Osteopathic Manipulative Medicine in Pregnancy: Physiologic and Clinical Effects
Osteopathic Manipulative Medicine in Pregnancy: Physiologic and Clinical Effects
The purpose of this study is to determine to what extent and by what physiological mechanisms
 Osteopathic Manipulative Medicine (OMM) affects selected conditions related to pregnancy,
 labor and delivery.
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