Physiotherapy for Postnatal Care

Postnatal care and exercise

Definition: It is the exercise program which the women undergo after pregnancy to maintain physical fitness and prevent complications.

Physiotherapy Aims

          ·          Re-educate and strengthen pelvic floor muscles

          ·          Care of perineum

          ·          Relief pain in perineum

          ·          To strengthen abdominal muscles

          ·          To give advise on posture and back core

          ·          Give instructions regarding the care of baby

          ·          To prevent postoperative complications

I. Initial postnatal exercises

1. Breathing exercises

·        Deep breathing exercises

·        Diaphragmatic breathing

·        Lateral costal and posterior basal expansion exercises

·        Helps in relaxation and circulation

2. Leg exercises

          ·          Ankle foot exercises

          ·          Elevation and compression

          ·          Lower limb movements

          ·          Improves circulation and prevents DUT

3. Pelvic floor exercises

          ·          It can be given within 6 hrs of delivery Uses:

          ·          Regain strength of muscles

          ·          Improve circulation

          ·          Promote healing

          ·          Relieve pain

          ·          Remove inflammatory exudate

Techniques:

          ·          Hold relax technique

          ·          Sustained contractions

          ·          Quick contractions

          ·          To stop mid flow urine

          ·          Interferential therapy

          ·          Faradism

Contractions:

          ·          200 contractions/day

          ·          Should be increased by 50 contractions/day

Note:

          ·          Sutures can be supported by sanitary pad, towel till perineal pain subsides

          ·          The pelvic floor muscles should be contracted every time the mother coughs, laughs, sneezes.

          ·          It can be done in sitting, lying or standing with feet apart.

4. Pelvic tilting exercises:

          ·          It can be done in side lying, crook lying or sitting at the edge of chair.

          ·          Pelvic tilting in prone kneeling by cat and camel exercises

          ·          Quick tilting relieves back pain

          ·          Rhythmic gluteal contractions helps to relieve pain from hemorrhoids or bruising.

5. Abdominal muscle exercises:

Uses:

          ·          After delivery the muscles becomes slack and intrabdominal pressure is reduced

          ·          Prevent diastasis rectii

          ·          Increased ligament laxity

          ·          Decreases chances of spinal muscle strain after delivery

          ·          For postural awareness

Exercises:

          ·          Crook lying with pelvic tilting

          ·          Crook lying with back flattening

          ·          Crook lying with back flat and sliding the legs forwards and backwards

          ·          Crook lying with tightening the abdominal muscles and lifting the head

          ·          Half crook lying with hip hitching

          ·          Sitting with trunk bending from side to side

          ·          Sitting with trunk rotation side to side

          ·          Crook lying with knees rolling from side to side

          ·          Contraction of hip extensors and maintaining forward/backward pelvic tilt

          ·          Prone lying with alternate leg raising and lowering

          ·          Prone lying and tightening of buttocks

6. Care of perineum:

          ·          Proper hygiene must be maintained to prevent infection

          ·          Frequent bathing

          ·          Changing of sanitary pods

          ·          The area should be kept dry

          ·          During bowel movements it should be supported by a clean folded sanitary towel

7. Relief of perineal pain:

          ·          Sitting on a cushion or pillows relieves pain

          ·          Side sitting or side lying for breast feeding

          ·          Prone lying with pillows under knee and abdomen

          ·          Ice massage, ice packs for 4-5 mins

          ·          Pulsed electromagnetic energy

          ·          Ultrasound

8. Episiotomy management Physiotherapy Management

Aims

          ·          To relieve pain

          ·          To promote healing

          ·          To improve circulation

          ·          To improve strength of pelvic floor muscles

          ·          To prevent infection

Means of Treatment

a. Pelvic floor exercises

          ·          Contractions and relaxations

o   Passage of urine

o   To stop diarrhea

          ·          Quick contraction

          ·          Elevator exercises

          ·          Pelvic tilting/rocking/rolling

          ·          Perineometer/Kegel‘s exercises

          ·          Vaginal cones

          ·          Foley‘s catheter/tampon

Uses:

          ·          Improves strength

          ·          Reduces pain

          ·          Decreases edema

          ·          Improves venous and lymphatic return

          ·          Removes transudates and traumatic exudates

b. Position

          ·          Adequate positioning with proper pillow support

c. Ice Massage

          ·          Crushed ice is packed in damp gauze or damp cloth and is placed over the site of incision or at the site of edema for 5-10 min.

          ·          Ice massage can be done by the lady herself

d. Warm saline water

          ·          To maintain perineal hygiene

          ·          Relieve pain and relaxation

          ·          To relieve burning sensation

h. Ultrasound:

          ·          It is done in crook lying position

          ·          Pulsed mode is used

          ·          Intensity is 0.5-1 W/cm2

          ·          Frequency: 3 MHz for superficial structures

          ·          Duration: 7-8 min

Uses:

          ·          To relieve pain

          ·          Remove traumatic exudates

          ·          Promote healing

Care:

          ·          The ultrasound head is washed with detergent and dipped in glutoraldehyde and dried after use

i. Pulsed electromagnetic energy

          ·          It is pulsed short wave diathermy

          ·          “No touch” mode is used

          ·          10-65 us pulse is used

j. Infrared radiations (IRR):

          ·          In crook lying position

          ·          Duration: 20 mins

          ·          Distance: 50-70 cm

Uses:

          ·          For pain relief

          ·          Improves circulation

          ·          Improves healing process