The need for Osteopathic intervention pre, during and post partum.
In practice, the large majority of osteopaths treat women during pregnancy. How often are we thinking of preparing the body for the processes of pregnancy? We need a full understanding the mechanics of the patients past, and considering the processes involved in the pregnancy to follow.
In the acceptance that the osteopathic profession are primary healthcare practitioners, we must consider past the musculo skeletal framework to understand the stressors which are placed on the body from hormonal fluctuations. As always a thorough case history is taken to ray out any underlying pathologies and create our differential diagnosis. In preparation for fertility and pregnancy different factors must be considered. The health of the system, the tissue tone, the viscera and it’s ability to slide and glide within the peritoneum. Consider any chronic pictures of infections or operations which may have left adhesions, altering blood supply, drainage and ultimately function. Readying the body for the incredible musculoskeletal, and hormonal demands on the body during pregnancy require reflection on the history of the patient, and their capacity towards health and optimal function.
In treating fertility and women’s health, we must consider the lower limbs, hips and pelvis in context with the upper lumbar spine. Understanding that the thoracolumbar fascia is ** important in its role of support, the psoas is integral in guiding the baby’s position into the lower pelvis, the pelvic floor and neighbouring viscera to ensure the tension is equal and dissipated. The torso, head and cervical spine play crucial roles in accessing and influencing the Hypothalmic Pituitary Axis, the body’s key to self regulation of both stress and hormonal activity. The balance of the sympathetic and parasympathetic nervous state will also allow a more efficient use of the body’s reserves. The tone of the muscles, must be coupled with the function of the joints, the balance in the neural control, and the integration of the body on a whole. The true interpretation of what makes Osteopathy unique. It is not that we are treating holistically and unspecifically, it is the opposite of treating quite specifically through good case histories, palpation and specific knowledge of the structures, and systems and how they interrelate, that differs us from our peers.
Pregnancy is a topic we have all covered and treated in some capacity. Whether it is a simple lower back complaint due to the mechanical pressures, or a more complex picture of recurrent miscarriages with a history of endometriosis. Our skills may vary, but our approach whilst treating women’s health must be consistent with the osteopathic principles we have all (at one point) been taught. The application of looking at the body in it’s entirety, the structure and function should be complete and not restricted to one system of the body. The musculo skeletal dysfunctions are one of the most dramatic and cause us to focus perhaps strongly on this system. However, whilst treating during pregnancy we must consider what stage the woman is in, what the uterine position is, the ligamentous balance and health as well as the nervous system. Treating, adjusting, and balancing the body to encorporate changes in a multi system approach allows for more effective and longstanding changes.
Post partum treatment is often neglected and can serve to be a crucial time for the mother, and in turn the child and family unit. Here we consider the labour and it’s effects, the ability of the body to regain stability both ligamentous and muscular repair. The pelvis and any congestion or dysfunction resulting in prolapses (uterine, bladder or rectum) all of which are areas that when addressed readily can respond rapidly, reducing potentially years of dysfunction and distress. The effects of breastfeeding on the cervical spine, upper thorax can also be addressed, along with ensuring efficient lymphatics, and drainage facilitating the incredible pressures of milk production. A common complication during breastfeeding is the blocking of ducts, and mastitis. As osteopaths, of course with proper consent, treating and understanding the mammary glands, the drainage, and the fascial connections to reduce blockages and maintain healthy fluid mechanics can support our patients, again leading to better mecahanics and more function. Always aiming to support this transitional period into motherhood.