Pregnancy and Car Accidents: Protecting Mother and Baby

A car accident during pregnancy is never “just a fender bender.” When a pregnant woman is hurt in a crash, she is caring for two people, and her body is already working harder than usual to carry the baby. In my office, I treat these patients differently from the very first visit.

Many of my pregnant patients come in weeks after the accident. Some were told their pain was “just the pregnancy.” Others worried that any treatment could harm the baby. In this article I want to explain why an injury during pregnancy deserves a careful evaluation, how we care for these moms safely, and what I have seen happen when they get the right care.

Why a Pregnant Body Is More Vulnerable in a Crash

Pregnancy changes the spine and pelvis long before any accident happens. Up to 90% of pregnant women experience low back or pelvic girdle pain, and over 30% have their first episode of low back pain during pregnancy (5). The reasons are weight gain, a shifting center of gravity, and the hormone relaxin, which loosens ligaments so the pelvis can open for delivery (5).

That looseness is helpful for birth, but it means the joints are less protected when a sudden force hits them. A crash that a non-pregnant patient might shake off can sprain loosened ligaments in the low back, sacroiliac joints and pelvis.

Prior injury matters too. A systematic review found that a history of back pain or physical injury increases the risk of back and pelvic girdle pain during pregnancy (4). In other words, an accident does not just hurt today. It loads the dice for the rest of the pregnancy.

Even the standard obstetrics textbook, Williams Obstetrics, acknowledges that evidence-based research guiding care for pregnancy-related back pain is still limited (5). That is why an evaluation by a provider who works with pregnant patients every day is so important.

Delivery Is Not to Blame for Chronic Back Pain

A common assumption is that if a mom has back pain after the baby comes, labor and delivery must have caused it. The research does not support that. Labor and delivery on their own do not cause chronic low back pain.

Eisenach and colleagues followed women after childbirth and found pain so rare at 6 and 12 months that they could not even build a model of chronic low back pain after labor. Only about 10% of women still reported pain at 2 months postpartum (1).

Labor can bring on some back pain, but there is broad agreement that pain before labor is one of the greatest risk factors for chronic low back pain afterward (2, 3). So when a woman is injured in a car accident during pregnancy, or right after delivery, and her pain never goes away, delivery should not take the blame. The injury needs to be evaluated and treated for what it is.

The Pelvis, Space for the Baby, and Head-Down Position

An injured pelvis can affect more than mom’s comfort. It can also affect how much room the baby has to move and turn.

Researchers describe intrauterine constraint as any force outside the developing baby that blocks its normal movement in the womb. Constraint can affect the baby’s spine and skeleton, and it can keep the baby from turning head-down, which may lead to a cesarean delivery (7). The obstetric literature also notes that anything that narrows the pelvis and reduces its capacity can contribute to a difficult labor, and a lifetime of stress and physical trauma to the spine and pelvis can throw off pelvic alignment (6).

The reasoning is straightforward: if the hips, pelvis and their movement are restricted, the overall space for the baby is restricted too. In my own practice, when I see the quadratus lumborum (QL) muscle shortened, or less space between the lower ribs and the top of the pelvis, I take it as a predictor that the baby may not be able to get head-down. Improving that space by pregnancy specific manual therapy and chiropractic is one of the changes that seems to help the baby flip. An injury raises those risks, which is why it should be evaluated.

I explain it to my moms this way: “There’s two reasons why babies don’t flip. One is developmental, and the second is constriction, tightness, tension, torsion of the uterus. And so I help with that one.” When one of my car accident patients had a breech baby at 34 weeks, I found a tight iliopsoas muscle, a shifted pubic bone and round ligament tension on one side. As I told her, when that muscle “becomes tight, it causes less space for the baby.” We increased her visits to twice a week. I’ve had patients whose babies were breech and flipped with this kind of care.

The goal is not to push the baby. It is to have “the pelvis balanced, moving well, that nothing gets shifted or stuck,” which “does improve the chances that the baby’s head down, that the labor is shorter.”

What a Thorough Evaluation Looks Like

This section describes what a thorough evaluation looks like, so you can judge whether your injuries were properly evaluated. Don’t just trust credentials. Know whether you received great care. After a car accident during pregnancy, a complete evaluation should include:

• A detailed history of the crash. Where you were sitting, which side was hit, whether you saw it coming and braced, which way your head and body were turned, and where the seatbelt and airbag hit you. These details tell the doctor which tissues took the force.
• Your pregnancy and your baby. How far along you are, whether your OB or midwife checked the baby after the crash (ultrasound and monitoring), any cramping, contractions or changes in the baby’s movement, and how your prior pregnancies and births went.
• Every symptom, rated. Each area of pain on a 0 to 10 scale, written as average pain and pain with exertion (for example, 5-8/10), plus how often it happens (intermittent, occasional, frequent or continuous), how intense it is, where it travels, and what makes it worse. Pain before the accident should be recorded too.
• What you can and can’t do. How long you can sit, stand, walk or drive, whether you can lift your other children or a car seat, and how you are sleeping and working.
• A concussion screen. Headache, dizziness, nausea, light or noise sensitivity, vision changes, ringing in the ears, memory and concentration, plus a balance test (such as Romberg). Many of my pregnant crash patients had a concussion that no one had explained to them.
• Range of motion and strength. Passive and active motion of the neck, low back, shoulders and hips, measured in degrees, with notes on where pain stops the motion. Muscle strength is graded from 0 to 5, and grip strength is measured in both hands.
• A neurological exam. Reflexes, sensation (soft touch, vibration, sharp and dull), and tests such as the Brachial Plexus Compression and Doorbell signs to find out whether numbness, tingling or radiating pain is coming from a pinched nerve in the neck or shoulder.
• Orthopedic tests for each region. Neck compression and distraction tests, upper limb tension, straight leg raise, Kemp’s, Minor’s and knee-to-chest tests for the low back, and Yeoman’s, Patrick’s (FABER) and thigh thrust tests for the sacroiliac joints and hips.
• Palpation of every joint, not just the sore spot. I check each region for muscle tone, tenderness and spasm, and for the exact joints that are restricted or painful. For example, one patient had restrictions at C2, C5 and C7 in the neck, at T2, T5 and T8 in the mid back, and at the segments where the disc is provoked, such as C6-7 and L5-S1. Trigger points are noted separately, because they call for different treatment.
• The pelvis, in detail. The position of the pubic bone (is one side forward?), the position of the sacrum (is it turned to one side?), leg length (a difference of a few millimeters to a centimeter and a half matters), and whether each sacroiliac joint is stuck or too loose. This is the area most often missed, and in pregnancy it is often the most important.
• Muscles that affect both mom’s pain and the baby’s space. The quadratus lumborum, piriformis, iliopsoas and round ligaments. A tight round ligament on one side can pull on the uterus and make the room for the baby uneven.
• A plan for imaging that protects the baby. No x-rays during pregnancy. An MRI only if symptoms are not improving or something is urgent.
• Diagnoses written out, with a treatment plan. Each injury named, how often you will be seen, and when you will be re-examined.
• Re-examinations that measure progress. Every few weeks, your pain, motion and function should be measured again and compared to the first visit, with a percentage of improvement. That is how you and your doctor know care is working.

How We Keep Treatment Safe for Mom and Baby

My goal with a pregnant patient is simple: reduce her pain and restore normal motion of the spine and pelvis without adding any stress to the pregnancy. That means the exam and the treatment are both adjusted to where she is in her pregnancy.

Gentle, adapted adjustments. I use low-amplitude, pain-free adjustments with the spine kept in a neutral position, never pushed to the end of its range. When a joint is too inflamed or the patient is very sore, I switch to gentle joint mobilization with no thrust at all. Positioning changes as the belly grows, using side-lying adjustments and a flexion-distraction table so she is comfortable and the baby is never under pressure.

Respecting inflamed joints. If a sacroiliac joint is inflamed, I do not adjust that side. I work on the restricted side and the sacrum instead, and let the inflamed joint calm down first.

Support for the pelvis and belly. Depending on the case, this includes a pelvic brace for sitting, gentle massage and visceral massage, lighter-load exercises, and self-care such as gentle round ligament massage that she can do at home each morning.

Imaging and concussion care with the baby in mind. As I tell my patients, “we’re not going to do an x-ray because you’re pregnant. MRI, although it’s generally safe for the baby, we won’t do it unless something’s urgent.” Most of what I need comes from a careful physical exam. Many of these moms also have concussion symptoms, and when I refer them to a concussion specialist I ask that management take the pregnancy into account.

Care that continues after the birth. For moms who return after delivery, the Webster Technique helps address the sacrum and pelvis. Protocols like Webster are studied for sacral and pelvic problems, symphysis pubis dysfunction, low back pain and sleep disturbance in pregnancy, and the research on spinal manipulation during pregnancy is described as a growing, emergent body of evidence (9). Before discharge, I coach moms on posture, core bracing and lifting so they are ready for carrying a newborn and a car seat.

A Brief Summary of the Treatments We Use

This section gives a short overview of the treatments available to pregnant and postpartum moms in our office, so you know what good care can include. Not every mom needs every treatment. The plan is matched to her injuries and to how far along she is. If you are receiving treatment but not improvement it may be due to lack of treatment variety.

• Pubic bone and pelvic drop adjustments. My main pregnancy adjustment. It is a very light drop, “comparable to stepping off a curb,” with the force going through the pubic bone, not the belly.
• Pelvic balancing and sacroiliac work. Gentle adjustments and mobilization of the sacrum, SI joints and sacrotuberous ligament, so one joint is not stuck while the other is overworked.
• Gentle spinal adjustments and mobilization. Low-force, neutral-position adjustments, or joint mobilization with no thrust when tissues are inflamed.
• Comfortable positioning. Seated, standing or side-lying with a pillow between the thighs, or face-down with a belly pillow when she is able.
• Neck care without twisting. Gentle traction, decompression and nerve glides instead of sudden neck adjustments.
• Rib and mid-back care. Rib mobilization and a gentle “hug” adjustment for a locked rib that makes breathing or sleeping hard.
• Flexion-distraction and traction. Gentle stretching of the low back on a specialized table to take pressure off irritated joints and discs.
• Soft tissue work. Round ligament release, iliopsoas and quadratus lumborum work, visceral massage and therapeutic massage.
• Craniosacral work. Light pressure on the head and sacrum to help the nervous system relax.
• The Webster Technique. For the sacrum and pelvis, during pregnancy and after delivery.
• Supports. A pelvic brace worn low, below the belly, for sitting, sleeping and travel.
• Exercise and home care. Lighter-load strengthening, hip and core work, round ligament self-massage, inversion exercises when the baby is not head-down, and daily walks for concussion recovery.
• Getting ready for baby. Coaching on posture, core bracing and lifting so mom can carry a newborn and a car seat without re-injuring herself.

What Recovery Looks Like: Cases From Our Office

These are real patients from my practice, described without identifying details. Every one of them improved with care adapted to her pregnancy.

Hurt late in the third trimester, then again in a second pregnancy. A young mom was rear-ended at 36 weeks and had contractions in the ER. She came in with neck and low back pain up to 8/10, tailbone pain, numbness in both hands and concussion symptoms. With gentle, neutral-position adjustments she was 60% better by her due date. After delivery her low back flared with the same pain she had after the crash, which tells me the injury, not the birth, was the source. She reached 100% about five months after the accident. Less than a year later, early in her next pregnancy, she was hit again and had a severe concussion, sacroiliac and hip pain. Using mobilization with no thrust, she was again 100% by 24 weeks and lifting her older baby without limits.

Injured in the first weeks of pregnancy, treated all the way through. A mom who was about 5 weeks pregnant at the time of a side-impact crash came to us at 16 weeks with neck pain radiating to both shoulders, low back and hip pain up to 9/10, and dizziness and nausea from a concussion. By 21 weeks she was 65% better and back at full duty at work. At 27 weeks, as the baby grew, her pelvis twisted and her pain flared, so we increased visits and added a pelvic brace, round ligament self-massage and gentler positioning. At her final exam at 32 weeks she was 95% better, with normal, pain-free motion of the neck, low back and hips, and sleeping through the night.

A crash ten days before the due date. A mom in her late third trimester was struck in a car accident, went into labor the next morning, and delivered. Four weeks later she was rear-ended again. When she reached me she could not lift her toddler or the infant car seat and had to stop breastfeeding because holding the position hurt. With care she was 50% better at six weeks, 75% at ten weeks and lifting her toddler, and fully recovered at about seven months with no permanent restrictions.

Second trimester, care before and after the birth. A mom about five months pregnant was hit in a side-impact crash that spun the car. She had a concussion, headaches, neck, low back and pelvic pain. We used gentle mobilization and side-lying adjustments during the pregnancy, and the Webster Technique after delivery, when holding the baby had triggered numbness in her hand. By her final visit she reported 100% improvement, with full grip strength and no limits lifting her child.

A seatbelt across the belly at 13 weeks. A mom about 13 weeks pregnant was the front passenger in a side-impact crash. The airbag hit her head and the seatbelt pulled hard across her abdomen. Her ultrasound in the ER was normal, but she arrived with a worsened right hip, neck, shoulder and low back pain, could sit only about an hour and a half, and woke three to five times a night from hip pain. On exam her pelvic joints were too loose, with one sacroiliac joint stuck and the other inflamed. As I explained to her, “usually one joint gets stuck, the other one’s irritated from too much movement, and the car accident didn’t help that situation.” We fitted a pelvic brace worn low, below the belly, and used side-lying adjustments and neck adjustments without twisting. About eight weeks after the crash she rated herself 95% better, was sleeping through the night, lifting 30 pounds and back to her usual workouts. At 33 weeks she took a multi-hour road trip with no pain.

After Delivery: Mom and Baby Both Deserve a Check

The risk does not end when the baby is born. Pregnancy hormones, including estrogen, progesterone and relaxin, keep circulating after delivery and continue to loosen joints and ligaments throughout the body (8). That leaves a postpartum mom more open to injury, and an accident in the weeks after birth can strain a spine that is not yet stable. Moms recovering from a difficult delivery or a cesarean also benefit from structured physical rehabilitation for the pelvic floor and pelvis (10).

Babies can be affected too. Mild to moderate musculoskeletal injuries during delivery are common in newborns but often missed, and a difficult or traumatic birth shows the strongest link to infant colic and excessive crying (11). Mechanical strain during birth can also cause a suboccipital sprain at the top of the neck, described as KISS syndrome, which leads to early movement problems in infants (12). If a mom was injured and her labor was difficult, I recommend having the baby checked as well.

Don’t Wait to Get Checked

“I do treat a lot of women who are pregnant, even without crashes. It just helps with birth, with baby’s positioning. It’s very safe, whatever we do for treatment for the baby and for mom.” That is what I tell every expecting mom who comes in after an accident.

If you were in a car accident while pregnant, or in the weeks after giving birth, get checked by your OB or midwife first, and then have your spine and pelvis evaluated. Pain that starts before labor is one of the strongest predictors of pain that lasts, so the sooner the injury is treated, the better your chances of a full recovery. Call Dr. Verg Chiropractic in Vancouver, WA or Clackamas, OR to schedule an evaluation.

References

1. Eisenach JC, Pan P, Smiley RM, Lavand’homme P, Landau R, Houle TT. Resolution of pain after childbirth. Anesthesiology. 2013 Jan;118(1):143-51. doi: 10.1097/ALN.0b013e318278ccfd. PMID: 23249931; PMCID: PMC3876485.
2. Mohseni-Bandpei MA, Fakhri M, Ahmad-Shirvani M, Bagheri-Nessami M, Khalilian AR, Shayesteh-Azar M, Mohseni-Bandpei H. Low back pain in 1,100 Iranian pregnant women: prevalence and risk factors. Spine J. 2009 Oct;9(10):795-801. doi: 10.1016/j.spinee.2009.05.012. PMID: 19574106.
3. Sencan S, Ozcan-Eksi EE, Cuce I, Guzel S, Erdem B. Pregnancy-related low back pain in women in Turkey: Prevalence and risk factors. Ann Phys Rehabil Med. 2018 Jan;61(1):33-37. doi: 10.1016/j.rehab.2017.09.005. PMID: 29042300.
4. Khorsan R, et al. Systematic review. Obstetrical & Gynecological Survey. 2009.
5. Weis CA, et al. Journal of Manipulative and Physiological Therapeutics. 2020 (citing Williams Obstetrics, 23rd ed.).
6. Ohm J. Chiropractic Care in Pregnancy for Safer, Easier Births (citing Williams Obstetrics).
7. Pistolese RA. Journal of Manipulative and Physiological Therapeutics. 2002 (citing Taylor, 1948).
8. DiMarco DB. Post Partum and Beyond: Managing Back Pain in Women.
9. Studies of the Webster Technique and systematic reviews of manipulative therapy for pregnancy-related conditions.
10. Keller L. Clinical practice materials on recovery after traumatic and cesarean births.
11. Journal of Clinical Chiropractic Pediatrics. 2017 (birth-related musculoskeletal injury and infant colic).
12. Journal of Clinical Chiropractic Pediatrics. 2012 (critical review of Biedermann’s research on KISS syndrome).