LECTURE 2

Birth Process as Initiating Factor of Vertebral Subluxation

• Kinematic Imbalance due to Sub-Occipital Strain (Biederman)

• 600 children, 100% with KISS

• 114 with visceral dysfunction

• 100% with global subluxation, considered by medical doctors to be clinically insignificant

• Abraham Towbin, M.D. - Neonatal deaths due to brain stem and spinal cord injury– 10% of neonatal deaths– 120 lbs. of pressure, in flexion and rotation

Obstetric Myths vs. Research Realities

• Myth: I only do cesareans when they are necessary.

• Reality: “It does seem clear to us that today’s rates are in a large measure a result of socioeconomic and not medical factors.”– Hurst and Summey 1984

• M: Once a cesarean, always a cesarean.

• R: “The concept of routine repeat cesarean birth should be replaced by a specific indication for a subsequent abdominal delivery.”– ACOG 1988

• M: I’m afraid labor just isn’t progressing the way it should.

• R: “It does not appear that liberal use of oxytocin augmentation in labour is of benefit…This does not imply that there is no place for oxytocin augmentation in slow progress of labour…It does suggest, however, that other simple measures, such as allowing the mother freedom to move around, and to eat and drink as she pleases, may be at least as effective and certainly more pleasant for a sizeable proportion considered to be in need of augmentation.” – Crowther et al. 1989

• M: Now that your baby is breech, the only safe thing to do is to schedule a cesarean.

• R: “Routine cesarean delivery of a near-term or term breech fetus increases maternal morbidity, maternal mortality, and the cost to society, but it does not provide a foreseeable benefit to the near-term and term breech fetus.”– Weiner 1992

• M: Electronic fetal monitoring allows us to rescue babies from death or brain damage.

• R: “Twenty-five years after electronic fetal monitoring became part of intrapartum care…it is yet to be proved of value in predicting or preventing neurological morbidity.”– Rosen and Dickinson 1993

• M: To avoid problems, at two (or even one) weeks after the due date labor should be induced.

• R: “It is apparent that the overwhelmingly redundant message of the …literature…is that there is absolutely no study, no evidence whatsoever, that routine induction at any gestational age improves outcome.”– Nichols 1985a

• M: Once membranes are ruptured, the baby must be born within 24 hours or infection sets in.

• R: “By waiting 24 hours, avoiding cervical examination, and allowing a reasonable latent phase of labor, (after induction-16 hours), we believe that the increase in cesarean section rates with induction can be minimized.”– Garite 1985

• M: We’ll rupture the membranes and get this show on the road.

• R: “The status of the membranes has but a small effect on the length of labor…We conclude that a routine clinical practice of rupturing membranes in the presence of normal labor progress adds little to labor management and should be questioned.”– Rosen and Peisner 1987

• M: An IV is necessary in labor because eating and drinking are dangerous--you never know when general anesthesia might be required.

• R: “From the sparse data available, we conclude that (eating & drinking in labor) is generally a safe, healthy, and natural practice…It would seem prudent, given the gaps in scientific information, to offer this option primarily to healthy, unmedicated women, and to restrict high-risk women to clear fluids and perhaps IV fluids later in labor.”– McKay and Mahan 1988

• M: Natural Childbirth makes about as much sense as natural dentistry, and epidurals are the Cadillac of anesthesia.

• R: “Reported maternal complications of epidural analgesia…include: dural puncture; hypotension; increased use of operative delivery; neurological complications; bladder dysfunction; headache; backache; toxic drug reactions; respiratory insufficiency; & even maternal death. The fetus may also suffer complications as a result of maternal effects or direct drug toxicity.”– Simkin and Dickersin 1989

• M: A nice clean cut is better than a jagged tear.

• R: “Like any surgical procedure, episiotomy carries a number of risks; excessive blood loss, hematoma formation, and infection… There is no evidence that routine episiotomy reduces the risk of severe perineal trauma, improves perineal healing, prevents fetal trauma or reduces the risk of urinary stress incontinence.”– Sleep, Roberts, & Chalmers 1989

• M: You don’t want a midwife when you can have the best--an obstetrician.

• R: “Analysis of national perinatal statistics from Holland, 1986, demonstrates that for all births after 32 weeks gestation mortality is much lower under the non-interventionist care of midwives than under the interventionist management of obstetricians at all levels of predicted risk. This finding confirms…the conclusions of all earlier impartial analyses from…other countries.”– Tew and Damstra-Wijenga 1991

• M: Home birth is so dangerous, it should be considered child abuse.

• R: “There is no evidence to support the claim that the safest policy is for all women to give birth in hospital…There is some evidence…that mortality is higher amongst mothers and babies delivered and cared for in institutional facilities in general and…obstetric units in particular.”– Campbell and Macfarlane 1986

• M: Obstetrics is a science whose practices are grounded in medical research.

• R: “We find a pervasive assumption, shared by medical practitioners and their clients alike, that obstetric practices are scientifically grounded. Even though a given medical practitioner, at any one time, may not just then have the data at hand which support his conviction, he knows that they exist…On examination, the evidence on which his conviction is based is sometimes non-existent, and if it does exist, is frequently far from clear-cut.”– Jordan 1993

M. Gottlieb, D.C.

• 10% of neonatal deaths

• 80-100 lbs. can cause vertebral end plate fractures

• 60-80 lbs. can cause paravertebral muscle tears

Global Subluxations

• Scoliosis (Windsor)

• Cervical Hypolordosis (Brieg)

• Cervical Kyphosis (Coleman)

Mechanoreceptors

KISS and Mechanoreceptors

• Parnell (La Salle Univ) and Upper Cervical Kinematics and Cortical Function

• Dentate ligaments

KISS con’t

• Ascending Spinal Pathways– Dorsal Column Medial Lemniscus– Dorsal Spinocerebellar Pathway

KISS con’t

• Descending Spinal Pathways– Vestibulo Spinal Pathway– Recticulo Spinal Pathway

• Travell on Chronic Pain and Fatigue