Postnatal Period

Original Editor - Safiya Naz
Top Contributors - Safiya Naz and Kim Jackson

Introduction

The period where new mother body go about its recovery phase is known as postnatal period. mother body that has undergone the process of pregnancy and birth and gradually changed into body shape and function.

Postnatal.jpg

The period capriciously distribute into three phase

  • first acute phase follows 24 hour from delivery
  • second sab-acute phase follows 7 days from delivery
  • third late phase follows 6 weeks upto 6 month from delivery[1]

The third phase which is late phase related to major muscles tone and connective tissue recovery the phase is gradually slower than acute and subacute phase from the pregnancy state[2]

Postnatal Clinical Presentation

  • More elastisity in ligament compare to pregnancy period which last 4 to 5 months from labour.
  • Elongated abdomina muscle and separation between the two recti abdominis muscles known as Diastasis recti abdominis[3]
  • Pelvic floor muscle decreses more strenth than during pregnancy
  • Abnormalities in the levator ani muscle[4]
  • urinary incontinence
  • genital prolaps and protrude into the vagina or press against the wall of the vagina.
  • Weaker perineal muscle [5]
  • Pelvic floor neuropathy
  • Incontinence of stool and flatus
  • Swollen extremities hands ,feet and ankles[6]
  • excessive weight gain[7][8]
  • low back pain (LBP)[9][10]

BENEFITS

  • improvement in mood
  • improvement in cardiorespiratory fitness
  • promotion of weight loss
  • Decreases developing upcoming chronic health conditions
  • reduction in depression
  • reduction in anxiety
  • psychological well‐being
  • improve sexual health and quality of life.[11][12][13][14]

Management

Diaphragmatic breathing

[15]
  • good postnatal technique that women should do immediately after birth.
  • Correct breathing strengthen your inner core[16][17]

aerobic exercises

[18]
  • research shows positive effects of aerobic and strengthening exercises on postnatal period[19].

Pelvic floor exercises

[20]
  • Pelvic floor muscle exercises are valuable for their strengthening and pain-relieving properties which decreases upcoming urinary incontinence[13]
  • Kegel exercises strengthen of pelvic floor muscle in postnatal women[21]

Hydrotherapy

researches shows the effective of a aquatherapy protocol as an alternative or adjunct to medication for early postpartum pain reduction[22][23]
[24]


Important Points

  • It is important that to motivate and encourage the mother.
  • Persuaded to participate.
  • Do not burden with too many exercises
  • Encourage movement.
  • Reassure them that the stitches will not pop if they move about.
  • Teach the exercises that are appropriate.
  • confined to bed for a prolonged period of time then ‘controlled’, and deep breathing and ‘vigorous’ circulatory exercises should be encouraged.
  • Obtain medical clearance from your provider before beginning
  • Begin with low-intensity activity and gradually increase to moderate efforts
  • Women who are competitive athletes and those doing higher-intensity training before pregnancy usually can return to those levels fairly quickly.
  • Light to moderate exercise does not seem to affect breast milk, whereas high-intensity exercise can increase lactate levels in milk.[14][25]

References

  1. Chauhan G, Tadi P. Physiology, Postpartum Changes. StatPearls Publishing. 2020 Mar 15.
  2. Romano M, Cacciatore A, Giordano R, La Rosa B. Postpartum period: three distinct but continuous phases. Journal of prenatal medicine. 2010 Apr;4(2):22.
  3. da Mota PG, Pascoal AG, Carita AI, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual therapy. 2015 Feb 1;20(1):200-5.
  4. DeLancey JO, Kearney R, Chou Q, Speights S, Binno S. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstetrics & Gynecology. 2003 Jan 1;101(1):46-53.
  5. Fonti Y, Giordano R, Cacciatore A, Romano M, La Rosa B. Post partum pelvic floor changes. Journal of prenatal medicine. 2009 Oct;3(4):57.
  6. Cho HL, Lee DK, Seung JH, Kim DI, Lee TK. The clinical study of Postpartum Edema. The Journal of Korean Obstetrics and Gynecology. 2002;15(3):151-.
  7. Christenson A, Johansson E, Reynisdottir S, Torgerson J, Hemmingsson E. Women's perceived reasons for their excessive postpartum weight retention: a qualitative interview study. PLoS One. 2016 Dec 9;11(12):e0167731.
  8. Farpour-Lambert NJ, Ells LJ, Martinez de Tejada B, Scott C. Obesity and weight gain in pregnancy and postpartum: an evidence review of lifestyle interventions to inform maternal and child health policies. Frontiers in endocrinology. 2018 Sep 26;9:546.
  9. de Winter J, de Hooge M, van de Sande M, de Jong H, van Hoeven L, de Koning A, Berg IJ, Ramonda R, Baeten D, van der Heijde D, Weel A. Magnetic resonance imaging of the Sacroiliac joints indicating sacroiliitis according to the assessment of spondyloarthritis International Society definition in healthy individuals, runners, and women with postpartum back pain. Arthritis & Rheumatology. 2018 Jul;70(7):1042-8.
  10. Tavares P, Barrett J, Hogg-Johnson S, Ho S, Corso M, Batley S, Wishloff K, Weis CA. Prevalence of Low Back Pain, Pelvic Girdle Pain, and Combination Pain in a Postpartum Ontario Population. Journal of Obstetrics and Gynaecology Canada. 2020 Apr 1;42(4):473-80.
  11. Larson‐Meyer DE. Effect of postpartum exercise on mothers and their offspring: a review of the literature. Obesity research. 2002 Aug;10(8):841-53.
  12. Hadizadeh-Talasaz Z, Sadeghi R, Khadivzadeh T. Effect of pelvic floor muscle training on postpartum sexual function and quality of life: A systematic review and meta-analysis of clinical trials. Taiwanese Journal of Obstetrics and Gynecology. 2019 Nov 1;58(6):737-47.
  13. 13.0 13.1 Evenson KR, Mottola MF, Owe KM, Rousham EK, Brown WJ. Summary of international guidelines for physical activity following pregnancy. Obstetrical & gynecological survey. 2014 Jul;69(7):407.
  14. 14.0 14.1 Roy, Brad A. Ph.D., FACSM, FACHE Postpartum Exercise, ACSM's Health & Fitness Journal: November/December 2014 - Volume 18 - Issue 6 - p 3-4
  15. https://www.youtube.com/watch?v=bQ5aSSHm6o0
  16. Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. Journal of musculoskeletal & neuronal interactions. 2019;19(1):62.
  17. reference
  18. https://www.youtube.com/watch?v=DjLxmAUR3To
  19. Rajsekhar H, Sumalatha P. PHYSIOTHERAPY EXERCISES DURING ANTENATAL AND POSTNATAL. INTERNATIONAL JOURNAL OF PHYSIOTHERAPY. 2015 Oct 1;2(5):745-50.
  20. https://www.youtube.com/watch?v=VhrSG-R90QM
  21. El Nahas EM, Mohamed MA, Kamal HM. Postnatal rehabilitation of pelvic floor muscles using aerobic and Kegel exercises. Bulletin of Faculty of Physical Therapy. 2017 Jul 1;22(2):67.
  22. Adherhold KG, Perry L. Jet hydrotherapy for labor and postpartum pain relief. MCN: The American Journal of Maternal/Child Nursing. 1991 Mar 1;16(2):97-9.
  23. Batten M, Stevenson E, Zimmermann D, Isaacs C. Implementation of a hydrotherapy protocol to improve postpartum pain management. Journal of midwifery & women's health. 2017 Mar;62(2):210-4.
  24. https://www.youtube.com/watch?v=mVvzsFk6rPo
  25. Daley AJ, Jolly K, Sharp DJ, Turner KM, Blamey RV, Coleman S, McGuinness M, Roalfe AK, Jones I, MacArthur C. The effectiveness of exercise as a treatment for postnatal depression: study protocol. BMC Pregnancy and Childbirth. 2012 Dec;12(1):1-8.
.