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----- Original Message -----
Sent: Wednesday, June 30, 2004 5:57
PM
Subject: Re: [ozmidwifery] Cervix
position and labour duration
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 -----
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
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
