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Monica Rezk DO

  • Graduate 2018
Scholarly Research Project

Osteopathic Manipulative Therapy in Prenatal Care at Shadyside Family Health Center

Monica Rezk, D.O.


Low back pain (LBP) occurs in about 50% of pregnant women, with some studies citing up to 90%.  Of these, 1/3 report reduction in quality of life and 4/5 report difficulty with daily routine. Conservative management is the gold standard LBP treatment in pregnancy.  Studies show that OMT improves LBP in pregnancy and leads to improved outcomes in labor and delivery.


This Quality Improvement project identified barriers to screening and implementing OMT in pregnant patients at the Shadyside Family Health Center (SFHC) and provided education on safe and effective OMT techniques in pregnancy to providers and Centering patients.  The project introduced OMT as part of routine prenatal care at the SFHC by OMT referral reminders during huddle, addition of pain score to the vital signs, and OMT referral option to 28-week checklist on prenatal office flow sheet.


Initial survey of SHFC providers showed low rates of screening and referral to OMT Clinic for LBP in pregnancy.  Chart review of patients who delivered in 2016 showed 53% (n=27) identified LBP and only 22% (n=6) were referred to OMT clinic.  Post intervention chart review of patients delivering in 2017 showed 56% (n=30) identified LBP and 50% (n=15) of patients were referred to OMT clinic.


Low back pain is common among pregnant patients at SFHC. Simple interventions to increase provider knowledge and increase screening rates of LBP increased the use of OMT to address pain. Further interventions could include adding OMT referral to Women’s Health LOPIR chart reviews and OBP3 prenatal chart reviews.