Ask Lynn: Where is the evidence?
Today, I am answering the question: Is there any evidence for what you are teaching with the Open Birthing Pattern in the pelvis?
I love this question because it brings up a very relevant conversation that I will be addressing in an upcoming Birth Healing Summit Podcast: What evidence should we use to guide our clinical decision-making?
We want to ensure that our patient care is based on the best available evidence (the research), tailored to individual patient needs and preferences (the client’s needs), and informed by the practitioner’s expertise (clinical expertise). In my practice and with the patterns I have found in the body, including the Open Birthing Pattern, I utilize these 3 pillars to guide the treatment I provide to my clients.
Best Available Evidence
When I first discovered the Open Birthing Pattern position of the pelvic bones after birth, I was curious about what the research said. I could find research explaining that the pelvic bones widen and move during birth, but I could not find much research about what happened to the pelvic bones after birth. I found one article that concluded the maternal pelvis was relatively stable during birth; however, most of the subjects in this study gave birth via cesarean section.
In my clinic practice, I found the ischial tuberosities splayed out to the side, sometimes more on one side than the other. This abduction of the tuberosities was not discussed in the research that I could find on the postpartum body. I continued my investigation to see what would help explain this abduction, and found some answers in the labor books I read. The pelvic bones were still in the position they go into to allow the baby out of the pelvic outlet. I was feeling this pattern for labor in the postpartum body.
While we know of motions of the pelvis for anterior/posterior rotations, inflare/outflare and upslips of the ilium, there is little research about the ischial tuberosities and their moving laterally for birth. Yet, this is what I find (and many of my students find) in postpartum clients. So, what do we do when what we find in the body is not yet in the research?
Tailored to Individual Patient Needs
This is where listening to our clients’ bodies comes into play and what allowed me to discover what is really happening in our postpartum clients. When we get outside of what we know about the joints of the pelvis and start palpating and seeing what we find in our clients, it can enable us to discover so much more that is going on in their bodies. The body knows way more than you and I. By listening to it through palpation practices I was able to tailor my treatment approach to my client’s body’s needs and got way better results with my clients. A lot of times, I was able to get patients out of pain in one session!
Comparing the quality of the tissues and mobility in the joints from side to side is my gold standard of assessment and one, I believe, every practitioner should be using. Bringing the spring testing we do to all the other joints in the body to the pelvis is another critical component to finding out what is really going on in our client’s body. Thank you, Jerry Hesch, for doing this!
The pelvic bones are shock absorbers from the lower extremities to the trunk. They need to be able to withstand the forces passing through them to function without pain. When the bones are not in their optimal position and lack the ability to transfer these forces, pain and dysfunction occur.
Practitioner’s Expertise
Over the years, and after working with thousands of clients, mobilizing the pelvic bones to bring them back to their original position after birth has been a game changer for my clinical results. Seeing client after client recover faster and more fully is another pillar of evidence I use to guide my treatment of not only the Open Birthing Pattern, but all the common postpartum patterns I see in the body.
It is not just my clinic that is getting these results. I frequently hear from my students how their clients who were plateauing prior to taking my courses are now getting better faster. The principles and techniques I teach are simple and easy to do. In my courses I share with you what I do every day in my clinical practice that works to get greater clinical outcomes.
Putting the Evidence to Work
Understanding how to assess and treat the different postpartum patterns after birth is critical for success in the care of your postpartum clients. It’s easy to do when you know what to look for and how to assess and then treat these different patterns.
In the Treating the Postpartum Pelvis online course, I dive into 4 patterns that show up in postpartum clients. You will learn:
- The signs and symptoms of each pattern
- The complaints your clients will have with each pattern
- How to assess for the patterns
- How to treat each pattern
- A home treatment program for some of the patterns that you can teach to your clients
The curriculum is very focused and efficient in giving you the information and techniques to work with the pelvis as I wanted a clear and concise course that would help you get results right away with your clients. I expand on other pelvic issues in the Holistic Treatment of the Postpartum Body course, but if you want to get better results with your postpartum clients in just 3 hours of online material, Treating the Postpartum Pelvis is a great place to start.
Going From Clinical Evidence to Research
So, while scientific research can show why my claims exist, there is not a study that has yet been done on the Open Birthing Pattern. I hope that there will be more money and interest to support the research on the postpartum body, but until them, I believe my students’ and my results are significant enough to prove that there is a strong basis for the Open Birthing Pattern theory. Two out of the three legs of evidence-based practice are present with what I propose, use in my practice, and teach in my courses. Good clinical results, in the thousands, make a very convincing case and will, hopefully, inspire more research on this topic outside of what I am working on directly.
Due to my passion for this work and these concepts, I am partnering with two professors to create research to prove the theory and clinical results I am seeing and hearing about on these ideas and concepts. Our challenge is finding a way to effectively measure the changes in the bony positions post-birth without having the funds to do MRI or radiologic studies. If you have any insights into how to measure pelvic outlet changes post-birth with the tools we currently have in the clinic, please let me know.
About the Author: Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com