Antenatal Physiotherapy

Antenatal Physiotherapy

A GUIDE FOR MOTHERS-TO-BE

Posture during pregnancy

During pregnancy, postural adaptations commonly occur due to constantly
changing forces on the spine:

1. In addition, as baby grows the increasing weight causes changes in the normal curvature of your spine.

2. Your centre of gravity changes often leading to a tendency to lean backwards. Consequently the normal curves of your back may be exaggerated. Most of your body’s pregnancy changes return to normal automatically after baby is born.
However your spine is still particularly vulnerable so it is important not to maintain these exaggerated curves after your pregnancy. Consequently it is important to watch your posture during and after pregnancy.
Maintaining good posture protects your back by recruiting your deep postural muscles. Be aware of your posture when standing, sitting and lying.

GOOD STANDING POSTURE:
1. Stand tall with your weight evenly on both feet.
2. Imagine a cord from the top of your head ‘lengthening’ your body toward the ceiling.
3. Remember to keep your shoulders back and head up. Tuck your bottom in.

BAD STANDING POSTURE:
1. The body releases hormones which soften the ligaments of the pelvis and lower back to facilitate baby’s growth and allows the baby an easier passage during labour.

GOOD SITTING POSTURE:
1. Try to ensure the height of your chair allows you to rest your feet comfortably on the floor.
2. Sit well back into the chair so that your lower back is fully supported. It may be necessary to place a small rolled towel at the small of your back.
3. Your hip and knees should be at 90° angle.
4. Very low soft chairs should be avoided.

BAD SITTING POSTURE:
1. Slouched with no lumbar support.

ABDOMINAL MUSCLE EXERCISE

Your tummy muscles will stretch and become weaker as your baby grows during pregnancy. These gentle exercises will help maintain their strength while providing support and stability for your lower back.

Position: All 4’s
Keep your back straight throughout the exercise.
• Allow your lower tummy (around your belly button and below) to relax away from your spine.
• Take a gentle breath in.
• As you breathe outwards, gently and slowly draw your lower tummy up and in towards your spine.
• Hold for 5 seconds while continuing to breathe normally, then relax.
• Repeat the exercise – try squeezing your pelvic floor muscle at the same time.
• Aim to build up to a 10 second hold, repeating 10 times.

GUIDE TO PELVIC FLOOR EXERCISES

What is the pelvic floor?
The ‘pelvic floor’ is a group of muscles occupying the floor of the pelvic basin.
It acts like a trampoline or sling providing support for the pelvic organs, including the bladder, womb and bowel. These muscles are prone to stretching and weakening as a result of childbirth, chronic coughing, repeated lifting, constipation and in some cases the menopause.

Pelvic Floor Exercises

The pelvic floor
Benefits of strengthening the pelvic floor:
• Keeps you dry.
• Helps prevent/stop leaking of urine with coughing, sneezing, exercise, dancing, laughing etc.
• Reduces the feeling of ‘something coming down’.
• Reduces urinary leaking associated with needing to rush to the toilet.
• Increases control of wind.
• May prevent the need for surgery.
• More enjoyable sex-life!

Identifying the pelvic floor muscle:
• Tighten and lift around the back passage (as if you were trying to stop passing wind). At the same time, include tightening of the front passages.
• One way of identifying the correct muscles is by touch and to try this try the following:
1. Place finger tips just behind the vagina.
2. Squeeze the pelvic floor muscle as above.
3. You should feel it tighten and lift up and away from your fingers.

GUIDE TO PELVIC FLOOR EXERCISES

Points to note:
• Make sure you are not holding your breath.
• Be careful that your legs or buttocks are not tightening.
• Remember no one should be able to see you doing the exercise.
• It is not recommended to exercise by ‘stopping and starting’ while passing urine.
• Be patient and stick with the exercises.
• It may take some weeks before you notice an improvement.

In addition:
• Drink 1 1/2 – 2 litres of fluid in total each day – try to eliminate coffee, tea and coke.
• If you are breastfeeding or are diabetic, you will need to drink more.
• Try not to go to the toilet ‘just in case’ – this may cause your bladder to hold less urine, increasing frequency.
• Avoid constipation by increasing the fibre in your diet to reduce straining.
• Avoid smoking, as coughing adds strain on the pelvic floor muscle.

If you need further advice, contact:
• Your GP or Consultant Obstetrician & Gynaecologist.
• Your Maternity Unit Physiotherapist.
• Your Public Health Nurse/Midwife.

Breathing Techniques for Labour

Remember
• There is no blue print for Labour and no standard to be achieved.
• Everyone’s labour is different.
• Accept your pattern of labour as best you can and stay with it contraction by contraction.

Your breathing exercises will help to keep you relaxed throughout your contractions, providing you with a focus, helping you to cope and ensuring you remain in control.

FIRST STAGE:

During this stage, your contractions will cause your cervix (neck of your womb) to dilate or open, to allow your baby to be born.

EARLY AND MID-FIRST STAGE:

It is often of benefit to move around and walk in your early first stage so that gravity is assisting you.

When each contraction starts:
• Adopt a position of comfort as suggested in the leaflet attached. Forward leaning in either sitting, standing or kneeling may help you cope with your pain by easing the pressure off the base of the spine.
• Focus your eyes on a point in front of you.
• Concentrate fully on your breathing, starting with slow, gentle, relaxed breaths.
• As the contraction builds, breathe a little deeper to help you over the peak; then as it eases, slow your breathing back down again.
• Always keep your breathing pattern under your control.
• If you feel the pain of labour in your back, rocking or circling your hips and pelvis rhythmically may help. Sitting on a birthing ball may assist with this.

Your birthing partner can help by:
• Massaging your back.
• Encouraging you to focus, relax and breathe calmly.
• Suggesting a change of position.
• Cooling your face with a wet flannel.
• Offering sips of water.
• Providing emotional support.

LATE FIRST STAGE:

As the contractions lengthen and become stronger, you may experience an urge to push, especially at the peak of a contraction. Let the midwife know and she will advise you if you are ready to push or not.
• If it is not time to push, ‘breathing in 3’s’ or ‘panting’ will help you to hold back:
– Rest one hand over your diaphragm muscle.
– Take a small breath in then pant out. Repeat rhythmically three times with a longer pant out at the end. Feel the diaphragm move as you breathe.
– Keep breathing in threes until the urge to push/contraction has passed.

• At any time in your first stage if you feel you are about to tense up and hold your breath focus on “sighing out slowly” (s.o.s breathing). As you concentrate on a long, slow, sigh-breath out your tension should release and your breathing relax again.

• As you transition from late first stage to second stage your mood may alter and you may feel emotional, weepy and tired. This is quite normal. Your birth partner and midwife will be able to support and encourage you through this stage.

• Remember your breathing techniques can be used alongside other types of pain relief as you choose.

SECOND STAGE:

At last your cervix is fully dilated to 10cms and you can now start to push and deliver your baby.

Positions commonly used are:
• Semi-sitting.
• Side lying.
• Prone kneeling.

Adopt the position that is both comfortable and practical for you. Your midwife will guide you with this.

Technique for ‘bearing down’:
• Remember to keep your head forward, tucking your chin down on your chest as you bear down.
• Try to keep your jaw and face relaxed.
• Breathe in fully, then give a long push.
• Go with the urge to push as you feel it.
• Let your breath go and repeat the above as long as the urge to push remains.
• Try not to squeeze your buttocks or tighten your pelvic floor muscle against any sense of bulging or stretching.
• Between contractions relax back and rest.
• As your baby’s head is about to emerge, work with your midwife to control the speed of delivery.
• Your midwife will direct you as to when to push and when to pant.

THIRD STAGE:

During the third stage the placenta is delivered and you may or may not be asked to help by pushing. This is a much shorter stage of labour lasting between 5 and 15 minutes.

Listen to the staff - they are there to help and guide you.

POSITIONS FOR EARLY FIRST STAGE LABOUR

1. Standing, leaning against the wall, feet well apart

2. Sitting facing backwards on a chair using pillows for comfort

3. Kneeling against a chairpiled with pillows/ beanbags/ birthing ball, relaxing forward

4. On all fours

5. Prone Kneeling

6. Using your partner for support

BACK MASSAGE FOR LABOUR

BACK MASSAGE FOR LABOUR

1. Many women in labour feel their contractions in the lower part of their back.
2. Your partner or support person can help by using back massage to ease the pain.
3. Make sure you are in a comfortable position such as side-lying or forward-lean-sitting using pillows for support.

Techniques:
• Use the palm of the hand directly over the area of pain in the lower spine.
• Apply a firm but comfortable pressure as you massage slowly in a circular direction.
• Apply a little more pressure for half the circle, then ease the pressure for the other half.
• Continue with the massage throughout the duration of the contraction, or until the back pain eases.

GUIDELINES FOR RELAXATION PRACTICE

Relaxation is good for you because:
• Helps to reduce muscle tension in labour. As you practise, you will become more aware of particular areas of tension in your body.
• Helps to conserve energy. You will be more alert and less exhausted after labour.
• Ensures a more adequate blood and oxygen supply to your baby and womb.
• Aids better communication with your midwife throughout your labour.

Position: Lying on your back, side-lying or sitting – well supported by pillows;
Breathing: Take 3 deep breaths, feeling your tummy rise as you breathe in and fall as you breathe out.

SEQUENCE

Shoulders

• Stretch your shoulders down away from your ears.
• Stop stretching your shoulders .
• Feel that your shoulders are lower and your neck feels longer.

Elbows

• Push your elbows away from your side.
• Stop pushing your elbows away.
• Feel that your elbows are open and slightly away from your side.

Hands

• Stretch out your hands, fingers and thumbs.
• Stop stretching them outwards.
• Feel how long and straight your fingers are as they rest.

Hips

• Roll your hips outwards.
• Stop rolling them outwards.
• Feel that your legs are slightly apart and falling outwards.

Knees

• Press your knees down into the supporting surface.
• Stop pressing them down.
• Feel how the supporting surface is holding up your knees.

Feet

• Push your feet down and away.
• Stop pushing them down.
• Feel your feet hanging loosely from your ankles.

Body

• Press your body back into the support.
• Stop pressing your body back.
• Feel the sensation of your body resting against the support.

Head

• Press your head back into the pillow.
• Stop pressing it back.
• Feel your head nestling comfortably in the hollow you have made in the pillow.

FACE

Jaw

• Pull down your lower jaw while keeping your lips together.
Stop pulling it down.
• Feel that your teeth are no longer touching and that the jaw-line is resting easy.

Eyes

• Close your eyes.
• Feel how your top lids are resting on the bottom lids.

Forehead

• Stretch your forehead in the direction of the sides of your face.
• Stop stretching your forehead.
• Feel how smooth your forehead is.

Repeat breathing as above.

AFTER A CAESAREAN-SECTION

This booklet will help you recover physically immediately after your caesarean-section. You will usually be in hospital for five days afterwards, and will be encouraged to get up and about as soon as possible.

Breathing exercises
While you are less active, it is important to use our lungs well, especially if you have had an anaesthetic:
• When sitting up in bed, take a deep, slow breath in through your nose, hold for the count of 3, then sigh the air out.
• Repeat this 5 times.
• Do this exercise regularly until you are up and about.
• If you feel the need to cough, try to support your wound with a small pillow or both hands. Bending your knees when lying in bed will help to ease strain on your wound when coughing.

COMFORT

Sitting
• When sitting up in bed, make sure you are well supported with pillows.
• Placing a small pillow or roll in the ‘small’ of your back may increase your comfort.
• Whether breast or bottle feeding a pillow underneath your elbow will help support you and your baby… and will help protect your stitches.

Lying
• When lying on your back, it may be more comfortable will a pillow under your thighs.
• When lying on your side, comfort may be increased by using pillows as shown.
This may also be a comfortable position for breastfeeding.

Getting out of bed

Important advice
• Try to attend a postnatal physiotherapy session prior to your discharge
• Your Physiotherapist will give you further advice on posture, back care and appropriate exercises.
• These are held Monday, Wednesday or Friday mornings at 11am in Room 14 on St. Angela’s Ward.

Going home in the car?
• Place a pillow between yourself and the seatbelt.

Driving
• Check with your insurance company that you are covered.
• CAN YOU CONCENTRATE?
• CAN YOU DO AN EMERGENCY STOP?

Lifting
• Avoid lifting a weight heavier than that of your newborn for 2 months.
• Always bend your knees and keep your back straight.

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