It is important for the expecting mother and everyone involved to stay well-informed of circumstances women encounter during pregnancy, particularly normal circumstances. Being well-informed of these circumstances along with when and why they occur makes the treatment change from trimester to trimester of the expectant mother.
Morning sickness is common during the first trimester of pregnancy. The woman tends to be nauseated with or without the presence of vomiting. Multiple etiologies have been cited as reasons for morning sickness. Hormonal influence on the GI tract, the growing uterus and emotional situations are among the most common. Changes in taste and smell also can occur with pregnancy. This can leave the woman hypersensitive to certain tastes or smells: tastes and smells that were not disturbing before. Nausea and/or vomiting may result from these hypersensitivities. Nausea and vomiting may prevent adequate nourishment, resulting in weight loss of 5 pounds or less. Weight loss of greater than 5 pounds is a concern and should be investigated.
As the uterus grows during gestation, the round ligaments supporting the uterus are placed under tension. This tension can lead to stretching, resulting in lower abdominal and/or groin pain. This pain can be unilateral or bilateral and often occurs when the expectant mother shifts positions. This condition is most common in the second trimester. During the second trimester fatigue is another common occurrence. Factors that induce fatigue: increased energy requirements, stress placed on postural muscles as a result of weight gain, shifts in the center of gravity and sleep disturbances. Fatigue associated with weight gain will get worse if the patient gains more weight than expected during the pregnancy.
Edema in the extremities is common during pregnancy especially during the third trimester. This is a result of decreased lymphatic flow and increased venous pressure. Significant swelling of the lower legs occurs as a result of these changes. Gastrointestinal symptoms are common once again in the third trimester and throughout pregnancy. Esophageal reflux can occur when hormonal changes result in relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus, creating “heart burn.” As the baby grows the most during this final trimester the increased abdominal size causes a shift in the center of gravity and increased strain on postural muscles. This is further complicated due to the production of the hormone relaxin during the third trimester. Relaxin’s function is to loosen ligaments of the pelvis to allow expansion of the pelvis and birth canal during delivery. The result in increased postural strain on a now- unstable frame. Relaxin is not target specific and circulates systemically so it can affect joints other than those of the pelvis, causing further postural and skeletal complications. As a result of postural changes the body makes during the three trimesters and an increase in relaxin during the final trimester it makes treatment of these gestational changes usually quite responsive to chiropractic care. A special point must be made regarding the effects of relaxin. The effects of the hormone are not reversed until 3-4 months post – partum. This means chiropractic care during the first three to four months post – partum is as important as care during the pregnancy.
Next weeks blog I will cover treatment after delivery for the mother and starting care for the newborn.