Login / Create an Account

Phone646.355.8777

Tags >> Pregnancy and Postpartum
Dec 26, 2014

pregnant yoga

If pelvic floor muscle training (PFMT) is instructed as part of a general exercise class during pregnancy, can this (PFMT) prevent urinary incontinence? A recent post on our site described the systematic review by Bo and colleagues in which the researchers suggested that fitness instructors and coaches should be trained in effective pelvic floor muscle training approaches. A recent article describes such an approach in which a Physical Activity and Sports Sciences graduate instructed in a general exercise class for pregnant women and the class also included PFMT. Nulliparous women completed participation in a pregnancy exercise class (n=63) or a control group (n=89), and in the exercise group, pelvic floor muscle exercises were included. The classes took place 3x/week, for 55-60 minutes each session, for up to 22 weeks, and 8-12 women were in each group class.

 

Within each exercise class, a typical prenatal program was followed consisting of an 8 minute warm-up, 30 minutes of aerobic training including 10 minutes of strength training, 10 minutes of PFMT and a 7 minute cool-down period. A heart rate monitor and a Borg Rating of Perceived Exertion Scale was used and the women were asked to exercise at a 12-14 on the Borg scale. For pelvic floor muscle training, women were instructed in the anatomy and function of the PFM and in the role of the PFM in urinary incontinence. Although the participants were not formally assessed for correct contractions, the women were instructed in methods of confirming a correct contraction at home such as stopping the flow of urine, self-palpation, or using a mirror to confirm contraction. The PFM exercises started with 1 set of 8 contractions, and the class included both long (6 seconds) and short (1 second) contractions. The participants worked up to a total of 100 exercise contractions that included a combination of short and long contractions, and they were also encouraged to complete the same number of exercises on days outside of class.

 

Women in the control group received "usual care" including care from a midwife and instruction in pelvic floor muscle health. The outcome tool completed by both groups included the International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) which was completed prior to and directly following intervention. At the end of the intervention, a significant difference was observed in the women in the exercise group (EG), as 95% of the EG denied leakage, whereas 61% of the control group denied leakage. Of those reporting leakage in the exercise group, the amount of leakage reported was small, and in the control group, amount leaked ranged from small to large. The key points of interest in this study include that first, participation in an exercise group that includes pelvic floor muscle training can prevent urinary incontinence in pregnancy, Secondly, although pelvic muscle function assessment is optimal, participants who did not have PFM contraction confirmed still had positive outcome from the treatment. And because most studies of PFMT are conducted by a physical therapist, this study is unique in its design of having a Physical Activity and Sports Science graduate conduct the intervention.

 


Dec 22, 2014

_

The American Heart Association/American Stroke Association Guidelines for Prevention of Stroke in Women reports that although stroke is not common during pregnancy, pregnant women are more at risk for stroke than non-pregnant young women. The guidelines describe the pregnancy-related physiologic factors of venous stasis, lower extremity edema, and blood hypercoagulability as factors in increased risk of stroke. Hypertensive disorders during pregnancy including preeclampsia can also increase maternal and fetal risk, with risk factors of obesity, age over 40, multiple pregnancy, and diabetes.

 

Postpartum hypertensive issues can also be a concern, and providers should be alert to the symptom of headaches as a potential marker of elevated blood pressure. Although rehabilitation professionals should routinely measure blood pressure in patients, numerous studies have demonstrated that we do not. The referenced guidelines give parameters for blood pressure readings for mild, moderate, and severely high blood pressure readings in pregnancy.

 

High Blood Pressure in Pregnancy
Diastolic (mm Hg)
Systolic (mm Hg)

Mild 90-99 140-149
Moderate 100-109 150-159
Severe ≥110 ≥160

 

The third trimester and the postpartum period bring the highest risk for stroke, and the authors of the guidelines point out that a stroke can occur with even moderately elevated blood pressure readings. Even if a woman recovers from elevated blood pressure in the peripartum period, she may remain at risk for developing further cardiovascular disease including stroke. Having gestational diabetes, which can later develop into Type 2 diabetes, can also increase stroke risk, meaning that every woman's history related to pregnancy and postpartum cardiovascular health should be taken with interest. Measuring blood pressure regularly is also a habit that therapists must develop.


Nov 20, 2014

Can pelvic floor muscle training during the peripartum period prevent or cure urinary incontinence? A systematic review was completed by two pioneering pelvic rehabilitation researchers, Kari Bo, and Siv Morkved, physiotherapists who are experts in pelvic floor therapy. The authors included twenty-two randomized, controlled trials (RCTs) or quasi experimental design studies in the field of pelvic floor muscle training during the peripartum period. Interventions included in the eligible studies included exercise and biofeedback, vaginal cones, or electrical stimulation. As is reported among many systematic reviews, the variability among study populations, criteria, and outcomes measures was wide, however, the authors did conclude that pelvic floor muscle training (PFMT) during and after pregnancy can prevent and treat urinary incontinence (UI). This training should be supervised, the contractions instructed should be close to maximum effort, and at least eight weeks duration is recommended based on the review.

 

Research issues cited as having potential effects on the research reporting include the lack of outcomes data measuring adherence to the instructed exercise programs. Also brought into question is the practice of treating patients with pelvic floor dysfunction once per week, which may effectively provide a suboptimal dose of care if the effect of treatment is to hypertrophy muscles and provide a plan of care based on strength measures. In many studies, the control group was also completing pelvic muscle exercises as part of "usual care" and creating difficulty in assessing differences among treatment and non-treatment groups. Another question posed by the authors is that if physiotherapists, nurses, and physicians are instructing in exercises, is the instruction equivalent based on training? To improve this potential factor, Bo & Morkved suggest that fitness instructors and coaches should be trained in effective PFMT approaches.

 

The take home point of this study is that PFMT should be a routine part of women's exercise programs,especially during the peripartum period. Bo & Morkved also point out that UI is inhibitory to exercise participation, and should be considered when designing postpartum exercise guidelines. To learn more about postpartum challenges to recovery of pelvic health and function, join faculty member Jenni Gabelsberg in California this winter for the Care of the Postpartum Patient. The next opportunity to take this course is in January in Santa Barbara!


Nov 20, 2014

Researchers in Brazil assessed the effects of low-frequency and high-frequency TENS, or transcutaneous electrical stimulation on post-episiotomy pain. This randomized, controlled, double-blind trial included the two electrotherapy interventions as well as a control group. TENS was applied for 30 minutes to the three groups: the high-frequency TENS (HFT) (100 Hz, 100 ms) the low-frequency TENS (5 Hz, 100 ms), and the placebo group. Electrode placement was near the episiotomy in a parallel pattern, and pain evaluations were completed before and after TENS application in resting, sitting, and ambulating. (Electrode placement specifics can be found in the article that is available within the above link.) The interventions and pain evaluations were carried out between six and 24 hours after vaginal delivery.

 

The intensity of the HFT and LFT was controlled by the participants, with instructions to allow the sensation to be both strong and tolerable. A total of 33 participants completed the study, with 11 in the HFT group, 13 in the LFT group, and 9 in the placebo therapy group. The researchers found that for HFT and LFT, pain improved following application of the electrotherapy, and the effects of the pain reduction lasted one hour after the intervention. Because TENS is a low-cost, low-risk modality, TENS use may be a welcome addition for postpartum care following an episiotomy. The women using high or low-frequency TENS in this study reported that TENS was comfortable and that they would opt to use it again.

 

If you are interested in learning more about postpartum care and issues such as episiotomies which can interfere with return to function, join faculty member Jenni Gabelsberg in Santa Barbara in January. In addition to discussing a wide variety of common musculoskeletal conditions, she will discuss pelvic floor issues following childbirth that can impact a woman's postpartum recovery. Click here to view the learning objectives for Care of the Postpartum Patient as well as additional dates and locations for this course.


Oct 10, 2014

pregnant yoga

Do women who participate in yoga during pregnancy feel more optimistic, more powerful, and more well? Yes! This is the reply from a study involving 21 women who enrolled in a yoga class for six weeks. While twelve of the women had previously practiced yoga, none were currently practicing. The format of the class involved the following components: checking in (sharing the prior week's experiences), centering (visualization and breathing exercises), warm-up (neck rolls, shoulder exercises, and side stretches), yoga flow (yoga standing positions such as sun salutation), standing postures (balance, wall positions), mat work (seated postures and hip exercises), Savasana (modified to left side lying), and meditation.

 

Outcomes tools utilized in this study included the Life Orientation Test-Revised for measuring optimism, the Power as Knowing Participation in Change Tool version II for measuring sense of power, the Short-Form 12 Version 2.0, and the Well-being Picture Scale. Participants in the study were also given a journal to document time spent practicing yoga, and how they felt after practicing yoga, both physically and emotionally. The authors conclude that yoga as a self-care practice can be used to promote self-care and well-being in women who are pregnant.

 

Why are feelings of power, well-being, and optimism valuable for women who are pregnant? The authors discuss the literature which has suggested higher levels of adaptive coping in women with high-risk pregnancies, and the concept that optimism is associated with physical health. Previous studies about using yoga during pregnancy have proposed benefits to the mother both during her pregnancy as well as during labor and delivery. The authors of the study also describe power within the perspective of Rogers' science of unitary human beings, with sharing of interesting philosophical concepts such as resonancy, integrality, and diversity of the human-environmental field.

 


Sep 25, 2014

pregnant yoga

An article this year in Canadian Family Physician concludes that "…pregnant women should avoid practicing hot yoga during pregnancy." Have you ever had a pregnant patient ask you if she should use hot tubs, warm pools, use hot packs, exercise in the heat, or participate in hot yoga? As always, the answer to some of the questions may be "it depends," as many factors must be considered including the woman's age, fitness status, pre-pregnancy exercise routines, general health, level of risk, what part of the body she wants to expose to heat, and ability to modify the requested activity. And, most importantly, the biggest driving factors behind our response to our patients is this: is there any known risk for the mother and her baby, and what does her physician say? If there is any known risk to the mother and to the viability of her pregnancy, then we always want to err on the side of caution.

 

What about yoga? Can participating in a hot yoga class increase core temperature and put the growing fetus at risk? The linked clinical reference article above cites some of the following factors as potential reasons why a person should not participate in hot yoga during pregnancy.

•Elevated core temperatures can occur with fever, extreme exercise, saunas, and hot tubs

•First trimester hyperthermia may lead to neural tube defects, gastroschisis, esophageal atresia, omphalocele, and encephaly in the developing fetus

•Heat decreases time to exhaustion, potentially leading to over stretching, muscle and joint injuries

•High temperatures may increase the risk of dizziness or fainting due to effects on blood pressure

 

I can imagine the arguments from all sides of the story, and we know that, especially in a highly litigious society, a medical provider will always suggest the most conservative approach. When the stakes are inclusive of both a healthcare license and the maternal/fetal health of our clients, rehabilitation professionals must also be medically conservative and mindful of the most safe, and effective health practices. Several prior posts have discussed the benefits of yoga during pregnancy, and the article by Chan and colleagues acknowledges that for pregnant women participating in yoga the benefits can include increased quality of life, decreased stress and anxiety, decreased pain, and improved sleep. Is it reasonable, then, to suggest that a woman avoid hot yoga during pregnancy?

 








Sep 12, 2014

pregnant

One thing I have decided after working with women during and after pregnancy is this: babies come when they want, and how they want to arrive. A mother's best laid birth plans will hopefully have enough flexibility to allow her to feel successful even if, and especially if, her plans have to change. A fundamental question that has been asked, from the standpoint of a mother's beliefs is, do women really feel they have a choice to deliver at home versus in a hospital?

 

Researchers in the UK asked this question of a diverse sample of 41 women who were interviewed. Despite the fact that in the UK, a woman can birth at home with a midwife (and this is covered by the National Health System) home births are unusual, accounting for only 3% of all births. And while it may seem exciting to read that in the US, the number of home births has risen by more than 50% over a decade, the actual numbers include that less than 2% of births occur at home according to the Centers for Disease Control (CDC) data.

 

Back to the concept of choice, when women were interviewed about where they planned to give birth, perceptions rather than fact ruled the day. The concept of which environments were "safe" versus "risky" were a common theme, with women having differing explanations of why a hospital might be more safe than the home environment, or vice versa. The authors describe the issue that, when healthy mothers with low-risk pregnancies give birth in hospital environments, medical interventions including surgical birth are more likely to place. Women who would choose a home birth reported beliefs such as not being able to have a 'natural' birth in a hospital, fear of contracting illness or disease, or of wanting to be at home surrounded by loves ones. Women also reported that at home, more control over the environment and increased ability to relax would be available.

 


Sep 02, 2014

c-section

When a woman is interested in a trial of labor after previous cesarean delivery (TOLAC), she and her health care providers will consider the pros and cons of delivery methods. Researchers have aimed to predict success with vaginal birth after cesarean section (CS), with the intention of limiting the risk factors for both the mother and the fetus. A failed trial of labor following a CS may be associated with higher maternal and perinatal morbidity, according to the American College of Obstetricians and Gynecologists (ACOG) practice bulletin.

 

The goal of a study published last year was to develop a model for predicting success in women desiring a vaginal birth after cesarean (VBAC) section. All women had one prior CS, all were carrying singletons. Transvaginal ultrasound was utilized to evaluate the Cesarean scar (CS) at 11-13, 19-21, and 34-36 weeks' gestation in 320 women. The measurement of the scar was termed residual myometrial thickness (RMT), and the measurements also included the change in RMT from the 1st to 2nd trimester. With increased evidence that CS healing and myometrial thickness in the lower uterus may improve success with VBAC, this study is the first to assess scar dimensions across the first and second trimesters.

 

The CS scar was visible in 89% of the women. Of these, 153 of the 284 were excluded from the prediction model development due to having had more than one prior cesarean delivery, so the hospital protocol of scheduling cesarean was followed. The remaining women were offered a vaginal birth trial, with 10 of the 131 undergoing CS prior to labor for varied reasons. The final count of women included in the analysis was 121, and of these cases, 74 had successful VBAC, 47 experience failed trials of labor, primarily due to fetal distress, failure to progress, or possible scar rupture. (In the women who did not have a visible scar, 82% had a successful vaginal delivery.)

 


Aug 20, 2014

This post was written by H&W instructor Ginger Garner, MPT, ATC, PYT. Ginger will be instructing the course that she wrote on "Yoga as Medicine for Pregnancy" in New York this November.

 

yoga

The power of language is inarguable. The spoken word affects how we see, perceive, and interpret the world around us. Language can also influence our actions and behavior, especially toward people around us.

The power of language in health care is not only important, but critical in prenatal health. The language a provider uses can help or harm a mother’s confidence and even her beliefs about birth.

 

Action to recognize and respond to the importance of language in general health care began with People First Language (PFL) movement. PFL advocates for mindful use of language that identifies the person first, rather than identifying the person based on their disability. Advocacy groups first started the movement for children’s sake. Mother’s who had given birth to children with Down’s syndrome wanted their children to be recognized as people first, rather than by their disability.


Aug 14, 2014

Hip

In a recent study examining demographic and obstetric factors on sleep experience of 202 postpartum mothers, researchers report that better sleep quality correlated negatively with increased time spent on household work, and correlated positively with a satisfactory childbirth experience. Let's get right to the take home points: how are we addressing postpartum birth experiences in the clinic, and how can we best educate new mothers in self-care? You will find many posts in the Herman Wallace blog about peripartum issues, and you can access the link here

The authors recommend that healthcare providers "…should improve current protocols to help women better confront and manage childbirth-related pain, discomfort, and fear." Do you have current resources with which you can discuss these issues (and a referral to an appropriate provider) when needed? In our postpartum 

course, we highlight the challenges a new mother faces due to the commonly-experienced fatigue in the postpartum period. According to Kurth et al., exhaustion impairs concentration, increases fear of harming the infant, and can trigger depressive symptoms. Issues of lack of support, not napping, overdoing activities,, worrying about the baby, and even worrying about knowing you should be sleeping can worsen fatigue in a new mother. (Runquist et al., 2007) 

 

Back to what we can do for the patient: investigate local resources. This may include knowing what education is happening in local childbirth classes (and providing some training when possible), respectfully inquiring of new mothers how they are doing with sleep and demands of running a household (and business or work life), and finding out what support/resources the new mother has but is not accessing. Patients are often hesitant to ask for help, or may feel guilty in hiring someone to help clean for the first few months, feeling that she "should" be able to handle the chores and tasks. Educating women about results of the research and about potential improvements in quality of life can help the entire family. 

 


  • «
  •  Start 
  •  Prev 
  •  1 
  •  2 
  •  3 
  •  4 
  •  5 
  •  Next 
  •  End 
  • »

Upcoming Continuing Education Courses

Menopause: A Rehabilitation Approach - Orlando, FL
Feb 21, 2015 - Feb 22, 2015
Location: Florida Hospital Sports Medicine and Rehabilitation

Breast Oncology - Phoenix, AZ
Feb 21, 2015 - Feb 22, 2015
Location: Spooner Physical Therapy

Pelvic Floor Level 2B - Houston, TX
Feb 27, 2015 - Mar 01, 2015
Location: Texas Children’s Hospital

Special Topics in Women's Health - San Diego, CA
Feb 28, 2015 - Mar 01, 2015
Location: Comprehensive Therapy Services

Pelvic Floor Level 1 - Bayshore, NY (SOLD OUT!)
Mar 01, 2015 - Mar 03, 2015
Location: Touro College: Bayshore

Care of the Pregnant Patient - Seattle, WA
Mar 07, 2015 - Mar 08, 2015
Location: Pacific Medical Center

Pilates for the Pelvic Floor - Denver, CO
Mar 07, 2015 - Mar 08, 2015
Location: Cherry Creek Wellness Center

Pelvic Floor Level 3 - Fairfield, CA
Mar 13, 2015 - Mar 15, 2015
Location: NorthBay HealthCare

Male Pelvic Floor - Nashville, TN
Mar 14, 2015 - Mar 15, 2015
Location: Vanderbilt University Medical Center

Pelvic Floor Level 1 - Denver, CO (SOLD OUT!)
Mar 20, 2015 - Mar 22, 2015
Location: University of Colorado Hospital

Pelvic Floor Level 2A - Madison, WI
Mar 20, 2015 - Mar 22, 2015
Location: Meriter Hospital

Coccyx Pain - Torrance, CA
Mar 28, 2015 - Mar 29, 2015
Location: HealthCare Partners - Torrance

Hip Labrum Injuries - Houston, TX
Mar 28, 2015 - Mar 29, 2015
Location: Women's Hospital of Texas

Pelvic Floor Level 1 - Seattle, WA (SOLD OUT!)
Apr 03, 2015 - Apr 05, 2015
Location: Swedish Medical Center Seattle - Ballard Campus

Myofascial Release for Pelvic Dysfunction - Tampa, FL
Apr 10, 2015 - Apr 12, 2015
Location: Florida Hospital - Wesley Chapel