Physiologic Changes during Pregnancy

00:01 So there are physiologic changes during pregnancy, As you can see, the growth of the uterus and the baby will compress on many different organs there are many different changes that occur in the mom's physiology also.

00:15 And so there are many different changes that occur in the mom's physiology also.

00:20 Cardiovascularly, there's increased plasma volume, decreased systemic vascular resistance that's usually due to the progesterone causing vasodilation, there's enlargening of the uterus and sometimes that could compress on the inferior vena cava and so women are not advised to sleep on their back especially later in the third trimester and instead it's best to ask them to lie on their left side to avoid compression on the IVC which would decrease venous return.

00:53 Patients during pregnancy also are at a hypercoagulable state.

00:58 The estrogen stimulates extra clotting factors so you need to be aware of potential DVTs (deep vein thrombosis) that could occur throughout the body.

01:12 There's also increased plasma volume, venous stasis, and decreased vascular flow so it could lead to increased varicosities, hemorrhoids, organomegaly, carpal tunnel syndrome and also leg edema.

01:28 There are significant changes to the respiratory system during pregnancy.

01:32 In fact, as the baby starts to grow larger, the diaphragm actually can be displaced up to 4 centimeters.

01:38 This displacement will tighten its attachments to the thoracolumbar spine that might hinder lymphatic drainage because of its relationship to the cisterna chyli.

01:48 The decrease in lymphatic flow sometimes could lead to organomegaly and increased edema.

01:55 The gastrointestinal system is also affected during pregnancy.

01:59 As you can see in the image, the growing baby will compress on the gastrointestinal tract.

02:08 This may cause decreased esophageal sphincter tone which leads to increased heartburn and reflux.

02:16 There might be decreased motility and increased gastric emptying time which then leads to nausea, constipation and hemorrhoids.

02:26 Patients may develop cholesterol gallstones during the first trimester thus increased risk for morning sicknes due to the increased estrogen.

02:35 Patients may also experience heavy vomiting developing hyperemesis gravidarum.

02:43 Pregnancy also affects the GU system.

02:46 Frequency and urgency is the frequent complaint.

02:48 This is due to the compression of the bladder.

02:50 Moms could also develop stress incontinence due to the increased pressure on the bladder.

02:55 The enlarged uterus also impairs lymphatic drainage and bladder emptying this increases the risk for urinary tract infections.

03:05 the endocrine system is intrically involved and changes drastically with pregnancy.

03:12 The pituitary enlarges, this increase levels of prolactin and oxytocin.

03:18 Prolactin is to help with milk production.

03:21 Oxytocin is to help with milk letdown and uterine contractions.

03:25 The thyroid also increases in its secretions of T3 and T4 as well as thyroid binding globulin.

03:31 Normal levels of free T3 and T4- remain relatively euthyroid.

03:38 There's also a physiologic hyperparathyroidism where there's increased calcium within the bloodstream to help support growth of the baby.

03:49 The hormone relaxin is also released from the corpus luteum.

03:54 This hormone is necessary to help soften the pubic symphysis and the ligaments.

03:59 This allows for greater expansion or pliability and softening of the ligaments then helps to accomodate changes during pregnancy to allow for the fetus to pass through the birth canal.

04:12 Pregnant women can actually be treated easier with OMT because they have this hormone on board that makes their ligaments more relaxed, serum levels are elevated throughout pregnancy until pretty much post partum day 3-4 and kind of remains in the tissues from up to 6-12 weeks after delivery.

04:34 So when does relaxin reaches peak? At 14 weeks and at delivery.

04:40 Again, this hormone helps all the ligaments to relax and thus allows for better passage of the baby through the birth canal.

04:50 So having a better understanding of the process of labor and delivery will help us to understand how we could better integrate OMT to ensure safe passage for the newborn.

05:01 So there's different stages of labor. The first stage is dilation.

05:05 So the cervix has to dilate to allow for the passage of the fetus.

05:12 Birth has four separate steps.

05:15 Usually there's a presentation of the head and then rotation, delivery of the posterior shoulder, and then the rest of the body and the umbilical cord afterwards.

05:25 So there's normal labor times for those who are delivering for the first time that could be up to a total of 30 hours and usually for the second baby, it could total up to 22 hours.

05:41 So there are five factors that will help determine whether or not there will be a succesful delivery.

05:46 Here we call the Five P's of Labor.

05:49 The first P is Passageway.

05:52 So the maternal pelvis and the soft tissues surrounding it is the passageway that the baby has to pass through.

05:58 And so if the maternal pelvis is too narrow, if the ligaments are too restricted, if the soft tissue is too rigid, and the passageway is not open enough for the baby to pass through, that will prevent succesful labor.

06:11 The second P is the Passenger.

06:13 So based on the baby, the baby's size the presentation, that will also play a part as to whether or not the baby could pass through the birth canal.

06:23 Powers.

06:24 So there's the involuntary uterine contractions of the mother and then the voluntary abdominal muscles and the diaphragm contractions of the mother.

06:32 So these are the two major forces helping to drive the baby through the birth canal.

06:38 The fourth P is Position.

06:40 Again, the position of the baby, the orientation of the head- those are all a major factor in labor.

06:48 And then the last P, the fifth P is Psyche.

06:51 And so what is the psyche of the mother? Is she able to carry through, and push through to allow for delivery of the baby? So these five "P" are things you consider for succesful labor and osteopathic manipulation could actually assist with the passageway, and also with the powers to help with the labor and delivery.

07:16 So let's look closer at the passageway and what should occur with the sacrum and pelvis during delivery.

07:24 So first, the iliac crest will diverge and the ischia will converge.

07:28 and what that does is to allow for descent of the baby's head into the pelvis.

07:33 The sacrum wil couternutate again to allow for the fetal descent into the pelvis.

07:39 Afterwards, the opposite would occur: The ischia will diverge, the iliac crest will converge and the sacrum will then nutate again to open the diameter for the final passageway of the head and the body.