physiology is explained system & organ wise references are provided of the particular books

1. PRENATAL
PHYSIOTHERAPY
Manashvi D
makwana

2. Agenda
Introduction
Maternal physiology
Antenatal care
-aims
-role of physiotherapy
-references
Presentation title 2

3. Introduction
Antenatal care is the care of the woman during pregnancy. The primary
aim of antenatal care is to achieve at the end of a pregnancy as a healthy
mother and a healthy baby. Ideally this comprise the series of events
occurring from conception through first second & 3rd trimester of the
pregnancy to the delivery of child
Presentation title 3

4. • First trimester- (0-12 weeks)- in this trimester both mother & fetus are
changing rapidly includes –
• Morning sickness – due to increase in level of hormones to sustain pregnancy
• Mood swings irritability & other physical symptoms – due to surges in
hormones
• Increase frequency of urination
• Reduced peristalsis of alimentary tract
• Second trimester (13-27 weeks)- the symptoms of the 1st trimester may
improve, baby grows larger & women begins to show larger belly
• appetite & weight
• Mother experiencing the movement of fetus (starts- 20 weeks)
• Skin pigmentation on face & belly due to pregnancy hormones
• Reduction in need to urinate often as uterus grows out of pelvic cavity,
reliveing pressure on the bladder 4

5. • Third trimester-(28-40 weeks)- physical & emotional challeges increases as
the fetus grows more in size & weight. Baby is considered full term at the
end of 37 weeks
• Edema on ankle, hand& face due to retained fluid
• Skin pigmentation becomes more apparent
• Backache
• Fourth trimester (first 12 weeks of postpartum)
Presentation title 5

6. PHYSIOLOGICAL CHANGES IN
ANTENATAL CARE
Presentation title 6

7. CHANGES IN GENITAL ORGAN
VULVA- becomes oedematous & hyperaemic
• Superficial varicosities may appear specially in multiparae
• Labia minora are pigmented & hypertrophied
VAGINA- vaginal walls become hypertrophied oedemantous & more vascular
• Increase blood supply of venous plexus surrounding the walls
• The length of the anterior vaginal walls is increased
• Secretion- copious, thin, & curdy white
• PH- acidic 3.5-6

8. • UTERUS- non pregnant state weighs about 60gm with the cavity of 5-10ml &
measures about 7.5 cm in length
• At terms it weighs about 900-1000gm & measures 35 cm in length
• Changes occurs in part of uterus body , cervix, isthmus
• There is an increase in growth a& enlargement of uterus
• Changes in muscle-1) hypertrophy & hyperplasia- occurs under the influence of
hormones estrogen & progesterone- limited to first half of pregnancy &
pronounced up to 12 weeks
2)stretching- the muscle fibers further elongate beyond
20 weeks due to distension by the growing fetus the
Wall becomes thinner
At term- measures about 1.5cm or less
8

9. • ARRANGEMENT OF MUSCLE FIBERS- 1) outer longitudinal- hood like
arrangement over the fundus; some fibres are continuous with round ligament
2) Inner circular- scanty & have sphincter like arrangement around the tubal
orifices
3) Intermediate- thickest & strongest layer arranged in criss-cross fashion through
which the blood vessels run.
9

10. VASCULAR SYSTEM- uterine artery diameter becomes double
• Blood flow increases by 8 folds at 20 weeks of pregnancy
• Vasodilatation is mainly due to estradiol & progesterone
• Veins become dilated & are valveless , numerous lymphatic channels opens up
the vascular changes are most pronounced at the placental site
WEIGHT- the increase in weight is due to increased growth of uterine muscles,
connective tissue & vascular channels
SHAPE- Nonpregnant pyriform shape is maintained in early months
• Changes to globular at 12 weeks
• As the uterus enlarges, the shape once more becomes pyriform or ovoid by 28
weeks
• changes to spherical beyond 36th week

11. 11

12. POSITION- Normal anteverted position is exaggerated up to 8 weeks
• the enlarged uterus may lie on the bladder
• Afterwards, it becomes erect, the long axis of the uterus conforms more or less
to the axis of the inlet, there is a tendency of anteversion
• In primigravidae with good tone of abd muscle it is held firmly against the
maternal spine
Contractions (Braxton-Hicks):- The contractions are irregular, infrequent,
spasmodic and painless without any effect on dilatation of the cervix
ISTHMUS- During the first trimester, isthmus hypertrophies and elongates to
about 3 times its original length.
• It becomes softer
12

13. CERVIX- hypertrophy and hyperplasia of the elastic and connective tissues.
• Vascularity is increased
• softening of the cervix (Goodell’s sign)
• Epithelium: the squamous cells become hyperactive
• Secretion: The secretion is copious and tenacious
• Anatomical: The length of the cervix remains unaltered but becomes bulky. The
cervix is directed posteriorly but after the engagement of the head, directed in
line of vagina.
FALLOPIAN TUBE- The total length is somewhat increased.
• The tube becomes congested.
• Muscles undergo hypertrophy.
• Epithelium becomes flattened, and patches of decidual reaction are observed 13

14. 14
OVARY- The growth and function of the corpus luteum reaches its maximum at 8th
week
• it measures about 2.5 cm and becomes cystic
• Hormones estrogen and progesterone—secreted by the corpus luteum maintain
the environment for the growing ovum before the action is taken over by the
placenta
• These hormones not only control the formation and maintenance of decidua of
pregnancy but also inhibit ripening of the follicles

15. • Breast- 2-4 weeks unusual tenderness and tingling may be experienced in the
breasts and enlargement begins soon- nodular & lumpy
• There is an increase in blood supply (veins may become visible on the chest)
• There maybe evidence of striation due to stretching of cutis
• 8 weeks-sebaceous glands in the pigmented area around the nipples become
enlarged and more active, appearing as noduless (Montgomery’s tubercles)
• 12 weeks-the nipples and an area around them (the primary and secondary
areolae), become more pigmented and remain so for as much as 12 months
after parturition. a little serous fluid may be expressed from the nipple
• 16 week- colostrum can be expressed.
• Human milk ‘comes in’ about the 3rd or 4th postpartum day.
15

16. 16

17. • CUTANEOUS CHANGES-
Face(chloasma gravidarum or pregnancy mask)- an extreme form of pigmentation
around the cheeks forehead & around the eyes – patchy or diffuse; disappears
spontaneously after delivery
Breast
Abdomen- linea nigra- brownish black pigmented area
In midline stretching from xiphisternum to symphysis
Pubis
Striae gravidarum- slightly depressed marks with varying length & breadth found
in pregnancy
Vascular spider & palmar erythema
17

18. HAEMATOLOGICAL CHANGES
BLOOD VOLUME- due to increased in vascularity of enlarging uterus, blood volume
is markedly raised during pregnancy
• The blood volume starts to increase from about 6th week expands rapidly
thereafter to max 40-50% above nonpregnant level at 30-32 weeks
PLASMA VOLUME- starts to in 6 weeks
• Rate of increase almost parallels to blood volume
• Reached to the extent of 50%
• Total plasma volume increase to the extent of 1.25 liter
18

19. RBC & HAEMOGLOBIN- RBC mass has increased to the extent of 20-30%
• Increase in demand of o2 transport during pregnancy
• Disproportionate increase in plasma & RBC volume produces state of
hemodilution(fall in hematocrit)
• Hb fall is about 2gm% from the non pregnant value
19

20. METABOLIC CHANGES
GENERAL METABOLIC CHANGES- total metabolic is increased due to the needs of
growing fetus & the uterus
• Basal metabolic rate is increased to the extent of 30% higher than that of avrg
non pregnant women
PROTIEN METABOLISM- positive nitrogenous balance throughout pregnancy
• At term, the fetus & placenta contains about 500gm of protein & maternal gain is
also about 500gm
CARBOHYDRATE METABOLISM- insulin secretion is in response to glucose &
Amino acid
• Hyperplasia & hypertrophy of beta cells of pancreas
• Increase insulin level favors lipogenesis (fat storage) this mechanism ensures
continuous supply of glucose to the fetus
20

21. • FAT METABOLISM- an avrg of 3-4 kg of fat is stored during pregnancy mostly in
the abdominal wall, breast, hips & thighs
• IRON METABOLISM- : Iron is absorbed in ferrous form from duodenum and
jejunum and is released into the circulation as transferrin
• About 10% of ingested iron is absorbed
• Total iron requirement during pregnancy is estimated approximately 1,000 mg
• In the absence of iron supplementation, there is drop in hemoglobin, serum
iron and serum ferritin concentration at term pregnancy Thus, pregnancy is an
inevitable iron deficiency state
21

22. WEIGHT GAIN
• In early weeks, the patient may lose weight because of nausea or vomiting.
During subsequent months, the weight gain is progressive until the last 1 or 2
weeks, when the weight remains static.
• The total weight gain during the course of a singleton pregnancy for a healthy
woman averages 11 kg
• This has been distributed to 1 kg in first trimester and 5 kg each in second and
third trimester.
• Importance of weight checking: Rapid gain in weight of more than 0.5 kg a week
or more than 2 kg a month ,in later months of pregnancy may be the early
manifestation of preeclampsia and need for careful supervision.
• Stationary or falling weight may suggest intrauterine growth retardation or
intrauterine death of fetus.
• Obese women are in increased risk of complications in pregnancy, labor and
puerperium
22

23. The total weight gain at term is
distributed approximately as:-
Presentation title 23

24. MATERNAL PHYSIOLOGY
ENDOCRINE
CARDIOVASCULAR
REPRODUCTIVE
RENAL & GIT
MUSCULOSKELETAL
& POSTURAL
NEUROLOGICAL
24
RESPIRATO
RY

25. ENDOCRINE SYSTEM
• The changes of pregnancy are orchestrated by hormones progesterone,
estrogens and relaxin seem to be the most important for the physiotherapist.
Increased joint laxity has been demonstrated in pregnancy
•
25

26. MUSCULOSKELETAL CHANGES
• Increase in joint laxity and joint ranges
• There is increased mobility of the pelvic joints due to softening of the ligaments
caused mainly by hormone
• Increase in water retention- oedema & nerve compression
• The distance between the two rectus abdominis muscles can be seen to widen
throughout a pregnancy and the linea alba may even split under the strain
(diastasis recti), and this may lead to poorer
mechanical function. (elongation of muscle)
• the lumbar and thoracic curves are increased
during later months of pregnancy due to enlarged uterus produces backache and
waddling gait.
26

27. RESPIRATORY SYSTEM
• With the enlargement of the uterus there is elevation of diaphragm 4cm &
breathing becomes diaphragmatic
• Subcostal angle (68-103)*
• Transverse diameter of chest expands -2cm ;chest circumference 5-7cm
• The mucosa of the nasopharynx becomes hyperemic and edematous. This may
cause nasal stuffiness and rarely epistaxis.
• A state of hyperventilation occurs
during pregnancy leading to increase
in tidal volume and therefore
respiratory volume by 40%
• Due to progesterone acting on repi
Centre
• in sensitivity centre of co2 the
Women feels shortness of breath 27

28. NERVOUS SYSTEM
• Some sorts of temperamental changes are found during pregnancy and in the
puerperium. Nausea, vomiting, mental irritability and sleep disorders are
probably due to some psychological background
• Postpartum blues, depression or psychosis may develop in a susceptible
individual
• Water retention quite frequently causes unusual pressure on nerves, particularly
those passing through canals formed of inelastic material like bone and fibrous
tissue (e.g. the carpal tunnel), with resulting neuropraxia. This can be relieved by
the use of lightweight splint
• There is an increase in threshold to pain at full term and in labor probably due to
increased levels of plasma endorphins and progesterone
• CSF pressure remains unchanged during pregnancy but is increased during
uterine contractions and bearing down. There is more dependence on
sympathetic nervous system for maintenance of hemodynamics. 28

29. CARDIOVASCULAR SYSTEM
29
• ANATOMICAL CHANGES: Due to elevation of the diaphragm consequent to the
enlarged uterus, the heart is pushed upward and outward with slight rotation
to left
• Muscle particularly, the left ventricles hypertrophies leading to enlargement of
the heart
• During pregnancy the heart rate & stroke vol(amount of blood pumped by a
heart with each beat) due to the increase blood volume & o2 requirement of
maternal tissue and growing foetus

30. Cardiac output
• The cardiac output (CO) starts to increase from 5th week of pregnancy and
reaches its peak 40–50% at about 30–34 weeks
• CO is lowest in the sitting or supine position and highest in the right or left lateral
or knee chest position
• Cardiac output increases further during labor (+50%) and immediately following
delivery (+70%)
BLOOD PRESSURE- during mid-trimester, changes in blood pressure may occur
causing fainting
• In later pregnancy hypotension may occur in 10% of women in unsupported
supine position termed as SUPINE HYPOTENSION SYNDROME (POSTURAL
HYPOTENSION)
• The pressure of gravid uterus compresses the vena cava, reduces the venous
return due to which the cardiac output is by 25-30% & blood pressure may fall
by 10-15%
Presentation title 30

31. REGIONAL DISTRIBUTION OF BLOOD FLOW
• Uterine blood flow - increased from 50 mL/min in nonpregnant state to about
750 mL near term.
• Pulmonary blood flow (normal 6,000 mL/min) is increased by 2,500 mL/min
• Renal blood flow (normal 800 mL) increases by 400 mL/min at 16th week and
remains at this level till term
• The blood flow through the skin and mucous membranes reaches a maximum of
500 mL/min by 36th week.
• Heat sensation, sweating or stuffy nose complained by the pregnant women can
be explained by the increased blood flow
Presentation title 31

32. URINARY SYSTEM / RENAL
• Kidney- enlarge in length 1cm
• Renal plasma flow 50-75% max
• Glomerular filtration rate (GFR) 50% throughout pregnancy
• Ureter –become atonic due to high progesterone & so that they are a little
dilated
• Hypertrophy of muscle & sheath of ureter specially pelvic due to estrogen
• There is an increased urinary output, and small changes in tubular resorption
• Bladder- hypertrophy of muscle & elastic tissue of the wall
• Late pregnancy- bladder mucosa becomes edematous & stress incontinence
due to urethral sphincter weakness, frequency of micturition reappears
• 6-8 weeks- frequency of micturition (subsides 12 weeks)
32
b

33. ALIMENTARY SYSTEM
33
• Nausea ,vomiting -if inappropriately managed in severe cases (hyperemesis
gravidarum) can lead to maternal dehydration, malnutrition and weight loss
• The gut musculature becomes slightly hypotonic and the motility of GIT is
decreased due to high progesterone level
• Increased salivation (ptyalism)
• Taste is often altered very early in pregnancy Increased appetite & thirst –
frequent small snacks
• Heart burn- (reflux esophagitis) relaxation of cardiac sphincter due to
progesterone & relaxin
• Emesis gravidarum- morning sickness 50%
• Constipation- reduced gut motility due to progesterone
Increased water & salt absorption

34. LIVER AND GALLBLADDER
• Although there is no histological change in the liver cells, but the functions are
depressed. With the exception of raised alkaline phosphatase levels, other liver
function tests are unchanged
• There is mild cholestasis (estrogen effect).
• There is marked atonicity of the gallbladder (progesterone effect)
This, together with high blood cholesterol level during pregnancy, favors stone
formation
34

35. Physiotherapy management in
antenatal care
Presentation title 35

36. Aims
• to promote and maintain optimal physical and emotional maternal health
throughout pregnancy
• to recognize and treat correctly medical or obstetric complications occurring
during pregnancy
• to detect fetal abnormalities as early as possible
• to prepare for and inform both parents about pregnancy, labor, the
puerperium and the subsequent care of their baby
• the overriding goal is that pregnancy will result in a healthy mother
and a healthy infant
Presentation title 36

37. • Offering education for parenthood
• To prepare women for labor, lactation & care for infants
• To develop awareness and control of posture during and after pregnancy
• To prepare for labor, delivery and post partum activities
• To teach the mother elements of child care, nutrition, personal hygiene, and
environmental sanitation
Presentation title 37

38. ROLE OF PHYSIOTHERAPY IN
ANTENATAL CARE
 Prevention/treatment of musculoskeletal problems
 Promoting healthy lifestyle
 Postural & ergonomic advice
 Preparing for labor
 Teaching relaxation technique
 Optimal physical fitness
Presentation title 38

39. Biomechanics on child bearing year
• During pregnancy a number of biomechanical & hormonal changes occur that can
alter spinal curvature, balance & gait patterns
• The significant physical & physiological changes occur during child bearing year
require musculoskeletal adaptations
• Lumbopelvic instability
• Postural deviations
• Modified lower extremity weight bearing & challenges with balance & gait
39

40. Presentation title 40

41. • FUNCTIONS OF LOCAL MUSCLE SYSTEM- local muscle play an imp role in
stabilizing joints of pelvic girdle & vertebral column
• Transverse abdominis with multifidus including their fascia creates a corset of
support for the lumbopelvic region
• According to Richardson & coworkers co-contractions of transverse abdominis &
multifidus increases the stiffness of SI joint
• POSTURAL DEVIATIONS-
41

42. Increase in
abdominal size
COG shifts
anteriorly
Counter
balanced by:-
Increase in lumbosacral
angle ,increase in lumbar
lordosis & thoracic
kyphosis
Protraction of
shoulders &
hyperextension
of knees
42

43. • MODIFIED LOWER EXTREMITY WEIGHT BEARING- static & dynamic changes of
lower limb
• Increased weight & anterior displacement of COG compensated by biomechanical
changes that results in posterior displacement of trunk center of mass
• The biomechanical changes related to realignment of spinal curvature include
increase in sagittal pelvic tilt
• CHALLENGES WITH BALANCE- balance & control of movement starts affected
mainly during 3rd trimester
• Static postural control decreases in situation of reduced base of support
• Decrease in postural stability of pregnant women increases the risk of fall when
compared to normal women
43

44. Wide BOS
Loss of
balance
Waddling
gait
44
GAIT

45. General
practitioner
obstetricia
n
Women's
health
physiotherap
ist
dietician
radiologist
45
Antenat
al care
team

46. Goals & treatment during antenatal
period
• To educate the mother regarding changes of pregnancy
• To increase & maintain CVS fitness
• To maintain abdominal function & prevent to diastasis recti or correct if it exist
• To train the mother for improving control strength of pelvic floor muscle by
educating awareness regarding it
• To prevent msk injury by teaching specific exercises & preventive measures
• To encourage resistance training to muscle strength & endurance
• To educate correct body mechanics & diff positions
• To improve the postural deviation & maintain it by increasing the awareness of
posture control
• To prepare the mother for labor & postnatal exercise & it imps
46

47. Prevention/treatment of musculoskeletal problems
posture
• Pregnancy back care- Postural, hormonal and weight changes, ergonomic
education involving sitting and working positions, bending, lifting and
householdactivities should all be considered
• Nerve compression syndrome- carpal tunnel syndrome
the following may all give relief: • ice packs (a small bag of frozen peas wrapped in a
wet handkerchief could be used at home) • resting with the hands in elevation •
wrist and hand exercises • ultrasound • splinting limiting wrist flexion
47

48. SI joint
• Pregnancy could have many possible effects on the sacroiliac joint; for example
joint laxity may allow repetitive new movement at one, or both, joints causing
pain, if combined with sufficient activity
• This usually disappears in a few months, but indicates transient stress. A
support belt may provide comfort for some women
• various self help maneuver can be taught to relive SPD
48

49. • SCIATICA- h reduced activity levels, within pain-free range.
Advice from the physiotherapist on positioning, back care, posture correction,
activities of daily living and pain relief
• COCCYDYNIA- this condition is rare antenatally unless caused by a fall.
cushion when sitting, taking pressure through ischial tuberosities and thighs • ice
packs, heat, and TENS.
49

50. SYMPHYSIS PUBIS DYSFUNCTION (SPD)
• Difficult activities will include: • getting in or out of the car or bath • changing
position in bed, particularly ‘turning over’ • dressing • walking, which is
severely restricted or impossible. The possible link with sacroiliac dysfunction
• Rest and reduction of non-essential ‘chores’
• keeping the legs adducted and avoiding single leg standing
• Pelvic support may reduce pain levels
• Gentle isometric contraction of hip adductors, in sitting – small cushion
between the knees (whilst maintaining pelvic stability), may relieve adductor
tension.
50

51. • MUSCLE CRAMP- • calf stretches to relieve muscle spasm
• knee extension with dorsiflexion will release calf cramp
• massage – deep kneading
• vigorous foot exercises, to prevent the bruise-like pain which often follows a
cramp ‘event’
• a pre-bedtime brisk walk, vigorous foot exercises, and a warm bath may be
prophylactic
Ankle dorsiflexion and plantar flexion, and foot circling carried out for 30 seconds
regularly, should be suggested; women should be advised not to cross the knees
when sitting
51

52. General Guidelines for Exercise
Instruction
• Physical examination is must prior to engaging a pt. in an Exercise Programmed.
• Each person should be individually evaluated for preexisting Musculo -skeletal
problems, posture & fitness level
• Exercise regularly, at least thrice a week
• Avoid ballistic movements & rapid change in directions.
• include warm-up & cool down session
• avoid an anaerobic pace.
• strenuous activities should be avoided.
• avoid prolong period of standing specially in third trimester.
• adequate caloric intake, increase to 300 kcal./day for ex. during preg. & 500
kcal./day for ex. during lactation.
• low resistance & high repetitions ex. is recommended, avoid valsalva maneuvers.
• stop ex. if any unusual symptoms occur. 52

53. contraindications
Absolute-• Cardiovascular disease
• Acute infection • A history of
recurrent spontaneous abortion
(miscarriage)
• Preterm labour in current or previous
pregnancy • Multiple pregnancy •
Vaginal bleeding or ruptured
membranes
• Incompetent cervix
• Pregnancy-induced hypertension
• Chronic hypertension, active thyroid,
cardiac, vascular or pulmonary
disease
Relative- • Women unused to high
levels of exertion
• Blood disorders such as sickle cell
disease and anemia
• Thyroid disease
• Diabetes – however, a carefully
supervised programme of gentle
exercising may actually benefit some
patients
• Extreme obesity or underweight

54. Sequence of exercise
• General rhythmic activities to warm-up.
• Gentle selective stretching
• Aerobic activities for CVS conditioning
• UL &LL strengthening ex.
• Abdominal ex
• Pelvic floor ex.
• Relaxation /cool down activities
• Educational information [if any] & postpartum ex. Education.
Presentation title 54

55. Exercise technique
• Postural exercise.
• Abdominal exercise
• Stabilization exercise
• Pelvic motion training & strengthening.
• Modified UL & LL strengthening.
• Perineum &adductor flexibility.
• Relaxation &breathing exercise
Presentation title 55

56. Postural exercise
Includes:
• Strengthening exercise
• Stretching exercise
• STRETCHING EXERCISES –
• Upper neck extensors & scalenes
• Scapular protractors, shoulder internal rotators & levetor scapulae
• Low back extensors
• Hip adductors [caution do not over stretch in women with pelvic instability]
• Ankle planter flexor
Presentation title 56

57. Presentation title 57
Scalene self stretching Scalene stretch by
therapist

58. Low back extensors stretching
Presentation title 58

59. Antenatal adaptation & exercises
• Hip adductor stretching/ exercise –
59

60. Strengthening Exercise
• Upper neck flexors lower neck &upper thoracic extensors
• Scapular retractors &depressor
• Shoulder external rotators
• Hip & knee extensors
• Ankle dorsi flexors
60

61. Presentation title 61

62. Pelvic tilting exercise/ pelvic floor
streghening
62

63. Exercises Abdominal muscles- plays a crucial role in trunk stability, maintaining good
posture & during 2nd stage of labor for expulsion of baby
1-leg sliding exercises/ B/l leg slide
2-quadruped pelvic tilt exercises
3-trunk curls/ diagonal curls
Corrective exercise for diastasis recti- head lift
Head lift with pelvic tilt
Spinal stability- possible factors affecting spinal stability
• Hormonal laxity of ligaments
• Lengthening
of abdominal
muscle
63

64. • Antenatal ergonomics- ergonomic during pregnancy involves educating women
regarding body mechanics positioning & energy conservation method
• Principles of ergo should be applied during
Activities of daily living
Instrumental activities of daily living
Work place
• Sitting
• Lying
• standing
64

65. 65

66. Presentation title 66

67. RELAXATION & BREATHING EX
• Relaxation & Breathing exercise.
Are given with the following objectives
1. To obtain rest during preg.
2. To help the mother regain normal health afterwards by preventing
unnecessary fatigue
3. Most common method of relaxation is MITCHELLS METHOD
Presentation title 67

68. 4. Patient position in kneeling forward on to one’s arm on a cushion placed
on a seat of a chair.
5. In this position wt. of the fetus lies on the anterior abdominal wall &
pelvic floor relaxes
6. In this position pt. take deep diaphragmatic breathing.
7. Other methods of relaxation are
a. mental imagery.
b. muscle setting – “Jacobson’s Method”
Presentation title 68

69. Touch relaxation
• It is used by involving the partner as the touch of partner seems to
provide relaxation
• Touch relaxation is responding to womens labour partners touch by
relaxing or releasing tense muscle
• This can be done with gentle pressure or stroking
• Women can start by tensing and releasing to her labour partners touch
Presentation title 69

70. Promoting healthy lifestyle
Prenatal advice & education regarding
• Diet
• Personal hygiene
• Use of drugs
• Alcohol & smoking
70

71. references
• 1) Physiotherapy in Obstetrics and Gynecology -Jill Mantle
• 2) DC Dutta’s OBSTETRICS including Perinatology and Contraception
• 3) physiotherapy in general medical & surgical condition- megha seth
Presentation title 71

72. Thank you