Osteopathic Approach in Pregnant Women and the Immediate Postpartum Period

Sandra Lois, DO, MSc, will take you on a journey exploring the Osteopathic Apprach in Pregnant Women and the Immediate Postpartum Period in this 3-day evidence-based master class!

OBJECTIVES, PURPOSE, RELEVANCE FOR THE PUBLIC TO WHICH THE COURSE IS REFLECTED

Pregnancy is a physiological process in which a series of changes occur in women from a biomechanical, haemodynamic, hormonal, metabolic and emotional point of view. As a consequence of adapting to these changes, a series of symptoms may arise in different systems (nausea, reflux, lumbosciatica, carpal tunnel syndrome...).

During this course we will go through the processes that take place throughout the three trimesters, during labour and in the postpartum period, and we will study the physiological adaptations that take place in each phase in order to identify in our patients which regions are not adapting in the most appropriate way and why.

The most recent scientific evidence shows that the osteopathic approach in this period of reproductive life is safe and effective. As health professionals we must be able to identify the possible red flags and know in detail the risks and benefits of our approach with scientific rigour. In order to be effective, we need to handle diagnostic and therapeutic tools that are adapted to our patients in their different states and clinical presentations.

The target audience is graduated osteopaths.

TOTAL CEUs EARNED: 21h

SKILLS THAT WILL BE ACQUIRED

At the end of the course the student will be able to:

• Relate and identify the physiological processes that take place in pregnant women, as well as the warning signs that indicate the need for a differential medical diagnosis.
• Understand the biomechanical, hormonal, vascular, etc. adaptations that occur throughout the trimesters.
• Identify easily and immediately those structural restrictions that may interfere with a correct adaptation.
• Apply osteopathic diagnostic tests and minimal intervention techniques in different positions and with different approaches, adapting to the needs and situation of each patient.
• Know how physiological childbirth takes place, as well as the most frequent medical-surgical procedures.
• Perform gentle and effective manoeuvres on the lumbo-pelvic complex, pelvic floor and hips in order to support the function of the birth canal.
• Discern between myths and reality regarding the approach to the pregnant patient and other common procedures based on scientific evidence.
• Recognise postpartum sequelae and establish a treatment plan based on timing and priorities.

Day 1

Morning

· Review of the physiological changes of pregnancy: from embryo to foetus and the continuous adaptation of the mother's different systems.

· Biomechanical changes during pregnancy throughout the trimesters, affecting her anatomy as a whole.

· Practice: Examination of the pregnant woman in standing and sitting position.

Afternoon

· Anatomy and biomechanics of the pregnant pelvis: the osteoarticular system under the effect of relaxin and subjected to changes in the visceral pelvic contents and endopelvic fascia.

· Practice: Examination of the abdomino-pelvic region and uterine ligaments

Day 2

Morning

· Review of the most frequent complaints and their physiopathology. We will analyse in detail the biomechanical and hormonal factors that may favour the appearance of certain clinical manifestations by body regions, as well as how to address them.

· Practice: Lying supine approach techniques

Afternoon

· Pathology of the pregnant woman

· Red flags and safety precautions

· Practice: Lateral decubitus approach techniques

Day 3

Morning

· Childbirth:

o Natural childbirth and its phases (dilatation, expulsion and delivery). Facilitating factors.

o Assisted and/or instrumented childbirth.

o Caesarean section

o Oxytocin and its important role in the process of maternity.

· Practice: prepartum check-up

Afternoon

· The postpartum period:

o The immediate postpartum period and its timing

o Obstetric sequelae and treatment plan

o Coccygodynia

SPECIFIC EQUIPMENT

Students should come with comfortable, elastic clothing that allows for wide movements and deep grasping in areas such as the ischirectal fossa.

LEARNING METHODS

- Lectures and introduction to the basic theoretical contents

- Discussion of presentation and the available scientific evidence

- case review involving different clinical presentations

- Demonstration and practice

SELECTED READINGS

o Liddle, Sarah & Pennick, Victoria. (2015). Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane database of systematic reviews (Online). 9. Art. No.: CD001139. 10.1002/14651858.CD001139.pub4.

o Hensel KL, Buchanan S, Brown SK, Rodriguez M, Cruser dA. Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects: the PROMOTE study. Am J Obstet Gynecol. 2015 Jan;212(1):108.e1-9. doi: 10.1016/j.ajog.2014.07.043. Epub 2014 Jul 25. PMID: 25068560; PMCID: PMC4275366.

o Gitlin RS, Wolf DL. Uterine contractions following osteopathic cranial manipulation. J Am Osteopath Assoc. 1992;92(9):1183 [Abst] Hensel KL, Roane BM. Does Compression of the Fourth Ventricle Cause Preterm Labor? Analysis of Data From the PROMOTE Study. J Am Osteopath Assoc. 2019 Oct 1;119(10):668-672. doi: 10.7556/jaoa.2019.114. PMID: 31566694.

o Stuber et al.: Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature. Chiropractic & Manual Therapies 2012 20:8.

o Franke H, Franke JD, Belz S, Fryer G. Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: A systematic review and meta-analysis. J Bodyw Mov Ther. 2017 Oct;21(4):752-762. doi: 10.1016/j.jbmt.2017.05.014. Epub 2017 May 31. PMID: 29037623.

o Sheraton A, Streckfuss J, Grace S. Experiences of pregnant women receiving osteopathic care. J Bodyw Mov Ther. 2018 Apr;22(2):321-327. doi: 10.1016/j.jbmt.2017.09.007. Epub 2017 Sep 11. PMID: 29861226.

o Thul TA, Corwin EJ, Carlson NS, Brennan PA, Young LJ. Oxytocin and postpartum depression: A systematic review. Psychoneuroendocrinology. 2020 Oct;120:104793. doi: 10.1016/j.psyneuen.2020.104793. Epub 2020 Jul 6. PMID: 32683141; PMCID: PMC7526479.

o Martingano D, Ho S, Rogoff S, Chang G, Aglialoro GC. Effect of Osteopathic Obstetrical Management on the Duration of Labor in the Inpatient Setting: A Prospective Study and Literature Review. J Am Osteopath Assoc. 2019 Jun 1;119(6):371-378. doi: 10.7556/jaoa.2019.066. PMID: 31135865.

o Einspieler C, Prayer D, Marschik PB. Fetal movements: the origin of human behaviour. Dev Med Child Neurol. 2021 Oct;63(10):1142-1148. doi: 10.1111/dmcn.14918. Epub 2021 May 10. PMID: 33973235.

o Corrêa Junior MD, Passini Júnior R. Selective Episiotomy: Indications, Techinique, and Association with Severe Perineal Lacerations. Rev Bras Ginecol Obstet. 2016 Jun;38(6):301-7. doi: 10.1055/s-0036-1584942. Epub 2016 Jul 11. PMID: 27399925.

o M Amorim M, Coutinho IC, Melo I, Katz L. Selective episiotomy vs. implementation of a non-episiotomy protocol: a randomized clinical trial. Reprod Health. 2017;14(1):55. Published 2017 Apr 24. doi:10.1186/s12978-017-0315-4

o Zaami S, Stark M, Beck R, Malvasi A, Marinelli E. Does episiotomy always equate violence in obstetrics? Routine and selective episiotomy in obstetric practice and legal questions. Eur Rev Med Pharmacol Sci. 2019 Mar;23(5):1847-1854. doi: 10.26355/eurrev_201903_17219. PMID: 30915726.

o Leon-Larios F, Corrales-Gutierrez I, Casado-Mejía R, Suarez-Serrano C. Influence of a pelvic floor training programme to prevent perineal trauma: A quasi-randomised controlled trial. Midwifery. 2017 Jul;50:72-77. doi: 10.1016/j.midw.2017.03.015. Epub 2017 Mar 27. PMID: 28391147.

o Stone, C. (2007) Visceral and Obstetric Osteopathy.

o Sandler, S. (2012) Osteopathy and Obstetrics