The Journal of the American Osteopathic Association, Virginia Tech, 2008/08, 108(8):429-430. doi: 10.7556/jaoa.2008.108.8.413, type of study: ,rct,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

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Keywords:

childbirth [59]
female [655]
labor [53]
maternal morbidity [2]
OMT [3925]
osteopathic manipulative treatment [3946]
randomized controlled trial [947]
women [608]

Abstract:

Osteopathic Manipulative Treatment (OMT) has been used for more than 100 years to enhance the physiologic process of labor and delivery by normalizing pelvic structures and providing adequate blood supply to the uterus. Maternal morbidity and mortality is a major health concern for developing countries and it was desirable to explore the benefits that OMT might have to offer. A randomized controlled trial in Santo Domingo, Dominican Republic at Hospital Maternidad Nuestra Señora de la Altagracia explored the relationship of OMT during labor and delivery on rates of cesarean section and perineal lacerations/episiotomies. A randomized sampling technique was utilized where each qualifying candidate received the next sequentially numbered envelope with a randomized number assigning her to either the treatment or control group. The staff physicians at the hospital managed the women in the control arm in the usual manner. Four Osteopathic Physicians and one pre-doctoral OMM fellow performed OMT on women during the first and second stages of labor and performed their deliveries. There were 33 parturients in the OMT Treatment group and 32 in the control, for a total of 65 in the trial. The results of a logistic regression analysis using Wald criterion, showed statistical significance P<0.05 in the treatment group for reduced rates of episiotomies in the primaparous (P = .04) and marginal significance in the combined primaparous and multiparous population (P = .05). The percentage of episiotomies in the primaparous treatment group was 35.29% and 75% in the control group. The percentage of episiotomies in the combined primaparous and multiparous groups were 15.15% in the treatment group and 37.5% in the control group. The cesarean rate for the treatment group was 9.09% and 18.75% for the control group (P = 0.098). The percentages of grade I & II perineal lacerations were 15.15% for the treatment group and 12.5% for the control group (P = 0.55) due to the extensive use of episiotomies in the control group. Cross-cultural issues made it difficult to perform the research as originally intended, yet the evidence shows Osteopathic Obstetrics provides a benefit to parturients. A multi-institutional randomized controlled trial is proposed as the next step for the evaluation of OMT during labor and delivery.