Care For New Mother

POSTNATAL  PHYSICAL THERAPY EXERCISE

Introduction

The postnatal or postpartum period is the period that occurs immediately after childbirth. The postnatal period is a critical, yet often neglected period in a new parent’s life. According to the World Health Organization (WHO), most maternal and newborn deaths occur in this period, therefore, proper parent and newborn management and care are vital.

The postnatal period is generally distributed into three distinct, but continuous phases:

• Acute Phase: 24 hours immediately following delivery
• Sub-Acute Phase: can last 2-6 weeks following delivery
• Late Phase: can last from 6 weeks – 6 months following delivery^[3]

The length of the Late Phase is dependent on major muscle tone and connective tissue recovery in the postpartum person. The physiological changes happening in the Late Phase are generally very gradual and subtle.^[2]

Postnatal Clinical Presentation and Considerations

• Increased elasticity in ligaments, which can last 4-5 months from
• Risk for thromboembolism due to increased clotting factors
• Elongation and separation between the two recti abdominis muscles known as 1
• Weakened pelvic floormusculature, including weakened perineal muscles
• Muscular abnormalities and weakness in the levator ani muscle
• Urinary incontinence
• Pelvic organ prolapse
• Pelvic floor neuropathy
• Incontinence of stool and flatus
• Swollen extremities hands, feet, and ankles
• Excessive weight gain
• Low back pain (LBP)

Physical Therapy’s Role in the Postnatal Period

Physical therapy, through a combination of manual therapies, specific treatments (such as pelvic floor muscle training), and therapeutic exercise, can improve health outcomes for new mothers in the postnatal period. Physical therapy interventions may help with the following:

• Improve mood
• Improve cardiorespiratory fitness
• Promote weight loss
• Reduce the risk of postpartum depression and anxiety
• Enhance psychological well‐being
• Improve sexual health and sexual dysfunction
• Lead to better outcomes assessing quality of life.

Specific Interventions

Diaphragmatic Breathing

It is a powerful breathing exercise to promote efficient respiration, bring awareness to breath control and postural control, enhance relaxation, and improve core muscle stability.

Pelvic Floor Exercises

Pelvic floor muscle exercises are vital for addressing pelvic pain, and urinary and faecal incontinence.  Pelvic floor exercises strengthen the pelvic floor muscles through muscular hypertrophy, allowing the muscles to better support the pelvic organs and structures and lessening the burden imposed on the supporting ligaments in and around the pelvis. Pelvic exercises also increase blood flow to the pelvic floor, which helps expedite the healing of damaged tissues.

• Kegel exercises, and other exercises that involve the repeated tensing and relaxing of the pelvic floor muscles, strengthen and improve the function in postpartum people.
• Biofeedback and electrical stimulation can also be used in concert with pelvic floor muscle exercises
• Pelvic floor exercises have been shown to help reduce symptoms of urinary and fecal incontinence

Hydrotherapy (Aquatherapy)

   Hydrotherapy has known effects to reduce pain, reduce muscle spasm and promote relaxation. A complete medical history of a postpartum person should be taken before attempting hydrotherapy to avoid health emergencies and negative health effects.