4. •What is child bearing year?
- “ time from conception through post partum
adjustments”
•Nine months of pregnancy + three months after
birth of baby
•What is fitness?
- physical + psycho-emotional well being
7. 1)To promote good health, poise and sense of well being
during pregnancy and encourage preventive medicine
2) To give opportunity to discuss fears and expectations
3) To provide instructions in skills to conserve energy, pain
tolerance level and strains of pregnancy
8. 4) To alleviate the stress and strain
5) To rehabilitate women during puerperium and
post natal life as same as pre – pregnant state
13. • Goals :
1) To educate the pregnant woman along with
her spouse by any means like ante natal
classes, pictures, videos, booklets etc.
14. • Education regarding :
- Pregnancy physiology and psychology
- Physical and psycho-emotional changes
- Need for partner and family support
- Screening examinations
15.
16. - Coping with changes and minor discomforts
- Small frequent meals
- Eat before rising
- Avid greasy and rich food
- Propping up the bed head
- If necessary, contact doctor
17. - Empty bladder often
- Take frequent fluid
intake
- Eat fiber reach diet
- If necessary, contact
doctor
33. • Goals:
1) To educate women to cope up with certain
physiological changes
2) To perform brief screening assessment before
starting actual exercise programme
3) To give proper exercise guidelines
4) To check contraindications
5) To inform regarding precautions
36. - Light frequent
meals
- Sleep in semi
recumbent position
- Ingest proper milk
- Avoid fatty foods,
coffee
37. Constipation &
haemorrhoids
- Increased soluble fiber
and fluid intake
- Increase activity level
like exercise, walking
- Change iron
supplements
- analgesics, ice ,
padding
38. - Support hosiery
- Avoid prolonged
standing
- Walk rather than stand
- Elevate feet when lying
- Rest frequently
39. • Exercise guidelines : set by the American College
of Obstetricians and Gynecologists
1) Consult with medical caregiver before
commencing exercises
2) Gradually increase exercises if previously
sedentary
3) Women can continue to exercise during
pregnancy and can experience health benefits
even from mild to moderate exercise. Regular
exercise at least three times per week is
recommended.
40. 4) Maximum heart rate should not exceed 140-150
beats/min or limit set in consultation with doctor.
5) Do not perform exercises that require lying on your
back after the first trimester of pregnancy.
6)Prolonged periods of motionless standing should be
avoided.
7) Avoid over flexing and overextending joints, quick
direction changes, jumping and jarring motions. Be
careful during exercises requiring balance and use
outside support.
41. 8) Modify the intensity of cardio exercise according to
perceived exertion or the “talk test.” Stop exercising
when fatigued and do not exercise to exhaustion. ”
listen to your body.”
9) Never exercise when you have a fever or if the
climate is hot and humid. Wear loose, cool clothing to
stay cool.
10) Drink liquids before, during and after exercise and
be particularly careful to ensure an adequate diet due
to increased caloric needs.
42. 11) Your fitness goals during pregnancy should not be
exercising for weight loss, increase in flexibility or
strength gain.
12) If a regular pattern of contractions, low back pain,
pelvic pressure, or any other unusual symptom
develops while exercising, stop and communicate with
your health care provider.
13) Always include at least a 5-minute warm-up and a 5-
minute cool down period.
14) Get up and down from floor carefully and keep legs
moving when you first stand up. This prevents blood
from pooling in the legs and causing dizziness.
43. 15) Pain, discomfort, or shortness of breath should be
avoided. Valsalva manoeuvers should be avoided.
16) Vary your exercise program. Some excellent
alternatives are walking, swimming and stationary
cycling.
44. Absolute contraindications Relative contraindications
Severe cardiovascular, respiratory
or systemic disease
History of repeated (3 or more)
miscarriage or premature labor
Uncontrolled hypertension,
diabetes or thyroid disease
Diabetes
Ruptured membranes or premature
labor
History of rapid labor or poor fetal
growth
Persistent bleeding after 1st
trimester
Early pregnancy bleeding
Incompetent cervix Sedentary lifestyle with very poor
fitness
Preeclampsia or toxemia Breech presentation after 28 weeks
Multiple pregnancy (triplets, etc.) Palpitations or arrhythmias
Poor fetal growth Anemia or iron deficiency
Extreme over- or underweight
45. Potential risk to the foetus from maternal
exercises
Hypothermia
Hypoxia
Abnormal heart rate
Decreased utero placental flow
Increased uterine contractions
Reduced maternal glucose level
Disruption of maternal endocrine haemostasis
Poor growth
58. Benefits of exercise
• Maintain healthy body weight and avoid
excess fat accumulation
• Maintain or improve cardiovascular fitness,
muscular strength, endurance, and flexibility
• Decreased musculoskeletal complaints such as
back pain
• Decreased minor discomforts of pregnancy
• Improved posture and body mechanics, which
may improve coordination, balance, and body
awareness
59. • breath awareness and relaxation
• Prevention and treatment of problems
associated with gestational diabetes,
hypertension, and preeclampsia
• Stress reduction and enhanced self-image
• Possible easing of labour with fewer
complications of delivery faster postnatal
recovery
64. • Goals:
1) To educate the woman to get relax and stress
free
2) To educate woman for dressing
3) To continue exercises as much as possible of
second trimester but with mild intensity
4) To educate the woman to cope up with changes
5) To educate and practice for different positions
helpful in labour
68. • Relaxation exercises/ techniques:
- Major aim is to prevent the mother becoming
unduly tired
- To help the mother in labour
- To help the mother to control her thoughts
and emotions
74. • “ the process in which the foetus, placenta
secundines are expelled from the uterus via
the birth canal after minimum period of 20
weeks”
• Mainly 3 stages of labour
75. • Stage 1 – from onset of labour untill full
dilation of cervix
• Changes during this stage – pain and
contractions
76.
77. • Stage 2 – full cervical dilation to expulsion of
the foetus from vagina
86. • Goals :
1) Relief of pain either of episiotomy or
caesarian
2) Ergonomic advices for preventing further
complications
3) Educate Exercise programme
88. - Advice for abdominal
binder or tubigrip or
supportive under wears
- Abdominal retraction
exercises
- Pelvic tilting exercise
- Progression with
coming up upto the
hands
90. - Ultrasound to the
periphery initially
- Warm compresses
- Crushed ice
- PEME
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101. 1) Jennifer Hollowell et al., did study on The
effectiveness of antenatal care programmes to
reduce infant mortality and preterm birth in
socially disadvantaged and vulnerable women in
high-income countries: a systematic review
• 36 distinct eligible studies covering a wide range
of interventions, including group antenatal care,
clinic-based augmented care, teenage clinics,
prenatal substance abuse programmes, home
visiting programmes, maternal care coordination
and nutritional programmes.
102. • Conclusions: There was insufficient evidence
of adequate quality to recommend routine
implementation of any of the programmes as
a means of reducing infant mortality in
disadvantaged/vulnerable women.
• BMC Pregnancy and Childbirth 2011, 11:13
103. • Ana L Vallim et al., did study on Water
exercises and quality of life during pregnancy
to evaluate the effects of a physical exercise
program of water aerobics on the quality of
life (QOL) of sedentary pregnant women
• 35 women was given routine antenatal care,
while another group of 31 women, in addition
to receiving the same routine care as the first
group, also participated in three classes of
water aerobics per week.
104. • QOL was evaluated by applying the WHOQOL-
BREF questionnaire in both groups at the
20th, 28th and 36th weeks of pregnancy.
• Conclusion : The great majority of the
participants considered that the practice of
water aerobics had benefitted them in some
way. QOL scores were found to be high in both
groups during follow-up. There was no
association between the practice of water
aerobics and QOL.
• Reproductive Health 2011, 8:14
105. • Po-Chun Ko, Ching-Chung Liang et al. did
study on A randomized controlled trial of
antenatal pelvic floor exercises to prevent
and treat urinary incontinence
• to evaluate the effect of antenatal pelvic floor
muscle exercise (PFME) in the prevention and
treatment of urinary incontinence during
pregnancy and postpartum period
• Three hundred women were randomly
assigned to the PFME group and control
group.
106. • Urogenital Distress Inventory-6 (UDI-6),
Incontinence Impact Questionnaire-7 (IIQ-7),
and question of self-reported urinary
incontinence.
• Conclusions: PFME applied in pregnancy is
effective in the treatment and prevention of
urinary incontinence during pregnancy, and
this effect may persist to postpartum period.
• International Urogynecology Journal January
2011, Volume 22, Issue 1, pp 17-22
107. • J.T. van der Spank ET AL. did study on Pain
relief in labour by transcutaneous electrical
nerve stimulation (TENS) by burst –
conventional obstetric TENS-apparatus
• On 59 women compare to epidural analgesia
• Conclusion : During TENS application the pain
scores were significantly lower (p<0.0001)
• Archives of Gynecology and Obstetrics
November 2000, Volume 264, Issue 3, pp 131-
136
108. • Keep the “WOMAN” fit and happy,
always gives “SAFTEY” to “MUMMY AND
BABY”
109. • R Sapsford et all; WOMEN’S HEALTH – a
textbook for physiotherapists, part two – child
bearing year
• Jil mentle, Jeanette Haslam, Sue Barton,
Physiotherapy in Obstetrics and Gynaecology,
pg no 93 – 244
• Elizabeth Noble, Essential Exercises for the
Childbearing Year: A Guide to Health and
Comfort Before and After Your Baby Is Born
110. • Margaret Polden, Jill Mantle , Physiotherapy in
Obstetrics and Gynaecology
• Exercise guidelines by The American College of
Obstetricians and Gynecologists, 2001
• Ann Thomson, Alison Skinner, Joan Piercy, Tidy’s
Physiotheray, twelfth edition , pg no :382-400
• Sandie Keane, Pilates for core strength
• Roger L. Hammer, PhD ,Jan Perkins, MSc,Richard
Parr, EdD, FACSM, Exercise During the
Childbearing Year. Journal of Perinatal Education,
9(1), 1-13; pregnancy, postpartum exercise,
guidelines.
111. • Jennifer Hollowell et al., The effectiveness of
antenatal care programmes to reduce infant
mortality and preterm birth in socially
disadvantaged and vulnerable women in high-
income countries: a systematic review, BMC
Pregnancy and Childbirth 2011, 11:13
• Ana L Vallim et al., Water exercises and quality of
life during pregnancy Reproductive Health 2011,
8:14
• Po-Chun Ko, Ching-Chung Liang et al. A
randomized controlled trial of antenatal pelvic
floor exercises to prevent and treat urinary
incontinence. International Urogynecology
Journal January 2011, Volume 22, Issue 1, pp 17-
22
112. • J.T. van der Spank ET AL. Pain relief in labour
by transcutaneous electrical nerve
stimulation (TENS) Archives of Gynecology
and Obstetrics November 2000, Volume
264, Issue 3, pp 131-136
