A Future Possible Role for OTs in Maternal Care?

Have you ever heard of E-Stim labor induction? A 2017 research article by Elizabeth Cole explores her experience in inducing labor among 8 mothers by using electrical stimulation of the muscles. She writes:

"This case shows that a relatively painless, affordable, safe, and nonpharmaceutical approach to inducing labor is feasible and may be useful. All of the women in this study stated that the treatment relaxed them during a time that, for many women, is nerve-wracking and worrisome, and they achieved their goal of avoiding medical induction."

So, why am I writing about E-Stim labor induction here? The first reason is 1.) This approach to labor induction appears to cause less stress, and less stress means a lowered chance of postpartum posttraumatic stress disorder (PP-PTSD) development for mothers down the road, 2.) This treatment is non-pharmacological--which typically results in fewer side effects, 3.) Moms would not need to stay in the hospital after their treatment; whereas, moms receiving Pitocin and prostaglandins do... which often leads to a chain of events that increase the odds of complications and cesarean sections, 4.) E-Stim is within the scope of practice of occupational therapists, 5.) Occupational therapy practitioners in women's health are well-positioned to provide E-Stim induction (with advanced training and further research establishing protocols). 

To be clear, occupational therapists should not attempt to induce labor at this time, as there is not enough research to safely guide this practice; however, moving forward, this is an area of research and potential implementation that could greatly enhance the profession's role in maternal care. Before I get too carried away discussing the possibilities, let's take a look at the researcher's outcomes.

Post Due Date

Of the 6 mothers who received E-Stim treatment, the average length of time before going into labor was about 20 hours after the first treatment--3 of these moms required only 1 treatment; whereas, 3 moms required 2 treatments. Among the moms who only needed 1 treatment, all went into labor within 1-6 hours.

Pre Due Date

Of the 3 mothers who received the treatment prior to their due dates, the greater length of time before a woman's due date, the less effective the treatment. For example, the mother who was induced via E-Stim 12 days before her due date required 3 treatments and did not go into labor until 196 hours after her first treatment. However, the other 2 women respectively went into labor 6 hours after the first treatment for one mom, and the other required 2 treatments resulting in labor within 54 hours of her first treatment.

Implications

What does this mean? It indicates that E-Stim induction is likely best used as a conservative treatment prior to other means such as Pitocin and prostaglandins, and should be used at 39 weeks gestation and beyond. Using this method also informs the woman's obstetrics provider as to how amenable to induction a woman is before taking on the risks associated with more traditional means of labor induction.

Remaining Questions

Some future areas of research may look at possible labor complications following E-Stim induction, impact on neonate longitudinally, best placement of electrodes, optimal settings of NMES machine, length of treatment, and dosage.

What setting could occupational therapy practitioners administer E-Stim induction treatments?

Occupational therapists could provide this treatment in the obstetrics provider's office, in the mother's home, or in the hospital or birthing center. No matter which setting this treatment occurs in, mother's and baby's vitals should be closely monitored.

Why occupational therapists and not other professions?

Certainly, occupational therapists are not the only profession trained on E-Stim. In fact, chiropractors, physical therapists, and some physicians are trained on using this device. However, occupational therapists' cost of service is lower than a physician's, and generally speaking, occupational therapists more frequently provide E-Stim than obstetrics providers. 

Chiropractors can practice in hospitals, but it is rare. In fact, only about 3.5% of chiropractors hold hospital privileges.  Chiropractic practitioners could still offer this service outpatient, but they are essentially limited to this location. 

Physical therapists could certainly provide this service, and both occupational therapists and physical therapists are in every hospital. However, I believe the edge goes to occupational therapists as they have a greater net of services they can provide and address in relation to moms in the maternal period: function, mental health, transition planning, pain management, C-section rehab, feeding infant, sexuality, applied ergonomics, activities of daily living (taking care of mom's changing body) and instrumental activities of daily living (managing child care and chores at home). Whereas physical therapists in women's health typically focus on pelvic girdle strength, pelvic floor dysfunction, pain management, and preventative care through aiding moms in maintaining their overall physical fitness. 

Ideally, both physical therapists and occupational therapists would be in every women's unit within every hospital in the United States where they can engage in transdisciplinary care as they usually do in most settings.

When discussing potential non-pharmacological induction, as in other treatments, no one healthcare provider owns exclusive rights to any given treatment. Rather, it is the focus of treatment that may vary between the professions... or, it often falls on whichever profession is currently treating the client and is available to do so. 

Despite the multiple "whos" of who could provide E-Stim induction, is the opportunity for practitioners and their profession to invest time and effort into studying this approach, applying it, establishing protocols, teaching it, and sending more practitioners into the field practicing this approach. Initiative and drive is so often what matters most when discussing and establishing providers' potential roles in any given setting and among any given population. This potential treatment is no different.

Certainly, should occupational therapy be interested in this potential treatment, there is an excellent match between holistic need and OT practitioner skillset. 

So, what do you think? Is E-Stim induction a possible future treatment occupational therapists could provide?