The Webster Technique
The Webster Technique:
An Offshoot of "Chiropractic Pediatrics"
An Offshoot of "Chiropractic Pediatrics"
Samuel Homola, D.C.
Many chiropractors are "adjusting" the spines of pregnant women to "assure normal delivery" and to prevent breech birth caused by "intrauterine constraint." This dubious treatment -- known as the Webster Technique -- is based on the equally dubious theory that vertebral subluxations can cause malfunction in the uterus by putting pressure on spinal nerves. Chiropractors who advocate the Webster Technique, claim:
- Failure to prevent sacral and pelvic subluxations can result in abnormal positioning of the baby in the uterus.
- Babies can be turned from a breech position to a normal vertex (head down) position simply by adjusting the sacrum.
These contentions are not merely nonsensical. Reliance on the Webster Technique during the final weeks of pregnancy can endanger both the mother and the child.
Many chiropractors who use the Webster Technique identify themselves as "chiropractic pediatricians," a title they are not qualified to claim. Most chiropractic students receive about 15 hours of classroom instruction in obstetrics and gynecology and 15 hours in pediatrics , certainly not enough training to warrant treating patients in these fields. Some chiropractic colleges offer postgraduate education in pediatrics. The International Chiropractic Pediatric Association offers a Diplomate in Chiropractic Pediatrics (D.I.C.C.P.), certified only by chiropractic boards. This program -- offered by two schools accredited by the Council on Chiropractic Education (CCE) -- requires 360 hours of classroom instruction in 30 modules, usually on weekends in various states around the country. Like the classroom instruction offered in chiropractic colleges, a diplomate program has no hospital affiliation and provides no hands-on clinical experience.
"As parents become more aware of the drugless benefits of chiropractic for their children," says the International Chiropractic Association's Council on Chiropractic Pediatrics, "it is imperative that DC's, as primary-care providers, remain on the cutting edge of their profession."  To further this goal, the I.C.P.A. offers a Certificate of Proficiency in the Webster Technique after a 12-hour course. "Because of the effect the chiropractic adjustment has on all body functions," claims the I.C.P.A., "pregnant mothers should have their spines checked regularly throughout pregnancy, allowing for safer, easier deliveries and optimized health benefits for both the mother and baby." 
With so little training and clinical experience in treating pregnant women and their babies, and with a limited treatment method that consists primarily of spinal manipulation, I cannot imagine how chiropractors can manage pregnancies or treat newborn babies and children. Subluxation-based chiropractors who offer such treatment feel that a spinal adjustment is adequate treatment for most ailments. Claiming that the adjustments "remove pressure on the spinal cord and the spinal nerves," such chiropractors manipulate the expectant mother's spine during pregnancy and then manipulate the spine of the newborn infant, a truly despicable practice.
Birth of the Webster Technique
The ICPA's founder, the late Larry Webster, D.C., developed an adjustive technique that he claimed would restore pelvic balance and function and prevent or correct breech birth, a technique now used by many "chiropractic pediatricians." One chiropractor who uses Webster's technique describes the treatment method this way:
The treatment is based on a specific protocol and observed reflexes that then uses chiropractic adjustive techniques on the sacrum. If you have never been "adjusted" before an adjustment is the application of light force by hand in a very specific direction on the spine to help the body correct a subluxation of the spine. The technique itself should be very gentle with the pregnant woman. The beauty of it is that it is based on the fact that the baby wants to be head down given the opportunity. The technique is designed to work with the body to normalize the bony and soft tissue structures of the pelvis so the baby CAN go head down. It is non-invasive and does not involve physically manipulating the baby at all.
Many times we do not see the patient until late into pregnancy so that possibility of labor starting AFTER the baby turns does exist .
Such statements should raise big red flags. Breech presentation commonly occurs during pregnancy, but most breeches rotate into the head-down (vertex) position by the end of the eight month. Failure to recognize that a breech will persist so that appropriate treatment can be started before labor begins endangers both the baby and the mother.
Before or during labor for example, if the cervix dilates sufficiently, a breech presentation poses the risk that if the "water bag" breaks, the umbilical cord can squirt into the vagina and create a life-threatening emergency. If labor begins and progresses to the point of delivery, a vaginally-delivered breech baby has a higher risk of sustaining serious neurological injury. In some of these cases, efforts to turn the baby through the abdominal wall are warranted. But even in the best of hands, simultaneous ultrasound monitoring is necessary, but the the fetus may still become entangled in its umbilical cord, necessitating an immediate cesarean delivery. Chiropractors do not have access to and are not trained in obstetric ultrasound and are not qualified to immediately deliver a baby if necessary.
Other malpositions can occur. When delivery begins with a face or brow presentation, the precise orientation of the presenting part is important. Proper medical management can make the difference between a healthy baby and one that may sustain serious neurologic injury. Shoulder presentations are generally undeliverable because the baby is essentially presenting by the long axis of the body. Adjusting the expectant mother's spine or sacrum in such cases would be useless and could delay appropriate treatment until it is too late to avert disaster.
Success Claimed by Chiropractors
The Webster Technique is claimed to be effective for turning breech babies. But the breech position is not the only abnormal position a baby can be in during delivery. Although all these presentations can be dangerous for the child and the mother, I would not expect a Webster Technique chiropractor to recognize the difference or to do anything different other than adjust the sacrum.
A survey mailed to 1,047 U.S. and Canadian ICPA members yielded reports of 112 cases of breech positions that chiropractors treated with the Webster technique. Of these, it was claimed that 102 were turned into proper positions with the Webster Technique . However, there are several reasons that these results should not be taken at face value:
- The survey was retrospective, which means it was subject to recall bias (selective reporting of favorable results).
- Only 187 chiropractors -- 18% of those surveyed -- returned the questionnaire. Such a low response rate is inherently subject to bias (chiropractors more apt to report cases they believe were successful).
- In 59 of the cases, the breech presentation was not confirmed by ultrasound, which introduced the potential for medical misdiagnosis.
Because most breech presentations earlier in pregnancy resolve on their own by term, there is no reason to believe that the chiropractic interventions in these cases were helpful. But the belief that such measures can be helpful could easily lead to the horrendous scenario of a chiropractor adjusting an expectant mother's sacrum when other measures are necessary.
Clear and Present Danger
Despite the nonsense promoted by chiropractic pediatricians who employ the Webster Technique, some subluxation-based chiropractic journals and associations continue to endorse such methods. An August 2001 issue of The Chiropractic Journal, for example, reported that the Webster Technique "has been highly successful in relieving intrauterine constraint and helping to convert breech presentations to cephalic presentations for more than 20 years."  The World Chiropractic Alliance recommends that spinal adjustments begin at birth and continue for life .
No pregnant woman should rely upon chiropractic adjustments to prevent or correct a breech birth or to change the abnormal position of a baby in the uterus. Chiropractors should not be allowed to adjust the spine of a newborn baby. Chiropractors who claim to be chiropractic pediatricians, or who offer the Webster Technique as a part of their treatment method, should be avoided by everyone -- adults and children alike.
Timothy N. Gorski, M.D., F.A.C.O.G., who practices obstetrics and gynecology in Arlington, Texas, served as a consultant for this article.
- Cherkin D and others. [../05RB/AHCPR/03.html Chiropractic in the United States.] Rockville, MD: Agency for Health Care Policy and Research, 1997. U.S. Department of Commerce publication PB9111693, pp 22, 24.
- ICA Council on Pediatrics, Accessed March 4, 2003.
- Webster technique defined. ICPA Web site, accessed March 4, 2003.
- Webster turning technique. The Power Company Web site, accessed March 4, 2003.
- Pistolese RA. The Webster technique: A chiropractic technique with obstetric implications. Journal of Manipulative and Physiologic Therapeutics 25(6):E1-9, 2002.
- The Webster Technique: A technique for pregnant women. The Chiropractic Journal, Aug 2001.
- Practice Guidelines for Straight Chiropractic. Chandler, AZ: World Chiropractic Alliance,1999, p 30
Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book [../05RB/BCC/00c.html Bonesetting, Chiropractic, and Cultism] supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book [../03Edu/C/homola.html Inside Chiropractic: A Patient's Guide] provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.