The Terrible Triad of Preganacy


As you may have heard on sports news, one of the devastating injuries feared by athletes is the “terrible triad” the combination of a torn ACL, MCL, and medial meniscus of the knee. Often requiring surgery, this injury can knock athletes off the field or court for at least six months or more, or force them into retirement.

In pregnancy, there is also a terrible triad.  It is not a surgical emergency jeopardizing a 4-year contract, but it is unpleasant just the same.

The Terrible Triad of Pregnancy

1. Weight gain: Predominately occurring in the third trimester, women will naturally gain weight as the developing baby adds 3.5 pounds and 5.5 inches of growth during this phase. The growth of the baby also compresses the diaphragm and ribs, making a full inhalation seem impossible. Swollen ankles, varicose veins, hemorrhoids, and indigestion round out the consequences of weight gain in the third trimester.

2. Structural shifts in alignment: As the center of gravity for mother shifts forward and upward with her weight gain, the weight distribution to her joints changes. The new postures and stresses to her knees, hips, and low back can create changes to her entire spine. The lumbar spine and hip joints are most commonly challenged. Gait alterations may occur as well, altering the load on her spine and increasing the incidence of strain/sprain injuries to her spinal segments and supporting structures (Ohm, 2013).

3. Ligament changes due to hormones: The hormones relaxin and elastin are critical to allowing the pelvis to successfully deliver the fetus.  Their function as the name suggests is to “relax” and create an “elastic” effect on not only the ligaments and structures of the pelvis, but the entire body. While integral to a successful birth outcome, these powerful hormones can cause shifts in alignment and gait alterations in the third trimester.  Mom may notice an increase prevalence of turning her ankle and changes in her overall posture as her mid-back and neck compensate for her shifts in weight. Chiropractic care is extremely effective during pregnancy, but the doctor needs to be highly aware of the changes in the spine and ligaments as they deliver the chiropractic adjustment. The same adjustment given to a woman before pregnancy and in her third trimester may have different outcomes if the doctor is not familiar with prenatal chiropractic care.

The combination of these three factors adds to the likelihood of pelvic distortion or misalignment, intra-uterine constraint, and low back or hip pain. Pelvic distortion relates to a change in the normal alignment of the pelvis. Intra-uterine constraint refers to any changes in sacral positioning that could interfere with normal positioning or movement of the baby. Low back pain has been reported in 42.5% (Clapp, 1993) to 90% (Revelli, 1992) of pregnant women. “There are no known contraindications to chiropractic spinal and pelvic adjustments throughout pregnancy other than those affecting any non-gravid (non-pregnant) individual (Ohm, 2013).”

The Terrible Triad in Pregnancy include changes that occur during pregnancy to ensure a successful birth. They are necessary physiological and biomechanical processes, but they can cause challenges if proper structural alignment is not maintained. Our office, in West Des Moines, supports the normal functioning of the spine and nervous system to create a healthy pregnancy and birth environment.


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“The 3 P’s” for a Normal Pregnancy

Pregnancy is a major event in any woman’s life.  Whether it is her first or fifth,  it is important to ensure that normal structure of her spine is maintained to diminish the chances of secondary issues arising throughout pregnancy, labor, and delivery.  One of the secondary problems that women may face is dystocia, or a difficult or abnormal labor.

When defining dystocia, Williams Obstetrics says, “Dystocia is very complex, and although ‘abnormal progress in labor’ seems simple, there is no consensus as to what ‘abnormal progress’ means.  Thus, it seems prudent to attempt a better understanding of normal labor in order to determine departures from normal.”  At Keystone Chiropractic, through Neuro-Structural Correction, it is our goal to restore normal spinal structure and allow all other processes to function normally.

Certainly, a number of factors can contribute to a difficult pregnancy, labor, and delivery.  Let’s take a look at “The 3 P’s,” and their effects on labor.

  1. The first “P” is Power; the ability of the uterus during labor and delivery to push the baby out.  Sometimes there may be insufficient contractions, or perhaps inappropriately coordinated dilation of the cervix.  In later stages of labor, there may be decreased voluntary muscle control.  It is important to understand that the uterus is, in large part, a muscle.  It requires a proper nerve supply to control and coordinate its functions.  If there is a structural shift in the low back, it very well could be obstructing the nerves which travel to the uterus and pregnant-361582_1280affecting the Power.
  2. The second “P” is Passage; in other words, the bony pelvis through which the baby will pass during delivery, but also where it resides throughout pregnancy.  When there is an abnormal shift within the pelvis, abhorrent motion of the pelvic joints begins to occur.  During pregnancy this can have secondary effects for the mother which can include things like increased discomfort and constraint on the uterus.  As labor and delivery approach, the structural shift and lack of motion can actually lead to a decreased space for the baby to pass through, making for a more difficult delivery.
  3. The last “P” is Passenger; or the baby.  If the mother has a structural shift, it may be obstructing the nerve supply which helps control development of the baby during pregnancy.  When labor and delivery are approaching, pelvic shifts, and the improper motion and decreased space, which can result, may prevent the fetus from positioning itself properly for delivery.  It is vital that the child, as it’s developing, receives the proper messages from the mother’s nervous system.

Throughout pregnancy, there are many physical and hormonal changes which may contribute to an increased possibility that the spine shifts from its normal position.  These structural shifts may lead to obstruction of the nerves traveling to the uterus, abnormal pelvic motion, and decreased messages being sent to the developing baby.  The goal of Neuro-Structural Correction is to restore these structural shifts to their normal position, using specific adjustments, and removing nerve obstruction to the uterus, regaining normal movement in the pelvis, and ensuring the proper messages are getting to the baby.

Normal Power and proper motion of the Passage are vital to a normal pregnancy and delivery.  It is also important that you, as the mother, are doing everything possible for the Passenger to ensure proper development during pregnancy and that the child is given the best chance to put themselves in the proper position for delivery.

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