Postnatal Period: Difference between revisions
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Audrey Brown (talk | contribs) (Grammar/wording for clarity. Person-first language editing. Added more content to the introduction. Updated reference from the WHO in the introduction.Specified "benefits of PT" under benefits heading.) |
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== Introduction == | == Introduction == | ||
The period | The postnatal or postpartum period is the period that occurs immediately after childbirth. The postnatal period a critical, yet often neglected period in a new parent's life. According to the World Health Organization (WHO)<ref>[https://www.ncbi.nlm.nih.gov/books/NBK190090/ WHO Recommendations on Postnatal Care of the Mother and Newborn. Geneva: World Health Organization; 2013 Oct. Executive summary.Available from: https://www.ncbi.nlm.nih.gov/books/NBK190090/]</ref>, most maternal and newborn deaths occur in this period, therefore, proper parent and newborn observation and care are vital. | ||
[[File:Postnatal.jpg|thumb]] | [[File:Postnatal.jpg|thumb]] | ||
The period | The postnatal period is generally distributed into three distinct, but continuous phases:<ref name=":2" /> | ||
* | * 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<ref>Chauhan G, Tadi P. [https://www.ncbi.nlm.nih.gov/books/NBK555904/ Physiology, Postpartum Changes]. StatPearls Publishing. 2020 Mar 15.</ref> | ||
The | 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.<ref name=":2">Romano M, Cacciatore A, Giordano R, La Rosa B. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279173/ Postpartum period: three distinct but continuous phases.] Journal of prenatal medicine. 2010 Apr;4(2):22.</ref> | ||
== Postnatal Clinical Presentation | == Postnatal Clinical Presentation and Considerations == | ||
* | * Increased elasticity in ligaments compare to pregnancy period, which last 4-5 months from [[Labour|labour.]] | ||
* Elongated abdominal muscle and separation between the two recti abdominis muscles known as [[Diastasis recti abdominis]]<ref>da Mota PG, Pascoal AG, Carita AI, Bø K. [https://www.sciencedirect.com/science/article/abs/pii/S1356689X14001817 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.</ref> | * Elongated abdominal muscle and separation between the two recti abdominis muscles known as [[Diastasis recti abdominis]]<ref>da Mota PG, Pascoal AG, Carita AI, Bø K. [https://www.sciencedirect.com/science/article/abs/pii/S1356689X14001817 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.</ref> | ||
* Pelvic floor | * Weakened [[Pelvic Floor Anatomy|pelvic floor]] musculature | ||
* | * Muscular abnormalities and weakness in the [[Levator Ani Muscle|levator ani muscle]]<ref>DeLancey JO, Kearney R, Chou Q, Speights S, Binno S. [https://pubmed.ncbi.nlm.nih.gov/12517644/ The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery]. Obstetrics & Gynecology. 2003 Jan 1;101(1):46-53.</ref> | ||
* | * Urinary incontinence | ||
* | * Genital prolapse and protrude into the vagina or press against the wall of the vagina. | ||
* | * Weakened perineal muscles <ref>Fonti Y, Giordano R, Cacciatore A, Romano M, La Rosa B. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279110/ Post partum pelvic floor changes]. Journal of prenatal medicine. 2009 Oct;3(4):57.</ref> | ||
* Pelvic floor neuropathy | * Pelvic floor neuropathy | ||
* Incontinence of stool and flatus | * Incontinence of stool and flatus | ||
* Swollen extremities hands ,feet and ankles<ref>Cho HL, Lee DK, Seung JH, Kim DI, Lee TK. [https://www.koreascience.or.kr/article/JAKO200210102406985.page The clinical study of Postpartum Edema.] The Journal of Korean Obstetrics and Gynecology. 2002;15(3):151-.</ref> | * Swollen extremities hands, feet, and ankles<ref>Cho HL, Lee DK, Seung JH, Kim DI, Lee TK. [https://www.koreascience.or.kr/article/JAKO200210102406985.page The clinical study of Postpartum Edema.] The Journal of Korean Obstetrics and Gynecology. 2002;15(3):151-.</ref> | ||
* | * Excessive weight gain<ref>Christenson A, Johansson E, Reynisdottir S, Torgerson J, Hemmingsson E. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5147953/ Women's perceived reasons for their excessive postpartum weight retention: a qualitative interview study]. PLoS One. 2016 Dec 9;11(12):e0167731.</ref><ref>Farpour-Lambert NJ, Ells LJ, Martinez de Tejada B, Scott C. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168639/ 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.</ref> | ||
* | * [[Low Back Pain and Pregnancy|Low back pain (LBP)]]<ref>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. [https://pubmed.ncbi.nlm.nih.gov/29513924/ 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.</ref><ref>Tavares P, Barrett J, Hogg-Johnson S, Ho S, Corso M, Batley S, Wishloff K, Weis CA. [https://pubmed.ncbi.nlm.nih.gov/31864910/ 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.</ref><br> | ||
== | == Physical Therapy's Role in the Postnatal Period == | ||
* improvement in mood | * improvement in mood | ||
* improvement in cardiorespiratory fitness | * improvement in cardiorespiratory fitness | ||
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* improve sexual health and quality of life.<ref>Larson‐Meyer DE. [https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2002.114 Effect of postpartum exercise on mothers and their offspring: a review of the literature]. Obesity research. 2002 Aug;10(8):841-53.</ref><ref>Hadizadeh-Talasaz Z, Sadeghi R, Khadivzadeh T. [https://www.sciencedirect.com/science/article/pii/S1028455919302086 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.</ref><ref name=":0">Evenson KR, Mottola MF, Owe KM, Rousham EK, Brown WJ. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134098/ Summary of international guidelines for physical activity following pregnancy]. Obstetrical & gynecological survey. 2014 Jul;69(7):407.</ref><ref name=":1" /> | * improve sexual health and quality of life.<ref>Larson‐Meyer DE. [https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2002.114 Effect of postpartum exercise on mothers and their offspring: a review of the literature]. Obesity research. 2002 Aug;10(8):841-53.</ref><ref>Hadizadeh-Talasaz Z, Sadeghi R, Khadivzadeh T. [https://www.sciencedirect.com/science/article/pii/S1028455919302086 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.</ref><ref name=":0">Evenson KR, Mottola MF, Owe KM, Rousham EK, Brown WJ. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134098/ Summary of international guidelines for physical activity following pregnancy]. Obstetrical & gynecological survey. 2014 Jul;69(7):407.</ref><ref name=":1" /> | ||
== | == Specific Interventions == | ||
==== Diaphragmatic breathing ==== | ==== Diaphragmatic breathing ==== | ||
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==== Hydrotherapy ==== | ==== Hydrotherapy ==== | ||
researches shows the effective of a [[aquatherapy]] protocol as an alternative or adjunct to medication for early postpartum pain reduction<ref>Adherhold KG, Perry L. [https://journals.lww.com/mcnjournal/Citation/1991/03000/Jet_Hydrotherapy_for_Labor_and_Postpartum_Pain.13.aspx Jet hydrotherapy for labor and postpartum pain relief. MCN:] The American Journal of Maternal/Child Nursing. 1991 Mar 1;16(2):97-9.</ref><ref>Batten M, Stevenson E, Zimmermann D, Isaacs C. [https://pubmed.ncbi.nlm.nih.gov/28376565/ Implementation of a hydrotherapy protocol to improve postpartum pain management]. Journal of midwifery & women's health. 2017 Mar;62(2):210-4.</ref>{{#ev:youtube|mVvzsFk6rPo|width}}<ref>https://www.youtube.com/watch?v=mVvzsFk6rPo</ref> | researches shows the effective of a [[aquatherapy]] protocol as an alternative or adjunct to medication for early postpartum pain reduction<ref>Adherhold KG, Perry L. [https://journals.lww.com/mcnjournal/Citation/1991/03000/Jet_Hydrotherapy_for_Labor_and_Postpartum_Pain.13.aspx Jet hydrotherapy for labor and postpartum pain relief. MCN:] The American Journal of Maternal/Child Nursing. 1991 Mar 1;16(2):97-9.</ref><ref>Batten M, Stevenson E, Zimmermann D, Isaacs C. [https://pubmed.ncbi.nlm.nih.gov/28376565/ Implementation of a hydrotherapy protocol to improve postpartum pain management]. Journal of midwifery & women's health. 2017 Mar;62(2):210-4.</ref>{{#ev:youtube|mVvzsFk6rPo|width}}<ref>https://www.youtube.com/watch?v=mVvzsFk6rPo</ref><br> | ||
== Clinical Pearls == | |||
<br> | |||
== | |||
* It is important that to motivate and encourage the mother. | * It is important that to motivate and encourage the mother. | ||
* Persuaded to participate. | * Persuaded to participate. | ||
Revision as of 14:36, 9 November 2021
Original Editor - Safiya Naz
Top Contributors - Safiya Naz, Audrey Brown, Nabeela Wali, Khloud Shreif, Kim Jackson and Rosie Swift
Top Contributors - Safiya Naz, Audrey Brown, Nabeela Wali, Khloud Shreif, Kim Jackson and Rosie Swift
Introduction[edit | edit source]
The postnatal or postpartum period is the period that occurs immediately after childbirth. The postnatal period a critical, yet often neglected period in a new parent's life. According to the World Health Organization (WHO)[1], most maternal and newborn deaths occur in this period, therefore, proper parent and newborn observation and care are vital.
The postnatal period is generally distributed into three distinct, but continuous phases:[2]
- 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[edit | edit source]
- Increased elasticity in ligaments compare to pregnancy period, which last 4-5 months from labour.
- Elongated abdominal muscle and separation between the two recti abdominis muscles known as Diastasis recti abdominis[4]
- Weakened pelvic floor musculature
- Muscular abnormalities and weakness in the levator ani muscle[5]
- Urinary incontinence
- Genital prolapse and protrude into the vagina or press against the wall of the vagina.
- Weakened perineal muscles [6]
- Pelvic floor neuropathy
- Incontinence of stool and flatus
- Swollen extremities hands, feet, and ankles[7]
- Excessive weight gain[8][9]
- Low back pain (LBP)[10][11]
Physical Therapy's Role in the Postnatal Period[edit | edit source]
- 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.[12][13][14][15]
Specific Interventions[edit | edit source]
Diaphragmatic breathing[edit | edit source]
- good postnatal technique that women should do immediately after birth.
- Correct breathing strengthen your inner core[17][18]
aerobic exercises[edit | edit source]
- research shows positive effects of aerobic and strengthening exercises on postnatal period[20].
Pelvic floor exercises[edit | edit source]
- Pelvic floor muscle exercises are valuable for their strengthening and pain-relieving properties which decreases upcoming urinary incontinence[14]
- Kegel exercises strengthen of pelvic floor muscle in postnatal women[22]
Hydrotherapy[edit | edit source]
researches shows the effective of a aquatherapy protocol as an alternative or adjunct to medication for early postpartum pain reduction[23][24]
Clinical Pearls[edit | edit source]
- 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.[15][26]
References[edit | edit source]
- ↑ WHO Recommendations on Postnatal Care of the Mother and Newborn. Geneva: World Health Organization; 2013 Oct. Executive summary.Available from: https://www.ncbi.nlm.nih.gov/books/NBK190090/
- ↑ 2.0 2.1 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.
- ↑ Chauhan G, Tadi P. Physiology, Postpartum Changes. StatPearls Publishing. 2020 Mar 15.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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-.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 14.0 14.1 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.
- ↑ 15.0 15.1 Roy, Brad A. Ph.D., FACSM, FACHE Postpartum Exercise, ACSM's Health & Fitness Journal: November/December 2014 - Volume 18 - Issue 6 - p 3-4
- ↑ https://www.youtube.com/watch?v=bQ5aSSHm6o0
- ↑ 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.
- ↑ reference
- ↑ https://www.youtube.com/watch?v=DjLxmAUR3To
- ↑ Rajsekhar H, Sumalatha P. PHYSIOTHERAPY EXERCISES DURING ANTENATAL AND POSTNATAL. INTERNATIONAL JOURNAL OF PHYSIOTHERAPY. 2015 Oct 1;2(5):745-50.
- ↑ https://www.youtube.com/watch?v=VhrSG-R90QM
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ https://www.youtube.com/watch?v=mVvzsFk6rPo
- ↑ 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.
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