Researchers have linked these hormonal changes to fewer childbirth complications, including a 75 percent reduction in premature births among depressed women. Though you don't need to be depressed to reap the benefits of massage, another Touch Research Institute study found that pregnant women suffering from depression had significant improvement in mood, as well as decreased anxiety, after receiving a 20-minute massage twice a week."

Bodywork for all new parents
​
Continuing to get regular bodywork after pregnancy is a great way to establish much needed self-care into the new routine of raising a child. Postnatal massage can help the body adjust back to it's pre-pregnancy shape more comfortably. It can also be helpful to all parents as they get used to new movements that come with raising children: feeding, carrying the baby and juggling carriers and bags. I have found that many of these sessions are focused on neck, shoulders, back and hips as you get used to these new movements. Stress and anxiety relief are also incorporated to sooth the mind and enhance the mood as parents move through this transitional time.


References:
1. The Benefits of Prenatal Massage by Belle: University Chancelor.

Authored by Dr. Lori Hulsing

Historically female fertility has received the spotlight (and blame) around baby-making and male fertility has been largely ignored by doctors and scientists alike. Only recently have researchers investigated how the health of the sperm influences conception, pregnancy outcomes, and the health of the baby. The omission of sperm health in studies and medicine has been a huge blunder considering that 50% of the genetic information is coming from the sperm. Focusing on this would likely prevent many couples from experiencing miscarriage and infertility—especially “unexplained infertility”— because many of these cases are likely caused by DNA damage or other sperm issues that are not measurable on a traditional semen analysis. Spending at least three months prior to conception focused on nutrition, healthy lifestyle choices, and a sperm-safe environment is an absolute must for every father-to-be and sperm donor.
 
Here are some steps for improving the health of sperm based on the latest research. This is not an exhaustive list but I included bullet points from a few of the most relevant fertility categories.
 
Diet & Nutrition

• A healthy anti-inflammatory diet is critical for sperm production. Deficiencies in vitamins, minerals and fatty acids have a detrimental impact on sperm health and deficiencies are very common in the United States. Aim for eating 3+ cups of vegetables and 2 servings of fruit per day. If you aren’t hitting this goal you may need additional nutrient supplementation. If you are on a more restricted diet including vegan, vegetarian, dairy-free, keto, paleo or autoimmune paleo you may need additional nutrient supplementation as well.
• Avoid sugary beverages like soda and sports drinks which decrease sperm motility.
• Avoid trans fats aka partially hydrogenated oil and polyunsaturated fats like soybean, corn, and sunflower oil. They have a negative impact on sperm and embryonic development.

 
Lifestyle

• If you smoke, quit. Smoking decreases male fertility, decreases IVF/ICSI success, and increases risk of complications if a pregnancy does occur. Some people may think smoking marijuana doesn’t count. Or maybe it doesn’t count if you eat it. No matter the delivery method, marijuana is not good for sperm either. Evidence shows it can lower motility and function of sperm. Quitting is hard so invest in a lot of support here. The effects of smoking do seem to be cumulative as well so if quitting isn’t an option cut back as much as possible.
• Exercise, but not too much. Studies show frequent intense exercise has a negative impact on sperm health as well as not moving enough.
• Heat can damage sperm and decrease sperm count so it’s important to avoid hot tubs, lots of biking, cell phones in the pocket, and computers in the lap.

 
Environment

• A focus on environmental factors is critical for improving sperm health and fertility. Eliminate all hormone-disrupting chemicals from your environment. These chemicals are found in plastics, cans lined with BPA, furniture covered in fire retardants, non-stick pans, lead paint and high VOC paint.
• Invest in a quality water filter to filter medications, heavy metals, and microbes from your water source.
• Invest in a quality HEPA air filter for your bedroom to improve the indoor air quality and reduce exposure to pollution.

 
Making lifestyle and dietary changes, taking targeted nutrients, and practicing self-care to boost fertility is not always easy. It can be so helpful to get support. If you are interested in learning more about how to boost fertility with an integrative approach, join me in the fall at my Fertility Class series designed for men and women wanting to conceive. We will cover these topics in a lot more detail with additional fertility optimizing discussions on diet and nutrition, hormone balancing, epigenetics, detoxification, environment factors, and treatment. It is never too soon to start planning!
 
P.S. If you were able to read this article without getting the Footloose soundtrack in your head for a week—nice work! I cannot say the same. “Let’s Hear it for the Boy[s] . . . “
 
Resources
Hum Fertil (Camb). 2018 Jan 31:1-10. doi: 10.1080/14647273.2018.1432078. [Epub ahead of print]
The association between trans fatty acids, infertility and fetal life: a review. Çekici H1, Akdevelioğlu Y2.
Hum Reprod Update. 2017 Jul 1;23(4):371-389. doi: 10.1093/humupd/dmx006.
Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies. Salas-Huetos A1,2, Bulló M1,2, Salas-Salvadó J1,2.
Hum Reprod. 2014 Jul;29(7):1575-84. Epub 2014 May 8. Sugar-sweetened beverage intake in relation to semen quality and reproductive hormone levels in young men. Chiu YH, Afeiche MC, Gaskins AJ, Williams PL, Mendiola J, Jørgensen N, Swan SH, Chavarro JE.
Arch Gynecol Obstet. 2014 Oct;290(4):777-82. doi: 10.1007/s00404-014-3281-x. Epub 2014 May 20.
The impact of cigarette smoking and alcohol consumption on sperm parameters and sperm DNA fragmentation (SDF) measured by Halosperm(®). Anifandis G1, Bounartzi T, Messini CI, Dafopoulos K, Sotiriou S, Messinis IE.
Eur Urol. 2016 Oct;70(4):635-645. doi: 10.1016/j.eururo.2016.04.010. Epub 2016 Apr 21.Cigarette Smoking and Semen Quality: A New Meta-analysis Examining the Effect of the 2010 World Health Organization Laboratory Methods for the Examination of Human Semen. Sharma R1, Harlev A2, Agarwal A3, Esteves SC4.
Fertil Steril. 1994 Jan;61(1):35-43. Cigarette smoking and sperm density: a meta-analysis. Vine MF1, Margolin BH, Morrison HI, Hulka BS.
J Assist Reprod Genet. 2015 Nov;32(11):1575-88. doi: 10.1007/s10815-015-0553-8. Epub 2015 Aug 16.
Marijuana, phytocannabinoids, the endocannabinoid system, and male fertility. du Plessis SS1,2, Agarwal A3, Syriac A4.
Am J Epidemiol. 2015 Sep 15;182(6):473-81. doi: 10.1093/aje/kwv135. Epub 2015 Aug 16.
Association Between Use of Marijuana and Male Reproductive Hormones and Semen Quality: A Study Among 1,215 Healthy Young Men. Gundersen TD, Jørgensen N, Andersson AM, Bang AK, Nordkap L, Skakkebæk NE, Priskorn L, Juul A, Jensen TK.
Andrologia 50:1 2018 Feb Sperm DNA fragmentation as a result of ultra-endurance exercise training in male athletes.Vaamonde D Follow, Algar-Santacruz C Follow, Abbasi A Follow, García-Manso JM Follow
Arab J Urol. 2018 Feb 13;16(1):10-20. doi: 10.1016/j.aju.2017.12.004. eCollection 2018 Mar.
Lifestyle causes of male infertility. Durairajanayagam D1.
Toxicol Appl Pharmacol. 2015 May 1;284(3):339-44. doi: 10.1016/j.taap.2015.03.001. Epub 2015 Mar 12.
Environmental exposure to lead induces oxidative stress and modulates the function of the antioxidant defense system and the immune system in the semen of males with normal semen profile.
Kasperczyk A1, Dobrakowski M1, Czuba ZP2, Horak S3, Kasperczyk S4.
Nat Rev Urol. 2016 Oct;13(10):584-95. doi: 10.1038/nrurol.2016.157. Epub 2016 Aug 31.Epigenetics in male reproduction: effect of paternal diet on sperm quality and offspring health. Schagdarsurengin U, et al.
Toxicol Sci. 2018 Mar 1;162(1):241-250. doi: 10.1093/toxsci/kfx246. Paternal Exposure to Environmental Chemical Stress Affects Male Offspring's Hepatic Mitochondria. Godschalk R, et al. Toxicol Sci. 2018.
Hum Reprod. 2017 Nov 1;32(11):2159-2169. doi: 10.1093/humrep/dex283. Preconception urinary phthalate concentrations and sperm DNA methylation profiles among men undergoing IVF treatment: a cross-sectional study.
Wu H, et al.
Hum Reprod Update. 2018 May 1;24(3):320-389. doi: 10.1093/humupd/dmy005. The effect of paternal factors on perinatal and paediatric outcomes: a systematic review and meta-analysis. Oldereid NB1, Wennerholm UB2, Pinborg A3, Loft A4, Laivuori H5,6,7,8, Petzold M9, Romundstad LB10,11, Söderström-Anttila V12, Bergh C13.
Environ Pollut. 2018 Apr;235:806-813. doi: 10.1016/j.envpol.2018.01.021. Epub 2018 Feb 21.
Seasonal variation of semen parameters correlates with environmental temperature and air pollution: A big data analysis over 6 years. Santi D1, Magnani E2, Michelangeli M3, Grassi R3, Vecchi B3, Pedroni G4, Roli L5, De Santis MC5, Baraldi E5, Setti M6, Trenti T5, Simoni M2.
Postgrad Med. 2015 Apr; 127(3): 338–341. Published online 2015 Feb 19. doi:  10.1080/00325481.2015.1015928. The Effects of Cigarette Smoking on Male Fertility. Jason R. Kovac, MD, PhD, FRCSC,1 Abhinav Khanna, MD,2 and Larry I. Lipshultz, MD2

Authored by Dr. Hulsing

Are you thinking about starting or growing your family in the future? Perhaps you wonder if you are doing everything you can to enhance your fertility and increase the chances of a healthy pregnancy and baby. Even if you have never considered the health of your eggs or sperm don’t feel bad. Many times we only consider our health when we don’t feel good or things aren’t working. This is especially true around fertility but there are so many things you can do to prevent problems in pregnancy, optimize the health of your future children, and increase the likelihood of getting pregnant by following a pre-conception health plan.

Preconception health is the health of men and women prior to conceiving. So a pre-conception health plan is a protocol to improve health with the goal of healthy eggs/sperm, a healthy pregnancy and healthy baby.

Pop Quiz Time! Who should be following a pre-conception health plan?
A)  Women over 35 trying to conceive 
B)  All Women trying to conceive 
C)  All Men trying to conceive 
D)  Men/Women who have been diagnosed with unexplained infertility or suboptimal fertility 
E)  Women/Couples undergoing fertility treatments including IVF and IUI 
F)  ALL of the above
The answer is F—all of the above. Are you surprised? If you chose answer “A” you aren’t alone. Many people think only women over age 35 trying to conceive should follow a pre-conception health plan. While age is one factor relating to egg health and fertility, it is certainly not the only factor and all women will benefit from improved fertility as well as healthy pregnancies and babies. Perhaps you knew this and chose answer B—which leads me to my next point.

Yes, all women should be following pre-conception health plans, but what about the men? Men are often forgotten about when it comes to fertility but ALL men trying to conceive should be following a pre-conception health protocol. The lack of knowledge and interest about all the ways men can improve the health of their sperm is absurd because sperm make up 50% of the equation and provide half of the genetics of the baby. Pre-conception health plans specific to sperm health can mean getting pregnant more easily and with fewer complications. Healthy sperm = healthy baby.

Perhaps you assumed that a preconception health plan would be too simple or basic to help men and women with unexplained infertility or suboptimal fertility but that couldn’t be farther from the truth. A pre-conception health plan that addresses the root cause could solve the unexplained infertility cases that make up 1/3 of the total cases of infertility. Comprehensive pre-conception plans that address healthy weight, toxicant exposure, adrenal hormone dysfunction, hormonal imbalance, endometriosis, autoimmunity, inflammation, nutrient deficiencies, nutrigenomics, and egg/sperm health at a cellular or even DNA level can often solve unexplained and suboptimal fertility issues.

In my experience, the previously listed items may not show up on conventional screening labs or perhaps are not addressed due to lack of familiarity by other health care providers. For example, there was research published in the journal Reproductive BioMedicine Online which showed 80% of the “unexplained fertility” cases in the study involved sperm DNA damage (This won’t show up on a basic semen analysis so it would be missed). A pre-conception health plan which addressed the health of the sperm at a DNA level by improving antioxidant status could be extremely beneficial in these situations and treat the underlying issue without resorting to more expensive and invasive treatments.

Another area which is often overlooked is the importance of incorporating a pre-conception health plan as part of fertility treatments such as Intrauterine Insemination (IUI) and In Vitro Insemination (IVF). Preparing for pregnancy and optimizing the health of the egg and sperm utilized in fertility treatments leads to more successful pregnancies. You just need to make sure you are woking with someone who is knowledgeable about combining natural and conventional therapies so you are enhancing and not interfering with fertility treatments. Integrative fertility treatment (combining conventional and natural therapies) is quickly growing in popularity because of better outcomes and there is a growing body of research published in peer-reviewed medical journals showing the efficacy of many botanical, hormone, nutrient therapies and lifestyle changes used alone and in conjunction with conventional fertility treatments. I am always happy to share these studies during appointments upon request.

Now that you know how important it is for all men and women trying to conceive to follow a pre-conception health plan, you may be wondering how far in advance you should schedule an appointment to create an individualized pre-conception health plan. This will depend on individual factors but the MINIMUM amount of time is 3 months. This is based on the amount of time it takes for the egg and sperm to complete a cycle. (It takes about 74 days for the sperm to complete a cycle and about 90 days for the egg.) It is pretty amazing that you can create healthier sperm and eggs in only 3 months. If you have known health issues or if health issues are diagnosed with basic screening tests it can take longer than 3 months so it is never too soon to schedule an appointment to create a pre-conception health plan.

Because the pre-conception health protocol is individualized to each person after considering health history, lab workup, age, lifestyle, fertility history, and goals, it is beyond the scope of this article to go into detailed treatment plans. Scheduling an appointment with Dr. Hulsing or another Naturopathic Doctor who specializes in fertility is the next step if you are interested in getting personalized and detailed recommendations to optimize fertility and achieve your goal of a healthy pregnancy and baby.