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Questions and Answers
What is one effective method to help pregnant mothers alleviate symphysis pubis dysfunction?
What is one effective method to help pregnant mothers alleviate symphysis pubis dysfunction?
Which of the following is a main aim of postnatal exercises?
Which of the following is a main aim of postnatal exercises?
What is a common approach to manage diastasis rectus abdominis in postpartum women?
What is a common approach to manage diastasis rectus abdominis in postpartum women?
Which statement best describes the role of physiotherapy in obstetric care?
Which statement best describes the role of physiotherapy in obstetric care?
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What is an inappropriate action for managing pain associated with coccydynia?
What is an inappropriate action for managing pain associated with coccydynia?
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What common manifestation is NOT associated with postnatal depression?
What common manifestation is NOT associated with postnatal depression?
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What is a recommended physiotherapy intervention for alleviating pelvic floor dysfunction?
What is a recommended physiotherapy intervention for alleviating pelvic floor dysfunction?
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During postnatal checkups, which assessment is NOT typically a focus?
During postnatal checkups, which assessment is NOT typically a focus?
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What is one of the main objectives of physiotherapy during the postnatal period?
What is one of the main objectives of physiotherapy during the postnatal period?
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What is one characteristic of diastasis recti that typically occurs postnatally?
What is one characteristic of diastasis recti that typically occurs postnatally?
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Which technique can improve circulation and reduce swelling in case of perineal pain?
Which technique can improve circulation and reduce swelling in case of perineal pain?
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Which intervention is important in managing Symphysis Pubis Dysfunction (SPD) during the postnatal period?
Which intervention is important in managing Symphysis Pubis Dysfunction (SPD) during the postnatal period?
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What is a characteristic symptom of Symphysis Pubis Dysfunction?
What is a characteristic symptom of Symphysis Pubis Dysfunction?
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What is a key focus of pelvic floor education following childbirth?
What is a key focus of pelvic floor education following childbirth?
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Which exercise is recommended to aid in circulation during recovery from potential deep vein thrombosis?
Which exercise is recommended to aid in circulation during recovery from potential deep vein thrombosis?
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What type of education does an obstetric physiotherapist provide to women?
What type of education does an obstetric physiotherapist provide to women?
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Which exercise is specifically beneficial for improving abdominal muscle control postnatally?
Which exercise is specifically beneficial for improving abdominal muscle control postnatally?
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What physical challenge is often faced during the postnatal period that can affect exercise capacity?
What physical challenge is often faced during the postnatal period that can affect exercise capacity?
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Which postnatal exercise technique enhances posture and reduces pain for new mothers?
Which postnatal exercise technique enhances posture and reduces pain for new mothers?
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What is one role of an obstetric physiotherapist in postnatal care?
What is one role of an obstetric physiotherapist in postnatal care?
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Which symptom is commonly associated with postnatal depression?
Which symptom is commonly associated with postnatal depression?
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Which symptom is NOT typically associated with the postnatal period?
Which symptom is NOT typically associated with the postnatal period?
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What is a recommended treatment for perineal pain that can also provide comfort while seated?
What is a recommended treatment for perineal pain that can also provide comfort while seated?
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What is a common emotional challenge faced by women in the postnatal period?
What is a common emotional challenge faced by women in the postnatal period?
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Study Notes
Women's Health Physiotherapy - Post Natal Period
- Course details: PHY 4182, Nur Alya Natasya, University of Cyberjaya
- Topic: Post Natal Period and management
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Learning Outcomes:
- Discuss complications of post natal period
- Explain post natal care
- Discuss physiotherapy intervention
- Design appropriate exercises to improve mothers' wellbeing
Topic and Structure of the Lesson
- Post natal complications
- Post natal care
- Physiotherapy intervention
- Post natal Exercises
Prenatal Image
- Changes in body shape and function
- Swollen abdomen
- Enlarged breasts
- Oedema (swelling) of face, hands, and legs
- Fat deposits on upper arms, hips, buttocks, and thighs
- Stretch marks
Postnatal Image
- Empty and sagging stomach and enlarged abdomen
- Lack of abdominal muscle control
- Painful, bruised, and oedematous perineum
- Difficulty in urination (micturition) and retention of urine
- Leakage of urine with coughing and sneezing
- Labile (easily changing) emotional state
- Fatigue
Postpartum Physical/Mental Condition
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Muscles and ligaments take 4-5 months to recover fully
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Separation between recti abdominis (diastasis/divarication) – small vertical gap (2-3cm wide, 12-15cm long) sometimes up to 12-20cm
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Gross divarication in women with narrow pelvis, carrying large babies, multiple births, or multiparous women
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Back susceptible to injury - reduced mechanical control and increased elasticity of ligaments
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Weaker pelvic floor muscles - stretching and trauma during delivery
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Perineum - bruised and oedematous
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Haemorrhoids
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Temporary or permanent loss of sensation
Oedema
- Oedematous, aching legs, swollen feet and ankles
- Causes: prolonged pushing during labor, pelvic congestion, dysfunctional urinary tract, or temperature in postnatal ward
Backpain
- Develops following birth
- Stretching and movement of lax joints, epidural anesthesia, lithotomy position, poor feeding/nappy-changing postures, tension and fatigue
Breasts
- Engorged
- Feel hot, full, and painful
- Pain up to axilla
- Limit arm movement, causing discomfort to mothers
What is Engorgement?
- Normal breast fullness can lead to engorgement if baby is not nursing often enough or not removing milk effectively
- Engorged breasts become very full, firm, hard, and skin may be red, taut, and shiny
- Some mothers have low-grade fever
- Nipples may flatten, making it difficult for baby to latch
Tips for Relieving Engorgement
- Nurse very frequently (minimum 8 times in 24 hours, waking baby by 3rd hour if necessary).
- Nurse even more often (every 1-2 hours)
- Apply heat to breast (5-10 minutes before nursing) using warm, moist compresses or a warm shower with gentle massage
- Apply cold compresses to breasts (15-20 minutes after feedings) using frozen peas/corn wrapped in cloth.
Other Postnatal Issues
- Massage firm, lumpy breast areas with fingertips while baby nurses.
- Use a well-fitted support nursing bra to feel more comfortable (avoid underwire bras)
- Consult healthcare provider before taking pain medication (Ibuprofen can help with swelling and pain)
- Cold cabbage leaves can reduce moderate-severe engorgement.
Psychological State
- Maternal preoccupation - too much concern about baby rather than herself
- Potential issue for therapist aiming to achieve rehabilitative aims
Postnatal Care
- Routine care: return home 6 hours after delivery, average 24-72 hours
- Special intervention: 5 days
- Obstetric team check-up at 6 weeks postpartum
- Blood pressure (B/P), breast, abdominal status, uterine involution, cervix status, smear test, contraception, any other problems
Establishing Breastfeeding
- Teaching skills for successful feeding
- Problems: engorgement, sore/cracked nipples, blocked ducts, mastitis
Pain Management
- Physiotherapist (PT) helps reduce pain
- Identify the pain
- Determine methods to use
Postnatal Check
- Obstetric team - 6 weeks postpartum
- Postnatal check-up - BP, breast, abdominal status, uterine involution and cervix status
- Performing smear test, discussing contraception or any other problems.
Postnatal Physiotherapy
- Assessment: assess mother as soon as possible post delivery
Revision - Ante/Post Natal Physiotherapy
- Minimize pain of sacroiliac joint dysfunction
- Help pregnant mothers with symphysis pubis dysfunction
- Ways/methods to help mothers with coccydynia
- 5 signs to terminate ante-natal physiotherapy exercises
Continuing (CONT)
- 4 main aims of postnatal exercise
- 4 physiotherapy methods to relieve perineal pain
- 3 common manifestations of postnatal depression illness
- Appropriate physiotherapy interventions to reduce DVT pain in the ilio-femoral region
Answers
- Various self-help maneuvers for sacroiliac joint pain relief
- Rest and reducing non-essential chores, keeping the leg adducted, avoiding single-leg stance, avoiding long strides when walking, uneven surfaces and excessive steps
- Gentle isometrics of hip adductors, pelvic support belts, and ice packs
- Cushion placement while sitting, gentle mobilisations, ice packs/heat, US and TENS
- Excessive shortness of breath, chest pain, palpitations, painful uterine contraction, presyncope, dizziness, amniotic fluid leakage, vaginal bleeding, excessive fatigue, abdominal pain, reduced fetal movement, etc
- Aim of physiotherapy include introducing an exercise and relaxation program, restoring muscle strength and tone, treating musculoskeletal problems, and teaching correct ergonomics
- Perineal pain relief methods - rest, ice packs (10–15 mins every 2–4 hrs), pelvic floor exercises (contract/relax technique), cushion use, electrotherapy, ultrasound, pulsed electromagnetic energy (PEME), low-level laser therapy, and surface heat
- Post-natal problems and physiotherapy
- "Maternal," "baby," "third day" blues, puerperal psychosis, Postnatal depression
- Bed rest until swelling subsides. Legs elevated, foot exercises, quadriceps and gluteal muscle contractions, hip/knee flexion and extension
Other Considerations
- Psychological state: Maternal preoccupation
- Pelvic floor muscles: Weak pelvic floor muscles, common postnatal factor in incontinence
- Constipation: Causes stretching of pelvic floor muscles, need for fluid intake and dietary adjustments
- Pelvic floor muscle exercises: Techniques to strengthen muscles
- Bladder habits: Importance of sufficient fluid intake
- Bowel habits: Straining avoidance, good fibre intake, and posture
- Rest and relaxation: Importance of rest and relaxation exercises.
- Physiotherapy assessment: Objective and subjective assessments are important to understand the condition thoroughly
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Description
Explore the critical aspects of post natal period management in this quiz designed for PHY 4182. Delve into post natal complications, care strategies, physiotherapy interventions, and suitable exercises to enhance mothers' wellbeing. This knowledge is essential for effective post natal recovery.
