Hi everyone, on today’s podcast, we’re going to talk with Lisa Vawter about how chiropractic care can help with the aches and pains of pregnancy. Welcome to the Evidence Based Birth® podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details. Hi everyone, and welcome to today’s episode of the Evidence Space Birth Podcast. Today we have here with us Lisa Vawter, owner of Lisa Vawter Chiropractic. Lisa is a dedicated women’s health chiropractor specializing in prenatal and postpartum care with a master’s in nutrition and certifications in the Webster technique, Spinning Babies® and BirthFit™, along with 100 hours of acupuncture training. Dr. Vawter’s practice offers comprehensive and holistic support for expectant and new mothers. Inspired by her own transformative experience with chiropractic care during pregnancy, Lisa is committed to providing compassionate and personalized care to help navigate the physical changes of motherhood. Lisa, welcome to the Evidence Based Birth® Podcast.
Dr. Lisa Vawter – 00:02:23:
Thank you. I’m excited to be here.
Dr. Rebecca Dekker – 00:02:25:
Yeah, I’m so excited we were able to connect in Kansas City at the Integrative Obstetric Conference there. And you gave an inspiring talk all about the power of chiropractic care in pregnancy. And you shared your personal story. And I was wondering if you could start off by telling our listeners a little bit about that story.
Dr. Lisa Vawter – 00:02:48:
Sure. This story is kind of like Billy from Family Circus, if you’ve ever seen that little comic where, he’s like goes all over the place and then he ends up where he needs to go, which is how I feel my story is. So for my whole life imagined I would be a physician in the traditional sense. So at a hospital and then in college picking a major, I decided that nutrition was more where my passions lie. I mean, I like biology and chemistry, but nutrition was just easy and I loved it. So I got my undergrad in nutrition. And I had applied to medical school directly out of college and got into the DO school in Kansas City. But at that point, I was really hesitant to go. And I feel like I had a little bit of emotional maturity as a 22-year-old. And I was like, you know, if I’m hesitating with this, there’s something here that I need to kind of wait on or sit on a little bit. So I didn’t go. And that fall, I started my master’s in nutrition, got my master’s in nutrition, graduated, had a job that was in a fine dining restaurant. And I was having a ton of fun and decided to just stay there. And so I didn’t pursue a career in my master’s degree. And so I was working, having a great time, paid off my student loans, bought a house, just being an adult. And then I had an epiphany. I got injured running, did the traditional like orthopedic, x-ray, MRI, cortisone, PT, and my hips still hurt.
And I was like, I’m too young for this. This is like, we’re not going to do a scope. They’re not going to do surgery. I need something else. And so after all of that, I saw a chiropractor and she was great. And so I saw her for a long time. And at some point with all the questions that I was asking her during our appointments, she was like, Lisa, I think you should go look at the chiropractic college. And so I did. I made an appointment to tour. I toured on a Friday. I applied that day. I got in maybe the next. And within the next five business days, I had my acceptance letter. And then the next trimester of chiropractic school started five weeks later. And so from the conversation with Dr. Heather to changing my whole life and starting a doctorate program was like five weeks. And the first day of chiropractic college, I met my husband. I didn’t know he was my husband at the time, but we met. And then in chiropractic school is kind of when, if you thought that was like fast and furious little snippet, chiropractic school really accelerated that. So Harrison and I got, we started dating about a month and a half after school started, got engaged, and then got married within the year.
And then while all of that was happening, obviously chiropractic school is very intense. We started planning on when to have kids. And so I got pregnant in chiropractic school. We kind of planted. I was like, well, if it happens, it’s fine. And so I had my daughter the last year of school. And so, in that experience, in school, you get adjusted in the student clinic and you adjust other students in the clinic. And so I was being adjusted while I was pregnant. And it just so happened that the timing was that. The first adjustments that I was learning to do, I was also trading with one of my friends in school who was also pregnant. And so from the very beginning, being pregnant and getting adjusted and adjusting my pregnant friend really, while also like concurrently having an explosion of learning about all of these things, about anatomy, about physiology and neurology and the nervous system function and embryology, what happens when a cell goes from one to two to four to eight to 16. And then about pregnancy and pediatric classes.
And so it was like happening to me while I was learning about it. And just the explosion of those two things really kind of like forged my passion. And so I’m going to wrap this up to say that despite being in an intense doctorate program and sitting all day and having a job on top of that and exercising, I stayed so comfortable throughout my pregnancy. And I was having these regular appointments with my provider and just asking her questions like, what do you tell people that come in with low back pain? What do you say to people that have sciatica? Who do you send people to when they say they’re having headaches? What do you tell people that are just like really miserable? And she is one of the best OBs in the city. And I have a really good relationship with her. And her answers were like, I don’t know. I mean, I say get a heating pad or do less or take some whatever is recommended that is okay to take during pregnancy. And so I feel like having that personal experience, walking that walk and learning at the same time and taking extra courses and learning about prenatal, that is what started my fire. And so I guess that is also like how I discovered the power of chiropractic care in pregnancy. It’s just my personal experience.
Dr. Rebecca Dekker – 00:08:27:
And then you went on to specialize in prenatal and postpartum chiropractic care.
Dr. Lisa Vawter – 00:08:33:
Yeah. Yeah. Because at school you learn the general techniques. There’s like a dozen general techniques and everybody kind of gravitate towards one or a couple. But you don’t really get the niching down or the specific, extra specific care on prenatal postpartum peds. That sort of thing is like, you have to go seek that out for yourself outside of school.
Dr. Rebecca Dekker – 00:08:58:
Okay. And I just was thinking about to the beginning of your story when you said your hip was hurting when you were young and traditional medicine or Western medicine didn’t seem to be helping. And I’m sure it was also very expensive in MRI. I’m like, oh, as someone who doesn’t really have health insurance, I would avoid one of those if I could, you know. But what was it then when you saw a chiropractor, what was wrong?
Dr. Lisa Vawter – 00:09:25:
I think, that’s a great question. So it was inflammation. MRI showed inflammation. But like why inflammation, right? Is it because I was in grad school doing research, running as fast as I possibly could, taking a 20 minute nap and then going to work at a restaurant and not eating well and probably not sleeping enough and drinking too much alcohol? Like it was probably all of those things.
Dr. Rebecca Dekker – 00:09:50:
Like seven things.
Dr. Lisa Vawter – 00:09:51:
Yeah, exactly. And then at that point, her chiropractic office was inside of a CrossFit gym. And so as a lifelong runner, lifting heavy weights just wasn’t something that I had done yet. I had kind of started discovering yoga and I knew that felt good and it felt good for my brain and for my body. And so, with Dr. Heather’s suggestion, she was like, you should probably start lifting weights like, if you’re stronger, it’ll support you running. And so I started doing that too. So I think that the combination of like the cortisol helped. I know it did, but it didn’t cure it. And then getting adjusted was part of it. Dr. Heather also did some serious soft tissue stuff. She did some dry needling, released those muscles that had probably been chronically compensating for a long time. And then built on it with strength and consistency.
Dr. Rebecca Dekker – 00:10:48:
So it sounds like it was like a more holistic approach.
Dr. Lisa Vawter – 00:10:51:
Yeah, exactly.
Dr. Rebecca Dekker – 00:10:53:
Yeah. And then in pregnancy, you mentioned low back pain and sciatica. What are some of the other changes your body undergoes in pregnancy and what symptoms can they cause? Because I agree, that’s when I had back and hip pain and headaches in my first pregnancy, they referred me to neurology. And I actually had a great neurologist who was quite holistic, but not a single medical doctor said, hey, go see a chiropractor, which is kind of, you know, looking back amazing because I had mild scoliosis. But then the second pregnancy, I had a midwife and she was like, go see this chiropractor. They’ll take care of you. And the regular care did help. So can you talk a little bit about the musculoskeletal changes in pregnancy and the symptoms that they can cause?
Dr. Lisa Vawter – 00:11:44:
Of course. How much time do we have?
Dr. Rebecca Dekker – 00:11:47:
I know you went into a lot of depth at the conference. Give us like a really brief, like maybe like three or four major things that happen to your body.
Dr. Lisa Vawter – 00:11:57:
Yeah. Okay. So first of all, that’s a great question. And I want to start off. I want to talk smidgen about the distinction between the normal necessary changes that the body undergoes to adapt to pregnancy to keep us safe and to keep the baby growing appropriately, and the common complaints that can crop up because of those changes. So I think the changes in pregnancy that our body undergoes are miraculous, and they have to happen, right? Like the ribcage, all the things that I’m going to talk about, they have to happen in order to keep our body safe and the baby safe. They don’t necessarily directly imply pain, right? So the common complaints that crop up aren’t a requisite of being pregnant, and so there’s just a big difference between the changes and the complaints. So the big physical changes of pregnancy that happen are most obviously abdominal expansion and separation, right? And everybody loves to talk about the diastasis recti, which also has to happen in order to accommodate for the growing uterus. It’s not like, nobody needs to push the panic button on that. It’s just totally normal. Altered center of gravity, right?
Because all of the growth is in the front, so your belly and your breasts, it’s a lot of weight in the front that isn’t being balanced in the back. Ribcage expansion, because as the uterus grows up, the angle of the ribs goes from about here to about here, and so your breathing mechanics change. All of those intercostal muscles and all of the joints where it attaches to the spine change too. And then all of these things happen in a wonderful symphony with relaxin hormone, right? Relaxin increases ligament and joint laxity. It also does a lot of other really helpful things in the body. It relaxes your blood vessels so that your increased blood volume can be accommodated for. It changes the way that your lungs breathe in and out oxygen so that that gas exchange can happen with your increase in metabolism. Does a lot of awesome things for the body. So it also readies the pelvis for the baby to pass through, and it changes the relation of the joints, allowing for that ribcage to expand. I think those are the biggest physical changes. The most common complaints that happen because those changes are occurring so rapidly.
Dr. Rebecca Dekker – 00:14:28:
Right, because even in the first trimester, you can start having joint issues, right? Even though you might not be visibly pregnant, but the relaxin hormone is circulating in your body already.
Dr. Lisa Vawter – 00:14:41:
Yeah, relaxin starts pumping at like week 12.
Dr. Rebecca Dekker – 00:14:44:
Okay.
Dr. Lisa Vawter – 00:14:45:
That is like once those first trimester hormones, once you kind of get past the peak of those, like really late first trimester, early second trimester, relaxin is surging. And so you can have some discomforts really early on. People are so surprised. They’re like, I didn’t know it would happen this early. I’m like, well, yeah. And then you explain like, you know, weeks 12 through 18 is the peak of relaxin. And then they’re like, oh, that won’t. I’m 16 weeks. That makes sense. I’m like, okay, yeah. Okay, so most common complaints are low back and SI joint pain, sciatica, which we talked about.
Dr. Rebecca Dekker – 00:15:21:
Can you explain where SI joint pain is? Because for someone who’s never seen a chiropractor, they might not know what that is.
Dr. Lisa Vawter – 00:15:28:
I’d love to. Give me a sec.
Dr. Rebecca Dekker – 00:15:30:
Okay, so if you’re listening to this podcast, you can also check out our video version on YouTube because Dr. Vawter is going to show us some actual things on there.
Dr. Lisa Vawter – 00:15:40:
I grabbed my spine. I think it’ll be easier to show just because it’s describing. I guess I could use cues, but I’ll use words too. So this is the back of the pelvis, the back of your, like in your low back where you rest your hands on top of your glutes is kind of what I’m showing here. So right here is the sacrum, this triangle shaped bone, and then this is your ilium of your pelvis. And so the SI joint is the sacroiliac joint. So right in here. And so this is where a lot of pain, that like sharp pain can come in your joint. Sometimes people have low back pain and they’ll point to like a band across the back. And then sciatica happens when the nerves that come out of here, here, here, and here come together. And they kind of pass under your glutes and under your piriformis and then comes down through here. And so this is kind of the big heavy hitters for low back and SI joint pain. That’s what I’m talking about. And then sciatica can be a combination of things, but it’s lumped into there because it’s in that area. The pubic symphysis pain is in the front. So it is the bone where the pelvis comes together in the front and there’s a cartilage disc and that’s your pubic symphysis. And there can be a lot of discomfort there because of your abdominals coming in and attaching there and the muscles from your legs coming up and attaching on your pelvis. There’s a lot of tugging that happens. And because that joint is also lax. Round ligament pain is a big one. People get that sharp shooting kind of in their abdomen as the uterus grows. I also like to talk about things never being in isolation, right? So to think that your round ligament pain is just purely the round ligament is I mean, it could be, right? But also you have three layers of abdominal muscles on top of that that are also growing and expanding. So it’s probably some muscle tension and muscle growth too happening in that area. And then rib pain. Rib pain can be like in the front, kind of like underneath the breast or in the back near the scapula, just off-center of the spine.
Dr. Rebecca Dekker – 00:18:08:
Okay. So kind of where the ribs, so some, a lot of people think of the ribs as being in the front, but they actually attach to your spine in the back.
Dr. Lisa Vawter – 00:18:16:
Spine in the back. Yeah. They wrap all the way around.
Dr. Rebecca Dekker – 00:18:18:
Right. So if your ribs are kind of not, they’re starting to shift. You’ll feel it sometimes. You could almost like point to a spot in your upper back right next to your spine.
Dr. Lisa Vawter – 00:18:31:
That kills. Exactly, right.
Dr. Rebecca Dekker – 00:18:33:
So that’s a rib pain.
Dr. Lisa Vawter – 00:18:33:
Okay. Very rib description of rib pain. And it varies a little bit. But when a rib is slightly misaligned or a little bit out, you can put your finger on it. And it hurts with every breath you take and it’s very acute. There are a few things that cause that and a lot of it is the muscles. So because the rib angles are changing, those muscles and their relation to that is they’re also having to adjust. And our breathing mechanics change. And because you feel like you can’t take a deep breath when you’re pregnant, so you’re taking these short, shallow breaths and your rib cage is kind of pumping and it’s changing just the biomechanics of how it works that those muscles can get angry and tired and spasm. And so that muscle spasm is what can kind of draw that rib up and out a little bit. And so the adjustment can help with getting that rib, like nudging it back down where it needs to go back into its home. But also doing a little soft tissue work to the intercostal muscles and teaching about proper breathing biomechanics can really resolve that condition really nicely.
Dr. Rebecca Dekker – 00:19:53:
What about like upper pain, like shoulders, neck and headaches?
Dr. Lisa Vawter – 00:20:00:
Yeah, so that also can happen really quickly because your breasts change really quickly, right? And so you have this added weight. And sometimes people aren’t changing their bra quick enough because they don’t realize that they need to do that. And so there’s just a lot of tugging and pulling in the front. And then also your head carriage kind of starts to lean forward just because there’s that pull and forward. And so, the muscles along the back of your neck can get really tense. They’re doing a lot of work. Chiropractic care can help address these things by checking on the mobility of the joint. Do you have proper range of motion? Can we put a little bit of motion into the joint to help restore the motion? Let’s do some soft tissue work to help release those muscles. And then let’s talk about your posture, right? How are you carrying yourself around? Are you being mindful of where your head is in space? Are you carrying your head in front of your shoulders? Let’s do some rehabilitative exercise to help you help yourself. Yeah, I think if, was that, did I answer your question?
Dr. Rebecca Dekker – 00:21:11:
Yeah, yeah, no. And you’re starting to get into what I’m most curious about. And that is how can chiropractic care alleviate some of these symptoms? So you’re saying that our body undergoes normal changes that are quite necessary, but also. Because of kind of how we’re compensating for those changes, we can start to have symptoms. So as a chiropractor, what are some of the things you offer to someone who’s experiencing these different complaints?
Dr. Lisa Vawter – 00:21:42:
Okay, short answer. Gentle adjustments. Soft tissue work. Education so that they can do some rehabilitative exercise and start integrating what we work on at home, right? That’s the short answer. Sometimes those treatments differ, right? Depending on what people can tolerate and what their complaint is. The broader answer, I think, that even if you don’t have any intention of seeing a body worker during pregnancy, a prenatal chiropractor or anyone else is that. The things that crop up and become complaints are because we aren’t paying attention to how we manage the load of pregnancy, right? Like, I think people can stay more comfortable for quite a bit longer if they just slow down a little bit and bring a little bit of mindfulness to their movements and how they’re moving throughout their day and their repetitive postures and patterns and their activities that they do all day every day, that if they bring a little bit of like, what muscles am I using to carry myself through the day, that they would be able to engage their core a little bit more mindfully, a little bit more stronger using their hip muscles to carry themselves instead of their low back. That is a lot.
That is a lot of where my teaching starts with patients. You know, I watch right off the bat, I watch just regular range of motion. I watch their walking and their squatting and bending over. And we’re going to start with it. We’re going to start there to see what do you do all day, everyday? How do you get out of the car? How are you, what do you do for a job? How do you, what do you have to do? What does your day require? And what is it, how are you doing? What are you, what muscles are you using to do these things? And a lot of the times before I even touch my, before I even put my hands on a patient, we can solve a lot of their problems just by saying like, okay. It looks like when you bent over. You just curled forward and you don’t have, your spine isn’t in neutral and you were using you’re all, the only thing you were using is your low back. Can you do X, Y, and Z, try it again. And they do it differently. And they’re like, whoa, that didn’t hurt. I’m like, okay. Yeah. So I think the common complaints crop up because we’re not thinking about how we’re moving. We’re not thinking about ourselves. You know, a lot of people are just moving too fast to even think about. Well, I mean, that’s just how our society is, right? Like, don’t think about your body. Work harder. Go faster. Send to that extra meal. Don’t go to the bathroom. You can’t eat right now. Those sorts of bodily, the things that your physical body is asking you for. We do a really good job of shoving them under the rug for a lot of our lives. And pregnancy, it just calls for a totally different skill set with how to heed what the body needs in order to manage the load of pregnancy and to stay more comfortable.
Dr. Rebecca Dekker – 00:24:58:
So you mentioned the load of the pregnancy, I mean, like the extra weight and kind of how it shifts your whole, how your body moves in space. For those of us who are listening, maybe sitting or standing, like, is there any simple exercises or tricks you can show us? Just like, let’s say, let’s take your head, for instance. Like you mentioned the head tends to be forward.
Dr. Lisa Vawter – 00:25:23:
Yeah.
Dr. Rbecca Dekker – 00:25:23:
So what can you like walk us through that, how you would kind of counteract that?
Dr. Lisa Vawter – 00:25:28:
Yes. So, all of these things that I’m going to say are they sound simple, right? But they’re not easy to continue to do over and over and over again. And so a lot of these cues are there just something you’re going to have to remind yourself a hundred times a day. And so what you’re doing is collecting moments of time where you have more optimal posture. You’re stacking your spine on top and you’re bracing your core or you’re sitting upright and you do that for a little bit of time and then you fall out of it. And so you’re collecting moments that you can maybe tack on to the end of the day where you would usually be in pain and you can keep yourself comfortable for just a little bit longer. So these aren’t by any means like the homework that I give in my office and the things that I’m going to say now, it’s not like do three sets of 10 and you’re cured. That’s really, I mean, you can. And when you start to feel better, you’re going to stop doing those things and then it’s going to come back, right? And so these pointers aren’t, they are for pregnancy. They’re for postpartum and they’re for when we’re 70 and we want to be really upright and have really great posture then too. So for like neck and shoulder discomfort, I love to do chin retractions. So stacking your ears on top of your shoulders, taking the burden of holding your spine or holding your head away from just your upper traps and your spinal erectors and distributing it to the anterior side of your neck. Is a really good one to help with that.
Dr. Rebecca Dekker – 00:27:16:
With that one, you just literally put your fingers on your chin and then push back like you’re making, you know. A triple, quadruple quintuple chin.
Dr. Lisa Vawter – 00:27:28:
Yeah. Yep. And you can feel the stretch down the back of your neck doing this. And you can also feel the front of your neck activating too.
Dr. Rebecca Dekker – 00:27:37:
Okay.
Dr. Lisa Vawter – 00:27:37:
That’s another part of this. So I like to do my chin retractions when I’m brushing my teeth. So I found that like teaching my kids to brush their teeth and I’m not even sure why else. I was like jutting my chin forward to brush my teeth. And I’m like, oh, my gosh, my neck hurts really bad as I’m brushing. So I started pulling my chin back to brush to see if I can hold the chin retraction the whole time. You know, the whole two minutes or three minutes that I’m brushing my teeth. That’s a lot. That’s, you know, twice a day you brush your teeth. That’s a good amount of time. I also love to play the game if I’m on an airplane to try and keep my head back on the headrest. So-
Dr. Rebecca Dekker – 00:28:15:
I’ve heard like if you’re driving, you can do that too. Like if you come to a stoplight, you can just kind of do it against the headrest. Yeah.
Dr. Lisa Vawter – 00:28:23:
Absolutely. And these things are ways to habit stack and integrate this like activation throughout your day. I don’t know how many times you’re in your car throughout your day, but if you’re in the car two or three or four times, that can add up. And again, if you forget. And you don’t do it for a day, but you’re like, oh, I remember this game, let’s do it again. You can do that for a lifetime, right? So that’s a good one for the neck. Also just like gentle range of motion, normal active range of motion. So flexion, tucking your chin, extension, looking up at the ceiling, lateral bending, ear to shoulder, other side, and then rotation. Looking over your shoulder, just putting your spine through a gentle, active range of motion is really helpful. It feels good. But again, these things, like the overarching theme is you’re taking a time out. And you’re moving your body and you’re kind of grounding and coming back to yourself to say, like, where is my head in space? And let’s move the spine. Motion is lotion. That’s what our joints love. You know, holding this forward head posture for a prolonged amount of time on the computer or scrolling on your phone or looking down at a new baby or, those like prolonged periods of time where you’re not moving your spine is when those aches start to come in.
Dr. Rebecca Dekker – 00:29:59:
Okay, so range of motion, different functional exercises that a chiropractor or physical therapists can teach you. What about specific techniques or adjustments like that a chiropractor might use? So if you go in, you talked about your chiropractor will hopefully like kind of observe your body mechanics, do some education with you, do some soft tissue work. But what about the manipulative movements they do on you? What can you expect?
Dr. Lisa Vawter – 00:30:29:
That’s a great question. I think a lot of people are curious about that, right? So the thing about the specific techniques. I don’t want to get bogged down in the details of the names of the techniques because…
Dr. Rebecca Dekker – 00:30:45:
Okay.
Dr. Lisa Vawter – 00:30:48:
Because there are dozens and a lot of them are appropriate, right? And I think it’s important to mention that chiropractic care is inherently conservative, right? We’re working outside of the body. We’re not putting anything into the body. And so there are a bunch of techniques that different providers gravitate towards that they like or that they use. And for pregnancy, gentle adjustments, meaning we don’t want a huge thrust, we don’t need rice crispy snap crackle pop, we don’t need anybody twisting you into a pretzel and laying their body on top of you to get that like. But you can like see that in your mind’s eye, right? Like I’m sure you’ve seen a TikTok or a YouTube of people just.
Dr. Rebecca Dekker – 00:31:42:
Yeah, I have a friend who says she just loves watching chiropractic adjustments on YouTube with all the cracking.
Dr. Lisa Vawter – 00:31:51:
And, like, who isn’t a sucker for a big, like, pop, you know, that just sounds relieving.
Dr. Rebecca Dekker – 00:31:57:
I know. And my most recent chiropractor is telling me that Sometimes when you like pop your own back or things that it’s not actually moving something back into place, but it’s just releasing a little bit of pressure that gives you a dopamine hit. And so he’s like, you got to be careful not to just be like, that’s why people crack their knuckles, basically. Like they’re not getting their fingers back into position.
Dr. Lisa Vawter – 00:32:23:
It just gives you a little bit of relief. It releases that gas in it. And then you have to do it again five minutes later. So for pregnancy specifically, the things that I would look for in a prenatal chiropractor would be having the certification, the Webster Technique. . That’s a sacrum assessment. There’s like six things that go into it. But that they do learning the Webster Technique. They do a deep dive into-
Dr. Rebecca Dekker – 00:32:51:
So look for a chiropractor for pregnancy who’s certified in that.
Dr. Lisa Vawter – 00:32:55:
In Webster, which isn’t the only thing. Webster is probably the most popular, but it’s not the only thing. I think being educated with Spinning Babies®, they do a lot of body balancing and techniques to help balance the mom and the pelvis to help baby find the optimal position. So Spinning Babies® is a good one to look for BirthFit™ does a great job with their education and how to, BirthFit™ focuses more on like the exercise component. There’s also another prenatal chiropractic education called Movement Tours, and they do a great job too. So I think Webster Technique is the oldest and probably the most popular or the most well-known name, and that is important, but there are others that are also important too. And so, but I think that finding someone that touts themselves or markets themselves as a prenatal chiropractic provider and you’re in the office and you see other pregnant women there, you see other kids there, is a really good thing to look for. You know, if you’re questioning, if you’re on the website or you’re asking around and they’re like, you know, I’m not sure if they see pregnant people, then that probably isn’t the person you should go see.
Dr. Rebecca Dekker – 00:34:13:
Okay. And normally with adjustments, most people lay on their stomach and obviously, your chest and your abdomen don’t necessarily allow for you to do that starting in pregnancy at some point. So what do chiropractors who specialize in treating pregnant people do for that?
Dr. Lisa Vawter – 00:34:33:
We use pillows. So my pillows have a big belly hole in the center. I have one for the first trimester that’s more shallow. And then the second trimester, the hole is a little bit deeper. And then for the third trimester, we stack them together.
Dr. Rebecca Dekker – 00:34:47:
So somebody will be able to lie face down.
Dr. Lisa Vawter – 00:34:49:
Yeah, it’s their favorite. It really is their favorite.
Dr. Rebecca Dekker – 00:34:52:
Might be like the only time that week or that month they can lay on their stomach.
Dr. Lisa Vawter – 00:34:56:
Yeah. But I also teach my patients, you know, if you have that the horseshoe shape or the big C-shaped pregnancy pillow, just coil that thing up. You know, the hole for your belly doesn’t have to be just like the size of your head, right? And so you can coil your pregnancy around and around and make like a small donut and put your pillow up top and lay on your belly. You know, you can make your own chiropractic pregnancy pillows to lay on your belly at home. You can just stack a couple pillows in a circle, make a small hole. And relax there for a little bit. Scroll on your phone for 15 minutes on your belly. You can do that for yourself at home. I mean, obviously I want people to come to my office, but I also want them to be able to help themselves and stay comfortable.
Dr. Rebecca Dekker – 00:35:39:
Right. Another thing I specifically remember from my pregnancy was, you know, I mentioned that rib pain earlier where you can like put your finger on it and it’s really angry and it hurts. And the chiropractor was able to just gently push. And what were they doing with my ribs there?
Dr. Lisa Vawter – 00:35:57:
That’s a great, that’s a… okay. So I was going to try and circle back to answer this question because I realized I kind of didn’t answer the question about adjustments two questions ago. So the important thing to remember with pregnancy is that the joints are already movable, right? And so putting motion into a spinal segment or into a joint in pregnancy doesn’t require heavy handedness. In fact, if you do a big manipulation or big adjustment, it can make the pain worse because you’re now taking a joint that the brain is perceiving as unstable, and making it more unstable, right? Our brain craves stability. That’s what your brain is begging for when it’s, you know, when your SI joint starts hurting or when your low back starts hurting. It’s your brain saying, we’re falling apart or the low back muscles are doing all the work. Well, why are the low back muscles doing all the work? It’s because they’re trying to hold on for dear life and keep that area of your, you know, the low back and the SI joint more stable. Okay. So as it pertains to your rib, say you’ve had a muscle spasm or you reached up onto a high shelf and that joint is just lax enough that it slips out a little bit, right?
Dr. Rebecca Dekker – 00:37:20:
So it kind of slipped out of place at some point.
Dr. Lisa Vawter – 00:37:23:
Yeah. So the rib, so this is where it attaches to the spine and the rib has kind of slid. Usually the ribs slide up. And so it slide, it just comes a little bit out of place, right? And there’s all muscles along this ridge of your rib and down here, right? And so what that chiropractor did is they put a force probably from above and they just kind of nudged that rib. Just down back. So you can do that really gently. And so whether they used their hands to kind of push at a specific point or whether they used an instrument, some people call it an activator or a clicker to be really specific with it, or whether they used a drop tablewhere you can lever up a table and then it kind of drops down to facilitate a gentle adjustment. There’s a lot of ways to do it. But what they were doing was just putting a specific motion into a spinal segment or into an area, into a joint to create, well, for you specifically to kind of knock that rib back down a little bit. But then, but to also when it pertains to like the pelvis to kind of.
Dr. Rebecca Dekker – 00:38:38:
Yeah, I was going to ask about that because I remember sometimes I would walk in and I could barely walk my left hip might be like, I just can’t even walk, you know?
Dr. Lisa Vawter – 00:38:46:
Yeah.
Dr. Rebecca Dekker – 00:38:47:
And then I would leave and I’m like, I can walk without pain. So what happened in the hip adjustment?
Dr. Lisa Vawter – 00:38:52:
So in the adjustment, a couple of things happen. We’re addressing a restricted area of motion, right? So we found an area that isn’t moving the same or isn’t moving adequately or properly, right? And that can be found with touch, me watching you move, you’re pointing at it and telling me this is where it hurts, right? And so the adjustment restores motion to the joint. And it also gives an impulse to the nervous system to say like, hey, we need some attention here. And so that impulse into the spine or into the pelvis affects the nervous system. And it sends a message to the brain that says, hey, release the tight tissues that are surrounding this area. And it kind of just releases everything and starts with a blank slate. And so then after the adjustment, what we can do to follow it up is to show you like, hey, brace your core to create some stability so your brain can stop throwing these SOS signals and clamping down on these tight and tender tissues, right? We need to properly breathe and brace, activate the proper muscles so that whatever compensation the body has created to create stability and lock an area down so that can kind of start unraveling a little bit, right? So when we can create some functional stability and moving really well using our big muscles, like our hip complex muscles, instead of like our small spine stabilizers can help balance and redistribute the work that the parts that are angry and mad have taken on and shift it to other parts that maybe aren’t activating enough. Or maybe they’re not, you know, maybe they’re just not on board as much as they need to be.
Dr. Rebecca Dekker – 00:41:05:
Okay, so can I ask you a quick favor?
Dr. Lisa Vawter – 00:41:07:
Yes.
Dr. Rebecca Dekker – 00:41:08:
Okay, so now you did the little functional movement with our neck with the chin retraction teaching us that. Is there a simple one you can teach our listeners for the lower body? You can either talk them through where they’re sitting or where they’re standing.
Dr. Lisa Vawter – 00:41:25:
Yes. Okay. So let’s do sitting because a lot of people do that all day, every day, right? Especially. This is specifically for pregnancy. So optimal sitting posture for pregnancy is legs in a V. So spread those feet out a little bit. And then up onto your sitz bones. So lean a little bit forward and hammock your belly kind of in between your legs and let your abdominal muscles go. So instead of leaning back onto your sacrum or kind of like slumping into your chair, which is where everybody ends up eventually, right? Especially if you’re on a video call. So sitting up, right? Widening those legs and then leaning and dumping your belly forward a little bit. That is the position that I would have them return to the most often. Now, how do we promote them getting into that position more often? Because they can’t, they’re not going to stay there. You’re going to shift. You’re going to cross your legs. You’re going to go back to where you were. So the way to do that more often is to stand up on a more regular basis. So getting up out of that chair every 30 to 60 minutes, at least every hour, right? Getting up. And then when you come back and you sit down, you’re going to return to that start position legs wide. Up on your sits bones, belly kind of hammocked forward, release your abdominals. And so when you sit back down, you can start there. And so the more you get up, the more often you’re in that start position, the more optimal your sitting is going to be. So-.
Dr. Rebecca Dekker – 00:43:06:
And what about standing then? So when you are standing, like, I don’t know, a lot of us, we just slouch as soon as we stand up. So how do you make that helpful when you stand?
Dr. Lisa Vawter – 00:43:15:
So I like to give the example of like cooking, right? You got to cook your meals. And so we’re going to be standing at the stove. And so we start there. And normally people are like, well, I don’t really know what I’m doing when I’m cooking. I’m just getting it done. Okay. So we want to stack rib cage over pelvis. So sometimes we’re leaning back. We’re kind of like hinging on our SI, kind of like letting our skeleton do the work or leaning forward, right? So we want to make sure that the rib cage is stacked over the pelvis. And then we want to make sure or check in with our breasts, where our breastbone and our pubic bone are. So a lot of the times in pregnancy, we kind of get that open scissors position where we’re just kind of like splayed forward. We’re just kind of like dumping our… Again, you can feel that like pulling at your low back where you’re just kind of like tilted forward. So we want to bring that pubic bone up just like here, just a millimeter. We don’t need to tuck our booty all the way under. We don’t want our booty to disappear. We want just a little bit of low abdominal activation to support the weight of the belly while we’re standing. Okay. And we’re going to bend our knees slightly.
Dr. Rebecca Dekker – 00:44:33:
So don’t walk your knees when you’re standing.
Dr. Lisa Vawter – 00:44:37:
We want… Okay. When you lock your knees or when your pelvis is tilted forward and your sacrum is jammed into your ilium, that is a stable place. Structurally, that is stable. That’s why your brain does it. It’s because the lockout of those joints creates structural stability, right? But over time and as the weight adds up, that is going to become painful because over and over those joints are going to start grinding on each other. And so it’s not functionally stable. There really aren’t any muscles involved when you lock out your legs or you jut your pelvis forward to create that stability. You’re just hanging and hinging on your joints. And that’s going to be painful. That’s what causes the pain. So when we stack our spine, right? So stacking the rib cage over the pelvis is stacking the spine. And when we bring the breastbone and the pubic bone into alignment, it shortens the abdominal line. And so those muscles are able to just gently engage a little bit more, kind of offsets the demand or the work of the low back, shifting it kind of around the abdominals, like 360, because your abs are 360. Your abdominal muscles are. That’s the core brace. And then when we bend our knees, we bring on board quads, hamstrings, glutes, calves. Those big, those muscles are big for a reason and we need to be using them.
Dr. Rebecca Dekker – 00:46:04:
So you’re basically just trying to have your whole core help and your legs support the weight instead of just putting it in a few spots carrying that load.
Dr. Lisa Vawter – 00:46:14:
To manage the load. Managing the load of pregnancy is the name of the game. If you handed me, I’m almost four years postpartum, my core is intact. If you handed me a 20-pound dumbbell or a kettlebell and said, here, hold this while you cook dinner.
Dr. Rebecca Dekker – 00:46:31:
And hold it all day.
Dr. Lisa Vawter – 00:46:33:
And hold it all day. And don’t put it down when you go to the restroom. And don’t put it down when you’re eating. And you need to hold it while you unload the dishwasher and while you’re typing those emails. I would want to quit. And set that thing down after a couple hours, it would be a lot. It’s too much. And so what I would do, though, if I had to carry that 20-pound weight around is pause for a sec before I sat down and before I stood up. I would have to like arrange it so that I could manage it and move it well. And so just because, you know, when you’re pregnant, it’s a baby and it’s amniotic fluid and your placenta and your breast tissue and it’s sneaky and it happens slowly over time. And you’re doing all the things when you’re pregnant that you weren’t doing. That you were doing not pregnant, right? And you’re probably doing more things. And so, yeah, you kind of have to bring a little bit of your mindfulness back into yourself. Managing the load, which is the belly and the forward center of gravity and the ligament laxity, managing the load of pregnancy and how heavy it gets. Even 10 pounds is heavy, heavier than before, right? And it’s progressive overload. And so you really have to consciously figure out a way to activate and manage it. And I tell my patients, in your brain. You have like 10 browser tabs open of like the things that you’re multitasking and the things you need to get done.
So you need to open up another tab in your brain that is your body and mindfulness and movement. And you’re not always going to be clicked on that browser tab. You’re going to be in the other browser tabs throughout the day. But at some point, you’re going to like glance up over at that browser tab and be like, oh, yeah, I remember I need to do that. And that is that’s how you do it. You do it over and over and over and over and over again. And then it’s going to repeat itself, but in reverse postpartum, right? And so you just, in pregnancy, our brain is changing, right? And ability to think about yourself is, it’s just shifted because primitively we’re trying to keep the baby, we’re trying to keep the baby alive. And then postpartum too, right? All of our efforts go outside of ourselves, externally to the baby. And so taking time to think about yourself, it takes a lot of work. It is practice. You have to practice doing it. It’s not just going to happen.
You have to be intentional with it. And you have to keep reminding yourself of it because over and over and over and over again, your efforts are not within, right? And so that is why it is sounds simple, but it’s not easy. And so especially if you have more than one kid. Thinking about how you’re going to get up off of the couch to go help someone. You’re not, taking that pause to be like, okay, plant my feet, press down through my heels, breathe and brace keep the chest up. That is, it’s really hard. And so, but the good thing is, is we get so many chances throughout the day to do it. That even if we change a small percentage of the way that we’re doing things, you’re going to feel better, um, at the end of the day or week upon week, if you just keep renewing your efforts and putting, you know, thinking about it every now and again.
Dr. Rebecca Dekker – 00:50:12:
So you’ve covered a lot with pregnancy and how chiropractic can help. How can you alleviate the concerns of people who are worried about the safety of chiropractic care in pregnancy?
Dr. Lisa Vawter – 00:50:24:
Age-old question. So I have a soft spot in my heart for this. A lot of my patients come from a hospital setting. They’re going to give birth in a hospital kind of in the traditional sense, and they would never set foot in a chiropractic office. Just because that’s not where their interests lie. And they are worried a lot about safety. And I think it’s valid, right? The evidence shows over and over that chiropractic care is, it is safe. It’s, there are no contraindications for chiropractic care through pregnancy. So, you know, early on is safe, middle of pregnancy safe, right before delivery is safe. The evidence for spinal manipulation across the board is a little bit inconsistent for results in other areas. But the safety component of chiropractic is repeatedly shown to be true. Overall incidences of adverse outcomes of spinal manipulation during pregnancy are really, really rare. In the research that I went through for our conference, there were a couple adverse events, but they weren’t related to the adjustment. And so there aren’t even really any adverse events directly related to a spinal manipulation in evidence anywhere. And so I think that is an important thing to note. I also like to kind of juxtapose the safety of chiropractic with the safety of pharmaceuticals or over-the-counter anti-inflammatories. And everybody knows the risks that are associated with using those, right? Like people know that they’re not supposed to take X, Y, and Z. They are supposed to take this, but not in the first trimester or not if they have this condition. So there are a lot of things to maneuver around when you’re taking over-the-counter anti-inflammatories.
Dr. Rebecca Dekker – 00:52:32:
Or even the risks of opioids for pain management are huge.
Dr. Lisa Vawter – 00:52:38:
People take opioids. There are a lot of prescriptions of opioids during pregnancy. It’s what the doctors have at their disposal to actually give people. And people know the risks of opioids and they’re willing to do it. But there are reported adverse outcomes with those things. A lot of them, actually. And so kind of putting those comparisons of body work is a resounding, overarching safety for chiropractic care, spinal manipulation. And I think it’s important to also address other prenatal providers and body workers, pelvic floor physical therapists, or a prenatal physical therapist, or a women’s health focused physical therapist, or a prenatal massage therapist, or a craniosacral therapist, right? All that stuff is really conservative. And it all, and it all helps. So it’s not just prenatal chiropractic. I would say that, you know, if you’re on the lookout, if you’re really scared about getting adjusted and that’s just not something you’re willing to do, go see someone else. Like, go seek out another therapist or provider. I am, I think that we do such a good job of tending to the other systems of the body in pregnancy. The providers, your birth provider takes care of that really well. The body and the musculoskeletal system for some reason is not.. The standard of care is not to like provide for that or to care for it, right?
Dr. Rebecca Dekker – 00:54:11:
And I think it’s because pain in general, especially in women is not always been taken seriously, right? So it’s just considered, well, this is just what you have to experience because you’re pregnant.
Dr. Lisa Vawter – 00:54:26:
It’s not true. It’s just not true. And so, I think that all of those options, you know, obviously I’m biased because I’m a chiropractor, but I think the safety of the body work techniques. When properly trained and, you know, precautions for pregnancy are taken, it’s really appropriate. It’s really safe. So that’s my statement.
Dr. Rebecca Dekker – 00:54:52:
Okay, so as we’re wrapping up our time with you, Dr. Vawter, I was wondering if you could just share with us maybe like an example of how someone was impacted positively by chiropractic care.
Dr. Lisa Vawter – 00:55:03:
I’ll do a patient that is top of mind. This lovely gal was in the end of her second trimester. She’s in health care. She works 12-hour shifts. And she’d had previous low back pain prior to pregnancy. And so she kind of was anticipating that it was going to come back. And up until she came into the office, she had been able to manage it. And then she was a little bit worried because it was getting worse. And she wasn’t able to cope through her shifts. And she had three shifts in a row coming up that she was terrified about. And so she came in two weeks before that was going to happen. So we had her first visit. We talked it through, did the adjustment, soft tissue work, gave her some things to work on at home. I came in on a Saturday to see her after the first week of shifts because she wasn’t going to make it in before her next set of shifts. And so we saw each other over the weekend. She said, I made it through the first two shifts this past week, and I felt so much better. The third shift was really hard. I had a lot of hard patients and my physical health. I just couldn’t do any of the things that we had talked about because it was a hard shift. And I was like, okay, I’m so glad you’re here. Let’s get you some care.
I gave her a SI belt that second visit because I was like, take this with you through your shifts. If you know that you’re not going to be able to do the work yourself or, like, concentrate on your body, put the belt on. It’s a tool. We love tools. Use it. And so that next week, she had three shifts right in a row. And she was like, same thing. The first two shifts were fine. I was able to manage them on my own. The third shift, I used the belt, and I felt great. So she went out of town like she was going to go. That’s why she’s working those three shifts in a row. She went out of town, came back. I saw her again. And she was getting ready to go to work the next week. And she was like, I am in such a better position physically now than I have been in months. She was like, I was so worried about doing those three shifts in a row and then leaving for vacation. And I felt so good. And so by her third visit, she was way more comfortable. She knew the tools that she was using were working for her. She had the belt if she needed it. And we were able to kind of just bump back to seeing her along her provider’s schedule instead of doing visits pretty close together. And I think her outlook for her third trimester for finishing up work and doing it comfortably was totally shifted from one of fear and guarding and worrying that this low back pain that she’d had for a long time was going to rear its head to be able to manage it and having the tools. I think that that is huge success.
Dr. Rebecca Dekker – 00:57:56:
That is awesome. So thank you so much, Dr. Vawter, for kind of like sharing with us all about body changes in pregnancy and education and how chiropractic can help and the safety. And I also want to let people know that we also talked about aches and pains in pregnancy in Episode 264. And that episode is more focused on tips for exercise to help reduce pain. So you can check out that episode. Dr. Vawter, do you have any way we can follow your work or any resources you recommend for our listeners?
Dr. Lisa Vawter – 00:58:30:
Sure. On Instagram, I’m @lisavawterchiro. And my website is Dr. Lisa Vawter. So D-R Lisa Vawter. And I’ll spell my name. V as in Victor. A-W-T-E-R.
Dr. Rebecca Dekker – 00:58:46:
And just so everybody knows, you all can follow Dr. Vawter at drlisavawter.com. And on Instagram, can you say your Instagram handle for us?
Dr. Lisa Vawter – 00:58:55:
@lisavauterchiro.
Dr. Rebecca Dekker – 00:58:57:
Awesome. All right, everybody, you can check out links and resources in the show notes. And thank you again, Dr. Vawter, for joining us today.
Dr. Lisa Vawter – 00:59:04:
Thank you so much.
Dr. Rebecca Dekker – 00:59:07:
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