OMM: Practical Video for OB

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.