OMM: Application and Adjunctive Therapies in Obstetrics

00:01 So there are things as physicians that we could help counsel our patients to help prevent complications of pregnancy.

00:09 One is to really focus on nutrition, have them stay hydrated, drinking plenty of fluids and water Make sure they eat small frequent balanced meals, make sure that they're taking their prenatal supplements.

00:22 There's different stretches that they could perform to help maintain range of motion of the spine.

00:28 These are different yoga poses including cat stretch, child's pose, pelvic tilts, shoulder rolls They could do some squatting and stretching exercises and also Kegel exercises to strengthen the pelvic floor.

00:45 For osteopathic manipulation, make sure that you check the different transition zones and junctions in the spine.

00:52 Look for key areas of possible viscerosomatics at T10-L2.

00:57 Look at the SI joints, we want to make sure that we look at the sacrum to make sure that it's moving well, remember that the sacrum has to move well to allow for proper nutation and counternutation during delivery.

01:11 We'll look at lymphatic drainage.

01:13 Edema is a big complication of pregnancy and that swelling could lead to different problems so we wanna take a look at how we could improve lymphatic drainage freeing up the thoracic inlet, taking a look at the axillary folds, anterior shoulder.

01:29 and pectoralis spasms could lead to compression of the lymph vessels leading to increased edema of the hands and also increased edema of the feet.

01:39 We want to look at the abdominal diaphragm, again the growth of the fetus could push on the abdominal diaphragm causing problems with diaphragmatic excursion and also how the cisterna chyli could drain the thoracic outlet or thoracic inlet.

01:56 We discussed potentially mesenteric lifts could also help decrease some of the fascial compression on the GI tract.

02:05 We could look at the cranium, and the upper cervicals, looking at the SBS for possible cranial strains.

02:12 the upper cervical C2 region, the OM suture as the cranial nerve especially the vagus comes down and supplies parasympathetic innervation to the rest of the body.

02:22 We could perform visceral techniques and fascial releases.

02:26 You could actually contact the abdomen and uterus and provide some gentle lifts to try to decrease some of the fascial strains from the uterus.

02:33 We could look for Chapman points related with the patient's complaints You wanna look around the sacrum, the L5 posteriorly, along the thigh, the IT band and the pubic tubercles.

02:45 And again, performing a CV4 could help with trying to balance the cranial rhythm.

02:52 So the transition zones and the sacrum are key areas to look at The thoracolumbar region may help to regulatate contractions, you could treat that region by paraspinal inhibition by just placing gentle pressure in that area If the mother cannot lie supine, sometimes you can also do this in the seated position.

03:10 We could do seated articulatory techniques to the thoracolumbar junction Remember that the sympathetic innervation to the uterus is T12 to L2 so applying this gentle inhibition could potentially treat viscerosomatic reflexes to the uterus.

03:25 For the sacrum, it may help to regulate several dilation so we wanna articulate the side joint and try to addresss those parasympathetic innervations going to the cervix.

03:39 One of the regions to really check is also the carpal bones in the wrist.

03:44 Carpal tunnel is the second most common musculoskeletal complaint of pregnancy.

03:48 The median nerve gets compressed along that carpal tunnel In a lot with pregnancy, it really has to do more with edema As many as 35 percent of pregnant women will complain about carpal tunnel symptoms Carpal tunnel isn't usually the only problem with hands and wrist, DeQuarvain's tenosynovitis could also occur, and also trigger finger.

04:11 A lot of these issues really come about from increased fluid retention and the hormones, it's more common with patients with hypertension and preeclampsia.

04:21 Make sure when you do see swelling, that you do check blood pressure and make sure that teh patient is not in preeclampsia.

04:28 Typically, patients will have more swelling during the antepartum period and also during the second and third trimesters.

04:35 Postpartum, with the start of lactation, the tail end of the breast gets more engorged and that kind of pulls into the axilla and then may inhibit lymphatic drainage from the upper extremity So it's important to look at those somatic dysfunctions, treat any sort of sympathetic innervation and reflexes of the upper extremity that runs from T1 to T4 or sometimes T1 to T8 Taking a closer look at lymph drainage, lymphatic movement is dependent on the proper rmotion of the diaphragms.

05:08 You could also peform abdominal lifts to promote lymph drainage Carpal tunnel release could help with lymphatic drainage of the hand Scapular release could help with swollen breast and tenderness and it will also encourage milk letdown.

05:23 Mastitis is also a complication that could potentially occur.

05:27 This is infection of the glands in the breast tissue, so when this does occur, you'd want to take a look and see if there's viscerosomatic reflexes from T1 to T8 especially in the T4-T6 area.

05:40 You want to look at possible rib dysfunctions There may be anterior posterior ribs that will also impede lymphatic drainage and you definitely want to take a look at the thoracic inlet to allow for proper lymphatic drainage.

05:55 There are different craniosomatic dysfunctions that we could look at and make sure that we treat.

06:02 We want to look at this sphenobasilar synchondrosis to encourage motion and movement of the CSF This may potentially help with decreasing morning sickness and also looking at the OM suture which has the jugular foramen there where the cranial nerve X, vagus nerve passes through providing parasympathetic innervation to all the different organs in the abdomen.

06:26 We want to look at the thoracic diaphragm, looking at potential liver congestion that also could contribute to morning sickness.

06:34 We want to treat areas of the cervical spine especially C2 and C3 because those are dural attachments going all the way down to the sacrum and again consider the different aspects of the vagus nerve.

06:48 CV4 is the technique compression of the fourth ventricle that we could perform to potentially influence uterine contractions There was a historical paper that looked at patients that had stalled labor so they went to labor and then it paused and then physicians applied the CV4 which helped to restart the labor so it may help in cases of stalled labor.

07:14 So there's some additional post partum considereations to think about especially for patients who's had C-sections So C-sections could be a low transverse incision which is the most common with that incision, usually it follows the dermatome for T12 so patients may have some somatosomatic reflexes going to the th T12 dermatome If there is a vertical incision, then that would reflex back to the T7 toT12 dermatome so if there is a C-section, definitely check for potential viscerosomatic reflexes The surgical incision usually causes an acute somatic reflex and that could also increase segmental facilitation, thus increasing pain So you want to treat the areas of facilitation with some gentle OMM, potentially could use inhibition, rib raising, any sort of soft tissue myofascial technique So additional considerations for OMM in postpartum care, we want to try to balance autonomic tone, make sure that we address any sort of viscerosomatic reflexes that might occur from the labor and delivery, We want to assist and restore function to the structures -the pelvis, the skeleton and the supporting soft tissue to try to decrease any sort of muscle spasm and improve joint mobility.

08:30 You want to try to promote circulation of lymphatics for proper healing You want to remember to double check the sacrum, So the sacrum, remember, at the end will move more - the base will move more anterior allowing for the head to pass through and the body to pass through but if it's stuck in that anterior position, what happens is that causes a pull on the whole craniosacral mechanism due to the dural connections and that may potentially lead to fatigue, depression and low energy.

09:00 Also you want to try to treat your patients as soon as possible after delivery Remember that the hormone relaxin still is circulating throughout the body for a couple weeks after delivery but as that hormone starts to decrease and wear out, then the ligaments will start to become more tighter and it may become harder to treat some of the somatic dysfunctions that are present.

09:25 So there was a study done on the effects of OMT on post partum pain.

09:29 This was a hospital-based study where patients were treated with OMM They were given pain scale and a questionnaire and what was found that overall, 59 patients in the study, there was overall decrease of pain scale from 0 to 10 being the worst pain pre-OMM, the average pain was at 5 and post OMT, they dropped to 2.9 So if anything, the study showed that OMT was safe and efficacious for the treatment of postpartum pain management.

10:03 So overall, OMT has a very important role in potentially supporting and treating patients during the pregnancy and even afterwards it helped restore and helped them recover from the delivery.