OMT for the Obstetric Patient: Practical Osteopathic Management

Anita Showalter, D.O, FACOOG (D)
Assistant Dean of Clinical Sciences
Associate Professor and Chair, Women’s Health
Pacific Northwest University of Health Sciences
Know the rationale for treating OB patients with
OMT
 Review the structural changes that affect somatic
dysfunction
 Become familiar with the scientific evidence for
treating OB patients osteopathically
 Review the osteopathic management of the
obstetric patient
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The changes in pain management during labor were
driven largely by patients
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 Henry Wadsworth Longfellow’s wife was one of the first women
recorded in the US to have used ether for the delivery of her
third child
 Many physicians felt this was a dangerous practice not suited for
a normal physiologic process
 Those not offering pain relief found their business suffering
 Birth became medicalized as most women began using
anesthesia for their deliveries and medical management was
necessary to counteract the physiologic changes caused by
analgesia/anesthesia
 Jaqueline H. Wolf. Deliver Me From Pain: Anesthesia and Birth in
America. John Hopkins University Press. Baltimore. 2009
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Does Osteopathy have a better idea?
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Relaxin – levels rise early in pregnancy
 Improves some conditions like fibromyalgia
 Worsens some conditions like short leg syndrome
Center of gravity – compensatory increase in lumbar
lordosis can cause/aggravate somatic dysfunction
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 Increased lordosis shortens the psoas
 A contracted psoas pushes the fetus forward in the pelvis
making it more difficult to descend, especially in obese patients
Pressure of the gravid uterus causes fluid
congestion
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 Edema
 Varicosities
 Hemorrhoids
Increased
tension
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Shorter labors. Whiting LM. 1911
 Women with OMT in prenatal care had significantly shortened
labor
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Decreased Mortality. Jones M. 1933
 DO’s had mortality rate of 2.2/1000. National rate 6.8/1000
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Decreased Complications. King HH, 2003
 Decreased complications in the treated compared to not treated
group, significant for decreased meconium staining, decreased
preterm labor and decreased need for operative vaginal delivery
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Improved Low Back Pain. Licciardone, John, 2010
 Patients treated with OMT had much less functional disability
than the not treated and placebo group.
Improve function
Decrease pain
Decrease complications
Optimize pelvic and fetal positions
For SI restriction, mild pubic shear, general balancing of
pelvic structures
Operator places hand on iliac crest with cephalad pressure and on flexed knee
with gentle pressure toward the table. The patient straightens her leg against
operators gentle resistance.
For Dysuria, Dyspareunia,
Pelvic pain with inability to weight bear
The pubic symphysis is checked for a shear. Knee is flexed on the
more caudad side. Operator leans into the leg until the barrier is
reached. Patient resists, relaxes and the operator finds the new
barrier. Repeat several times.
For sciatica, pelvic pain, asymmetry of the visceral structures
Fingers are placed at the upper pole of the SI. A compressive force is directed
toward the fingers. The middle pole then the lower pole are identified and the
vector is redirected. The extremity is then abducted and circumferentially
taken to neutral.
For thoracic discomfort, dyspnea
Patient relaxes against operators chest. Hands are placed on the
thorax and a springing action is done to articulate each segment.
Expedite the process
Decrease pain
Improve outcomes
Minimize pelvic floor damage
Reduce operative vaginal and
surgical deliveries
For SI restriction, mild pubic shear,
general balancing of pelvic structures
Operator places hand on iliac crest with cephalad pressure and on flexed knee
with gentle pressure toward the table. The patient straightens her leg against
operators gentle resistance.
Lumbosacral decompression to prepare for delivery, correct
acynclitism, treat arrested descent
Patient’s knees are flexed and externally rotated. Operator’s hand is placed
with fingertips at the sacral base and traction is applied. Patient kicks both
legs quickly and forcefully to straighten legs.
Used to Improve quality of
contractions in labor at T12 to
L2. Treat with percussion or
rhythmic motion for 1 minute
every 15 minutes
For low back pain and to mobilize the sacrum
Gentle pressure is applied while the patient does respiratory
assist. Hands will eventually start to spread apart from each
other. Can place patient in various positions to complete.
Correct dysfunction from birth
Prevent/treat breast infections
Treat pubic diaphysis
Treat postpartum depression
For galactorrhea, mastitis, mastodynia, post radiation pain
Operator places hand in axilla with the palmar surface against the chest
wall. A pumping action is initiated by pulling the arm while pressing against
the chest wall. May move in different planes of motion.
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For sciatica, pelvic pain, asymmetry of the visceral structures
Fingers are placed at the upper pole of the SI. A compressive force is directed
toward the fingers. The middle pole then the lower pole are identified and the
vector is redirected. The extremity is then abducted and circumferentially
taken to neutral.
For pelvic pain, interstitial cystitis, endometriosis,
pain from uterine fibroids, Mittleschmertz
Patient is supine. Tenderpoints are identified and treated in the counterstrain
method for 90 seconds. Serial points may be treated without returing to neutral.
For Hemorrhoids, Incontinence, Pelvic Pain
Thumbs are placed on the medial aspect of the ischial tuberosities.
Lateral pressure is applied. Patient takes several breaths with extended
exhalation phase.
For Postpartum Depression, increases sense of well being
Technique resets sacrum higher in the pelvis to reduce pelvic drag.
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Ectopic Pregnancy
Placenta Previa
Undiagnosed bleeding
Preterm labor
Ruptured membranes in labor (relative)
MIND – Reassure the patient that her body was
designed for this process and that you will assist her
for the healthiest outcome possible
 BODY – Know the biomechanical changes that
happen in pregnancy, labor and delivery and optimize
the structure to improve physiology, reduce pain,
avoid damage and correct dysfunction
 SPIRIT – Embrace the welcoming of a child into the
world, the rite of passage into motherhood, motherchild bonding and the creation of a family
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Email: [email protected]
Pacific Northwest University of Health Sciences
200 University Parkway
Yakima, Washington 98901
Cell 509-494-9359
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Whiting LM. Can the length of labor be shortened by
osteopathic treatment? J Am Osteopath Assoc. 1911;11:917921.
Jones M. Osteopathy and obstetrical mortality and stillbirth
and infant mortality: Symposium on osteopathy in
obstetrics chaired by S.V. Robuck, DO. J Am Osteopath
Assoc. 1933;33:350-353.
King, HH, Tettambel, MA, Lockwood, MD, Johnson, KH,
Arsenault, DA, Quist, R. Osteopathic manipulative
treatment in prenatal care: a retrospective case control
design study. J Am Osteopath Assoc, Dec 2003; 103: 577 582.
Licciardone JC, Buchanan S, Hensel KL, et al. Osteopathic
manipulative treatment of back pain and related symptoms
during pregnancy: a randomized controlled trial. Am J
Obstet Gynecol 2010;202:43.e1-8.