While chiropractic care for infants has generated substantial controversy (and rightly so), there has been little criticism regarding chiropractic prenatal care. Back pain is, of course, common during pregnancy, but – although it is reasonably safe – there isn’t good evidence that chiropractic care can be effective during pregnancy. Chiropractic care for back pain, however, isn’t the most egregious service chiropractors offer pregnant women. What is? Chiropractic care for breech presentation of the fetus.
Breech positioning occurs when a fetus is positioned bottom-first, rather than the common presentation of head-first. It’s not particularly common and the best course of action is generally to perform a caesarean section. As caesareans are not without side-effects, it’s understandable that expectant mothers would like to pursue alternatives. Enter, chiropractic.
In a 2009 article published in Canadian Chiropractor, CMCC graduate John Minardi promotes what is known as The Webster Technique – a technique “specifically designed to detect and correct for pelvic subluxations that occur in a pregnant patient.” Of course, we know that’s bullshit because subluxations don’t exist, but what does he claim is the purpose of this approach? To “improve birth outcome,” naturally.
Luckily, CMCC graduates are often more scientific than their US-educated counterparts. They may not all understand science, but they at least understand the importance of science. In his article, Minardi (who teaches the technique) cites a single paper supporting the approach: “The Webster Technique in a 28 Year Old Woman with Breech Presentation & Subluxation“.
The paper is exactly what it sounds like; it’s a case study that followed an individual woman with breech presentation who received chiropractic care in the form of Webster’s technique. Her follow-up indicated that the fetus re-positioned to the vertex (head-down) position. The study concluded – based on this alone – that Webster’s technique should be offered to all patients instead of a caesarian section. This is an interesting conclusion considering that spontaneous correction occurs in the majority of cases regardless. This study portrays mastery only of regression to the mean and should be cast adrift with the multitude of chiropractic case studies making unsubstantiated claims.
So exactly how pervasive is this unsubstantiated technique in the business of chiropractic? Every word in this sentence links to a London, Ontario Chiropractor advertising Webster’s Technique. Good job, none of you. Of course, there is no firm data because there is no oversight of unscientific chiropractors in Ontario, but – based on 29 chiropractors identified online in London offering the technique and using data from the CCO – at least 21% of chiropractors in London sell this bit of pseudoscience.
One of the most prolific chiropractors offering the technique is London’s own B.J. Hardick (recently suspended for illegal blood tests). His YouTube video describes a 32-week pregnancy adjustment that he seems rather confident in:
If this is a claim of 100% efficacy, disclosure of the supporting data would certainly be interesting. Regardless, practitioners who claim Webster’s technique is effective at turning breech fetuses have put themselves in a precarious position; a well-defined clinical trial with objective measures of outcome would be easy to run at a low cost and possibly low risk. Yet – after decades of promotion – all we have are useless case studies and useless surveys.
As it stands, the promotion and practice of Webster’s technique as a remedy for breech presentation is quite possibly patient abuse, yet offerings like these appear to be endemic to chiropractic in Ontario. A little bit of reservation from chiropractors offering unsubstantiated techniques would be great. Widespread adoption of a culture that respects and understands science would be even better.