Osteopathic Manipulative Medicine in Pregnancy: Physiologic and Clinical Effects

The osteopathic philosophy of health is built on a model in which basic body functions are
coordinated and integrated by the musculoskeletal system. Osteopathic medical students are
taught to consider these aspects in assessing, diagnosing, and treating the individual
patient. As a treatment method that reflects the osteopathic philosophy, osteopathic
manipulative medicine (OMM) is a body-based modality in which the patient is evaluated and
treated as a whole to improve physiologic functioning and remove impediments to optimal
health and functioning.

During pregnancy, a woman's body is challenged by significant and extensive physiological and
biomechanical changes. Some physiological changes, such as increased fluid volume and
sympathetic tone, may lead to consequences such as edema, preterm labor, and
meconium-staining of the amniotic fluid. The biomechanical state of the woman's body is also
drastically affected; as the fetus grows and the uterus expands, the center of gravity shifts
forward, rotating the pelvis anteriorly and increasing the lordosis of the low back, and may
also affect the motion of the hips and legs. These postural changes also have consequences
such as low back pain, decreased functional status, and altered gait. Both these physiologic
and biomechanical consequences can have a significant long-term impact on the health of the
mother and child.

OMM is theorized to facilitate the body's adjustment to the physiological and biomechanical
demands of pregnancy and improve the outcomes of pregnancy, labor and delivery. Clinical case
studies report reduced back pain, shorter labor, and fewer incidences of peripartum
complications in patients who receive prenatal OMM. However, to date we have found no
published systematic investigations of the efficacy of OMM in managing the adverse effects
that pregnancy has on a woman's musculoskeletal system, nor have we found any published
systematic studies to prove the mechanisms of action of OMM in managing pain, edema, or gait
in pregnant patients.

Thus, the overall question that guides this proposal is: to what extent and by what
physiological mechanisms does Osteopathic Manipulative Medicine (OMM) affect selected
conditions related to pregnancy, labor and delivery? Based on the principles and theories of
OMM and the limited previous studies, the hypothesis of this study is that OMM improves
clinical outcomes including low back pain, functional status, incidence of meconium-stained
amniotic fluid, and complications of labor and delivery, and that the physiological changes
related to improved autonomic regulation, peripheral hemodynamic regulation, and
biomechanical changes related to gait are, in part, responsible for these clinical benefits.

Inclusion Criteria:

- The woman must have medical clearance from her obstetrician at each study visit

- Must be less than or at 30 weeks gestation at the start of the study

Exclusion Criteria:

- Deemed high risk by the obstetrician (including but not limited to: abruptio placenta,
placenta previa, severe pre-eclampsia/eclampsia, vaginal bleeding, gestational
diabetes)

- Age 17 years or younger. Females 17 years of age and younger are considered pediatric
high risk pregnancies and therefore ineligible for inclusion

- If a patient receives any other manual therapies such as massage, physical therapy, or
chiropractic therapy, during the trial, she will be dropped from the study

- Subjects with a history of syncope either before or during this pregnancy will be
excluded from participation in the substudy