Re: [ozmidwifery] Cervix position and labour duration

[Simone Keddy]

Hi Lieve and Monica,   Thanks for your replies, I'll try and answer them!   I did a post graduate course in Osteopathy in Obstetrics at the European School of Osteopathy in Kent.  We were taught internal techniques by Christine Michel, a French midwife and osteopath. (the French are very open!).  The main reason for doing internal techniques were:    to treat restrictions of the coccyx if not resolving with external treatments, as it is important to be able to move freely during labour, and is the major attachment of the pelvic floor.  (this can be a PR or PV technique)   TO asses tension and/or previous scaring of the pelvic floor and perineum, As osteopaths we will work with the tissues of the body to ensure that there is no tension affecting the free function of the area.   To assess the cervix for position and tension of the uterosacral ligaments that may restrict its dilatation   To asses the obturator interna muscle which cannot be palpated externally.    I would not describe the treatment as massage!  It is an assessment of the function and then treatment is usually a functional technique.  Probably easiest to describe it as an unwinding of tension in the tissues, finding the ease.   The treatment is not strong or as invasive as you may perceive. There is no force used during the treatment, it is quite gentle and not uncomfortable like other internal exams I have had with midwives, doctors and nurses.    I use internal techniques occasionally.  I have found that in some patients it can make a dramatic difference.  I had one lady who had sciatica prior to falling pregnant, which then got progressively worse until she saw me.  Most of the treatment was external, however on discussion with her she felt that an internal technique was appropriate.  She had a massive spasm of her obturator interna muscle.  This released with treatment and she felt an immediate change in the comfort of how the baby was sitting plus a significant improvement in her symptoms.  I believe that this was of benefit to her for her later labour, as if it ad not been released it could have restricted the baby's descent and position.   Lieve, Why do you feel that it is dangerous during pregnancy? There is less force than during sexual intercourse and no more germs likely to be presented.  I would be interested to know your reasoning.   I am trying to put my osteopathic training into the big picture of pregnancy and childbirth.  From my training I felt that if you released tension around the uterosacral ligaments this would help the dilation of the cervix.  Normally the assessment would be done by 28 to 30 weeks gestation.  This would then help the cervix during labour.   Monica, if it moves during or just before labour, then if it is restricted would that slow the progression?  I do not generally treat women in labour, although I have seen one lady who was in early labour when she came for her last appointment.  In most cases I am not using internal techniques anyway. The treatment is an inhibition technique of the uterosacral ligament, which if tense will tend to pull the cervix posteriorly and superiorly.  It is quite a simple technique and one that could possibly be used by midwives!   My aim with the posting this question was to see if the osteopathic perspective fitted in with what midwives found in practice. If midwives find that there is no relationship, then I would therefore review my treatment aims. Lieve this is why I am interested to know why you feel the internal technique is dangerous as obviously I would not want to be doing anything to harm my patients!   I was also interested to see that you feel that the cervix may represent the position of the baby.  I do work a lot around the external structures to help the baby adapt an anterior presentation.   AS for the treatment described by the osteopath, it is difficult to comment.  I feel that there are some genuine reasons for an internal assessment, but each case needs to be assessed individually.  I Give my patients written information, time to consider their options, ask questions and schedule an appointment if so desired.  They must sign a consent form and are offered a chaperone if they wish.  In most cases I will only do one internal assessment for a patient, unless there is a major problem that needs to be addressed.  I think that it is important that the osteopath is qualified, and registered,  If you have any concerns you can contact the registration boards, or any association they are a part of to check up on them.  It may be a genuine treatment depends on what he was doing and why, however there can be bad apples in any profession so be aware.   I hope this all makes sense to you   Simone Keddy                  ----- Original Message ----- From: Lieve Huybrechts To: [EMAIL PROTECTED] Sent: Wednesday, June 30, 2004 5:09 PM Subject: Re: [ozmidwifery] Cervix position and labour duration Hoi Simone,   I am independent midwife in Belgium and we send a lot of mothers to an osteopath for different reasons.   The position of the cervix often tells a lot over the position of the child, so when there is a posterior position in the baby you find mostly a posterior cervix. So it is important during pregnancy to inform mothers how to get an anterior position for their babys. An osteopath can help there to resolve tensions in the utero-sacrale ligaments.   I don't believe in vaginal examinations during pregnancy and I will seldom do it, I think it causes more harm than good. So I don't think that we have to check so for the position of the cervix. I would rather acces the position of the baby and help the mother to correct it by her behaviour.   I alsohave  a question for you: last week I had a homebirth. The mother had a long prelabor. She started on sunday morning and gave birth on monday evening. During labor she told me she had visited an osteopath who did vaginal techniques on her. So he indeed did twice a vaginal touche. He calls himself an energetic osteopath. I made a phonecall to him because I was  surprised and I needed a good explanation for the treatment he gives. I always try to convince women and gyns  that a vaginal checkup during pregnancy is not neccesary and possible harmfull and now there is again an osteopath who is doing it. He explained that he was thaught that most of women have leisures in the vagina and cervix, caused by vaginal infections. He massages them and he promises a fast and easy birth.( not so in this case) Do you have some more information over this treatment? I want to be informed about what happens to the pregnant women.   warm greetings Lieve   From: Simone Keddy To: [EMAIL PROTECTED] Sent: Wednesday, June 30, 2004 5:34 AM Subject: [ozmidwifery] Cervix position and labour duration Hi all,  I just have a question that some of you may be able to help me with.  I am an osteopath with a special interest in osteopathic care during pregnancy, having done post graduate studies in the UK.    One of the things we learnt about in our course was the position of the cervix and how that could affect the rate of dilation during labour.  The theory being that if the cervix is held posteriorly then the uterine contractions will not be pushing the baby's head directly over the cervix and thus decrease the rate of dilatation.   AS part of my course I spent some time observing midwives in the hospital setting in the UK.  I discussed this with them and they told me that they recorded the position of the cervix as being posterior or not during labour, but did not correlate this to predicted outcome.   So after all that blurb.. what I wanted to know is: in Australia is the position of the cervix noted? and secondly is there any correlation made to rate of dilation of the cervix?   I was wanting to know peoples opinion on this, since as an osteopath it is something that I could assess and offer some treatment for ( by addressing tension in the uterosacral ligaments etc.), thus hopefully helping the natural progression of labour.   I would be interested in any feedback that anyone may have.   And I must finish with saying that I really enjoy reading all the emails and I have learnt a lot from it. So thanks to all   Simone Keddy