Physiotherapy for Antenatal Care

Antenatal care and exercise

 Definition: It is the exercise program that the woman undergoes from the period of conception up to the birth of child.

Goals

          ·          To promote and maintain physical and emotional health of the lady throughout pregnancy

          ·          To identify and treat the medical and obstetric complications of pregnancy

          ·          To detect fetal abnormalities as early as possible

          ·          To inform and prepare family of parents about pregnancy, labor, delivery and care of the baby

          ·          Thus, the main aim should be healthy mother and healing infant

Physiotherapy Aims

          ·          Antenatal education about physical and psychological changes during pregnancy

          ·          Prepare the woman for delivery and prevent post operative complications

          ·          Psychological support

          ·          Proper fluid and nutrition intake

          ·          To teach leg, abdominal and pelvic floor exercises

          ·          Advise on back care and lifting

          ·          Regular checkups and examination

          ·          To teach methods for controlling neuromuscular tension and prevent circulatory complication

          ·          Adequate relaxation

          ·          To teach positions required for labor

Exercise Program

A. Early bird classes

          ·          To gain interest and motivation

          ·          Antenatal education

          ·          Mental preparation

          ·          Prioritization towards pregnancy

B. Back arc and posture

i. Postural awareness in lying, starting, sitting

          ·          For e.g. standing erect, sitting erect with pillows

 ii. Postural awareness during lifting, bending, and household activities

          ·          For e.g. while lifting objects floor it is advisable to never stoop, feet should be apart to increased base of support and any object lifted must be held close to the body.

          ·          Later during pregnancy patient is not advisable to climb on high stools or ladder due to lack of balance.

iii. Postural muscles to be stretched

          ·          Neck extensors

          ·          Shoulder internal rotators

          ·          Scapular protractors

          ·          Lumbar spine muscles

          ·          Hamstring

          ·          Calf muscles

vi. Postural muscles to be strengthened:

          ·          Neck muscle

          ·          Scapular retractors

          ·          Spine extensors

          ·          Hip and knee extensors

          ·          Dorsiflexors of ankle

c. Pelvic floor contractions and tilting exercises:

Instructions

          ·          Try stopping passing urine

          ·          Stopping/passing wind

          ·          Hold and relax   

          ·          Vaginal cones exercises

Contractions

          ·          200 contractions/day

Number of sessions

          ·          3-4 sessions/day

Pelvic tilting

          ·          By sitting at the edge of chair

          ·          In lying or prone kneeling

           ·          It helps in abdominal muscle strengthening, maintains good posture and prevents

d. Exercise to improve circulation and prevent cramps:

          ·          Explanation about the effect of circulation on pregnancy

          ·          Women with sedentary jobs are advised to do more exercises

          ·          Ankle dorsiflexion/plantar flexion (30 times)

          ·          Foot circling (30-40 times/session)

          ·          Avoid cross leg sitting

          ·          To teach self stretching in bed, with foot in dorsiflexion and not in plantar flexion to prevent calf cramps

          ·          Warm water bath, pre-bed time walk, avoid sitting for long time, foot exercises in bed before going to sleep also helps to relieve cramps during pregnancy

e. Relieve fatigue:

          ·          Stress coping strategies

          ·          Relaxation

          ·          Reassurance

f. To relieve sacroiliac pain, pubic pain, lumbar pain by low grade mobilization, soft tissue kneading, pelvic support

g. Advise on life style:

          ·          Type of work and how long to continue

          ·          Sports activities are encouraged

          ·          Alteration in life style

h. Teaching neuromuscular control

1. Mitchell’s Relaxation method

          ·          It is based on the physiological principle of reciprocal relaxation of muscles

          ·          Here, one group of muscles contract while the other group relaxes

          ·          The proprioceptors in the muscles and joints records the position of relaxation which is relayed and registered in the cerebellum

          ·          For e.g. For hunched shoulders: Pull your shoulders towards the feet-feel that the shoulders are away from ear- thus your neck may feel longer

2. Jacobson’s (contrast) method:

          ·          It involves alternatively contracting and relaxing various muscle groups throughout the body to develop a recognition of difference between tension and relaxation

3. Touch and massage:

          ·          Effleurage

          ·          Stroking

          ·          Kneading

4. Suggestions and visualization

i. Breathing Exercises

          ·          Takes care of postural hypotension, syncope and respiratory complications

          ·          Positions for breathing

o   High side lying

o   Long sitting

o   Arm lean sitting

o   Wall lean standing

j. Teaching positions for labor

1. First stage (waiting for cervical dilation)

          ·          Upright position with gravity assisting fetal descent

          ·          Walking about

          ·          Leaning forwards with support

2. Second stage (expulsive effort of giving birth):

          ·          Explains assistive techniques for delivery (episiotomy, forceps delivery Cesarean section)

          ·          Pain relief by TENS

          ·          Modified squatting position or use of child birth chair

3. Third stage (expulsion of placenta, cord and membranes):

          ·          Relaxation and breathing techniques

k. Swimming and water exercises:

          ·          Aerobic exercises like sports, jogging, walking, swimming should be encouraged

          ·          Encourage regular swimmers to continue swimming

Uses:

          ·          Buoyancy of water supports the increasing weight of pregnant lady

          ·          Tanning and muscle strengthening

          ·          Improves physical fitness and endurance

          ·          Yoga can also be done

l. General guidelines:

          ·          Avoid jerky, buoyancy or ballistic movements

          ·          Exercise at least 3-4 times a week

          ·          Practice warm-up exercises and cool down exercises before and after an exercise program respectively

          ·          Avoid strenuous activities in hot and humid weather

          ·          Maternal heart rate should not exceed 140 beats/min

          ·          Take adequate fluids, nutrition to prevent dehydration

          ·          Exercises should be done within the physiological limits of pregnancy