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Care of the Postpartum Patient

Herman & Wallace Pelvic Rehabilitation Institute

Objectives

Upon completion of this continuing education seminar, participants will be able to:
1. Define common terminology of the labor and delivery and the postpartum period.
2. Describe the physiologic changes in the postpartum period that assist a woman's body in returning to pre-pregnancy state.
3. List the endocrine system changes, including the risk for thyroid dysfunction, that influence the female patient during the postpartum period.
4. Define the stages of labor, common complications of labor and delivery, and the postpartum red flags.
5. Describe common clinical presentations for perineal trauma and pelvic floor dysfunction.
6. List indications and potential complications of c-section deliveries, as well as principles of c-section recovery.
7. List 2 common conditions and recommended treatment for the spine and trunk, abdomen, pelvic floor, pelvic girdle, upper and lower extremities during the postpartum period.
8. Instruct the postpartum patient in safe return to fitness activities.
9. Describe the challenges that new mothers face and instruct in practical strategies for body mechanics, sleep hygiene, and time management for postpartum recovery.
10. Complete medical screening for conditions in postpartum that require referral.

Target Audience

This continuing education seminar is targeted to physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals. Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.

Agenda

Day One:
7:30 Registration 8:00 Course goals, introductions, pre-test 8:30 Postpartum period 9:15 Labor and Delivery Issues 10:00 BREAK 10:15 Spine and Trunk Common Complaints Lecture 11:00 Spine and Trunk Common Complaints Lab 12:00 LUNCH 1:00 Pelvic Girdle Common Complaints Lecture 1:45 Pelvic Girdle Common Complaints Lab 2:45 BREAK 3:00 Abdomen and Pelvic Floor Lecture 3:45 Abdomen and Pelvic Floor Lab 4:45 BREAK 5:00 Case Study 5:30 Questions, Post-test 6:00 Adjourn

Day Two:
8:00 Questions, pre-test 8:30 Upper Quarter Common Complaints 9:15 Upper Quarter Common Complaints Lab 10:15 Break 10:30 Lower Quarter Common Complaints 11:15 Lower Quarter Common Complaints Lab 12:15 LUNCH 1:00 Postpartum considerations 1:45 Postpartum fitness programs 2:30 BREAK 2:45 Case Studies 3:30 Questions, post-test 4:00 Adjourn

Description

The woman who has just given birth is not only learning to adapt to motherhood, but her physiology is constantly adapting to the changes within the postnatal period. Her uterus will go through involution, or a return towards prenatal size, fluid volumes in her body will drastically reduce, affecting her cardiovascular responses, and the remarkable machinery involved in her endocrine system will again shift in response to varying hormonal needs. In this 2-day continuing education course the participant will learn about a variety of important challenges faced by the postpartum woman that are due, in part, to such physiological changes.

Although the postpartum period may be defined as the time immediately following the birth of a child until 6 weeks later, many patients present to the clinic years or even decades later who have issues that stemmed from the peripartum period. Physical changes including postural dysfunction, pelvic girdle dysfunction, diastasis recti abdominis, and foot size changes, if left unaddressed, can lead to persisting muscle imbalances and musculoskeletal dysfunction. For example, headaches can be mechanical in nature, resulting from retained postural habits gained in late pregnancy. Breathing patterns are altered from trunk, rib, and respiratory diaphragm alterations, and unless these patterns are identified and re-trained, breathing patterns remain suboptimal. Length and activation changes in the abdomen caused by a separation of the rectus abdominis are believed to alter trunk and pelvic muscle stability, potentially setting up a woman for lumbopelvic dysfunction in the postpartum period.

Research tells us that pelvic girdle pain (PGP) in pregnancy may be as high as 50% (Gutke, Ostgaard, & Oberg, 2006), and that 1 in 4 women who develop PGP in pregnancy develop chronic postpartum pain (Ostgaard, Anderson, & Karlson, 1991). Care of the Postpartum Patient emphasizes the evaluation and intervention strategies needed to alleviate lumopelvic pain so that more patients may have the opportunity to avoid chronic postpartum pain. In addition to addressing these common musculoskeletal conditions in this continuing education course, breast health, breastfeeding, scar massage, episiotomies, postpartum fitness, and pelvic floor dysfunctions (incontinence, pelvic pain, bowel dysfunction) are covered.

The postpartum period is also an important time in which the rehabilitation provider must be aware of serious medical issues that may arise. Such medical issues can include gestational hypothyroidism, development of diabetes mellitus following gestational diabetes, postpartum hemorrhage, and postpartum psychosis. Medical screening for these and other conditions are discussed in this second of the Peripartum Series of continuing education courses.

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