Physiotherapy in Antenatal and Post-natal Care

Pregnancy is one of the most important period in the life of a woman, a family and a society. Therefore, great attention is given to antenatal care by the health care systems of most countries. Antenatal care is care of the woman during pregnancy which starts immediately from the time of conception. The primary aim is to achieve at the end of the pregnancy, a healthy mother and a healthy baby.

Maternal Physiology and Postural Changes

Pregnancy involves significant maternal physiology changes including cardiovascular, respiratory, endocrine, and musculoskeletal systems. Notable musculoskeletal changes include:

• Increase in body weight and abdominal size due to growing uterus.
• Increase in joint laxity and joint ranges.
• Increased water retention leading to oedema and nerve compressions.
• Drop in the pelvic floor leading to pelvic floor dysfunction.
• Pregnancy associated osteoporosis (PAO) and painful muscle cramps.

As the abdominal size increases, the center of gravity (COG) shifts anteriorly. This is counter-balanced by an increase of lumbosacral angle, an increase of lumbar lordosis and thoracic kyphosis, protraction of the shoulders, and hyperextension of the knee.

Role of Physiotherapy in Antenatal Care

Physiotherapy plays an important role in both antenatal and postnatal care. During antenatal care, the role of physiotherapy includes the prevention and treatment of musculoskeletal problems, providing postural and ergonomic advice, and promoting healthy lifestyles. Physiotherapists aim to:

• Promote muscle tone, strength and endurance.
• Enhance relaxation and teach relaxation techniques.
• Prepare women for labor and the post-natal program.
• Identify complications early for treatment.

Management of Musculoskeletal Problems

Physiotherapists address specific issues that arise during pregnancy:

Back and pelvic girdle pain: Proper postural education is essential, and activities that reproduce the symptoms should be avoided. For relief of pain, gentle massage, hot pack, and TENS may be used.

Sacroiliac joint dysfunction: A support belt and various self-help maneuvers can be taught to relieve sacroiliac joint pain.

Symphysis pubis dysfunction: Management includes rest, reduction of non essential chores, and keeping the leg adducted while avoiding single-leg stance.

History of Antenatal Care

Prenatal care started in Edinburgh at the turn of the 20th century. Later, Janet Campbell started a national system of antenatal clinics with a uniform pattern of visits and procedures. Based on her work in India in the 1930s, Vaughan instituted antenatal exercise classes in England, writing that “flexible hips and spine are conducive to ease of labor.” During the mid-1950s, “keep fit” exercises introduced by obstetric physiotherapist Helen Heardman were included with relaxation and breathing skills for pain management for labor.

Post-natal Care

Postnatally, physiotherapists focus on restoring muscle strength through an exercise program. They also treat issues like perineal pain and provide education on proper posture while caring for a baby.