Incidence of sacral somatic dysfunction in vaginal delivery after spontaneous labor

Pregnancy produces numerous physiological and structural changes in the pregnant person as the fetus grows. An increase in the hormone relaxin throughout pregnancy causes ligamentous laxity to allow the body to stretch and make room for the fetus and prepare the body for birth. This relaxation of the musculoskeletal system contributes to lumbar lordosis, pelvic pain, lumbar disc herniation, and joint pain. These changes may persist after delivery, causing years of lumbar and sacral pain. Although multiple reports indicate that 50 % of delivered patients will develop back pain, which is likely multifactorial, few studies have evaluated postpartum people for sacral dysfunctions.

Our study focused on investigating the incidence of sacral dysfunctions in recently postpartum patients. The objectives for this study include: (1) to assess the type of sacral somatic dysfunction present in postpartum patients; and (2) to investigate the correlation between various demographic factors (age of mother, gravida, para, gestational age, utilization of anesthesia, postpartum day of osteopathic evaluation, position of baby at delivery, operative delivery via forceps or suction, weight of baby) and sacral somatic dysfunctions.

This study was conducted by third year osteopathic medical students recruited during their obstetrics and gynecology clerkship rotation. Study participants were evaluated for sacral dysfunction utilizing a standardized palpatory technique. The findings made by student evaluators at each palpated site were recorded in a password-protected Microsoft Teams account. Principal investigators utilized this data to make a specific sacral diagnosis for each patient. Additional demographic data were recorded and utilized for analysis of risk factors. All data were analyzed and compared utilizing t test, analysis of variance (ANOVA) methods, chi-square tests, and descriptive statistics with the aid of JASP and SPSS software.

A total of 62 patients participated in the study. Sacral dysfunction has been identified in 100 % of patients. The total incidence of each diagnosis includes: three nonphysiologic, 24 physiologic neutral, and 35 physiologic nonneutral. There was a statistically significant association between nonphysiological diagnoses and an increased fetal weight as well as a shorter interval between birth and evaluation. Additionally, vacuum-assisted deliveries were more likely to result in a nonphysiologic or physiologic nonneutral diagnosis.

Understanding the incidence of various sacral dysfunctions in postpartum patients can provide us with a deeper understanding of potential causes of back pain following vaginal delivery. In the future, we hope that this pilot study will contribute to further understand factors contributing to sacral dysfunctions in parturient. Our aim is to take a more proactive approach to addressing specific sacral dysfunctions, thereby decreasing postpartum lower back pain.