Exercise for Perinatal and Postpartal Woman

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– Exercises promote body fitness. Exercise during pregnancy is usually beneficial, depending on the woman’s health, conditioning and stages of pregnancy.

 

Benefits of Exercises

Prenatal

– Diversion

– Reduce anxiety and tension

– Quiets the mind

– Promotes sleep

– Decrease constipation

– Stimulate appetite.

 

During Labor

– Help the woman to relax and to control herself

Postnatal

– Restore abdominal and Perineal muscle tone

– Restore figure.

– Prevent complications like Thrombophlebitis

– Kegel’s exercises enhance perineal healing and improve vaginal, perineal and pelvic muscle tone.

 

Contraindications of Exercise for Perinatal and Postpartal Woman

Prenatal

– H/O small for gestational age babies

– IUGR

– Risk for preterm delivery

– Placenta previa

– Bleeding

– Multiple gestation

– H/O recurrent spontaneous abortions

– Incompetent cervix

– Maternal heart disease

Postnatal

– Abdominal delivery

– Extensive perineal repair

 

List of Exercises

Advisable

Not advisable

– Cycling

– Swimming

– Cross-country skiing

– Jogging

– Running

– Walking

– Horse riding

– Water skiing

– Racquet ball

– Ice skating

– Surfing

– Mountain climbing

 

Prenatal Exercises

– Each exercise is done twice at first and progressed to five times at a stretch as tolerated. The sequence can be repeated in reverse order.

– Relax and breath deeply between each exercise.

1. Abdominal-tightening on outward breath

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Position:

– Take a deep complete breath in through nose.

– Keep the ribs still and expand your abdominal wall upward.

– Slightly parting lips blow out air through mouth slowly, but forcibly.

– Pull in your abdominal muscles until you feel that you emptied your lungs.

Progression:

– Can do sitting or standing.

– Avoid taking too many deep breaths in succession.

– You may feel dizzy.

 

2. Pelvic floor exercise

Position :

– Lying down on back, side or front.

– Keep the legs apart.

– Chest is relaxed for normal breathing.

Action :

– Draw up the pelvic floor, feel the additional squeeze from the sides as the sphincters are tightened and the inside passages become tense.

– Give more concentration to the front portion of the pelvic floor- the master sphincter surrounding the vagina and urethra.

– Place one hand over the pubic bones and tighten the birth canal as high as the level of your hand. Hold for 2–3 seconds and then completely relax.

– Release all the tension in the pelvic floor.

– Release your jaw too.

– Do 2-3 times and end the exercise with a contraction, so that the muscle floor return to its supportive resting state.

Progression :

– Hold each contraction for 5 sec. A series of 5 exercises at a time. Do 50 or more times a day.

 

3. Foot-Bending and foot stretching

The movement of frequent foot bending and stretching and ankle-rotating provides a venous pump to assist the return of blood from the lower legs and will minimize varicosities and swelling of the ankles. Also helps to relieve cramps.

Position :

– Sitting or lying.

– Keep the legs relaxed over a pillow or the feet can be elevated or rest the foot on the opposite knee.

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Action:

– Bend the ankle as far as you can, pulling your toes up toward you, thus stretching the calf muscles.

– Then point the foot downward, making an arch. Do this several times and take a short rest before repeating. If pointing the foot results in cramps, just stretch up…. Relax…..stretch up.

 

4. Ankle-rotating

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Position:  Same as foot bending and foot stretching.

Action :

– Make large slow circles with each foot, first in a clockwise, then in a counterclockwise direction.

 

5. Pelvic-tilting

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Position :

– Lying on the back with the knees bend. On late pregnancy you can use other recommended positions if you are uncomfortable.

Action:

– Roll the pelvis back by flattening the lower back down on the floor to the maximum.

– Contract the abdominal muscles on outward breath and tighten the buttocks muscles too. Place a hand just above the pelvic bones so you can feel the muscles working.

– Hold the position for 3 sec. And then relax. Keep breathing.

– Do not raise your buttocks at all or shift your shoulders and add as much additional abdominal wall retraction as you can.

Progression :

– After learning the correct movement try it standing, side lying, sitting or on all-fours.

 

6. Straight Curl-up

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Position :

– Lying on the back with knees bent, pelvis tilted back.

Action:

– Bring your chin onto your chest. As you breath out, fold forward without any jerking or hinging movement. Come up just as far as the back naturally bends with the waist still down on the surface. This is about 8 inches or an angle of 45º. Slowly return to the starting position, do not drop back. The arms are held outstretched in front at first to aid the trunk.

 

6. Straight Curl-up

Caution :

– Do not do this in the last trimester of pregnancy if the recti muscles have separated from pregnancy.

– During postpartum support the recti muscles if they have separated more than 3 fingers width. To support cross hands over the abdominal area to pull the muscles toward the midline as the head is raised.

 

Breathing and Relaxation Techniques

1. Conditioned Relaxation

– This helps to relax the body.

– The woman lies or sits in a comfortable position with pillows for support.

– Now some one will give her instructions or she listens to an audio cassette recording.

Steps

1. Take a few slow, deep breaths.… inhale … exhale … inhale … exhale.

– Spend a 3 seconds pause at each … and 6 sec. between paragraphs. (practice 3-5 times a week).

2. Cleansing breath. … exhale. … take a deep breath through your nose … Blow it out through your mouth. You will get a tingling sensation in your body as you relax.

3. Breath slowly and deeply. … Concentrate your attention on your breathing, focus your eyes on an imaginary spot in the center of your forehead. … See it from the inside of your head. Raise your eyes way up so as to stare at the spot. Concentrate your attention on it. … Your eyelids become tense. … Now count 1 … 2 … 3… Close your eyelids firmly but not too tightly. Now a soothing feeling radiate all around your eyes. Breath slowly and deeply … Feel the relaxation in your eyes. Allow the relaxed feeling gradually radiate to all your body. Continue breathing slowly and deeply. Continue this till your whole body is relaxed.

 

2. Tense-release relaxation:

– Assume a comfortable position.

– Keep your limbs well supported.

– Become aware of your breathing.

– Slow down and relax more on each exhaled breath.

– Close your eyes.

– Wrinkle your forehead, lifting your eyebrows as high as you can. Hold for a few seconds.

– Release and feel the tension flowing from your forehead and scalp.

– This way tighten each part of your body one by one – nose, jaw, shoulders, hands, back, abdomen, buttocks, thighs, feet and toes.

 

3. Guided Imagery:

– Here you are using some imaginary situations to make you relax.

– Imagine that you are lying on a billowy cloud, moving gently through space. Feel the texture and slow rocking motion of the cloud. If colors come into your mind, let yourself be surrounded by them. Feel relaxed and simply rest weightless. Continue deep breathing and let yourself fully relaxed.

– Imagine you are floating on your back in water (in a river, lake or ocean) and leisurely looking at the sky. Feel it. Listen to the sound of water if you hear it. Continue breath deeply and relax.

– Imagine that you are lying in the cool, high, grasses of a fresh green meadow. Feel it. Relax. Listen to the water flow of the near by brook. Get relaxed.

 

4. The opening flower

– Single most effective guided imagery exercise for labor. The opening flower stands for the dilating cervix during first stage and for the opening birth canal during the second stage.

– During contractions, imagine a blossoming flower. E.g.. Rose. Imagine it opening petal by petal opening, and opening, until it is fully open. Get relaxed as in other exercises.

 

5. Neuromuscular control – “Partner Feedback Relaxation”

Directions:

– choose a comfortable position with pillows for support.

– The emphasis is always on the relaxation (not on the tensing or the quickness in relaxing).

– Relax to touch as well as to verbal instructions.

– Breath comfortably throughout the exercise.

– The woman learns to relax herself. The woman practice with her husband for 5 min. daily.

– Continue on with contracting left arm and left leg, right arm and right leg, buttocks, neck …. This is helpful to get relaxed during labor also.

 

6. Breathing techniques for labor

– Paced breathing strategies promote optimal psycho-physiologic responses to stresses. Respiration modulates and is modulated by the central nervous system and the autonomic nervous system.

Principles:

– Maintenance of adequate oxygenation of woman and fetus

– Enhancement of the opening of airways and elimination of the inefficient use of muscles to decrease the cost of breathing.

– Provision of a means of attention focusing.

– Definition of the rate and pattern based on an individuals own respiratory physiology.

 

Types of Breathing

1. Cleansing breaths.

– Effortless , relaxed breaths to a comfortable depth, similar to a sigh, taken at the beginning and end of contractions.

2. Slow paced breathing

– Slow rhythmic breathing pattern at a repetitive rate that is comfortable for the woman. Lowest rate is half of the woman’s normal breathing.

3. Modified paced breathing

– Done at a faster rate than slow paced breathing.

– Rate not greater than twice the woman’s normal respiratory rate.

– Modified paced breathing interspersed with soft blows to create a pattern is called patterned paced breathing.

4. Breathing for birth

– Open glottis with vocalization at will

– Open glottis with slow exhalation

-  Short breath holding ( 5-6 sec)

 

Postpartum Exercises

Phase – 1

– Can be started within 24 hours.

– Abdominal-tightening on outward breath

– Pelvic floor exercise

– Foot-bending and foot-stretching

– Ankle rotating

– Pelvic tilting

Phase – 2

Leg-sliding

Position: Lying on back, knees bent, pelvis tilted backward and lumbar spine flattened. Keep breathing normally through out.

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Action:

– Hold the position of corrected pelvic tilt as sliding the heels.

– Slowly stretch the legs out straight.

– If the abdominals are unable to keep the back flat draw the knees back up again, one at a time, to the point where spine began to arch.

– Work in this range until your abdominal maintain a flattened back with the legs outstretched.

 

Phase – 3

– Straight curl-up

Diagonal curl-up

– Position: Lying on the back with knees bend.

– Action: Bring you chin on to your chest. As you breath out, fold forward reaching with your outstretched arm to the outside of the left knee. Slowly return back to the starting position. Repeat the movement to the right knee.

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– Caution: If there is a separation of the recti muscles post pone this exercise until the condition has been corrected. This is easier than the straight curl up and can be done prenatal also.

 

Kegel exercise

– Tightening and relaxing the pubococcygeal muscle keeps the vagina toned, increases the strength of the perineum and helps prevent or control haemorrhoids. Practice stopping urine by squeezing this muscle several times.

– Squeeze the pubococcygeal muscle for 3 sec., relax for 3 sec. And squeeze again. Start with 10 times a day and increase to 100 times twice daily.

– Squeeze and release, then squeeze and release alternately as rapidly as you can. This is flutter exercise.

– Bear down as during bowel movement, concentrate on vagina, not on rectum. Hold for 3 sec.

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