Postnatal Period

Original Editor - Safiya Naz
Top Contributors - Safiya Naz, Audrey Brown, Nabeela Wali, Khloud Shreif, Rosie Swift and Kim Jackson

Introduction

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), most maternal and newborn deaths occur in this period, therefore, proper parent and newborn management and care are vital.

The postnatal period is generally distributed into three distinct, but continuous phases:

• 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

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.

Postnatal Clinical Presentation and Considerations

• Increased elasticity in ligaments, which can last 4-5 months from labour.
• Risk for thromboembolism due to increased clotting factors
• Elongation and separation between the two recti abdominis muscles known as Diastasis recti abdominis
• Weakened pelvic floor musculature
• Muscular abnormalities and weakness in the levator ani muscle
• Urinary incontinence
• Pelvic organ prolapse
• Weakened perineal muscles
• Pelvic floor neuropathy
• Incontinence of stool and flatus
• Swollen extremities hands, feet, and ankles
• Excessive weight gain
• Low back pain (LBP)
  

Physical Therapy's Role in the Postnatal Period

Physical therapy, through a combination of manual therapies, specific treatments (such as pelvic floor muscle training), and therapeutic exercise, can improve health outcomes for new mothers in the postnatal period. Physical therapy interventions may help with the following:

• Improve mood
• Improve cardiorespiratory fitness
• Promote weight loss
• Reduce the risk of postpartum depression and anxiety
• Enhance psychological well‐being
• Improve sexual health and sexual dysfunction
• Lead to better outcomes assessing quality of life.

Specific Interventions

Diaphragmatic Breathing

Diaphragmatic Breathing is a powerful breathing exercise to promote efficient respiration, bring awareness to breath control and postural control, enhance relaxation, and improve core muscle stability.

Exercise

Numerous studies show positive effects of aerobic and strengthening exercises for people in the postnatal period. . The United States Department of Heath and Human Services (USDHHS), "recommended that healthy postpartum women who were not highly active or engaging in vigorous intensity physical activity should obtain at least 150 minutes of moderate intensity aerobic activity spread throughout the week. Those who were highly active could continue their physical activity into the postpartum period, provided that they remained healthy, and should discuss this issue with their healthcare provider. " Additional guidelines suggest returning to pre-pregnancy exercise levels gradually and advise caution with resuming high-impact activity too soon after childbirth.

If the postpartum person is breastfeeding, light to moderate exercise does not seem to affect breast milk, whereas high-intensity exercise can increase lactate levels in milk.

• Specific, deep core strengthening and stability exercises can help heal diastatis recti and improve quality of life in postpartum people.

Pelvic Floor Exercises

Pelvic floor muscle exercises are vital for addressing pelvic pain, urinary and fecal incontinence, and sexual dysfunction. Pelvic floor exercises strengthen the pelvic floor muscles through muscular hypertrophy, allowing the muscles to better support the pelvic organs and structures and lessening the burden imposed on the supporting ligaments in and around the pelvis. Pelvic exercises also increase blood flow to the pelvic floor, which help expedite the healing of damaged tissues.

• Kegel exercises, and other exercises that involve the repeated tensing and relaxing of the pelvic floor muscles, strengthen and improve sexual function in postpartum people.
• Biofeedback and electrical stimulation can also be used in concert with pelvic floor muscle exercises
• Pelvic floor exercises have been shown to help reduce symptoms of urinary and fecal incontinence

Hydrotherapy (Aquatherapy)

Research has shown the efficacy of an aquatherapy protocol as an alternative or adjunct to medication for early postpartum pain reductionHydrotherapy has known effects to reduce pain, reduce muscle spasm and promote relaxation. A complete medical history of a postpartum person should be taken before attempting hydrotherapy to avoid health emergencies and negative health effects.

Clinical Takeaways

• Obtain medical clearance from the postpartum person's primary care provider before beginning physical therapy intervention
• Be aware of any pre-existing or prior medical conditions for the postpartum patient
• Encourage a return to movement
• Identify fear-avoidant behaviors early and address them
• Teach the exercises that are appropriate.
• Include exercises and interventions that strengthen and stabilize the pelvic floor
• Begin with low-intensity activity and gradually increase to moderate efforts
• Women who are competitive athletes and those doing higher-intensity training before pregnancy can usually return to those levels fairly quickly.
• If the postpartum person is on bedrest for a prolonged period of time, teach diaphragmatic breathing and vigorous circulatory exercises (ex. ankle pumps).

References

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