Women's Health Physiotherapy: Post Natal Period

Women's Health Physiotherapy - Post Natal Period

• Course details: PHY 4182, Nur Alya Natasya, University of Cyberjaya
• Topic: Post Natal Period and management
• 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

• Muscles and ligaments take 4-5 months to recover fully

• Separation between recti abdominis (diastasis/divarication) – small vertical gap (2-3cm wide, 12-15cm long) sometimes up to 12-20cm

• Gross divarication in women with narrow pelvis, carrying large babies, multiple births, or multiparous women

• Back susceptible to injury - reduced mechanical control and increased elasticity of ligaments

• Weaker pelvic floor muscles - stretching and trauma during delivery

• Perineum - bruised and oedematous

• Haemorrhoids

• 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

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.