Webster Technique: To Pregnancy and Beyond!
Hello and Welcome to my Blog!
Everyone at Dr. Super’s House of Health knows that I really do love all of my patients but that babies and pregnant women come first in my heart. When I first decided to be a chiropractor I thought I was going to be bored treating back and neck pain all day, same thing day in and day out. When I got to Palmer College of Chiropractic I quickly realized how naive I was and how many different types of specialties existed. I went from being scared of boredom to being completely overwhelmed and feeling like I had to choose one technique or patient population over the other. I was a rugby player so of course I gravitated towards working with athletes in the rehab department and studied techniques that focused on soft tissue work and extremities. I also felt drawn to working with upper cervical specific techniques due to the difference they made for me personally. At the time, I was purposefully navigating away from pediatrics and pregnancy due to some personal experiences. I had put it out of my mind to work with those populations all together. That lasted until I met Drs. O’Neill and Bhogal who first introduced me to Webster Technique during my OB/Peds class.These two instructors and chiropractor extraordinaires taught me How to Find a Subluxation (literally, that’s what the class was called) and OB/Peds.
Before choosing chiropractic I wanted to be an obstetrician and volunteered in a local hospital while in pre-med. I quickly was told by observing obstetricians that I didn’t have the heart for it and I was too soft; the nurses would catch me crying when I saw a laboring woman who was trying to advocate for her birth while being whisked off for a C-section, sick babies who were born into the world of withdrawal, and of course loss or injury during birth seemed to be an accepted part of life in the ward. I had a completely different picture for birth! I thank heaven that my instructors were able to remind me what birth, labor and pregnancy were really about. They taught me how these patients need chiropractic care and how we can help them to have a safe and successful labor. I quickly joined the pediatric chiropractic club and during my clinicals I chose staff doctors who had pregnant patients to treat. As soon as I graduated, I signed up for my Webster’s Certification. I was blessed to receive instruction under Dr. Jeanne Ohm before her passing and I have never seen a more passionate person (besides Ina May Gaskin) when it comes to physiologic birth (A.K.A. natural labor without medical intervention). I remember thinking she was nuts when she told me she had all six children at home; no ultrasounds during pregnancy, no check ups, no fetal heart rate monitor, no drugs, no obstetrician. All 8 of her grandchildren were also natural home births. She walked the walk! She made sure she had regular adjustments and Webster technique while pregnant and she firmly believed that was all she needed.
Dr. Larry Webster had invented the technique in the 80’s and it has been observed clinically to be associated with improved pregnancy outcomes since that time (Jeanne,O., 2012). This technique has had a lot of controversy in the medical world due to differences in philosophy (I discuss some of this in my last blog post as well as “Why Philosophy is Important in Medicine”) as well as differences in descriptions between providers. Dr. Jeanne Ohm explains, “Due to the empirical observations that pregnant women under chiropractic care with breech fetal pregnancies were reporting correction of fetal position to vertex following the use of the Webster Technique, the technique was inappropriately described in its early days as a “breech turning technique” by both patients and some chiropractors” (Jeanne, O., 2012). Since then, chiropractors who use this technique on pregnant women have been accused of practicing obstetrics without a license. I promise you, no such thing is happening (at least in my office). So what is this Webster technique really about?
The International Chiropractic Pediatric Association (ICPA) clarified the intent of the technique in 2012, “The Webster Technique is a specific chiropractic sacral analysis and diversified adjustment. The goal of the adjustment is to reduce the effects of sacral subluxation/ SI joint dysfunction. In doing so, neuro-biomechanical function in the pelvis is facilitated. Sacral subluxation may contribute to difficult labor for the mother (i.e., dystocia), caused by inadequate uterine function, pelvic contraction, and baby mal-presentation. Correction of sacral subluxation may have a positive effect on all of these causes of dystocia” (About the Webster technique, 2022). This technique is to be used on all weight bearing individuals regardless of sex or gender and is not specific to pregnancy. So what does this technique look like and who needs it then?
The adjustment can look different depending on the practitioner because Webster is a specific analysis, not an adjustment! I personally utilize table Thompson Drop Technique and chiropractic pregnancy pillows to optimize patient comfort during the adjustment (my pregnant moms love these pillows and ask how they can get them until I tell them they are over $200!). I also use an arthrostim tool to adjust the pubic symphysis when I find a dysfunction there as well. The coccygeal fascia and pelvic floor is intimately connected to the pubic symphysis. During pregnancy the body releases a hormone called “relaxin” which allows softening of the tissues of the birth canal and ligaments around and connected to the pubic symphysis (Bani, 1997). My patients who once had stable pelvic alignment and are now pregnant find it irritating that they are so “loosey goosey all of a sudden”. If a pregnant woman does not have proper pelvic or lumbar stability before they are pregnant, they are more likely to subluxate during pregnancy. These women are also prone to having new conditions develop during pregnancy such as tailbone pain, sciatica, pubic symphysis pain, round ligament pain, coccygeal pain, and something one of my patients refers to as “lighting crotch” (if you have been pregnant and don’t know what this is, then good for you!).
The adjustments don’t stop at the pelvis either! It is important for the nervous system to be free of interference when preparing for a natural process such as birth. Therefore it is important for me to adjust whatever I find (a T4, C1, L5, Sphenoid, Tibia, etc.). There was something extra that Jenaie Ohm instructed me on when working with pregnant women and that was how special the sphenoid could be for pregnant women or women trying to get pregnant due to its relationship with the pituitary gland. During pregnancy, the pituitary gland grows an average of 0.08 mm/wk and will peek at labor before slowly shrinking again postpartum (Elster, 1991). This little gland nestled into the sella turcica of the sphenoid is responsible for “the support of the fetus (volume support, nutritional and oxygen supply, clearance of fetal waste), protection of the fetus (from starvation, drugs, toxins), preparation of the uterus for labor, breastfeeding, and protection of the mother from potential cardiovascular injury at delivery” (Foyouzi, 2004). For information on how I adjust the sphenoid, refer to my previous blog post titled “My Favorite Adjustment: The Sphenoid Special”. Dr. Jeanie Ohm also taught me the importance of reducing round ligament tension to reduce round ligament pain. When I gently maneuver this ligament, the baby sometimes will give me a “high five” and play “patty cake”. The pregnant mother usually experiences an increase in baby movement during pregnancy which I find fascinating!
Webster protocol for pregnancy differs depending on the pregnant mothers situation. I usually start Webster analysis as soon as I find out my patient is pregnant. When someone is around 28-34 weeks I usually recommend once a week until an ultrasound discovers the baby is head down. When I have women come to me later in pregnancy (after 34 weeks) and they are trying to avoid an ECV or Cesarean then I increase frequency to 2-3x/wk (this is typical Webster protocol, but I find the frequency is not always necessary unless there is a time constraint). I have seen hundreds of pregnant women who have wanted a natural birth but were inhibited by a breech presentation and I can only remember five women who did not have their baby go head down. In each case, unique circumstances were inhibiting the baby from proper movement in the uterus; 2 babies had the umbilical cord wrapped around the neck or body, one involved twins where one baby cooperated and the other did not, a placenta previa, and low amniotic fluid.
My passion for treating women and babies is my greatest WHY in chiropractic. Why do pregnant women need chiropractic care? Because their body is going through some serious changes and challenges and needs all the support it can get without interfering with the natural birthing process. In my opinion, chiropractic is a great way to support and promote a healthy physiologic birth. Do women who see chiropractors still occasionally need interventions? Heck yes. There is no way to predict or prevent all that can happen during labor and as long as there is a healthy baby and mom at the end, that birth was a success in my book. I find great joy in supporting my patients' dream of having the birth they have always wanted. I am also baffled that women during labor are defined as being “greedy” or “selfish” when aiming for a natural birth at the “expense of their baby”. In these instances the laboring woman is often not working within the restrictions of the hospital and are set up to have very little chance of birthing without interventions of some kind (for more information on this read my blog post titled “Gaslighting During Childbirth: What Every Expecting Mother Should Look Out For!”). I am proud to be a part of my patient’s birth team by supporting their body the best way I know how; with an adjustment.
Feel well and do good,
ADIO
Dr. Tabetha Super
References:
Jeanne, O., & Alcantara, J. (2012). The webster technique: Definition, application and implications. Journal of Pediatric, Maternal & Family Health – Chiropractic ~ Volume 2012 ~ Issue 2 ~ Pages 49-53. Vertebral Subluxation Research. Retrieved May 8, 2022, from https://vertebralsubluxationresearch.com/2017/09/10/the-webster-technique-definition-application-and-implications/?msclkid=e21b0667cf1611ec88d1d447cc772b6
About the webster technique. ICPA. (n.d.). Retrieved May 8, 2022, from https://icpa4kids.com/training/webster-certification/webster-technique/?msclkid=92b70776cf1a11ecbd6b1fe29ce0997e
Bani D. Relaxin: a pleiotropic hormone. Gen Pharmacol. 1997 Jan;28(1):13-22. doi: 10.1016/s0306-3623(96)00171-1. PMID: 9112071.
Elster, A. D., Bonneville, F., & Miki, Y. (1991, November 1). Size and shape of the pituitary gland during pregnancy and post partum: Measurement with Mr Imaging. Radiology. Retrieved May 8, 2022, from https://pubs.rsna.org/doi/abs/10.1148/radiology.181.2.1924800#:~:text=The%20pituitary%20gland%20enlarges%20throughout%20pregnancy%20but%20should,12%20mm%20may%20be%20acceptable%20immediately%20post%20partum.?msclkid=be6443eccf1d11ecb9fc949737d2d592
Foyouzi N, Frisbaek Y, Norwitz ER. Pituitary gland and pregnancy. Obstet Gynecol Clin North Am. 2004 Dec;31(4):873-92, xi. doi: 10.1016/j.ogc.2004.08.003. PMID: 15550340.