Osteopathy for Postpartum and DRA
The current standard of care for postnatal people in North America consists of a six-week check up with their family physician or health care provider (WHO, 1998). The six-week check-up involves education around contraception, breastfeeding and involves a vaginal exam or an assessment of any incision sites. The location of the incision site is dependent on the method of delivery, the physician will assess either the perineum or lower abdomen following a caesarean section. Unless the new parent vocalizes any other health concerns they are typically cleared to resume all regular forms of exercise and activities. Postnatal care from a physician or health care provider terminates after the required six-week check up. In Europe, particularly in France, postnatal patients receive 8 to 10 pelvic floor physiotherapy treatments as a part of their subsidized health care. It is safe to say that North America is a little behind when it comes to prioritizing postpartum care but the tides are changing.
Based on clinical experience, common symptoms that may not be addressed at the six week check-up include: bladder dysfunction, urinary incontinence, heaviness through the pelvis, pubic symphysis pain, diastasis rectus abdominus (DRA), caesarean section scar discomfort and perineal scar discomfort. Furthermore, recommendations for safe and effective exercises for the early postpartum period are often missed. This is largely due to lack of time allotted to continued care during the postnatal period. Appointments are brief and thus physicians cannot be expected to be able to address all subjective complaints during the short time allotted.
This gap in continued care during the postnatal period is often made smaller by alternative health providers like: physiotherapists, pelvic floor physiotherapists, chiropractor, naturopaths, acupuncturists, traditional chinese medicine (TCM) and osteopathic manual practitioners. Pelvic floor physiotherapy is generally the first recommendation I make for postnatal women experiencing any pelvic discomfort, pain with intercourse, pelvic organ prolapse and scar tissue build up in the perineum. As an osteopathic manual practitioner who has specialized in pre and postnatal care, I make a conscious effort to work with other practitioners to address these common symptoms.
What is Osteopathy?
Osteopathic manual therapy is a natural form of medicine which views the body as one interdependent and continuous system. Osteopaths aim to restore normality and function throughout the entire body by determining the root cause of imbalance and discomfort. Treatment involves a hands on approach to address tension and restrictions in the spine, muscles, fascial system, viscera, abdominal organs, reproductive organs and cranial-sacral system. Often treatment is subtle, intuitive but potent and powerful.
How can Osteopathy Support Health During the Postnatal Period?
The past three years of my career have been spent immersed in literature regarding the effects of global osteopathic treatment on DRA in postnatal women. DRA is the over-stretching of the space between the six-pack muscle which occurs in 100% of pregnancies (1). More relevant to this blog, DRA is observed to persist into the postnatal period, well beyond the six weeks allotted to postnatal care. In fact, at 6-8 weeks postpartum, 50% of people still have a DRA and the condition persists in 30-40% at 12 months postpartum. Without any intervention, this condition persists and can present with associated conditions like: pelvic floor dysfunction, urogynecological dysfunction, incontinence and low back pain (2). Thus, if you are postnatal and have been struggling with any urogynecological or lumbopelvic discomforts, you may have an undiagnosed underlying DRA which is contributing to your symptoms.
Based on the finding of my thesis study: “The effects of global osteopathic treatment on diastasis rectus abdominus in postnatal women”; osteopathic treatment in conjunction with a six week exercise program reduces DRA. After four global osteopathic treatments, first time mothers displayed significantly less DRA. After initiating a home based exercise program, subjects displayed an even greater decrease in inter-recti distance and less DRA.
Osteopathy can aid in the facilitation of healing during the postnatal phase. As previously mentioned, osteopathic manual practitioners seek to treat the entire individual, and do not assume that the location of discomfort is necessarily where the dysfunction originated. When it comes to postnatal care, osteopathic treatment offers a holistic hands on approach to health and is incredibly helpful for resolving the following signs and symptoms:
1) Low back pain
2) Pelvic pain
4) Shoulder tightness
5) Neck tightness
6) Postpartum anxiety
8) Scar tissue release
At any stage of life, health care should be catered towards the individual and be cooperative in nature. Practitioners of different specialties can collaborate to assure optimal care and distribute the load amongst the health system. If you are struggling with any of the common symptoms reported in this blog, I hope you found some reassurance and comfort knowing that all your resources have not been exhausted. There are alternative options and help available for you, especially during some of the most vulnerable months of your existence.
1) Mota, P. G. F., Pascoal, A. G. B. A., Carita, A. I. A. D., & Bø, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual therapy, 20(1), 200-205.
2) Spitznagle, T. M., Leong, F. C., & Van Dillen, L. R. (2007). Prevalence of diastasis recti abdominis in a urogynecological patient population. International Urogynecology Journal, 18(3), 321-328.
3) World Health Organization. (1998). Postpartum care of the mother and newborn: a practical guide: report of a technical working group.