Integrating osteopathic manipulative treatment into prenatal care visits in a family medicine resident clinic.

Abstract

Literature describing the integration of osteopathic manipulative treatment (OMT) during prenatal care visits in a resident clinic setting are scarce. Concise and readily accessible resources reviewing OMT in pregnancy are limited. We sought to integrate OMT into routine prenatal care appointments in a family medicine resident clinic setting and create a concise resource for those performing OMT in pregnancy. Musculoskeletal (MSK) pain in pregnancy is common. Specifically, low back pain (LBP) often accompanies pregnancy and may negatively impact sleep, the ability to work, and the ability to complete daily tasks. Treatment options for LBP in pregnancy are limited due to the concern for fetal or maternal harm associated with pharmacologic options or invasive procedures. OMT is a low-risk intervention that has been demonstrated to improve back pain and reduce deterioration of back-specific function in pregnancy. Over a 12-month period, one resident physician offered OMT during routine prenatal care visits in a family medicine resident clinic. During the study period, we identified barriers to integrating OMT along with solutions. Barriers to integrating OMT were noted in three areas: clinic setup and logistics, attending physician awareness of OMT in pregnancy, and treating physician knowledge of OMT in pregnancy. OMT provides pregnant patients withadditional treatment options and relief from MSK pain. This may reduce the number of patients with untreated MSKpain and benefit those who are unable to attend additional appointments outside of prenatal care due to financial or logistic barriers. OMT can be integrated intoroutine prenatal care visits in a training setting by providing complaint-specific OMT and determining how treatments can be performed for each unique examination room and table. Reviewing OMT in pregnancy with the attending physician prior to treatment, contraindications to OMT in pregnancy, and visualizing how treatments will be altered in pregnancy allows for smooth integration.