Postnatal Care PDF

Women’s Health Physiotherapy PHY 4182 Nur Alya Natasya © 2019, University of Cyberjaya. Please do not reproduce, redistribute or share without the prior express permission of the author. Post Natal Period and management Sub-title or...

Women’s Health Physiotherapy PHY 4182 Nur Alya Natasya © 2019, University of Cyberjaya. Please do not reproduce, redistribute or share without the prior express permission of the author. Post Natal Period and management Sub-title or Date © 2019, University of Cyberjaya. Please do not reproduce, redistribute or share without the prior express permission of the author.  Topic/ Chapter Learning Outcome Post natal Period ❑ Discuss the complication of post natal ❑ Explain the post natal care ❑ Discuss the physiotherapy intervention ❑ Design appropriate exercises to improve general wellbeing of mothers © 2019, University of Cyberjaya. Please do not reproduce, redistribute or share without the prior express permission of the author. Topic and Structure of the lesson Post natal complications Post natal care Physiotherapy intervention Post natal Exercises © 2019, University of Cyberjaya. Please do not reproduce, redistribute or share without the prior express permission of the author.  Prenatal image Prenatal – change in body shape and function, swollen abdomen, enlarged breasts, oedema of the face, hands and legs, deposits of fat on her upper arms, hips and buttocks and thighs and even perhaps stretch marks.  Postnatal image ❑An empty and sagging stomach and enlarge abdomen ❑Lack abdominal muscles control ❑Painful , bruised and oedematous perineum ❑Difficulty in micturition and retention of urine ❑Coughing and sneezing – leakage ❑Emotional state – labile ❑Fatigue  Postpartum physical/mental condition Muscles and ligaments: Take 4 to 5 months to recover fully Separation between the two recti abdominis ( diatasis or divarification) small vertical gap 2-3 cm wide and 12-15 cm long. Sometimes measuring up to 12-20 cm width and extending nearly the whole length of the recti muscles Gross divarification – women with a narrow pelvis, carried large babies, multiple birth and multiparous women  Cont. ❑ Back susceptible to injury –reduced mechanical control and increased elasticity of ligaments ❑ Weaker pelvic floor muscles – stretching and trauma during delivery ❑ Perineum – bruised and oedemmma ❑ Haemorrhoids ❑ Temporary or permanent loss of sensation  Oedema ❑ Oedematous, aching legs, swollen feet and ankles ❑ Causes – prolonged pushing during labour, pelvic, pelvic congestion, dysfunctional urinary tract, or the temperature on the postnatal ward  Backpain Backpain – develops following birth Stretching and movement of the lax joints, epidural anesthesia, lithotomy position, poor feeding or nappy-changing postures, tension and fatigue may all be causative factors  Breasts ❑ Engorged ❑ Feel hot, full and painful ❑ Pain up to axilla ❑ Limit the arms movement and cause discomfort to young mothers  What is Engorgement? Normal breast fullness can lead to engorgement if your baby is not nursing often enough and/or not removing milk effectively. Engorged breasts become very full, firm, hard, and the skin can be red, taut and shiny. Some mothers have a low-grade fever. The breast may become so swollen that the nipples flatten making it difficult for your baby to latch.  Tips for relieving engorgement ▪ Nurse very frequently--a minimum of 8 times in 24 hours, waking the baby by the third hour if necessary. Nursing even more often, every 1-2 hours, is helpful. ▪ Apply heat to the breast for 5-10 minutes before nursing. Using warm, moist compresses or taking a warm-hot shower with gentle breast massage can help the milk flow. ▪ Apply cold compresses to your breasts after feedings for 15-20 minutes. Cold can reduce swelling and inflammation. A bag of frozen peas or corn wrapped in a cloth molds easily to the breast and can be reused. Do not apply ice bags directly to your skin.  CONT. Massage firm, lumpy areas of your breasts with your fingertips while the baby is nursing. Gentle massage or breast compressions can help with milk drainage. A well-fitted, supportive nursing bra may make you feel more comfortable. Avoid underwire bras during this time. Ibuprofen (Motrin or Advil) can help alleviate both pain and swelling. Discuss with your healthcare provider before taking any medication. Some mothers find cold cabbage leaves can be helpful to reduce moderate to severe engorgement. It is not clear if there is a substance in the leaves that reduces swelling or if it is simply the cool temperature of the leaves that provides relief.  Psychological state Maternal preoccupation – concern too much about baby than herself Potentially be an issue for the physiotherapist attempting to achieve rehabilitative aims  Postnatal care Routine care Return home – 6 hrs after delivery Average – 24 hrs to 72 hrs special intervention – 5 days  Establishing breastfeeding To teach skills leading to successful feeding Problems – engorgement, sore or cracked nipples, blocked ducts, and mastitis  Pain management PT to help reduce the pain What pain? What methods to use?  Postnatal check Obstetric team – 6 wks postpartum Post natal check – B/P, breast, abdominal status, uterine involution and status of the cervix, performing smear test, discussing contraception or any other problems  Postnatal physiotherapy Assessment: Assess mother as soon as possible post delivery REVISION –ANTE/POST NATAL PYSIOTHERAPY 1.How to minimize pain of sacroiliac joint dysfunction? 2.How to help pregnant mothers from symphysis pubis dysfunction 3. What are ways/methods to help pregnant mothers with coccydynia? 4. Give 5 signs to terminate ante-natal physiotherapy exercises  CONT. 5.Give 4 main aims of post natal exercise 6. List 4 physiotherapy methods to relieve perineal pain 7.Name 3 common manifestation of post natal depression illness 8.If the DVT is in ilio-femerol region, what are the appropriate physiotherapy interventions to reduce the pain?  ANSWERS 1.Support belt Various self-help maneuvers can be taught to relieve sacroiliac joint pain 2.Rest and reduction of nonessential chores Keeping the leg adducted Avoiding single-leg stance. Avoid long strides when walking, walking on uneven surfaces and excessive use of steps Gentle isometrics of hip adductors Pelvic support belts Ice pack 3. A cushion can be placed while sitting Gentle mobilisations Ice packs/heat, US and TENS 4. Excessive shortness of breath. Chest pain or palpitations. Painful uterine contraction. Presyncope or dizziness. Leakage of amniotic fluid. Vaginal bleeding. Excessive fatigue. Abdominal pain. Reduced fetal movement  ANSWERS 5. The main aims of physiotherapy during this period are: Introducing an exercise and relaxation program, thereby assisting the new mother’s in physical recovery Restoration of the muscle strength and tone Treatment of musculoskeletal problems Teaching correct ergonomics for breast-feeding, handling the baby and house-hold chores Role Of Physiotherapy In Post-natal Care. 6. Perineal pain Rest and apply ice for 10 to 15 mins, every 2-4 hours Pelvic floor exercises using contract-relax technique improves circulation and reduces swelling Use of cushion when sitting Electrotherapy: ultrasound, Pulsed electromagnetic energy (PEME), low level laser therapy, infrared or surface heat Post-natal Problems and Physiotherapy  ANSWERS 7.The ‘maternity’, ‘baby’, ‘third day’ blues Puerperal psychosis Postnatal depression 8. Bed rest may be advised till the swelling subsides Legs in elevation Foot exercises, quadriceps and gluteal muscle contractions, hip and knee flexion and extension can aid in circulation. Note:Deep vein thrombosis If the DVT is in calf: Vigorous ankle-toe movements and legs elevated Avoid pressure on the back of the calf while carrying out any activities  Role of Physiotherapist Women’s Health Physiotherapy Obstetrics Gynecology  OBSTETRIC PHYSIOTHERAPY The role of the obstetric physiotherapist is to help the woman to adjust to the physical changes throughout pregnancy and the puerperium so that stress is minimized.  Obstetric physio continued This will include assessment and treatment of: Any skeletal and muscular problems such as Symphysis Pubis Dysfunction and back ache. She will give pelvic floor education and is a skilled teacher of effective relaxation, breathing awareness and positioning thus helping women to prepare for labour. In the postnatal period, she will give advice on physical activity, teach post natal exercises and where necessary give specialized treatment  Physiotherapy Assessment Objective Assessment: Posture Lumbar/thoracic spine Sacro iliac joint Bony Alignment Palpation  Physiotherapy Assessment Management of symptoms: Explanation of condition provision of support Pelvic Mobility and Pelvic Floor Exercises (tubigrip/pelvic belt) Treatment of Dysfunction: Advice regarding aggravating Muscle Energy Techniques (MET) factors Mobilisations Care with hip abduction!! Release of muscle spasms Bed mobility teach technique Positions of comfort © 2019, University of Cyberjaya. Please do not reproduce, redistribute or share without the prior express permission of the author. RECTUS ABDOMINIS  What is Diastasis Rectus Abdominis? DRA is a common condition that affects many women during the childbearing years. As a fetus grows within the uterus, the uterus expands, which places stress across the structures surrounding it, specifically the muscles. The primary abdominal muscle on the front side of the body is called the rectus abdominis. This muscle is divided into a left and right half by a thick band of connective tissue called the linea alba As the uterus expands, stretching across the rectus abdominis potentially could occur. In some cases, the weakening and stretching of the linea alba connective tissue creates a separation between the right and left sides of the muscle, or diastasis.  IMPLICATIONS OF DRA The abdominal muscles have many important functions within the body, including postural support, movement, breathing, and protection of the internal organs. Therefore, if their structure is affected by DRA, a woman may have difficulty controlling her posture, which may put her at an increased risk for injury. Additionally, for a woman juggling the many stresses of having a new baby, the discomfort, weakness, and changes to postural control that may result from DRA can negatively effect her quality of life. https://www.youtube.com/watch?v=gmqjLD_hJ-c DRA DRAM  SYMPTOMS OF DRA Symptoms of DRA typically develop gradually over the course of a woman’s pregnancy and may linger following labor and delivery. Separated abdominal muscles themselves are not always painful, but the effects of DRA can cause pain.  A woman with DRA may experience any number of the following symptoms: visible and palpable (detected by touch) separation of the rectus abdominis muscle. Feelings of “flabbiness” in the abdominal muscles. Pelvic-floor muscle dysfunction that causes urinary or bowel problems (incontinence, leakage, constipation, etc). Low back or pelvic or hip pain. Poor posture. Feeling weak through the midsection. Sexual pain.  How Can a Physical Therapist Help? Postural Training. Improving postural control is one of the most important components of treatment for women who are dealing with DRA. Physical therapist will help to stabilize core, without overuse of the rectus abdominus muscle. This will involve training other core muscles, such as transverse abdominus (a deep abdominal muscle), and pelvic floor muscles. Physical therapist will show how to perform daily activities, such as lifting and carrying your baby, while using proper posture.  CONT. Stretching. When certain muscles become weak and overstretched, other muscles may become overactive and tight. Physical therapist will teach which needs to be gently stretched to improve strength and posture. Bracing. Sometimes taping or bracing of the low back and abdominal region can provide soothing external support for women with DRA in the early phases of rehabilitation. It can also help teach the proper position for midsection, as it provides support and decreases any pain may be feeling.  CONT. Education. Physical therapist can help to understand the movements or activities that are best to avoid, (For example, women suffering from DRA should not perform traditional sit-ups or crunches.) Physical therapist will be able to teach a safe and effective ways to regain your full function. Pelvic Floor Muscles Pelvic Floor Muscles Function of Pelvic Floor Muscles PELVIC FLOOR  What are the symptoms of SPD? The most common symptom of SPD is a sharp pain in the pelvis when walking, climbing stairs, turning in bed, standing on one leg, and certain exercises. The pain can be in the frontal pelvis and radiate throughout the perineum and even towards your upper thighs and buttocks. You trusting pain. It does not feel normal and sometimes even a clicking sound can be heard.  PAIN RELIEVING FOR SPD Wear a pelvic support belt made for pregnancy. Do your Kegels, & Pelvic Tilts. Avoid known triggers. Seek help.  Additional Tips use pillows to support your lower back when sitting stop wearing high heels use ice packs lay on your side instead of your back never cross one leg over the other when sitting avoid jumping or jarring activities avoid bike riding avoid stairs if possible sit on your fitness ball for relief Causes of Weak PFM Constipation PFM Exercises Post natal problems Incontinence Post natal care Physiotherapy Assessment Post Natal Exs Cont. Exercise with baby Cont. Exercise Cont. CONT. Rest and Relaxation  Thank you Address Telephone Website University of Cyberjaya 03 - 8313 7000 www.cyberjaya.edu.my Persiaran Bestari, Cyber 11, 63000 Cyberjaya, Facsimile Email Selangor Darul Ehsan, Malaysia. 03 – 8313 7001 [email protected]