Dr. Mario Awwad, D.C.

Prenatal Care

Chiropractic adjustments quicken recovery time and assist the body in normalizing overall pelvic and spinal biomechanics. Prenatal care during pregnancy assists mom in having a successful pregnancy and birth. It keeps mom and baby healthy and provides mom with needed physical and emotional support.




The Birthing Plan

Developing a birth plan plays an important role during the prenatal period. It is a written plan which outlines the wishes and wants of the mother in relation to procedures to be followed and actions to take during the prenatal period, during the birth and postpartum. The more detailed and specific the birth plan is, the more likely a successful outcome will be achieved. The following list includes many of the points which should be addressed and determined early on in pregnancy:

  • Choice of caregiver
    • obstetrician
    • certified nurse-midwife
    • lay midwife

  • Other Practitioners
    • chiropractor
    • pediatrician
    • massage therapist
    • acupuncturist

  • Birth Venue
    • hospital birthing room/chair delivery room
    • home
    • birthing center

  • Prenatal care
    • frequency of visits (primary care giver & chiro care)
    • what do you do at visits

  • Prenatal testing
    • ultrasound frequency - abdominal vs. transvaginal (should always be performed by an ultrasonographer)
    • amniocentesis
    • CV sampling
    • alfa-feto protein tests - to identify neural tube defects
    • non-stress test
    • other blood tests

  • Levels of activity during the pregnancy
    • working outside the home
    • working in the home
    • other children
    • exercise

  • What is your view on:
    • anesthesia during birth
    • what is your c-section rate
    • how do you feel about vaginal birth after cesarean
    • how do you feel about childbirth classes
    • how do you feel about nursing
    • how do you feel about testing in women over 30

  • Labor
    • how long to stay home before attending birth venue?
    • how long can I labor before intervention?
    • when would pitocin be used?
    • level of monitoring during labor
    • IV
    • what positions can I assume?
    • how mobile can I be?
    • can I eat?
    • under what circumstances would a c-section be performed?
    • would you deliver a breech vaginal?

  • Medications during labor
    • epidural
    • anesthesia
    • IV drugs

  • Birth
    • can siblings be present?
    • can my husband/labor support person be with me the whole time?
    • how long can I push?
    • what signals will you have to do a c-section?
    • can I hold the baby directly after the birth before weighing etc.?
    • will you be there the entire time?
    • how often do you do an episiotomy?

  • Postpartum
    • can the baby room-in?
    • who can visit the baby?
    • what will the baby eat immediately after birth?
    • can I begin to nurse immediately?
    • frequency of visits?
    • which pediatrician will see the baby?
    • when can we go home after the birth?
    • given a c-section, how long will I be in the hospital?
    • should something be wrong with the baby, what type of services does the hospital offer?
  1. Fallon J. TextBook on Chiropractic & Pregnancy. International Chiropractic Association. 1994 - Arlington, Virginia.

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Regular Chiropractic Adjustments

Regular chiropractic adjustments play an integral role in the prenatal and postpartum periods. The adjustments help counter the effects of increased weight gain, altered weight distribution, and excessive ligament laxity. This keeps the spinal and pelvic regions healthy, biomechanically sound, and minimizes soft tissue irritation and discomfort.

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Proper Diet and Nutrition

Maintaining a complete nutritious diet accompanied with supplementation is critical for mom's health and the health of the developing fetus. Making appropriate nutritional choices during pregnancy can be confusing but your chiropractic doctor can help guide you. Also, additional supplementation of prenatal vitamins and minerals is crucial; such as folic acid to prevent neural tube defects in your child.

Pregnancy requires an additional 300 calories per day in order to maintain metabolic homeostasis. Thus, those exercising should pay close attention to ensure adequate nutritional intake.

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Exercise / Physical Activity Program

Except in special cases, mild to moderate physical activity and exercise during pregnancy is not only safe, but has been shown to be beneficial.

Kegel Exercises

Kegel exercises are extremely important for the pregnant woman. They function to improve and maintain pelvic floor muscular tone which is vital during pregnancy and delivery. These exercises are best initiated early in pregnancy and continued throughout the term of the pregnancy. This ensures that during the delivery process the pelvic musculature is able to withstand the changes taking place during labor. They're also important in decreasing the likelihood of tearing during delivery as well as the later development of hemorrhoids.

These exercises are performed by squeezing the muscles of the pelvic floor. This is done by contracting and holding the same muscles used to start and stop urination in midstream.

Exercise In Pregnancy Is Safe (For Mother and Fetus)

A recent study published in the American Journal of Obstetrics and Gynecology finds that women who exercised prior to their pregnancy can continue to do so without negatively affecting the fetus' growth or the pregnancy itself. According to the researchers, "Our results indicate that healthy and well-conditioned women may take part in exercise during pregnancy without compromising fetal growth and development as judged by birth weight or complicating the course of pregnancy or labor." Forty-two women participated in either a medium or high intensity exercise program throughout their pregnancy, including 6 weeks postpartum. The women exercised 6 times per week, participating in strength, interval and endurance training. All 42 women had been physically active prior to the pregnancy.

Overall, researchers discovered no differences between the high and medium intensity exercise groups in terms of labor, fetal birth weight, or the health of the infant immediately after birth. The researchers did note that women who exercised more gained more weight during pregnancy and went into labor earlier if they had a girl.

  1. American Journal of Obstetrics and Gynecology 1998;178:280-286.

Exercise may protect against miscarriage

A study from the journal Epidemiology indicates that women who continue to exercise regularly during their pregnancy have a 40% lower risk of having a miscarriage of a chromosomally normal fetus compared with those who do not exercise. In the study, researchers interviewed 346 women who had suffered a miscarriage, asking them about exercise and other habits during their pregnancy. From these interviews, researchers were able to determine that exercise, such as swimming, jogging and aerobics, reduced the risk of miscarriage of a chromosomally normal fetus, but other physical activities such as housework, childcare or employment did not have this protective effect.

According to researchers, "The protective effect of exercise, but not of other forms of activity, may arise from the sustained aerobic nature of exercise; exertion during employment, housework and childcare is often sporadic." Of the women interviewed, approximately 25% claimed to have exercised during their pregnancy.

  1. Epidemiology 1999;10:6-7, 73-75.

Athletes Can Work Out During Pregnancy

According to a case report in The Lancet, a 33 year old distance runner continued to exercise intensely throughout her pregnancy and gave birth to healthy twins, without complications. Throughout the woman's pregnancy, she ran an average of 66 miles per week with a heart rate of 130-140 beats per minute up until 3 days prior to giving birth. The researchers did warn that women who were inactive prior to their pregnancy would have to be more cautious.

  1. The Lancet 1998;351:1182

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Soft Tissue Work

Soft tissue work includes massage, trigger point work, soft tissue mobilization, and other soft tissue procedures. These techniques assist in keeping muscles and other tissues relaxed and flexible while reducing bouts of muscle aches and pains.

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