Pregnancy

Pregnancy and Post-Partum Osteopathy

Pregnancy brings profound changes to the body. As the baby grows, the mother's posture shifts, ligaments become more lax under the influence of hormonal changes, and the musculoskeletal system must continuously adapt. These adaptations can give rise to a range of discomforts that osteopathy can help to manage through gentle, non-invasive manual techniques adapted to each stage of pregnancy.

Common Discomforts During Pregnancy

The following complaints are frequently reported during pregnancy and may benefit from osteopathic care:

• Lower back and pelvic pain — The progressive shift of the centre of gravity forward, combined with increased ligamentous laxity, places additional stress on the lumbar spine and sacroiliac joints. This is the most common reason pregnant women consult an osteopath.
• Sciatic-type pain — Compression or irritation of the sciatic nerve can occur as the pelvic structures adapt to the growing uterus, causing pain radiating into the buttock or leg.
• Rib and thoracic discomfort — As the uterus expands, the ribcage must accommodate the growing baby. Intercostal tension, difficulty breathing and upper back pain are common in the second and third trimesters.
• Digestive complaints — Gastric reflux, nausea and bloating are frequent during pregnancy. While primarily hormonal, these symptoms can be compounded by mechanical constraints that osteopathic treatment may help to relieve.
• Pelvic floor tension — The pelvic floor is under increasing strain throughout pregnancy. Addressing pelvic and lumbar mechanics can contribute to better support of the pelvic floor.
• Sleep disturbance — Musculoskeletal discomfort is a major contributor to sleep difficulties during pregnancy. Releasing tension and improving comfort can support better rest.

An Adapted Approach

Osteopathic care during pregnancy is characterised by the use of gentle, non-forceful techniques. No high-velocity thrusts are employed. The treatment is adapted to the trimester and to the specific needs and comfort of the patient. Positioning during the session is carefully considered, using side-lying or semi-reclined positions as appropriate.

The osteopath evaluates the mobility of the spine, pelvis, ribcage and diaphragm. Treatment typically focuses on optimising pelvic alignment, releasing lumbar and thoracic tension, and ensuring adequate mobility of the diaphragm and ribcage. This global approach aims to support the body's ability to adapt to the evolving demands of pregnancy.

Third Trimester and Preparation for Delivery

In the third trimester, osteopathic care can focus on preparing the body for delivery. Ensuring adequate mobility of the pelvis, sacrum and lumbar spine may contribute to more favourable conditions for childbirth. The osteopath assesses and addresses any restrictions that could affect pelvic mobility during labour.

It is important to note that osteopathic treatment does not replace obstetric care. It is a complementary approach that works alongside the medical follow-up provided by the midwife and obstetrician.

Post-Partum Osteopathy

The post-partum period brings its own set of musculoskeletal challenges. The body must readjust to its pre-pregnancy state, and the demands of caring for a newborn (breastfeeding postures, carrying, sleep deprivation) can contribute to new discomforts or reactivate pre-existing ones.

Common post-partum complaints that may benefit from osteopathic care include:

• Persistent lower back or pelvic pain
• Sacroiliac or coccygeal pain following delivery
• Upper back and neck tension related to breastfeeding postures
• General muscular fatigue and postural strain
• Perineal discomfort (in coordination with pelvic floor rehabilitation)

A post-partum osteopathic consultation is typically recommended 6 to 8 weeks after delivery, or earlier if significant pain is present. The osteopath works in coordination with the midwife and any pelvic floor rehabilitation programme that may be in progress.

Number of Sessions

During pregnancy, 1 to 3 sessions per trimester are usually sufficient to manage discomfort and support the body's adaptations. Post-partum, 1 to 2 sessions are generally adequate to address residual musculoskeletal issues and facilitate recovery. The frequency is always adapted to the individual patient's needs and response to treatment.

References

• Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. (2010). Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. American Journal of Obstetrics and Gynecology, 202(1):43.e1-8. PMID 19766977
• Franke H, Franke JD, Belz S, Fryer G. (2017). Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: a systematic review and meta-analysis. Journal of Bodywork and Movement Therapies, 21(4):752-762. PMID 29037623