physiotherapy ante-natal education class post-natal pain. 9 the diagram below shows you the location...
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Physiotherapy ante-natal education class
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Contents 3 Looking after your back and pelvis in
pregnancy and the post-natal period
3 Sleeping in pregnancy
4 Exercises to try – from our class
4 Pelvic tilts
4 Abdominal hollowing
5 Pelvic floor exercises
6 Exercise in pregnancy
8 Postnatal exercise
8 Perineal massage
10 Optimal foetal positioning
11 Labour
13 The post-natal period
14 Notes
15 Contact details
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Looking after your back and pelvis in pregnancy and the post-natal period About 8 out of ten (80%) of women will experience some degree of back pain in pregnancy and 2 out of 10 (20%) of women pelvic pain. This means it is really important to look after yourself to help prevent and manage pain. Try and follow these simple tips day-to-day: • Change positions regularly, for example, every 30
minutes at a desk, stand up and sit down or go and get a glass of water.
• Bend from the knees rather than the hips. • Use pelvic tilts (discussed later in this booklet) to
encourage movement in the lower back and pelvis. • Be as active as possible within pain limits. • Share the load. Ask for help from partners and friends. • Avoid activities which make the pain worse. This
may include standing on one leg. • Try and find other ways to perform activities which
cause discomfort. Sleeping in pregnancy As pregnancies progress, staying comfortable at night can become increasingly difficult. It is recommended that you don’t sleep flat on your back from 20 weeks of pregnancy. This is because the weight of the womb can reduce blood flow to the heart and lungs. We recommended sleeping on your side (in reality you’re likely to switch between right and left sides throughout the night). Also, try sleeping with a pillow between your legs and under your bump. Some women find pregnancy pillows useful.
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Exercises to try – from our class Pelvic tilts • Pelvic tilts can be completed sitting, standing, lying
and on a gym ball. • Slowly stick your bottom out, chest out and sit up tall
to tilt your pelvis forward. • Then slowly tuck your bottom underneath you,
rolling the pelvis backwards and tucking your tummy up to your chest
• Repeat slowly from one position to the other, for a few minutes.
Abdominal hollowing Start in a relaxed standing position with your stomach relaxed. Imagine you have a string from your bellybutton to your spine, which is being gently pulled tighter. This should result in your bump lifting up slightly. Try and hold this for 10 seconds and most importantly use with activities such as standing up, walking, turning in bed, and lifting.
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Pelvic floor exercises Slow-twitch exercises 1. Close and draw up the muscles around your back
passage, as if you are trying to stop passing wind. Make sure that you do not contract your buttock muscles while you do this.
2. Continue to close and draw up the muscles around your vagina and urethra, as though you are trying to stop the flow of urine.
3. Hold for as long as you can, and then slowly relax. Rest for the same amount of time, for example, hold for a count of 8 and then relax for a count of 8.
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Fast-twitch exercises 1. Pull up the pelvic floor muscles as before. 2. Hold for one second and then relax. 3. Repeat 5-10 times or until your muscles feel tired. Exercise in pregnancy It is recommended that pregnant women aim to exercise for 20-30 minutes on most days, at a moderate intensity level (it should require some effort, but you should still be able to have a conversation). Benefits of exercise in pregnancy include: • maintaining healthy weight gain in pregnancy • reducing the risk of diabetes in pregnancy • improving or maintaining fitness levels • promoting good mental health.
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Types of exercise include: • walking (adapting pace to achieve moderate
intensity) • swimming • stationary Cycling • pregnancy yoga and Pilates • strengthening exercises. If you are very active, you can continue with your physical activity, as long as you discuss with your healthcare provider how your activity should be adjusted over time. It is recommended that you seek further advice from your midwife or obstetrician before exercising if you know your pregnancy is deemed higher risk or you have had any of the following: • on-going vaginal bleeding in your second or third
trimester • loss of fluid vaginally • low-lying placenta or placenta praevia • weakening of the cervix (neck of the womb) • are at risk of early labour or are carrying more than
one baby • pre-eclampsia • high blood pressure • ruptured membranes • severe anaemia • uncontrolled medical conditions (diabetes/heart,
lung, seizure or thyroid conditions) For details of the full guidelines, visit w: www.acog.org.
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Post-natal exercise Feeling ready to return to different forms of exercise will depend on you and the type of delivery you have. We generally advise gentle exercise up to six weeks post-natal (walking, pelvic floor exercises, pelvic tilts and the bump-lift). At six weeks you may find you are ready to return to low impact exercise (swimming, cycling, yoga, Pilates, light weights). We recommend waiting until you are at least 12 weeks post-natal before returning to impact exercise. If you are unsure about your return to exercise post-natally, and if you are having pelvic floor symptoms, we would advise seeking a referral for a Women’s Health physiotherapy review. Perineal massage The perineum is the area between the vagina and the back passage (anus). Completing perineal massage during pregnancy can reduce your risk of requiring stitches from the delivery. If the perineal area is stretched before you give birth, it is thought that it will stretch more easily during delivery. If this is your first pregnancy commence the perineal massage at 34 weeks pregnant. For other pregnancies, 36 weeks. For second-time mums, it may also help reduce post-natal pain.
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The diagram below shows you the location you are aiming to stretch during perineal massage.
Partners: Pour some oil onto your 1st and 2nd fingers and massage it firmly into the perineum using a circular motion. Then put your oiled two fingers about 4-5cms into the vagina, and press downward (towards the rectum). Use firm, steady pressure, but be gentle. Then slide your fingers from side-to-side in a rhythmic ‘U’ – or sling-type motion. Use just enough pressure that the tissue just begins to sting. Women: If your partner is not available to help, use your thumbs instead of two fingers to perform the side-to-side, sling-type motion. Research suggests that completing this one or two times each week will give you the best outcome.
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Optimal foetal positioning To help encourage your baby into the right position for birth, the following positions may be useful to use at the end of your pregnancy. The evidence is uncertain about how much these positions might help. For more information please talk to your midwife. These recommendations are intended to use gravity and posture to encourage the baby’s face to be facing your tailbone. This position is known to reduce the duration of labour, and the need for assistance (rather than when the baby is facing your pubic bone).
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Labour The following information has been adapted from the National Institute for Health and Care Excellence (NICE) guidelines.
Early first stage Adopting upright postures may help to: • reduce the duration of the second stage of labour • reduce the need for an assisted delivery and episiotomy • prevent additional pressure on your pelvis. The main aim is to find a position you are comfortable in during labour. This may change several times during the delivery. Positions you choose will also depend on the progress of labour and recommendations from your health professionals.
There may be painful contractions and the cervix will be under 4cm dilated Early first
stage
Late first stage
(established)
Second stage
There may be painful contractions and the cervix will be under 4cm dilated
Regular painful contractions and the cervix is over 4cm dilated
Passive: 10cm dilated but no expulsive contractions
Active: 10cm dilated with expulsive contractions (pushing commences)
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Side lying with support for your upper leg.
On all fours supported with a ball (could also be a beanbag or chair) and/or on your knees using the head of the bed for support.
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The post-natal period When feeding your baby, always sit well-supported in a chair or on the bed. You may find placing a folded towel or small pillow behind your waist makes you feel more supported. You can also feed your baby while lying on your side. When changing your baby, try to have the changing station at waist height. This means you won’t have to bend forwards, and it will be easier to lift your baby once you have finished. When bathing your baby, try kneeling down to avoid an awkward position for your back. If you are standing, make sure the baby bath is at waist height. When lifting, remember to bend from the knees, tighten your pelvic floor and abdominal muscles and keep the object you are lifting close to your body.
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Notes
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Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: 020 7188 8748, Monday to Friday, 9am to 5pm Your comments and concerns For advice, support or to raise a concern, contact our Patient Advice and Liaison Service (PALS). To make a complaint, contact the complaints department. t: 020 7188 8801 (PALS) e: [email protected] t: 020 7188 3514 (complaints) e: [email protected] Language and accessible support services If you need an interpreter or information about your care in a different language or format, please get in touch. t: 020 7188 8815 e: [email protected] NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111
Contact details Women’s Health physiotherapy department, t: 020 718 85084 For more information leaflets on conditions, treatments, and services offered at our hospitals, please visit w: www.guysandstthomas.nhs.uk/leaflets
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NHS website Online information and guidance on all aspects of health and healthcare, to help you take control of your health and wellbeing. w: www.nhs.uk Get involved and have your say: become a member of the Trust Members of Guy’s and St Thomas’ NHS Foundation Trust contribute to the organisation on a voluntary basis. We count on them for feedback, local knowledge and support. Membership is free and it is up to you how much you get involved. To find out more, please get in touch. t: 0800 731 0319 e: [email protected] w: www.guysandstthomas.nhs.uk/membership
Leaflet number: 4653/VER1 Date published: October 2018
Review date: October 2021 © 2018 Guy’s and St Thomas’ NHS Foundation Trust
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