Women’s health

Women and children first: The osteopathic approach to obstetrics-gynecology

DO ob-gyns use their musculoskeletal expertise and holistic outlook to guide patients through some of life’s biggest moments.


On a typical day, a DO obstetrician-gynecologist might treat an expectant mother, a teen getting an annual wellness checkup or a woman experiencing severe pelvic pain. But whatever the situation, DOs’ extra musculoskeletal training and holistic approach can give them an edge in diagnosing and treating women’s health concerns.

Mind, body, spirit

The osteopathic emphasis on treating each patient’s body, mind and spirit is especially important in obstetrics-gynecology, DOs agree. “A woman’s reproductive system has a lot to do with her identity—as a woman, as a sexual being and as a mother,” says Anita Showalter, DO. “Obstetrics, traditionally, has been the area with the greatest joy and the greatest suffering.”

Fortunately, joyful outcomes are much more frequent, notes Dr. Showalter, an ob-gyn and the assistant dean for clinical education at Pacific Northwest University of Health Sciences College of Osteopathic Medicine in Yakima, Washington.

Anita Showalter, DO, poses at Providence Anchorage (Alaska) Medical Center. She serves as an ob hospitalist there, as well as at the Yakima (Washington) Regional Medical & Cardiac Center.

The osteopathic perspective also shapes DOs’ approach to labor and delivery. Dr. Showalter previously practiced in a part of Ohio with a large Amish population, whose members typically prefer to avoid unnecessary medical interventions.

“As DOs, we know birth is a normal physiologic process,” Dr. Showalter says. “We need to honor that, be patient, and give the body’s normal physiology time to work.” At Dr. Showalter’s Ohio practice, where she treated mostly Amish and Mennonite patients, the cesarean section rate was around 7%. Nationally, around 30% of births occur by C-section.

Diagnostic edge

Because they receive additional training in the musculoskeletal system, DO ob-gyns are able to take a more global approach to diagnosis. “As ob-gyns, we focus very much on the female organs,” explains Dr. Showalter. “But as a DO, I’m uniquely trained to look for signs of somatic dysfunction in the surrounding tissues as well, which is especially important when treating patients who have pain.”

Daniel Martingano, DO, co-authored a recent case report in The Journal of the American Osteopathic Association on how an osteopathic structural exam was used in diagnosing a pregnant patient who had isolated soleal vein thrombosis.

“When you’re treating a patient who has an ectopic pregnancy or deep vein thrombosis, doing an osteopathic structural exam can be helpful because it can give you a hint as to which organ is stressed,” says Dr. Martingano, a resident at NYU Lutheran Medical Center in Brooklyn.

OMT for moms and babies

Osteopathic manipulative treatment offers particular benefits for expectant and new mothers. Research suggests that OMT can reduce back and pelvic pain during pregnancy and labor, as well as postpartum; it can also be used to address breastfeeding issues. James Lindemulder, DO, an ob-gyn who practices in Goshen, Indiana, offers OMT to new moms who are having trouble producing enough milk, while Dr. Showalter has used OMT with infants who are struggling to nurse.

The DO difference

DOs’ holistic approach to treatment can be especially impactful for ob-gyn patients who’ve struggled to find effective diagnosis and treatment elsewhere. Dr. Lindemulder recalls a patient who’d suffered from debilitating pelvic pain since giving birth nine months earlier.

“She had lost her job and told me her situation was intolerable—she was in utter agony,” Dr. Lindemulder says. An osteopathic structural exam revealed that the woman’s pelvic floor muscles had spasmed and remained in a rigid position.

After several sessions of OMT and physical therapy, the woman’s pain began to lessen. “Within three weeks, she was moving around, playing with her kids and was in good spirits,” Dr. Lindemulder says. As a thank-you, the patient sent Dr. Lindemulder a fruit basket and a note: “You’ve given me my life back.”


  1. Linda Prin

    It seems that your practice really cares about the pre/post stages of labor with the mother and the welfare of the baby is also emphasized. My little sister is expecting and although she is new to the gyno-experience, it would be grand for her to understand that there are aides to good health after and before having a child. I will pass the message to her that she should look for a DO -OBGYN. Thank you. http://www.merkouris.net/gynecologist-anchorage-alaska

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