Effect of Osteopathic Obstetrical Management on the Duration of Labor in the Inpatient Setting

Participants

• Number: 100 women
• Criteria of inclusion: women with the expectation of vaginal delivery
• Criteria of exclusion: presence of absolute contraindications to OMT during delivery, including acute abdomen, blood pressure > 160/110 mmHg, unexplained visual disturbances, heavy vaginal bleeding preceding delivery, gestational age < < 34 weeks, treatment refusal, magnesium sulfate somministration as seizure prophylaxis in the setting of preeclampsia with severe features or severe gestational hypertension, scheduled cesarean delivery due to prior obstetrical conditions
• Groups of study: 2 groups
  • Group 1: standard obstetrical management with OMT, 50 women (mean age 28 years)
  • Group 2: standard obstetrical management, 50 women (mean age 28 years)
  • The groups included women of different ethnic background, in particular Hispanic, white, Asian, Middle Eastern and black

Interventions and evaluations

• Assessment of the total labor time, the presence of stained amniotic fluid and the necessity to perform a cesarean delivery for failure to progress in labor or lack of descent
• 1 OMT session not more than 20 minutes after the admission to the labor and delivery unit
• OMT: standardized treatment designed to act on specific structural and neurovascular components put under stress during labor
  • structural assessment of T12-L2, sacrum and lower extremities, Chapman points for the uterus and broad ligaments (assessment repeated the first morning after delivery)
  • suboccipital decompression (cranial nerve X), thoracic inlet release (lymphatic drainage), rib raising (T12), paraspinal inhibition (L1-2), sacral inhibition (S2-4). In the meantime, the treated woman was encouraged to breathe deeply
• obstetrical management: all women received epidural anesthesia and intravenous oxytocin at a certain point of the labor. The different decisions were made in accordance with the American College of Obstetricians and Gynecologists guidelines
• OMT performed by 3 osteopathic obstetricians
• Obstetric management administered by an osteopathic obstetrician and performed by osteopathic obstetricians in the group with OMT and by allopathic obstetricians in the control group

Results

• Primary outcomes: the group with OMT in addition to the obstetric management showed a shorter labor time compared to the group with standard obstetric management alone in a statistically significant manner (11.34 hours vs 16.57 hours). All other outcomes showed no statistically significant differences, both on the total sample and on the subgroups of primiparous and multiparous women.
• Further analyses: before the delivery, 90% of the women showed positive Chapman points for the uterus and 100% of them showed positive Chapman points for the broad ligaments of the uterus. After the delivery, the percentages of women with positive Chapman points dropped to 30% and 5%, respectively.

Discussion

The OMT proved to be able to act positively on the total labor time, considering that the protocol of techniques was thought to act on those structural and physiological aspects that can be particularly affected by the process of childbirth. In addition, the choice of specific techniques followed the pharmacological principle of using the “minimum effective concentration” to achieve an important result, also without adverse effects. Although a personalized OMT may be closer to the reality of the practice, especially to the clinical reality, it is not always possible to have enough time and resources to implement it, unlike an OMT defined by technical specifications.

Since OMT was performed in conjunction with epidural anesthesia, these two interventions may have acted synergistically in reducing labor time. Although this approach could be tiring, it could nevertheless encourage, for the operator, the opportunity to be close to the woman in labor and to support her.

Previous studies on the subject have shown a reduction in time of labor in relation to OMT performed in the intrapartum period. The OMT performed only in the antenatal period does not seem to reduce the labor time.
In addition to having a limited sample, the use of oxytocin and epidural anesthesia does not allow to fully understand the effect of OMT.