00:01
So there's been some research performed
looking at how osteopathic manipulation could
influence different aspects of pregnancy,
so there were some older reports
looking at labor time on average so we
had patients that had their first child
and then with OMT, the average
labor time was 9 hours 20 minutes
and without, it was 15 hours
and if they had a previous child having
OMT had average delivery time of 5 hours
without OMT - 9 hours, so you could see how
OMT was able to decrease overall labor time.
00:45
There was another published study looking
at pregnant women who received OMT
versus those who did not
and the OMT group had decreased
complications compared to the non-OMT group
with less maeconium staining, less preterm delivery, less
need for forceps, and a slightly lower C-section rate.
01:07
There was a study looking at the application of
putting inhibitory pressure in the lumbar region
versus placebo which they put
pressure on the upper thoracic region
and so with the patients, out of 500 patients, 352
had complained of lower back pain during labor.
01:26
Group 1 received lumbar pressure and of
the group that received lumbar pressure,
23% requested major pain meds
and 4% received minor pain meds
whereas group 2 which had the placebo
or the upper thoracic pressure-
33% of those required, and requested major pain
medications and 8.3% requested minor pain medications
so you could see with this study that the
application of lumbar inhibitory pressure
helped to decrease the need for major pain
medications or just pain medications in general.
02:07
More recently, there was a large study
published which was funded by the NIH
looking at how osteopathic manipulation could
help with women from their third trimester on
with lower back pain and they were
able to show that they were able to
decrease the amount of lower
back pain during pregnancy
and so what I wanted to do is to share
with you the protocol to give you
ideas and consideration in terms of what
you can do and treat for pregnant patients
and the safety of this protocol was proven as there
were very few side effects and complications from it.
02:45
And so the study protocol started with the patient
seated and they performed articulatory technique
on the thoracic spine to try to
improve thoracic compliance,
the patient was then placed supine and cervical
soft tissue and myofascial was performed,
followed by thoracic inlet myofascial
release and the lateral recumbent position.
03:08
Patients had their
scapulothoracic junction release
with myofascial release and then
lumbosacral soft tissue technique.
03:21
In the supine position, they did
doming of the abdominal diaphragm
and then at the pelvis, it was
a concentrated technique
to try to improve any sort of ligamentous
strain and improve pelvis mobility.
03:35
There was anterior-posterior pelvic diaphragm
unwinding, SI articulatory technique,
frogleg sacral balanced ligamentous tension technique, ilial
muscle energy rotations and pubic decompression.
03:49
All five of these pelvic technique
were geared to try to improve
sacral pelvic mechanics and try to decrease
any sort of restrictions in the area.
03:59
Finally, the patient was treated with CV4
to help treat any cranial dysfunctions.
04:07
So you could see here, a graph
of the summary of the results,
the red line was the group treated with
OMT with usual obstetric care.
04:15
The blue line was ultrasound sham
with usual obstetric care.
04:23
And then the green line
was usual care only
and you can see how, even though the
OMT group had more pain to start,
it stayed relatively even and did not
increase like the other two groups.
04:38
So overall, the OMT group presented with worse
disablity scores, at the end had the best scores.
04:45
So overall, researchers found that there is
significant benefits with OMT in pregnancy:
decreases the probablility of having meconium
staining, decreases the use of forceps,
decreases the likelihood of having preterm
delivery and decreases the duration of labor.
05:02
Overall, it could also potentially help decrease
blood pressure, decrease fluid overload,
decrease sacroiliac dysfunction thus decreasing low
back pain and decrease carpal tunnel symptoms.
05:15
Prior to performing OMT, we have to be very clear on the
indications and contraindications during pregnancy.
05:21
So indications include craniosomatic
dysfunctions during pregnancy,
if patients have scoliosis or other structural
conditions associated with pregnancy,
treating edema, congestion or other pregnancy-associated
condition that could benefit from OMT is indication.
05:40
Contraindications include undiagnosed vaginal
bleeding, any threatened or incomplete abortion,
ectopic pregnancy, placenta previa, placenta
abruption, premature rupture of membranes,
preterm labor, prolapsed umbilical cord,
eclampsia and severe preeclampsia
and other surgical,
medical emergencies.