POSTNATAL CARE
B.Sathyaprabha,
Associate Professor
Faculty of Physiotherapy
Puerperium
• Changes in various systems
• Uterus shrinks, birth canal and perineal repair
• endocrine system rebalances to pre pregnant state
• Lactation
• emotional changes
Immediate postnatal problems
• perineal dysfunction/pain
• Genito urinary dysfunction
• After pains
• Circulatory dysfunction-varicosities,
oedema,SVT,DVT,pulmonary embolism,haemorroids
• Breast problems
• Postnatal depression and anxiety
Long term problems
• Perineal pain and discomfort
• Incontinence
• Dyspareunia
• Diastasis recti, diastasis symphysis pubis
• Back pain
• Carpal tunnel syndrome
• Mastitis
POSTNATAL PERIOD
• Hospital-based
• Immediate postpartum (hospital
discharge to six weeks postpartum)
• Later postpartum (six weeks to one
year, corresponding to cessation of
breastfeeding)
Evensonet al, ObstetGynecolSurv. 2014 July ; 69(7): 407–414.
Assessment
• Obstetric history- GPLAD
• Medical and surgical history
• Bladder and bowel habits
• Weight gain
• Posture
• edema
• Musculoskeletal and neurological evaluation
• Perineum/Pelvic floor strength
• Abdominals strength-check Diastasis Recti
Assessment of Edema & Homan’s Sign
• ASSESS legs for dependent edema in feet and
legs.
• Press down gently on the patient’s knee (legs
extended flat on bed ask her to dorsiflex her
foot)
Perineal tear
Pelvic foor assessment
Medical and
surgical history Voiding frequency
Storage Symptoms
Bladder diary
Cough stress test
Incontinence screening-
Questionnaire, PAD Test
Uro dynamic reports
PF TESTING -ADJUNCTS
• Perineo meter
CORE
ASSESS FOR
Flexibility
Muscle strength
Range of motion
Mobility
LACTATION
• If breastfeeding, assess nipples for:
• Fissures
• Cracks
• Soreness
• Inversion
Diastasis Recti
IN LSCS- A GAP OF MORE
AFTER THAN 2
PUERPERIUM FINGERS
IN VAGINAL
DELIVERY -3RD
DAY POST
DELIVERY
Perineal pain-Towel method
Correct positioning for opening
bowels
Musculoskeletal dysfunction
• Low Back Pain
• Thoracic pain
• SPD-symphysis pubis dysfunction
• Coccydynia
• SID-sacro iliac dysfunction
• PGP-pelvic girdle pain
BENEFITS OF POSTNATAL EXERCISE
• Improved lumbo pelvic stability
• Strengthening muscles
• Awareness of posture while feeding/ lifting/ carrying
• Improved aerobic fitness, general health, production
of endorphins
• Reduced fatigue – increased energy
• Reduced SUI/ Lactation induced bone loss
Mottola, “Exercise in the Postpartum Period: Practical Applications”, Current
Sports Medicine Reports 2002, 1:362–368
Contraindications to exercise
• Joint or pelvic girdle pain
• Inadequate healing, discomfort
• Excessive fatigue
• Gross separation of rectus abdominis
Ensure baby state and Maternal health including mental
state.
Exercise and education program for
uncomplicated vaginal delivery
• Pelvic floor restoration-goals-continence,
Strength,endurance
• stop test
• quick contraction-3 sec
• long holds-15 sec
• increase frequency and strength
Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 650. American College
of Obstetricians and Gynecologists. Obstet Gynecol 2015;126:e135–42.
www.acog.org
• Abdominals –goals-strenghen and eliminate diastasis
recti
• Evaluation
• Tummy tuck contractions-Pelvic tilt,briging,rocking
• Progress to leg slides
• Unilateral SLR
• Posture-goals-restore and strengthen upper back
muscles
• balance abdominals and back strength
• Strengthen upper,mid,lowback muscles,hip muscles
• Concentrate ‘at risk’ areas
upper back
low back
pelvic floor
abdominals
Exercise and education program for
cesarean delivery
• Chest care
• Circulatory care
• Pelvic floor restoration
• Abdominals
pelvic tilting-sitting
leg slides with pelvic tilt
hula-hip hiking
• Posture care
ADL REVIEW
• proper lifting and carrying of baby
• Positions of nursing
• Education on back, abdominals and breast support
• Aerobic conditioning-goal-to promote endurance and
general
strengthening-FITT
postnatal exercise class
swimming
walking
• Conscious relaxation-to cope with all physical and emotional
changes ,improve feeling of well-being
DR Care
1- Avoid straight leg raising, double leg lowering, sitting
straight up from lying position, side flexion and
rotation.
2- Avoid constipation to avoid bearing.
3- Avoid carrying heavy objects.
4- Applied post natal exercises till two months after
delivery.
5- Avoid succession pregnancy (at least 3 years
distance).
Lactation and exercise
• At maximal intesity of exercise ,Lactic acid
level is increased but not at moderate
intensity.
Evenson et al, ObstetGynecolSurv. 2014 July ; 69(7): 407–414.
THANK YOU….
