Login / Create an Account

Phone646.355.8777

Tags >> Pregnancy and Postpartum
Jul 21, 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

Research has long confirmed the effects of maternal health on fetal development and outcomes. But scientific inquiry into the genesis of disease processes in an adult with no apparent risk factors has been uncharted territory until the last few decades.

 

The interrelationship between maternal stress and fetal “programming” was considered as early as the mid-1980’s, beginning with the suggested connection between poor nutrition in early life and adult disease. But the developmental origins of adult health and disease were not studied until the mid-1990’s, with little understanding of the etiology until the last two decades.

 


Jul 18, 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 Labor and Delivery and Postpartum" in Washington this August.

 

yoga

You may or may not realize that the United States has a very poor track record for postpartum care. In fact, the US has the worst track record for not only postpartum care, but for maternal and infant mortality and first-day infant death rate in the developed world (Save the Children 2013). Between 1999-2008, global mortality rates decreased by 34% while the US’s rates doubled for mothers (Coeytaux et al 2011).

 

In After the Baby’s Birth, maternal health advocate Robin Lim writes,

"All too often, the only postpartum care an American woman can count on is one fifteen minute appointment with her doctor, six weeks after she has given birth. This six week marker ends an arbitrary period within which she is supposed to have worked out most postpartum questions for herself. This neglect of postpartum women is not just poor healthcare, it is abusive, particularly to women suffering from painful physical and/or psychological disorders following childbirth."


Jul 08, 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 Labor and Delivery and Postpartum" in Washington this August.

 

Note: This post is for colleagues, patients, and friends whose greatest desire is to have a healthy baby via natural childbirth. In this article, natural childbirth refers to an unmedicated delivery of your baby, assisted with natural, non-pharmaceutical means. While not all women have the luxury of natural childbirth, and some choose other means, please know that Ginger’s course supports all women and their personal decisions about birth.

 

yoga

My first natural birth was December 27, 2005. After a long, hard labor that started on Christmas, my son Michael arrived safe and healthy into my arms.

 


Jun 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 Labor and Delivery and Postpartum" in Washington this August.

 

yoga

Physical therapists often see women during pregnancy and postpartum, but what can physical therapists do to foster better birth outcomes?

 

A 2012 study conducted in Norway underscores the importance of childbirth education, which can take place as part of patient education and counseling in physical therapy. The study looked at 2206 women with intended vaginal delivery in order to assess the association between fear of childbirth and duration of labor. Labor duration was found to be significantly longer in women with fear of childbirth, with the rate of epidural analgesia, induction, and instrumental vaginal delivery also being higher in fearful women. The authors posit that “anxiety and fear may increase plasma concentrations of catecholamines, and high concentrations of catecholamines have been associated with both enervated uterine contractility and a prolonged second stage of labour.” (Adams et al 2012).

 


Jun 20, 2014

This post was written by guest blogger Laura E Nimon OTR/L, CLT-LANA. Laura will be attending Ginger Garner's course that she wrote on "Yoga as Medicine for Labor and Delivery and Post Partum " in Seattle this August.

 

 

From the time a woman hears the words “You’re pregnant” she becomes flooded with information regarding what she should/should not do to have a healthy pregnancy—but how much is accurate, and why is a healthy delivery not further discussed?

 

Over the last decade yoga has become a highly recommended form of exercise to maintain/improve flexibility and cardiovascular status in a gentle and safe manner. There is a plethora of information and sales directed to pregnant women and these women should be wary consumers as not all classes or home videos are safe due to the hormonal changes experienced in pregnancy that can exacerbate a prior joint condition or create one if an exercise is done improperly.

 


Jun 18, 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

Pregnancy brings the most enormous changes in a woman’s life, and is arguably the most profound change that the body can experience.

 

It is no secret that America claims the most shameful maternal health and birth outcomes in the developed world. For more information, read my previous post on American Childbirth: A Human Rights Failure? However, physical therapy can have quite a bit to do with turning those statistics around. Informing mothers about their right to access physical therapy can help improve birth statistics by improving a mother’s health and well-being, not just treating a case of pregnancy-associated low back pain or sciatica.

 


Jun 16, 2014

yoga

 

A recent literature review addressing the effectiveness of yoga for depression reports that the positive findings are promising. The 2007 National Health Interview Survey (NHIS) found that yoga was one of the top 10 complementary health approaches used among adults in the United States. (The linked page for the NHIS also includes a video of the scientific results of yoga for health.)

 

Yoga is not only about bodies bending- ancient yoga traditions offer physical, mental, and spiritual techniques that are designed to be holistic in nature. Many instructors in the US focus on the many physical benefits of yoga, yet there are many types of yoga, many instructors with varied levels of training, and many health issues that require an individualized program of yoga therapy. In relation to the potential effects of yoga on depressive symptoms, theories in neurobiology point to the potential positive effects on the HPA (hypothalamic-pituitary-adrenal) axis, according to the linked article by Lila Louie.

 

While none of the articles described in the literature review are specific to the one patient group or population, the subjects studied include incarcerated women, older patients, university students, and patients from the general population who struggle with depression. One group of patients known to be at risk for severe depression is postpartum women. The definition of postpartum varies, and a generous definition may include any issue that, once imparted in a postpartum period and left unaddressed, could persist throughout a woman's lifetime. This is commonly seen in the clinic as uncorrected postural dysfunction, pelvic floor dysfunction, or gait changes, for example.


May 23, 2014

Research by Wong and colleagues published by the American College of Obstetricians and Gynecologists reported on the incidence of postpartum lumbosacral and lower extremity injuries. Of 6048 women who were interviewed, 56 had a new injury, confirmed by physiatrist evaluation. The researchers noted that "Women with nerve injury spend more time pushing in the semi-Fowler-lithotomy position than women without injury." The researchers also noted that women who were nulliparous (had not given birth previously), who had an assisted (forceps or vacuum) birth, or who experienced a prolonged second stage of labor, were at increased risk of nerve injury.

 

 

The most common nerves involved included the lateral femoral cutaneous nerve, followed by the femoral nerve. Radiculopathies occurred at the L4, L5, and S1 levels. The authors make the following recommendations: changing positions frequently during the pushing phase, avoiding prolonged thigh flexion, avoiding extreme thigh abduction and external rotation. Other labor-related perineal nerve injuries have been documented by Sahai-Srivastava et al. to occur due to prolonged squatting or to prolonged pressure from birth attendants at the knees. 

 

 

The research by Wong and colleagues highlights the important of interviewing patients about past and current symptoms, birth histories including length of time spent pushing and in what positions a woman was pushing. Teaching a woman and her birth assistants about providing support to the birthing woman's body can be very helpful; a birthing woman may welcome support of a limb, yet avoiding over-compression or sustained positions without intermittent breaks may reduce risk of nerve injury. Because the authors also noted a correlation between nerve injuries and maternal pushing at higher fetal stations (the fetus had not descended as far into the birth canal), they recommend attempting to shorten active pushing time by allowing the fetus to descend further prior to pushing. (This concept in itself is a very interesting topic to be followed-up on in another post!)


Apr 29, 2014

During the postpartum period, not only is a new mother adjusting to the needs of her infant, she is also recovering mentally, physically, and emotionally. Physical challenges can include fatigue, back pain, and healing abdominal or perineal wounds. Emotionally, women are also at increased risk for depression and anxiety which may negatively impact health of the mother and infant. 

 

 

Recent research evaluated 6 clinical guidelines from the United Kingdom, Australia, and the United States for the postpartum period. (The authors point out that maternity care in these countries varies.) The guidelines fit into four main themes: maternal health, maternal mental health, infant health, and breastfeeding. Only 1 of the guidelines was deemed to have enough detail to provide data about both the mother and the infant that would guide the provider regarding care. The article states that "…scarcity of comprehensive guidelines for mothers and infants is a concern because of the stress many women experience at this time, the high burden of maternal morbidity postpartum and the significant interplay between the health of the mother and infant." 

 

 

This information is valuable to the rehabilitation provider as we work with women in the postpartum period. We can initiate conversations about a woman's energy levels, sleep, and nutrition. We can inquire politely about her infant, about breastfeeding and support that she has at home. Our patients can be encouraged to discuss any concerns or anxieties about her healing or about parenting. If we do not know the answer, we can seek resources or recommend that the patient consult her healthcare team. Many women are not sure how they should be feeling, physically or emotionally, and the new mother should be reassured that any concerns she has are valuable issues to discuss. If she knows that you care about her symptoms and questions, she is more likely to express concern or share information that can help guide care, including referrals to appropriate providers.


Apr 24, 2014

In our blog, we have highlighted the importance of recognizing and screening for postpartum depression. What relationships exist between a person's posture and depression in the postpartum period? Prior research reporting on four studies of posture (Riskind & Gotay, 1982) noted that subjects placed in a slumped physical posture appeared to develop helplessness more easily than those placed in an upright posture. These authors also stated that physical posture was a valuable clue for an observer who attempted to identify states of depression. Results of the fourth study include that "…subjects who were placed in a hunched, threatened physical posture verbally reported self-perceptions of greater stress than subjects who were placed in a relaxed position."

 

 

A recent study addressed depression, back pain and postural alignment in eighty women between 2 and 30 weeks postpartum. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS). Pain scales included a visual analog scale (VAS) and the Nordic Musculoskeletal Questionnaire (NMQ), while posture was assessed with visual observation. Findings of the study include that VAS pain scores were elevated in the women who were depressed. Back pain intensity and postpartum depression were also strongly associated. The authors suggest that back pain may be a risk factor for postpartum depression as well as a comorbidity. The article further states that physical therapists "…should be prepared to identify depressive symptoms as a comorbidity associated with posture changes and recurrent symptoms, signs of remission and recurrence that generate difficulties for treatment progression." 

 

 

Can we look at this issue as a chicken and egg discussion, as in, is poor posture causative  to depression, or vice versa? And, if smiling has been determined to have the ability to improve happiness, can improved posture positively affect symptoms of depression? We know that postural dysfunction and pain can be a vicious cycle in our patients. Is screening for depression an equally important aspect of postural correction? Could postural taping, support, or re-training positively affect postpartum depression, and if so, should we be assessing and re-assessing our patients for depression as a means to document therapy benefits? The fun thing about reading research results is that the studies often lead to more questions, further hypotheses, and curiosity in relationship to how we interact with our patients. Can patients understand the relationship between postural correction and emotional health? Sounds like an opportunity for more research, and for dialoging with our patients!


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

Upcoming Continuing Education Courses

Athlete and the Pelvic Floor - Columbus, OH
Aug 02, 2014 - Aug 03, 2014
Location: OhioHealth Neighborhood Care Rehabilitation

Pudendal Neuralgia - San Diego, CA
Aug 09, 2014 - Aug 10, 2014
Location: Comprehensive Therapy Services

Biomechanical Assessment - Arlington, VA
Aug 16, 2014 - Aug 17, 2014
Location: Virginia Hospital Center

Yoga as Medicine for Labor and Delivery and Postpartum - Seattle, WA
Aug 16, 2014 - Aug 17, 2014
Location: Pilates Seattle International

Pediatric Incontinence - Greenville, SC
Aug 23, 2014 - Aug 24, 2014
Location: Proaxis Therapy

Pelvic Floor Level 1 - St. Louis, MO (SOLD OUT!)
Sep 05, 2014 - Sep 07, 2014
Location: Washington University School of Medicine

Meditation and Pain Neuroscience - Winfield, IL
Sep 06, 2014 - Sep 07, 2014
Location: Central DuPage Hospital Conference Room

Visceral Mobilization Level Two - Boston, MA
Sep 12, 2014 - Sep 14, 2014
Location: Marathon Physical Therapy

Coccyx Pain - Nashua, NH
Sep 13, 2014 - Sep 14, 2014
Location: St. Joseph Hospital Rehabilitative Services

Visceral Mobilization of the Urologic System - Scottsdale, AZ
Sep 19, 2014 - Sep 21, 2014
Location: Womens Center for Wellness and Rehabilitation

Care of the Postpartum Patient - Maywood, IL
Sep 20, 2014 - Sep 21, 2014
Location: Loyola University Stritch School of Medicine

Pelvic Floor/ Pelvic Girdle - Atlanta, GA
Sep 27, 2014 - Sep 28, 2014
Location: One on One Physical Therapy

Assessing and Treating Vulvodynia - Waterford, CT
Sep 27, 2014 - Sep 28, 2014
Location: Visiting Nurses Association - Southeastern

Pelvic Floor Level 2B - Durham, NC
Oct 03, 2014 - Oct 05, 2014
Location: Duke University Medical Center

Male Pelvic Floor - Tampa, FL
Oct 04, 2014 - Oct 05, 2014
Location: Florida Hospital - Wesley Chapel