Question
Dr. Dolan,
I had my first visit to a chiropractor today at 31 weeks pregnant. I know without x-rays it is difficult to know exactly what underlying spinal problems exist. The treatment I received was 10 minutes TENS therapy to my lower back (is it commmon to use this machine when treating a pregnant patient?)  Then I was adjusted gently, lying on my side.  I didn't feel any pain from the adjustment or the TENS, but I just want to know if the use of the TENS machine is safe as long as it is positioned on my back.

Answer
Chiropractic during pregnancy, staten island pregnancy, chiropractic during pregnancy,






Hello Rebecca,


Congratulations on your pregnancy and new addition to the family!
Congratulations on utilizing safe, effective Chiropractic care during your pregnancy.  This treatment approach should not only make your pregnancy (with increased weight and altered weight carrying postures/ movements) more comfortable, but should make labor and delivery easier for you.

When patients attend a Doctor of Chiropractic--- the thing that makes chiropractic doctors different from other health care providers is:,,,, the adjustment.  Striving to find mis-alignments (vertebral subluxation complex; alteration/ aberration in position/ movement patterns of the joints in the spine), and the correction of these subluxations (chiropractic technical term), through adjustment is what Chiropractic and Chiropractors are all about.

Now,,, on to the tens treatment.

I will list a couple of websites on safety/ use of tens in pregnant patients, and give my personal opinion.

You will find this statement or something similar when asking about TENS or many other medications/ treatments during pregnancy:  something like:  "....warning- the safety of use of XXXXX  during pregnancy has not been established...."

For example:  " Warnings
This device should be used only under the continued supervision of a physician. TENS is ineffective for pain of central origin, (i.e. appendicitis, hepatitis). TENS is of no curative value; it is a symptomatic treatment which suppresses pain sensation which would otherwise serve as a protective mechanism on the outcome of the clinical process.
-----Safety of TENS devices for use during pregnancy or delivery has not been established.---
For external use only. Electronic equipment such as EKG monitors and EKG alarms may not operate properly when TENS is in use. The user must keep the device out of the reach of children. Also, this device should not be used over metal implants or sleep apnea monitors. ..." - this taken from:  http://www.foam-mattress.com/backstore/tenssafety.htm   --- you will find similar on many TENS websites, or medication/ other treatment websites.

This statement says safety has not been established; it also means that 'problems' have not been established either.

In pregnancy, most,,, if not all drugs/ many treatments are frowned upon and 'contraindicated'.  During pregnancy, many treatments are frowned upon and 'contraindicated' (not used).  My Mom, often tells us she never smoked, drank, even took an aspirin when she was pregnant with us (sister and me)!

I would not utilize a TENS machine over the abdomen or pelvis AT ALL in a pregnant patient.
Depending upon build/ habitus of the patient, how far along in pregnancy, I might use it over the lower back-- but probably not.  Not because of fear of problems for the baby,,,, but because of the fear of possible legal ramifications.  Pregnancy is fraught with miracles AND sadness- while I do not believe the therapy machines in use in doctors offices or physical therapy offices have the depth of penetration or capability to cause problems,,,, it is better safe then sorry in the legal arena.

Using TENS distant from the Uterus/ Abdomen/ Pelvis 'pregnancy site'; ie upon a foot/ knee/ leg/
neck/ arm/ hand is far less problematic.  Electrical current does not even pass near the baby.

In pregnancy I would not utilize TENS over the abdomen, pelvis, or lower back.  Please,- Do not get 'crazy';  because I am sure physiologically no harm will be done/has been done to the baby; but the perception that it even MIGHT cause a problem,,, is not worth the worry to the Mom or Doctor.

It is best to be very very conservative during pregnancy- that is why MOMs to be come to the chiropractic doctor in the first place- for health maintenance, safe pain relief, safe pain prevention.

It is best to be very very conservative during pregnancy- that is why MOMs to be, and medical doctors usually utilize NO medications at all during pregnancy--- even if a drug/ or treatment has not been shown to cause any problems during pregnancy, it has also not been shown to be absolutely safe.

Depth of penetration of the therapy machines commonly in use in doctors offices is just not very deep, which adds to safety of the devices, and decreases the likelihood of any complications.

A concern of any electrical stimulation in a pregnant patient is the initiation of contractions- bringing on labor and delivery.  When electrical stimulation has been applied in pregnant patients, if contractions started (rare), the contractions stopped when the stimulation was turned off.

One group in England has taken a stand on TENS use:
http://www.oaa-anaes.ac.uk/assets/_managed/editor/File/PDF/info_for_mothers/TENS...

This group actually says that TENS use may be good for the placental blood flow.  To quote:
"...TENS has been used for years by pregnant women for many years  without any reported side effects for either the mother or baby...." - http://www.oaa-anaes.ac.uk/assets/_managed/editor/File/PDF/info_for_mothers/TENS...






From  a  sales  site:
http://www.masters.com.au/what_TENS.htm
"....Contraindications
Except in the case of certain individuals using pacemakers, there are no known contraindications for TENS. The use of a TENS with a pacemaker may prevent the pacemaker from working. If you have a pacemaker, you must get a clearance from your consultant cardiologist that it is O.K. for you to use a TENS machine.  

Precautions:
1. TENS devices should be used with caution where the cause of the pain has not been established.
2. TENS stimulation is of no curative value. That is, TENS does not do anything to the underlying cause of the pain.
3. Treatment outcome (with TENS ) will be influenced by the cause of the pain, the patient's psychological state and use of medication.
4. TENS should be kept out of the reach of children.
5. Electrical stimulation over the carotid sinus, i.e. anywhere over the front of the neck, may be hazardous.
6. The safety of TENS during pregnancy has not been established. ...."



Given all of the above,  I think you can see that it is highly unlikely that TENS could harm you or the baby.  Given all of the above, I think you can see that the worry that some side effect may happen-- it is just not worth the worry- psychologically or legally for you or the doctor.

I would continue with the adjustments, but probably cease the TENS over the Abdomen, Pelvis, or lower back.

You may find this information interesting:

".....What are the benefits of chiropractic care during pregnancy?
Chiropractic care during pregnancy may provide benefits for women who are pregnant. Potential benefits of chiropractic care during pregnancy include:

Maintaining a healthier pregnancy
Controlling symptoms of nausea
Reducing the time of labor and delivery
Relieving back, neck or joint pain
Prevent a potential cesarean section

...... The Journal of Manipulative and Physiological Therapeutics reported in the July/August 2002 issue an 82% success rate of babies turning vertex when doctors of chiropractic used the Webster Technique. Further, the results from the study suggest that it may be beneficial to perform the Webster Technique as soon as the 8th month of pregnancy when a woman has a breech presentation........."
         from:  http://www.americanpregnancy.org/pregnancyhealth/chiropracticcare.html



".....As I write this today, two of our beautiful practice members are awaiting the arrival of new additions to their families. Adjusting women through pregnancy is one of the most rewarding parts of our work, because a healthier pregnancy means an easier labor and delivery, and a better transition for the baby into this life.......
.......Adjustments result in easier pregnancy, significantly decreased mean labor time, and assists new mothers back to prepartum health. In one study, women receiving Chiropractic care through their first pregnancy had 24% shorter labor times than the group not receiving Chiropractic, and multiparous subjects reported 39% shorter labor times. Thirty-nine percent-that's a massive difference. In addition, 84% of women report relief of back pain during pregnancy with Chiropractic care. Because the sacroiliac joints of the pelvis function better, there is significant less likelihood of back labor when receiving Chiropractic care through pregnancy......"
         from:  http://www.planetc1.com/chiropractic-articles/pregnancy-chiropractic.html



".....Italian Study on Chiropractic & Pregnancy
Postpartum pain was relieved in 90 of 120 patients who received chiropractic adjustments....."
        from:  http://www.dcdoctor.com/pages/rightpages_wellnesscenter/pregnancy/chirocare.html
      




Excellent Sites:

http://www.icpa4kids.org/research/pregnancy/chiro.htm

http://www.pregnancy-info.net/chiropractic_pregnancy.html

http://www.youtube.com/watch?v=AKc5LyijLDU

http://www.youtube.com/watch?v=B2FV916gylk&feature=related

http://www.youtube.com/watch?v=11VN2sGMdbI&feature=related

http://www.youtube.com/watch?v=s68Yr38-lAQ&feature=related  



I hope all of this information helps your decision making in healthcare; before, during, after pregnancy!



My Staten Island Pregnancy patients get the safe efficient Chiropractic Adjustment appropriate for THEM.  Usually my pregnant patients do not get any adjunctive modalities- because of that very common statement:  ".... safe use has not been established during pregnancy..." (again- notice it does not state that utilization WILL CAUSE problems, but use has also not been shown to be absolutely safe).


I hope I did not alarm or upset you.  Discuss this with your doctor.  Your Doctor of Chiropractic is there to help, not cause additional worry!

I hope this all helps.

If you need further information, do not hesitate to RE-contact me here at
AllExperts.com
http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm



Thank you for your question,
I wish you luck in returning to good health,
your Staten Island Chiropractic expert,


Dr. Victor Dolan, DC, DACBSP
Email newsletter: . . . . . http://drvictordolan.chiroweb.com





Information provided for discussion/ educational purposes only,  information may/ may not apply to this specific case.  No doctor/ patient relationship stated or implied exists with this communication.