Antenatal care

A full description on Antenatal Physiotherapy Program process

1. By: BabitaPandey
Antenatal
Physiotherapy
Program

2. Click to add titleIntroduction:
Pregnancyisatimeoftremendousmusculoskeletal,physicalandemotional
changesfortheladyandyetisaconditionofwellness.Exerciseprograms
duringpregnancyandafterchildbirtharedesignedtominimizeimpairments
andhelpthewomanmaintainorregainfunctionwhilesheispreparingfor
arrivalofbody

3. Click to add titleAims:
•Learn safe body mechanics
•Develop awareness & control of posture during & after pregnancy
•Prevent / treat impairments & painful conditions associated with pregnancy.
•Promote / maintain safe CV fitness
•Develop upper bod strength for demands of child care
•Learn relaxation skills to relieve stress of labor
•Offer education for parenthood
•Prepare the woman for labor, lactation & care of infant

4. Click to add titleCHANGES DURING PREGNANCY:
•Weightgainofapproximately11kg
•Uterusbecomesmoreofanabdominalorganratherthanpelvicorgan
•Abdominalmusclesarestretched
•Bloodpressuredecreasesinearlytrimester,reachesitslowestlevel
midwaythroughpregnancyandthenrisesgraduallyfrommid
pregnancytoupto6weeksofdelivery
•Ligamentsbecomelax
•Posturalchangesoccurlikeroundedshoulders,increasedcurvature
oflowback,walkingwithwiderbaseofsupport

5. Click to add titleStages:
*1
st
trimester of pregnancy: 0-3 months
•Problems: Vaginal bleeding, Nausea, Vomiting, High fever, Vaginal discharge
& itching, pain or burning during urination, Calf pain, headaches, swelling,
flow ups of chronic diseases.
*2
nd
trimester of pregnancy: 3-6 months
•Problems: Nasal problems, Dental issues, Urinary incontinence, Dyspnea,
Dizziness, UTI
*3rd trimester of pregnancy:6-9 months
•Problems: Preterm labor, Vaginal bleeding, Pre-eclampsia
*Others common problems. *( Included in next page)

6. Click to add title*Stages:
*Others common problems.
Diastasis recti –This is separation of the rectus abdominal muscle. Any separation larger than two finger width is considered
significant. One can have low back pain due to this and transitions from lying down straight to sitting position can be hampered.
Every pregnant woman must be tested for this and only then exercises should be started.
Upper and Lower back pain –This occurs because of postural changes of pregnancy, increased ligamentous laxity and decreased
abdominal function. Learning correct body mechanics is vital.
Sacroiliac joint pain –This could be caused again due to lax ligaments in a pregnant female. In early stages rest and ice, manual
therapy techniques to correct asymmetry, gentle non weight bearing movements in the bed return the joint to its normal position.
Work involving leaning forward should be avoided and avoid single leg standing activities.
Carpal tunnel syndrome –This is a compression disorder caused due to fluid retention, hormonal changes or circulatory
compromise. The pregnant female complaints of tingling or numbness in hands or weakness of the hand with pain could be present.
Splints, ultrasound therapy and exercises to strengthen the hand are helpful.
Symphysis pubis dysfunction –This dysfunction is due to asymmetry that would have occurred at the pubic bone at the pelvis
due to muscle imbalance and lax ligaments .Rest and reduction of nonessential activities. Pelvic support, water based exercise is a
good option but breaststroke to be avoided.

7. Click to add titleGUIDELINES FOR EXERCISE:
•Get a physical examination from your gynecologist before
participating in any exercise program
•Exercise should not exceed pre-pregnancy levels
•Drink fluids before, during and after exercise
•Include appropriate warm up and cool down
•Avoid ballistic movements
•Don’t allow any joint to go beyond its physiological range
•Don’t hold your breath
•Don’t do any exercise that causes pain
•Don’t do any exercise where there is a possible loss of balance
•Don’t exercise in hot humid environment
•No contact sports e.g. horse riding, scuba diving, jumping should be done

8. Click to add titlePhysiotherapy Program:
Itisatypeofprogramthataimstopreventinglowback
painanenhancingphysicalpreparationfordeliveryby
meansofjointstretchingandmusclestrengthening.
Antenatalcareisthepillarofsafemotherhood.

9. Click to add titleTypes of antenatal exercise:
(1)Pelvicfloorexercise
•Sitonachairwithyourbackagainsttheseatback
•Tightenthevaginal,urethralandanalmusclesasiftryingtowithholdurinationor
defecation.Youcanalsodothisexerciseinastandingposition.
*Pelvicfloorexerciseenhancesthecontrolandsupportofpelvicfloormuscles.It
helpsyouprepareforchildbirthandpreventsuterineprolapse,urinaryincontinencea
ndhemorrhoid.

10. Click to add title*Types of antenatal exercise:
(2)Backandabdominalexercise
•Sitonachairwithyourbackagainsttheseatback
•Breathenaturally
•Tightentheabdomenandthenpressthepelvisdownwardstoflattenyourlowbackagainstthe
seatback.Holdfor5seconds,andrelax
*Thisexercisehelpsyoubycorrectingthelowbackandpelvicposture.Itstrengthensyourabdominal
musclesandpreventsbackpain.
•TailorExerciseforpregnancy
Itstrengthenthepelvic,hipandthighmusclesandcanhelprelievelowbackpain.
•TailorSit:Sitonthefloorwithyourkneesbentandanklescrossed.Leanslightlyforwardand
keepyourbackstraightbutrelaxed.
•Tailorpress:Sitonthefloorwithyourkneesbentandthebottomsofyourfeettogether.Grasp
youranklesandpullyourfeetgentlytowardyourbody.Placeyourhandsunderyourknees.While
pressingyourkneesdownagainstyourhands,pressyourhandsupagainstyourknees.Holdfora
countoffive.

11. Click to add title*Types of antenatal exercise:
(3) Ankle exercise
•Sit on a chair with your back against the seatback
•Start with one ankle and turn the foot upwards and downwards. Each up-and
-down movement is counted as one time. Repeat ten times
•Rotate the ankle to draw an inward or outward circle. Each circular moveme
nt is counted as one time. Repeat ten times
•Repeat the same steps at the other ankle
•Ankle exercise helps reduce leg swelling and varicose vein, thus alleviating
the problem of leg cramps

12. Click to add title*Types of antenatal exercise:
(4)Lowerlimbsrelaxationexercise
•Thisexerciseenhancestheflexibilityandstrengthofinnerthighsand
pelvicmuscles.Ithelpsyougetaccustomedtothedeliveryposition
andpreventthighspasmduringdelivery
•Sitonastablelowchairagainstawallandspreadyourthighssideways
.Holdfor5secondsandrelax

13. Click to add title*Types of antenatal exercise:
(5)Breathingexercise
•Breathingtechniquesforpainreliefduringlabor.ExhalebeforeinhaleissuggestedA.Abdominal
breathing
•Suitableformildpain
•Breatheinthroughthenoseandfeeltheabdomenexpand.ThenbreatheoutthroughthemouthB.
Lowercostalbreathing
•Suitableformediumpain
•Putyourhandsonthelowerribcage.Breatheinthroughthenoseandfeelyourchestexpand.Then
breatheoutlightlythroughthemouth79C.ApicalbreathingSubsequentVisits
•Suitableforseverepain
•Crossyourhandsbelowtheclavicleswithyourmouthslightlyopen.Breatheinthroughthenose
andthemouth.Breatheoutlightlyasiftryingtoflickertheflameofacandlewithoutblowingit
out,andfeeltheupperlungsmovingslightlyupanddown
*Duringcontractions,trytorelaxandcontrolyourbreathing
*Inbetweencontractions,restandrelaxasmuchasyoucaninthemostcomfortableposition

14. Click to add titleStretching exercises for pregnancy:
Stretchingexercisemakesthemuscleslimberandwarm,whichcanbeespecially
helpfulwhenyou’repregnant.Herearesomesimplestretchesyoucanperform
beforeorafterexercise:
•Neckrotation
•Shoulderrotation
•Swim
•Thighshift
•Legshake
•Anklerotation

15. Click to add titleKegel Exercises During Pregnancy:
Kegelexerciseshelpstrengthenthemusclesthatsupportthebladder,uterus,and
bowels.Bystrengtheningthesemusclesduringyourpregnancy,youcandevelop
theabilitytorelaxandcontrolthemusclesinpreparationforlaborandbirth.Kegelexercisesarealso
highlyrecommendedduringthepostpartumperiodtopromotethehealingofperinealtissues,
increasethestrengthofthepelvicfloormuscles,helpthesemusclesreturntoahealthystate,and
increaseurinarycontrol.
TodoKegels,imagineyouaretryingtostoptheflowofurineortryingnottopassgas.Whenyoudo
this,youarecontractingthemusclesofthepelvicfloorandarepracticingKegelexercises.While
doingKegelexercises,trynottomoveyourleg,buttock,orabdominalmuscles.Infact,noone
shouldbeabletotellthatyouaredoingKegelexercises.Youcandothemanywhere!
WerecommenddoingfivesetsofKegelexercisesaday.Eachtimeyoucontractthemusclesofthe
pelvicfloor,holdforaslowcountoffiveandthenrelax.RepeatthistentimesforonesetofKegels.

16. Click to add titleContraindications:

17. Click to add title
EXERCISES TO BE DONE DURING PREGNANCY:
•In the first trimester usually no exercises are advised .Only simple walking for 15-20
minutes is advised.
•In the second trimester one should do exercises for the core strengthening, buttock
strengthening and upper back strengthening.
•In the third trimester more of duck walking, squats, lunges and relaxation methods
should be done

18. Click to add titleUNSAFE EXERCISES DURING PREGNANCY:
•Both straight leg raising should be avoided as it puts undue stress on the low back more
than it can tolerate. It can cause back injury or diastasis recti hence should not be attempted.
•Fire hydrant exercise –This exercise is done in all fours position –like dog peeing. If the
leg is elevated too high then it can stress the sacroiliac joint and low back hence should be
done with caution.
•Standing on one leg exercises can also cause balance problems because of increased body
weight and shift in center of gravity.

19. Thank You