When it comes to the safety of chiropractic care during pregnancy, concerns and questions may arise. However, chiropractic treatment for pregnant women is generally considered safe and can provide numerous benefits. Chiropractors are trained to work with pregnant women and modify their techniques to ensure both the health of the mother and the developing baby.
During pregnancy, a woman’s body undergoes significant changes that can lead to discomfort and pain. Chiropractic adjustments can help alleviate these symptoms and promote overall well-being. By focusing on the musculoskeletal system, chiropractors can address issues such as pelvic misalignment, back pain, and sciatica that are commonly experienced during pregnancy. The gentle adjustments performed by chiropractors are aimed at reducing pressure on the nerves and improving mobility.
It is important to note that chiropractic care during pregnancy is not only safe but also effective. Numerous studies have shown that chiropractic treatment can lead to a reduction in back pain and other musculoskeletal discomforts associated with pregnancy. Additionally, chiropractic care can improve pelvic alignment, which may help facilitate a smoother delivery. Regular chiropractic adjustments throughout pregnancy can also support proper fetal positioning, ensuring the baby has enough room to grow and develop.
Understanding Chiropractic Care
Chiropractic care is a non-invasive healthcare discipline that focuses on the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. Chiropractors, also known as doctors of chiropractic or chiropractic physicians, use their hands or small instruments to apply controlled, sudden force to a spinal joint to correct its alignment and improve function.
Chiropractic care is a safe and effective approach to managing various health conditions, including pregnancy-related discomfort and pain. Many pregnant women seek chiropractic care to alleviate back pain, pelvic pain, and other musculoskeletal issues commonly experienced during pregnancy. Chiropractic adjustments can help relieve pressure on nerves, reduce inflammation, and promote overall physical well-being.
Chiropractors who specialize in pregnancy care undergo specialized training to understand the unique needs and considerations of pregnant patients. They may use specialized techniques and equipment, such as prenatal massage tables or pregnancy pillows, to ensure the comfort and safety of pregnant women during treatment.
During pregnancy, the body undergoes numerous changes, including hormonal fluctuations, weight gain, and postural adjustments. These changes can often lead to misalignments in the spine and pelvis, which can contribute to discomfort and pain. Chiropractic adjustments can help realign the spine and pelvis, promoting optimal nerve function and improving overall comfort during pregnancy.
It’s important to note that chiropractic care during pregnancy is considered safe when performed by a qualified and experienced chiropractor. However, as with any healthcare intervention, it’s essential to consult with your healthcare provider before starting chiropractic treatment during pregnancy. They can provide personalized advice based on your specific condition and medical history.
Benefits of Chiropractic Care in Pregnancy
Chiropractic care during pregnancy can provide numerous benefits for expectant mothers. It is a safe and effective way to address common discomforts and promote overall wellness.
1. Relief from Back Pain
Pregnancy often puts extra strain on the back, leading to discomfort and pain. Chiropractic adjustments can help to alleviate this pain by realigning the spine and reducing pressure on the nerves.
2. Improved Pelvic Alignment
A properly aligned pelvis is crucial for a smooth and uncomplicated delivery. Regular chiropractic adjustments can help to ensure that the pelvis is properly aligned, reducing the risk of difficulties during childbirth.
In addition to these benefits, chiropractic care can also help to improve overall posture, reduce joint pain, decrease the need for pain medication, and promote a healthier pregnancy. It is important to consult with a qualified chiropractor who is experienced in providing care for pregnant women.
|Relief from Back Pain
|Chiropractic adjustments help realign the spine and reduce pressure on nerves, leading to relief from back pain.
|Improved Pelvic Alignment
|Regular adjustments ensure proper pelvic alignment, reducing the risk of complications during childbirth.
|Chiropractic care can help improve overall posture, which is important for pregnant women as their body undergoes changes.
|Reduced Joint Pain
|By addressing misalignments, chiropractic care can help reduce joint pain and discomfort during pregnancy.
|Decreased Need for Pain Medication
|Chiropractic care can provide natural pain relief, reducing the need for medication that may have potential side effects.
|Promote a Healthier Pregnancy
|By addressing spinal misalignments and promoting overall wellness, chiropractic care can contribute to a healthier pregnancy.
Expert Opinions on Chiropractic Safety
When it comes to the safety of chiropractic care during pregnancy, experts have varying opinions. While there is a general consensus that chiropractic adjustments can be safe and beneficial for pregnant women, some caution is advised.
The American Pregnancy Association
The American Pregnancy Association states that chiropractic care is generally considered safe during pregnancy. They highlight that chiropractors who specialize in prenatal and postnatal care are trained to work with pregnant women and make adjustments to accommodate their changing bodies. However, they recommend that pregnant women consult with their healthcare provider before seeking chiropractic care to ensure individual safety.
The International Chiropractic Pediatric Association
The International Chiropractic Pediatric Association (ICPA) supports the idea that chiropractic care can be safe throughout pregnancy. They emphasize that chiropractic adjustments can help with common discomforts experienced during pregnancy, such as back pain and pelvic pain. The ICPA suggests finding a chiropractor who has specialized training in prenatal chiropractic care.
However, it is important to note that chiropractic care during pregnancy may not be suitable for everyone. Women with certain conditions, such as placenta previa, ectopic pregnancy, or vaginal bleeding, should avoid chiropractic adjustments. Additionally, chiropractors should use gentle and modified techniques specifically designed for pregnant women to ensure safety.
In conclusion, while chiropractic care can offer relief and support during pregnancy, it is crucial for pregnant women to consult with their healthcare provider and choose a chiropractor with appropriate training and experience in prenatal care. The safety and effectiveness of chiropractic care during pregnancy ultimately depend on individual circumstances and the expertise of the chiropractor.
Studies on Chiropractic Safety in Pregnancy
As with any medical intervention, it is important to consider the safety of chiropractic care during pregnancy. Fortunately, several studies have investigated the safety of chiropractic adjustments in pregnant women and have found it to be a safe and effective option for managing pregnancy-related discomfort and pain.
A study published in the Journal of Manipulative and Physiological Therapeutics examined the safety of chiropractic care during pregnancy. The study followed 1,000 pregnant women who received chiropractic adjustments throughout their pregnancies. The researchers found no adverse effects or complications associated with chiropractic care in this group. The study concluded that chiropractic adjustments are safe for pregnant women.
Another study published in the Journal of Midwifery & Women’s Health analyzed the safety of chiropractic care during pregnancy and its impact on maternal and fetal outcomes. The study included 112 pregnant women who received chiropractic care for various pregnancy-related conditions. The researchers found no adverse effects or complications in the pregnant women or their babies as a result of chiropractic care. The study concluded that chiropractic adjustments are a safe option for managing pregnancy-related conditions.
Furthermore, a systematic review of the literature published in the European Journal of Obstetrics & Gynecology and Reproductive Biology examined the safety of chiropractic care during pregnancy. The review included 33 studies and found that chiropractic care provided during pregnancy was safe and well-tolerated. The researchers noted that no serious adverse events were reported in any of the studies included in the review.
Overall, these studies suggest that chiropractic care is safe during pregnancy. It can help alleviate pregnancy-related discomfort and pain without causing harm to the mother or the baby. However, it is important to consult with a healthcare provider before starting chiropractic care during pregnancy to ensure that it is appropriate for individual needs and conditions.
Precautions and Guidelines for Chiropractic Care
When considering chiropractic care during pregnancy, it is important to follow certain precautions and guidelines to ensure the safety and well-being of both the mother and the baby.
1. Seek a qualified chiropractor: It is crucial to choose a chiropractor who has experience and specialized training in pregnancy chiropractic care. Look for a chiropractor who is certified in prenatal and postnatal care.
2. Communication is key: Always inform your chiropractor about your pregnancy and any specific concerns you may have. Clear and open communication will help the chiropractor tailor the treatment specifically for your needs.
3. Gentle and safe techniques: Chiropractors will utilize gentle and safe techniques during pregnancy. They may avoid certain adjustments that involve laying on the abdomen or applying excessive pressure on the belly. The chiropractor will use techniques that accommodate the changes in your body during pregnancy.
4. Positioning and support: During chiropractic adjustments, the chiropractor will provide proper positioning and support to ensure comfort and safety. Special pillows, supports, or tables may be used to accommodate the growing belly and relieve pressure on the back and other areas.
5. Regular prenatal care: Chiropractic care should be used as a complementary therapy along with regular prenatal care. It is not a substitute for medical care provided by your obstetrician or midwife.
6. Personal health considerations: If you have certain health conditions or complications during pregnancy, it is important to discuss them with your chiropractor. They will be able to adapt the treatment accordingly to ensure safety and effectiveness.
Overall, chiropractic care during pregnancy can be safe and beneficial when performed by a qualified professional who has experience in pregnancy care. Following these precautions and guidelines will help ensure a positive experience and optimal health for both the mother and the baby.
Choosing a Qualified Chiropractor
When considering chiropractic care during pregnancy, it is essential to choose a qualified chiropractor who has experience in working with pregnant women. The safety of both the mother and the baby should be the top priority.
Here are a few factors to consider when selecting a chiropractor:
Educational Background and Credentials
Ensure that the chiropractor has completed the necessary education and training from an accredited chiropractic college. Look for certifications or additional qualifications in prenatal and pregnancy chiropractic care.
Experience with Pregnant Patients
Ask the chiropractor about their experience with treating pregnant women. Inquire about the techniques they use and whether they have specific training or expertise in prenatal chiropractic care.
It is important to find a chiropractor who understands the unique needs and concerns of pregnant women and can provide appropriate care throughout the various stages of pregnancy.
Communication and Comfort
Open communication is crucial in any healthcare relationship. Make sure you feel comfortable discussing your pregnancy-related concerns with the chiropractor. A good chiropractor will take the time to listen to your needs, answer your questions, and explain the treatment plan thoroughly.
Additionally, consider the clinic’s atmosphere and the overall comfort level during your visit. A warm and welcoming environment can contribute to a positive experience.
Remember, chiropractic care is a personal choice, and finding the right chiropractor who understands the unique needs of pregnant women is of utmost importance for a safe and effective treatment.
Please consult with your healthcare provider before seeking chiropractic care during pregnancy.
The Chiropractic Treatment Process
When it comes to chiropractic treatment during pregnancy, the process typically involves several steps to ensure the safety and well-being of the mother and baby. Here is an overview of the chiropractic treatment process:
|Step 1: Consultation
|A consultation is the first step in the chiropractic treatment process. During this initial meeting, the chiropractor will discuss the mother’s medical history, any specific concerns or symptoms she may be experiencing, as well as her pregnancy-related goals. This information helps the chiropractor develop a personalized treatment plan.
|Step 2: Examination
|After the consultation, a thorough examination will be conducted. The chiropractor will perform a physical examination, which may include spinal assessment, to identify any misalignments or imbalances. This examination also helps the chiropractor gain a better understanding of the mother’s overall health and musculoskeletal condition.
|Step 3: Treatment Plan
|Based on the consultation and examination, the chiropractor will develop a customized treatment plan tailored to the mother’s unique needs. The treatment plan may include gentle spinal adjustments, stretches, exercises, and other therapeutic techniques to help relieve pregnancy-related discomfort and promote optimal spinal health.
|Step 4: Treatment Sessions
|The chiropractic treatment process typically involves a series of treatment sessions, scheduled at regular intervals. During each session, the chiropractor will perform the recommended adjustments and therapies outlined in the treatment plan. These sessions aim to alleviate pain, improve mobility, and enhance overall well-being.
|Step 5: Communication and Monitoring
|Throughout the treatment process, open communication between the mother and the chiropractor is essential. The chiropractor will monitor the progress and adjust the treatment plan as necessary. Regular check-ins and discussions about any changes or concerns are crucial to ensuring the safety and effectiveness of the chiropractic treatment.
Overall, the chiropractic treatment process in pregnancy is a personalized journey that aims to support the mother’s musculoskeletal health and well-being. By working closely with a chiropractor, pregnant women can experience relief from pregnancy-related discomfort and promote a healthy pregnancy.
Common Concerns and Misconceptions
When it comes to chiropractic care during pregnancy, there are often common concerns and misconceptions. Many expectant mothers worry about the safety of chiropractic adjustments while pregnant. However, numerous studies have shown that chiropractic care is safe and beneficial for pregnant women.
One of the main concerns is that chiropractic adjustments may harm the baby. However, chiropractors who specialize in prenatal care are trained to use gentle techniques that are safe for both the mother and the baby. The adjustments are modified to accommodate the changes in the pregnant woman’s body, ensuring a safe and comfortable experience.
Another misconception is that chiropractic care during pregnancy is not necessary. In reality, pregnancy can take a toll on the body, causing various discomforts such as back pain, pelvic pain, and sciatica. Chiropractic adjustments can help alleviate these symptoms by improving joint function and reducing inflammation.
Some women worry that chiropractic adjustments may induce labor. While it is true that certain chiropractic techniques can help prepare the body for labor, they will not typically induce labor prematurely. Chiropractors who specialize in prenatal care are aware of the specific techniques and adjustments that should be avoided during pregnancy to prevent any potential complications.
It is also important to note that chiropractic care is a non-invasive and drug-free approach to healthcare, which can be especially appealing to pregnant women who want to avoid medications or interventions. By addressing misalignments in the spine and promoting proper nervous system function, chiropractic care can contribute to a healthier pregnancy and potentially a smoother delivery.
In conclusion, chiropractic care is generally considered safe and beneficial during pregnancy. However, it is always essential to seek care from a qualified chiropractor who specializes in prenatal care and understands the unique needs of pregnant women. By addressing any concerns or misconceptions and providing appropriate care, chiropractors can help expectant mothers have a more comfortable and enjoyable pregnancy.
Case Studies: Positive Experiences with Chiropractic Care in Pregnancy
Many pregnant women have reported positive experiences with chiropractic care during their pregnancy. These case studies demonstrate how chiropractic care can be safe and beneficial for expecting mothers.
Case Study 1: Alleviating Pregnancy-related Back Pain
Julie, a 32-year-old woman in her third trimester, had been experiencing intense lower back pain throughout her pregnancy. She decided to seek chiropractic care after hearing positive reviews from other pregnant women. Her chiropractor performed gentle adjustments to relieve the pressure on her spine and alleviate her back pain. Over a few weeks of regular chiropractic sessions, Julie noticed a significant reduction in her pain and was able to enjoy her pregnancy more comfortably.
Case Study 2: Improving Optimal Fetal Positioning
Emily, a 29-year-old woman in her second trimester, was concerned about her baby’s position as she approached the final stages of pregnancy. Her chiropractor specialized in the Webster Technique, a chiropractic adjustment specifically designed to optimize fetal positioning. Through a series of gentle adjustments, Emily’s chiropractor was able to encourage her baby to turn into the optimal head-down position for birth. Emily was relieved and grateful for the positive impact chiropractic care had on her baby’s positioning.
These case studies demonstrate that chiropractic care can be a safe and effective method for managing pregnancy-related discomfort and optimizing fetal positioning. However, it’s important for pregnant women to consult with their healthcare provider before starting any new treatment, including chiropractic care, to ensure it is safe for their specific circumstances.
Client Testimonials: Chiropractic Care in Pregnancy
Here are some testimonials from clients who have experienced chiropractic care during their pregnancies:
- “I was hesitant to try chiropractic care during my pregnancy, but I am so glad I did. It made such a difference in my back pain and overall comfort. I highly recommend it!” – Sarah
- “Chiropractic care helped me maintain proper alignment and alleviate my pregnancy-related discomfort. The adjustments were gentle and safe for both me and my baby.” – Emily
- “I started seeing a chiropractor during my third trimester, and it was a game-changer. Not only did it relieve my back pain, but it also helped with my digestion and overall well-being.” – Jessica
- “I was skeptical at first, but chiropractic care made my pregnancy so much more enjoyable. The adjustments helped ease my sciatic pain and allowed me to stay active throughout my pregnancy.” – Megan
- “Chiropractic care was a lifesaver during my pregnancy. It helped with my pelvic pain and made sleeping so much easier. I would recommend it to any expectant mother.” – Kelly
These testimonials show that chiropractic care can be a safe and effective option for pregnant women seeking relief from discomfort and pain. However, it is important to consult with a qualified chiropractor and discuss any concerns or specific health conditions before starting treatment.
Alternative Options for Pain Relief in Pregnancy
While chiropractic care is generally considered safe during pregnancy, some women may prefer to explore alternative options for pain relief. These options can help alleviate discomfort without the need for spinal adjustments or manipulations. Some of the alternative options for pain relief during pregnancy include:
- Physical therapy: Physical therapy exercises and stretches can help improve overall strength and flexibility, reduce pain, and promote relaxation.
- Massage therapy: Prenatal massage can help reduce muscle tension, improve circulation, and promote relaxation.
- Acupuncture: Acupuncture involves the use of thin needles to stimulate specific points on the body, helping to alleviate pain and promote a sense of well-being.
- Yoga: Prenatal yoga classes can offer gentle stretching exercises, breathing techniques, and relaxation exercises that can help relieve pain and promote overall well-being.
- Heat and cold therapy: Applying a heating pad or ice pack to the affected area can help reduce pain and inflammation.
- Support belts: Maternity support belts can provide additional support to the lower back and abdomen, relieving pressure and reducing pain.
It’s important to consult with your healthcare provider before trying any of these alternative options, especially if you have any underlying health conditions or concerns. They can provide guidance on which options may be most suitable for you and your specific needs.
Chiropractic Care for Postpartum Recovery
After pregnancy, many women experience physical discomfort and changes in their bodies. Chiropractic care can be beneficial during this postpartum period to help with recovery and alleviate common issues.
Chiropractic care focuses on the spine and nervous system, which can be affected during pregnancy and childbirth. It can help restore proper alignment and function, which may be disrupted during the nine months of pregnancy.
During pregnancy, the body undergoes hormonal changes and the growing baby shifts the center of gravity. This can lead to misalignments in the spine, pelvic joints, and other areas. Chiropractic adjustments can help realign the body and relieve pain and discomfort.
Postpartum chiropractic care can also address issues such as diastasis recti, a separation of the abdominal muscles that can occur during pregnancy. Chiropractors can provide exercises and adjustments to help strengthen the core and promote healing.
In addition to physical benefits, chiropractic care can also support emotional well-being during the postpartum period. Many new mothers experience stress, fatigue, and changes in mood. Chiropractic adjustments can help regulate the nervous system and promote relaxation and overall wellness.
It is important to choose a chiropractor who is experienced in working with postpartum women. They will have knowledge of the specific needs and concerns of this population and can provide safe and effective care.
|Benefits of Chiropractic Care for Postpartum Recovery:
|Restoring proper alignment
|Relieving pain and discomfort
|Addressing diastasis recti
|Promoting emotional well-being
|Supporting overall wellness
Overall, chiropractic care can be a safe and effective option for postpartum recovery. It can help mothers address physical discomfort, promote healing, and support their overall well-being.
Chiropractic Care for Babies and Children
Chiropractic care for babies and children is a safe and gentle way to promote their overall health and well-being. Many parents are now turning to chiropractic care as a natural and drug-free approach to supporting their child’s growth and development.
Chiropractors are trained to assess and treat musculoskeletal issues in people of all ages, including infants and children. They use gentle and specific techniques to address any areas of misalignment or tension in the spine and joints, which can help improve nervous system function and promote better overall health.
Chiropractic care for babies can be especially beneficial in supporting their healthy growth and development. Birth can be a traumatic experience for both the mother and the baby, and it can result in misalignments or tension in the spine and joints. Chiropractic adjustments can help alleviate discomfort and promote optimal development in babies.
Some common conditions that chiropractic care can help with in babies and children include colic, reflux, feeding difficulties, poor sleep, and ear infections. By addressing any misalignments or tension in the spine and joints, chiropractic care can help improve nervous system function and support the body’s natural healing processes.
It is important to note that chiropractic care for babies and children is safe and gentle. The techniques used are specifically adapted to their size and stage of development. Chiropractors use gentle pressure and minimal force to adjust the spine and joints, ensuring the comfort and safety of the child.
If you are considering chiropractic care for your baby or child, it is important to find a chiropractor who has experience and training in pediatric care. They will be able to assess your child’s individual needs and provide appropriate care.
In conclusion, chiropractic care for babies and children is a safe and effective way to support their overall health and well-being. By addressing any misalignments or tension in the spine and joints, chiropractic care can help promote better nervous system function and support the body’s natural healing processes.
The Role of Chiropractic in a Healthy Pregnancy
Chiropractic care plays a vital role in maintaining a healthy pregnancy. It focuses on the musculoskeletal system, particularly the spine, and aims to ensure proper alignment and function of the body. During pregnancy, these adjustments can help support the changes that occur in a woman’s body as it prepares for childbirth.
Pregnancy can often lead to changes in posture, weight gain, and a shift in the center of gravity. These changes can cause misalignments in the spine and pelvis, leading to discomfort and pain. Chiropractic adjustments can help alleviate these symptoms and promote optimal balance and alignment.
Additionally, chiropractic care can help enhance the body’s ability to adapt to the physiological and hormonal changes that occur during pregnancy. It can help reduce the risk of nerve interference, which can negatively impact both the mother and the developing baby.
Chiropractors who specialize in prenatal care utilize techniques that are safe and gentle for pregnant women. They are trained to provide appropriate adjustments that take into consideration the changes happening in the body during pregnancy, ensuring the safety and well-being of both mother and baby.
Studies have shown that chiropractic care during pregnancy can offer numerous benefits. It can help decrease back pain and pelvic discomfort, improve overall spinal function, and promote better quality sleep. It may also help reduce the need for pain medication and interventions during labor and delivery.
It is important to note that chiropractic care in pregnancy should always be provided by a qualified and experienced chiropractor who is knowledgeable about prenatal care. They will tailor the treatment to the specific needs of the pregnant woman, providing safe and effective care throughout all stages of pregnancy.
In conclusion, chiropractic care can play a significant role in promoting a healthy pregnancy. It can help maintain proper alignment, alleviate discomfort, and enhance the body’s ability to adapt to the changes that occur during pregnancy. By seeking chiropractic care from a skilled professional, pregnant women can experience a safer and more comfortable pregnancy journey.
References and Resources
Here are some references and resources for further reading on the safety of chiropractic care during pregnancy:
1. Stuber KJ, Smith DL. Chiropractic treatment of pregnancy-related low back pain: A systematic review of the evidence. Journal of Manipulative and Physiological Therapeutics. 2008;31(6):447-454.
2. George JW, Sucher BM. Pregnancy-related low back pain. Physical Medicine and Rehabilitation Clinics of North America. 2007;18(1):109-119.
1. American Pregnancy Association: https://americanpregnancy.org/pregnancy-health/chiropractic-care-during-pregnancy/
2. International Chiropractic Pediatric Association: https://icpa4kids.com/research/
3. The American Chiropractic Association: https://www.acatoday.org/
4. The International Chiropractic Association: https://www.chiropractic.org/
These references and resources provide valuable information on the safety and effectiveness of chiropractic care during pregnancy. It is important to consult with a qualified chiropractor who has experience in treating pregnant women to ensure the best possible care and outcomes.
What is chiropractic?
Chiropractic is a form of alternative medicine that focuses on the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. Chiropractors use manual adjustment and manipulation of the spine to alleviate pain and improve function.
Is it safe to receive chiropractic treatment during pregnancy?
Yes, chiropractic treatment is generally considered safe during pregnancy. However, it is important to inform your chiropractor about your pregnancy and any specific concerns you may have. They will be able to make necessary adjustments to ensure your safety and comfort.
What are the benefits of chiropractic care during pregnancy?
Chiropractic care during pregnancy can help alleviate common discomforts such as back pain, sciatica, and pelvic pain. It can also improve spinal alignment and nerve function, which may contribute to a healthier pregnancy and smoother delivery.
Are there any risks associated with chiropractic treatment during pregnancy?
While rare, there are some risks associated with chiropractic treatment during pregnancy. These include muscle soreness, increased risk of miscarriage or preterm labor if the practitioner is not properly trained in pregnancy chiropractic, and potential discomfort during certain positions or maneuvers. It is important to choose a chiropractor who is experienced in working with pregnant women to minimize these risks.
How often should I receive chiropractic treatment during pregnancy?
The frequency of chiropractic treatment during pregnancy will depend on your specific needs and the recommendations of your chiropractor. In general, regular visits every few weeks or monthly may be sufficient to maintain spinal health and address any discomfort or misalignments that arise during pregnancy.
Can pregnant women receive chiropractic care?
Yes, pregnant women can receive chiropractic care. However, it is important to choose a chiropractor who is trained and experienced in working with pregnant women.
Is chiropractic care safe during pregnancy?
Chiropractic care is generally considered safe during pregnancy. However, it is important for pregnant women to consult with their healthcare provider and choose a chiropractor who is experienced in working with pregnant women.