ROLE OF PHYSICAL THERAPY TREATMENT IN ANTENATAL CARE

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ABSTRACT

BACKGROUND

Different types of physical therapy treatment interventions like postural guidance, nutritional guidance, and exercises performed by antenatal patients could have advantageous effects on pregnant women and fetus.

OBJECTIVE

To evaluate the role of different physical therapy treatments in the antenatal patient.

SEARCH STRATEGY

A Literature search is done through PubMed, Google Scholar and the Institute for Scientific data (ISI) net of Knowledge on the consequences of physical exertion throughout pregnancy on maternal and baby outcomes was performed. The knowledge about physical exercises during pregnancy is not clear. This review article is designed to explore the interventions of physical exercises during pregnancy in healthy normal women.

SUMMARY

Physical therapy is very essential for antenatal women to maintain their health during pregnancy. It has been documented that physical exercises are safe for the fetus and in long term by improving the quality of life of pregnant women. Healthy pregnant women should perform and continue regular physical exercises on daily basis by following the recommended guidelines. All pregnant women who are not facing any complications in their pregnancy should be encouraged to contribute to aerobic and strengthening exercises. Antenatal women undergo many body changes during their pregnancy for example weight gain which alters balance and coordination. The goal of physical exercises during pregnancy to maintain good health and fitness. Physical exercises during pregnancy should reduce the risk of back pain, constipation, gestational diabetes, preeclampsia and cesarean delivery. However, physical exercises promote healthy weight gain, improve general fitness, and strengthen heart and blood vessels, and helps to reduce the weight of the baby after pregnancy.

KEYWORDS

Antenatal Care, Physical Activity, Exercise, Physical therapy, Maternal Health, Pregnant Women, Pregnancy

 

 

Syeda Rida Baqir

Department of Physical therapy,

Bahria University Medical and Dental College Karachi, Pakistan.

Hafiza Tuseef Sayyar

Department of Physical therapy,

Bahria University Medical and Dental College Karachi, Pakistan.

 

Shafaq Aslam

Department of Physical therapy,

Bahria University Medical and Dental College Karachi, Pakistan.

[Baqir RS, Sayyar TH, Aslam S. Role of Physical Therapy Treatment in Antenatal Care. Pak.j.rehabil.

2021; 10(2):103-112]

DOI: 10.36283/pjr.zu.10.2/014

 

This is an open-access article distributed under the terms of the Creative
Commons Attribution Licence (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/

 

INTRODUCTION

The aim of antenatal exercises to improve the physical and psychological health and prevents pregnancy induced pathologies in pregnant women. Regular physical exercises such as low impact aerobic and stretching exercises offers fitness to the each individual which is the dream of every individual. The engagement of an individual in everyday plan physical activity is obligatory to maintain the health and fitness.1 Previous types of research proved that Improvement of memory, protection from chronic illnesses, maintenance of weight, reduction of blood pressure, maintenance of glucose level, Improve sleep, improvement of cardiac fitness, increase musculoskeletal strength, reduction of anxiety and depression can be achieved by physical activity. Despite any age limit every individual, especially pregnant women, needs to perform exercises during pregnancy because it is very beneficial in maintaining her health and also acts as a preventive measure for any discomfort caused by pregnancy’s normal physiological changes.2 Awareness regarding the promotion of antenatal care of pregnant women and fetuses plays a vital role in the health care system nowadays because to obtain safe maternity and improved neonatal outcomes it is important to perform accurate and appropriate exercises during pregnancy. According to recent research done by WHO showed that: healthy pregnant women should visit at least four times during pregnancy for antenatal classes in a specified period according to the guidance given by the physical therapist.3 As pregnancy begins first antenatal class should be done as early as possible that helps in the prevention of various problems associated with pregnancy like spina bifida, iron deficiency, body pain due to incorrect posture, etc. The last antenatal class should be done at 37 weeks of gestational

age near the expected date of delivery that helps the women to cope up with the labor period effectively, multiple baby births, etc.4 One of research mention that approximately 25 to 30 percent of antenatal women need more than four visits during pregnancy due to another complication associated with physiological changes during pregnancy.5 Some of the problems that can be caused by being overweight during pregnancy, poor posture, shifting in the Centre of gravity are as follows: backache, inflammation of the sciatic nerve, overuse strain injury, pain in the sacroiliac joint, weakness of pelvic floor muscles, cervical pain, breathing difficulties, indigestion, legs cramps, fatigue, headache, swelling, separation of diastasis recti muscles (six-packs) and urinary incontinence. These complaints may or may not disappear after the delivery of the baby.6 For the reduction of pregnancy-related discomforts experienced by pregnant women and improvement of mother and baby antenatal care include: exercise, postural guidance is very important during pregnancy because pregnancy plays a vital role in the development and management of own health and effective parenting behavior.7 The reduction in pain threshold, duration of labor, injuries of baby by birth, maintenance of blood pressure, and blood glucose level during pregnancy can be achieved by antenatal exercises. Insufficient care of antenatal women can cause adverse effects to mother and fetus as well. Because approximately 25% of women’s death occurs during pregnancy concerning variation in the prevalence rate of disease, miscarriages, the ferocity of different countries, More than half of antenatal deaths occur due to hypertension and hemorrhage due to inappropriate care of women during pregnancy.8

 

Who Guidelines for Antenatal Women

According to WHO all antenatal and postnatal women should follow the following guidelines:

  • Pregnant women should do regular physical exercises such as aerobic of moderate intensity for at least 150 min on daily basis.
  • Pre-pregnant women who were physically active such as performing aerobic and yoga exercises them should continue their physical activities during pregnancy as well.
  • Pregnant women who were not able to perform aerobic exercises should start physical activities gradually and then increases the frequency and intensity and duration of exercises.
  • The urinary incontinence is reduced by performing pelvic floor muscle exercises on daily basis.
  • A sedentary lifestyle should be limited in pregnant women by replacing small intensity of physical activities which is beneficial for them.9

Pregnancy safety consideration

There are many safety considerations which is necessary for the pregnant women during their pregnancy.

  • Pregnant women should avoid physical exercises during humidity and excessive heat.
  • She should drink plenty of water during and after physical exercises.
  • Pregnant women avoid participating in such physical exercises in which are associated with direct physical contact and might be responsible for falling such as at high altitudes.
  • After the first trimester, pregnant women avoid exercises in a supine position.
  • Pregnant women who performing athletic competitions more than the recommended guidelines should seek out proper supervision from specialist healthcare providers for any kind of complication.9

 

METHODOLOGY

The present review article extracted out from different research websites including Pub Med, Google Scholar, and Science direct the Institute for Scientific direct by searching the medical terms including; knowledge and physical exercises during pregnancy, physiotherapy, antenatal exercises, yoga, and posture exercise. The literature review was completed by searching 50 articles from last 25 years. In the current review; we restrict the search to permit for the inclusion criteria to assessed the having controlled trials of healthy pregnant women who underwent physical exercise program in which fetal and maternal outcomes included. For this, the following articles were screened and then analyzed by consistently reviewing their abstracts.  Afterward, fifty full texts were accessed and their reference lists were additionally reviewed.

Prevalence of Antenatal Physical Therapy

The prevalence and characteristics of antenatal exercises are studied by different researchers in many countries. One of the researchers reported in his research about the level of physical activity among pregnant women in the U.S is that only 15.8% of females are involved in antenatal exercises at the suggested level.10 Another research from Ireland reported that only 21.5% of antenatal females have no complications related to pregnancy and they are doing exercises at the recommended level.11 There is a decrease in frequency and duration of exercise in non-pregnant women instead of antenatal women in Danish. There is a reduction of physical activity during the 3rd trimester of pregnancy who usually do exercises a regular basis during pregnancy, however, 6 to 29% of the increase in sedentary activity of the antenatal patient.12 Figure-1 shown the prevalence of physical activity in Pakistan.

Figure-1: Prevalence of physical activity during pregnancy in Pakistan13

Physical Therapy Interventions

Previous studies reported that the following are the different essentials interventions which are required to treat and manage antenatal women in physical therapy: 14-20

  • Breathing Exercises
  • Aerobic Exercises
  • Stretching Exercises
  • Strengthening Exercises.
  • Yoga
  • Postural Guidance
  • Nutritional Guidance

Breathing Exercises

Breathing Exercises are useful for antenatal women during labor for pain management. Following are some breathing exercises that can be performed during pregnancy:

  • Abdominal breathing
  • Lower costal breathing
  • Apical breathing

Abdominal breathing

Abdominal exercises are performed by breathing in through the nose and sense to expand the abdomen and then breathe out through the mouth. This exercise is appropriate in minor labor pain.

Lower costal breathing

Lower costal breathing can be performed by breathing in through your nose and sense to expand your chest then breathe out through your mouth slowly, this exercise is appropriate for moderate pain during labor.

Apical breathing

Apical breathing is performed by placing cross hands below the level of clavicles and breathe in through your nose and breathe out through the mouth slowly and sense to move your upper lobes of lungs up and down slowly. This exercise can be useful in severe pain of labor.

It is suggested to antenatal women that they should try to stay calm and relax during labor contractions and perform breathing exercises to maintain their breathing and comfort position.21

Aerobic Exercises

For the promotion of physical fitness and strengthening of muscles, many exercises can be performed by an antenatal patient. Aerobic exercises such as walking, hiking, Jogging, Biking, Swimming are some of the effective ways which elevate the heart rate and provides oxygen and blood to the muscles.22 walking is the easiest way to perform aerobics so the duration of walking can be 20- 30 minutes three to four times a week for pregnant.23

Stretching Exercises

Stretching exercises can also be an effective way of being physically active during pregnancy such as pectoral stretch which can prevent round shoulders during pregnancy.24 piriformis stretch which can stabilize the pelvis and make it easy to perform activities of daily living.25 hamstring stretch which can reduce the hamstring muscles shortening and that is usually the main cause of backache and misalignment of the pelvis.26 calf stretch can produce more stability during walking by producing more force during the push-off phase during pregnancy.27

Strengthening Exercises

Strengthening exercises are also very helpful for the physical fitness of antenatal patient some of the strengthening exercises which can be very beneficial are as shown in figure-3.

Bridging, this exercise is more specific for postural muscles and mainly Gluteus maximus strengthening. According to researches, lumbar spine proprioception is also improved through bridging.28 Squats is a stretching exercise that increase stabilization of lower limbs focuses on gluteus maximus.

Yoga

Yoga derived from SANSKRIT ROOT, meaning is to unite, to join and to yoke. Combination of deep breathing, stretching exercises, meditation and posture is called Yoga. Its purpose is to unite your soul,mind and body.Their are many beenfits of yoga which is discussed in previous researches some of the benefits of yoga are: Reduction of stress, depression, longterm pains associated with joints,muscles and bones and also helps to maintain blood pressure and sugar levels.29 Moodswings, discomfort associated with musculoskeletal problems,increase in weight,pain,swelling all problems can be efficiently manage by yoga during pregnancy.30 Figure-4 illustrated the different poses and exercises of yoga of antenatal patients which can easily perform without and side effects.

Postural Guidance

The word Posture derived from the Latin word PONERE meaning is: to put or place. Posture is defined as the attitude or carriage of the body.31 Due to physiological changes postural changes during pregnancy is very common which inturns cause backache in 50% to 70% of antenatal patients.32-34 The development of back pain has been related to spinal changes, especially an increase in lumbar curvature, which alters the distribution of loads, causing increased tensions in lumbar structures.35,36 Figure-5 represent both the bad posture and good posture during pregnancy:

Nutritional Guidance

According to Canada`s Food Guide to Healthy Eating, Pregnant women should choose healthy foods from basic food groups (carbohydrates, proteins, fats and oil, vitamins and minerals) with a focus on proper hydration to prevent dehydration which is very dangerous for women and fetus. Exercising women during pregnancy requires more caloric requirements to overcome the need for additional energy and also daunt the starving to lose weight.38,39 Inhibit the use of caffeine in the form of smoking, alcohol intake. More information regarding nutrition guidelines during pregnancy is discussed in Canadian research published in 1999.40

DISCUSSION

According to research, a sedentary lifestyle is more common in pregnant women as compared to physical activity level at pre-pregnancy state. Another study shows that women who are physically active during their pregnancy may have fewer chances of occurrence of hypertension, diabetes, body aches, depression, fatigue, preterm labor.41, In addition, there is a risk of body pain associated with pregnancy especially in women who can experience low back pain which in turn causes a reduction in the level of physical activity and reduce the efficiency of performance in every type of work. A large amount of absenteeism from office work of women job is also due to back and throughout body pain during pregnancy, For management of pain during pregnancy pharmaceutical therapy may be harmful to a baby that is why conservative treatment is preferred which is considered to have minimal or no side effects so physical therapy play a vital role in prevention and management of pain during pregnancy because through this female can be physically active and can minimize all expected body pain during pregnancy.42

It is a common belief and multiple times proved that: Being physically active during pregnancy is very beneficial for antenatal women and babies as well. For lifestyle modifications, pregnancy is the best time. There is no need to perform aggressive exercises during pregnancy only moderate level exercises are recommended during pregnancy.43 According to different studies it is proved that exercise and different interventions use in physical therapy treatment can reduce pain, increase the efficiency of performance and activities of daily living. According to public health policies, there is a reduction in the overall number of LSCS( lower segment cesarean sections) rate due to active participation in an antenatal physical therapy program which includes relaxation exercise.44 In addition one of the research reported that due to participation in antenatal physical therapy programs stress and fear of labor is also reduced in women.45 According to research conducted in Brazil, the majority of the females favored vaginal mode of delivery due to the fear of pain at labor during lower segment cesarean section procedure.46 Another research of Sweden reported that women’s fear of labor and their favor towards LSCS(lower segment cesarean section) increased more in the first trimester of pregnancy which shows the sign of anxiety during pregnancy.47 Another research reported that health policy regarding prenatal care aimed at improving the health of women and promote quality of life-based on evidence-based practices with special consideration that: do not use gratuitous interventions and preserve women choice as well. The presence of caregivers of women’s own choice during childbirth will be an effective measure in motivating women during labor. The use of conservative techniques for the management of pain during labor should be encouraged as well comfortable position preference by women should be allowed.48 General recommendations regarding frequency, period, the intensity of exercises during pregnancy have not existed yet, but the benefits of physical exercises to baby and antenatal women although increased, awareness regarding the benefits of exercises to antenatal women and baby is reported in many studies. Doctors are considered as the vital person in educating antenatal women about the benefits of exercise and behavior of women towards exercise as the doctor has the vital role in the education of antenatal women about the benefits of exercise and behavior of women towards exercise.49,50 In our literature search we mention the different physical therapy exercises for antenatal women for the benefits of baby and pregnant women and can provide a better outcome to the female in response to physical activity.

 

CONCLUSION

Physical therapy during pregnancy is very important for the prevention and treatment of problems associated with pregnancy as mention in the above systemic review. It provides many benefits for pregnant women and babies. Women who attend antenatal classes during pregnancy on regular basis and follow instructions include: all exercises according to different trimesters protocols and guidelines regarding posture and nutrition are more physically active and painless during pregnancy as compare to women not taking classes during pregnancy.

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