Introduction to Midwifery

Postnatal Exercises

DEFINITION

A series of physical exercises that are performed by the postnatal mother to bring about optimal functioning of all body systems and prevent complications.

PURPOSES

To improve the tone of muscles, hence regaining previous body shape and size
To educate about correct posture and body mechanics
To prevent stress continence of urine
To minimize the risk of puerperal venous thrombosis
To prevent backache
To prevent genital prolapse

PROCEDURE

The exercise can be started soon after child birth and repeated up to five times twice a day, at first. The no. of exercises is gradually increased as the mother gains strength.

Nursing Action

Explain the procedure to the patient
Provide privacy
Advise that the exercises can be done from home too. Sometimes it requires a helper

ABDOMINAL EXERCISES

Abdominal Breathing

Instruct the woman to assume the supine position with knees bent
Instruct her to inhale through the nose, keep the rib cage as stationary as possible, and allow the abdomen to expand
Then contract the abdominal muscles as she exhales slowly through the mouth
Instruct her to place one hand on the chest and one on the abdomen when inhaling
Then the hand on the abdomen should rise and the hand on chest should remain stationary
Ensures that exercise is being done correctly and ensures the adequate intake of air while inhaling
Repeat the exercise five times

Head Lift

This exercise can be started within few days after childbirth
Instruct the mother to lie supine with knees bent and arms outstretched to her side
Instruct her to inhale deeply first and then exhale while lifting the head slowly
To hold the position for few seconds and relax

Head and Shoulder Raising

On the second postpartum day instruct woman to:
- Lie flat with pillow and raise the head until the chin touches the chest
On the 3rd postpartum day instruct her to:
- Raise both head and shoulder off the bed and lower them slowly
- Gradually increase the no. of repetitions until she is able to do this for 10 times

Leg Raising

This exercise may begin on 7th postpartum day
Instruct woman to:
- Lie down on the floor with no pillows under the head, point toe and slowly raise one leg keeping the knee straight
- Lower the leg slowly
- Gradually increase to 10 times each leg

Pelvic Tilting and Rocking

Instruct woman to:
- Lie down on the floor with knees bent and feet flat, inhale and while exhaling flatten the back hard against the floor so that there is no space between the back and the floor
- Inhale normally, hold breath for up to 10 sec., and then relax
- Repeat up to 10 times
Tightens the abdominal muscles and muscles of buttocks

Knee and Leg Rolling

Instruct woman to:
- Lie flat on her back with knees bent and feet flat on the floor or bed
- Keep the shoulders and feet stationary and roll the knees to side to touch first one side of the bed then on other
- Maintain a smooth motion as the exercise is repeated five times
Later, as flexibility increases, the exercise can be varied by the rolling of the knee only
This will strengthen the oblique abdominal muscles

Hip Hitching

Instruct mother to:
- Lie on her back with one knee bent and other knee straight
- Slide the heel of the straight leg downwards, thus lengthening the leg
- Shorten the same leg by drawing the hip up towards ribs on the same side
- Repeat up to 10 times keeping the abdomen pulled in
- Change the opposite side and repeat

Abdominal Tightening

Instruct woman to:
- Sit comfortably or kneel on all fours
- Breath in and out, then pull in the lower part of the abdomen below the umbilicus while continuing to breath normally
- Hold for up to 10 seconds
- Repeat up to 10 times

CIRCULATORY EXERCISES

Foot and Leg Exercises

Instruct mother to:
- Sit or half lie with legs supported
- Bend and stretch the ankles at least 10 times
- Circle both feet at the ankle at least 20 times in each direction
- Brace both knees, hold for a count of four, then relax
- Repeat 12 times

PELVIC FLOOR EXERCISE

Kegel Exercise

Instruct woman to:
- Sit, stand or half-lie with legs apart, close and draw up around the anal passage as though preventing the bowel action, then repeat for front passages as if to stop the flow of urine mid-stream
- Hold the contraction for ten seconds (to a count of six)
- Repeat up to 10 times
- Continue to do this exercise for 2-3 months
After 3 months if the mother is able to cough deeply with full bladder without leaking the urine then she may stop exercise
If leaking occurs, she may continue the exercise for rest of her life
This exercise helps to regain the full bladder control, prevents uterine prolapse, and ensures the sexual satisfaction in future

CHEST EXERCISE

Instruct her to:
- Lie flat with arms extended straight out to the side, bring both hands together above the chest, while keeping the arms straight, hold for few seconds and return to the starting position
- Repeat the exercise 5 times daily initially
Instruct the mother to bend her elbows, clasp her hands together above the chest, and press her hands together for a few seconds
- Repeat this for at least 5 times
This exercise increases the strength and tone of the chest muscles

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