With a growing interest in Women’s Health Physical Therapy, I wanted to do something beneficial regarding pregnancy care for the women in Guatemala. As part of the UNC PT Outreach team we aim to meet the needs of underserved populations while increasing cultural competence among future PTs. I am joining the team of fellow students, faculty and local PT’s in giving PT care in hospitals, clinics, and schools as well as presenting at health fairs. Along with presenting to the people of Guatemala I will present my Powerpoint presentation to my fellow travelers.
Pregnancy is a daunting and huge topic, but as therapists we should be knowledgeable of the standard of care that women receive while pregnant. Nutrition and physical activity are vital and very important during pregnancy. Women should know and therapists should be able to give advice, especially regarding physical activity.
Pregnant women may even visit the PT clinic with musculoskeletal issues. Their bodies go through a range of changes, which can lead to different issues.
PT’s should be aware of the body changes that occur during pregnancy. They include: 7
- Normal weight gain is 25-30 lbs for single pregnancy, but can be 50-60 lbs for a multiple pregnancy
- Cardiac output increases 30-50%
- Total blood volume increases 20-40%
- Blood pressure drops at the beginning of pregnancy, but then returns to pre-pregnancy levels. Blood Pressure should NOT get higher than pre-pregnancy levels.
- The increase in estrogen contributes to joint laxity
- The rectus adominis muscle is separated at the linea alba as the stomach grows
- 20-50% of women suffer some degree of incontinence
PT’s should also be aware of the postural changes that occur which include:7
- Forward head
- Rounded shoulders
- Hyperextended knees
- Pronated feet
- Widened base of support
- Increase cervical, thoracic, and lumbar curves
Because of these changes different postural dysfunctions can occur like thoracic outlet syndrome, carpal tunnel, LBP, lumbar or sacral root irritation, pubic separation, and occasional parasthesias.7 Therefore PT’s can help with posture correction, pain management strategies, provide external supports, create exercise programs, and use modalities. 8
I will also present at the health fair giving out information on safe pregnancy practices. Completing a health literacy assessment I wanted to be culturally sensitive about the information I was providing. Literacy levels are low, so pictures need to do all the talking. Two handouts were created that will talk about Diet and Exercise during pregnancy as well when to call the health professional. Mayan women usually only receive care from midwives unless there is a major health problem, so I want them to be aware of these issues that need attention. English Flyer 1 English Flyer 2 Spanish Flyer 1 Spanish Flyer 2
After my Powerpoint presentation a short quiz will be given to test the understanding of the listeners. They will also fill out a peer evaluation form on my presentation skills. There will be an overall group feedback form given to the health professionals at the health fair.
A huge thanks goes out to Lisa for all her help and guidance! Thanks to Sadye for help with translation. Thanks to Kim and Dr. Figuers for their guidance on my committee!
References:
- Pregnancy and Preconception Health. Womenshealth.gov. http://www.womenshelath.gov/pregnancy/before-you-get-pregnant/preconception-health.html. Accessed March 12, 2014.
- Good Health Before Pregnancy: Preconception Care. The American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq056.pdf?dmc=1&ts=20140317T1233031095. Accessed March 12, 2014.
- Akkerman D, Cleland L, Croft G, Eskuchen K, Heim C, Levine A, Setterlund L, Stark C, Vickers J, Westby E. Institute for Clinical Systems Improvement. Routine Prenatal Care. Updated July 2012.
- Sfakianaki A. Prenatal vitamins: A review of the literature on benefits ad risks of various nutrient supplements. Formulary. 2013 Feb;48(2):77-82.
- Routine Tests in Pregnancy. The American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq133.pdf?dmc=1&ts=20140317T1305081368. Accessed March 12, 2014.
- Kirkham C, Harris S, Grzybowski S. Evidence-Based Prenatal Care: Part I. General Prenatal Care and Counseling Issues. Am Fam Physician. 2005 April;71(7):1307-1316. http://www.aafp.org/afp/2005/0401/p1307.html. Accessed March 12, 2014.
- Figuers C. The Childbearing Year. Duke’s Women’s Health Class at Duke University School of Medicine. May 7, 2013.
- Figuers C, Pannullo A. Prenatal and Postpartum Examination and Interventions. Duke’s Women’s Health Class at Duke University School of Medicine. May 16, 2013.
- Pregnancy – Staying healthy and safe. Womenshealth.gov. http://www.womenshealth.gov/pregnancy/you-are-pregnant/staying-healthy.html. Accessed March 12, 2014.
- Pregnancy complication. Pregnancy. Women’shealth.gov. http://womenshealth.gov/pregnancy/you-are-pregnant/pregnancy-complications.html . Accessed April 13, 2014
- Irion J and Irion G. Women’s Health in Physical Therapy. 2010. Lippincott Williams & Wilkins, a Wolters Kluwer business. Baltimore, MD.
- Labor and delivery, postpartum care. Mayo Clinic. http://www.mayoclinic.org/healthy-living/labor-and-delivery/in-depth/home-birth/art-20046878. Accessed April 13, 2014.
- Wax JR, Lucas FL, Lamont M, Pinette MG, Cartin A, Blackstone J. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Am J Obstet Gynecol. 2010 Sep;203(3):243.
- Childbirth Problems. Medline Plus. http://www.nlm.nih.gov/medlineplus/childbirthproblems.html. Accessed April 13, 2014.
- Pregnancy – Recovering from birth. Womenshealth.gov. http://www.womenshealth.gov/pregnancy/childbirth-beyond/recovering-from-birth.html. Accessed March 12, 2014.
- McGann B. Maya Childbirth Traditions in a Medical Pluralist Society: An Ethnomedical Perspective. http://www.academia.edu/386087/Maya_Childbirth_Traditions_in_a_Medical_Pluralist_Society_An_Ethnomedical_Perspective. Accessed April 21, 2014.
- United States. The World Factbook. CIA. https://www.cia.gov/library/publications/the-world-factbook/geos/us.html . Accessed April 13, 2014.
- Guatemala. The World Factbook. CIA. https://www.cia.gov/library/publications/the-world-factbook/geos/gt.html. Accessed April 13, 2014.
4 Responses to “Standard Of Care Through Pregnancy”
Lisa Johnston
Nice job on your presentation Stephanie. The flyers worked well at the health fairs also!
Meredith Haigh
Hey Stephanie!
I found your capstone really interesting! I’ve always felt a calling to be a mother but simultaneously have been terrified of everything that comes along with it, the first chronological thing being pregnancy. Everyone has such a different experience with pregnancy and some are WAY worse than others! I agree with you that as physical therapists, we need to be able to provide best practice to women who are pregnant because it is a very natural part of life that very commonly causes musculoskeletal problems because of the huge change our body makes. I think that in general, PT’s are undereducated in regards to treating this population. I could be wrong but I don’t remember a single lecture on treatment for women in pregnancy. That’s a huge problem! I’m so glad that you addressed this topic and I really enjoyed learning from you. I did not realize the several cardiopulmonary changes that occur with a normal pregnancy- another topic that we, as a class, seem to have trouble with!
I have a few questions for you after reading through your powerpoint:
1. I’ve heard a lot about the importance of folic acid during and after pregnancy and noticed that you mentioned it as being one of the most important aspects of pregnancy. Did you find if it is important to take prior to pregnancy? And if so, should all women in childbearing ages be taking folic acid regularly even if they are not planning for a family yet?
2. I have low back pain commonly because of my lordotic posture. Because of this, I’m sure I will have LBP during pregnancy because of the increased weight anteriorly, exacerbating my lordotic curve. Do you have any suggestions based on your research that would help me to prepare for this or to do during pregnancy to reduce LBP? Would an external support such as the one pictured in your PPT help?
3. You mentioned using modalities for pain during pregnancy. I remember from my first clinical that ultrasound around the area of the belly or low back is contraindicated. What other modalities are contraindicated during this time? E-stem?
Thanks so much! Excellent work! I really really enjoyed reading through your project!
Meredith Haigh
Ryan Rubio
Stephanie-
I loved your PPT presentation. I wish Jessamyn and I had had a copy back when she was pregnant. You are right, pregnancy is a very daunting time, and every little thing makes you afraid and paranoid about the health of the baby and/or the mother. I like to think that my wife and I are pretty informed people, but rational thinking often goes out the window when you have a baby on the way.
Your materials are pretty comprehensive, but I wondered if in your presentation you go further into the importance of managing emotional health as well as physical health in pregnant women. I remember that this was a major concern for us, as my wife had recently lost her mother not long before she got pregnant. My wife’s case was extreme, but not unique. Many women experience some level of anxiety while pregnant. Many doctors focus on the physical aspects of the pregnancy with thorough measurement of weight, belly size, etc and not the mental health component. Sometimes providing information to women with anxious tendencies and pregnancy hormones heightens their stress, rather than abating it.
My wife described how important it was that she received support managing her emotional health in addition to her physical health. Frequently, it wasn’t just the information she received at doctor visits that mattered, but the way in which she received it.
I wondered if you had come across materials emphasizing tactics for communicating with pregnant women, counselors, or support groups to help minimize that stress as well as prepare to face any labor and delivery fears. We did a few classes that really helped. I think this is a resource that we as PTs should be able to recommend.
You point out that prenatal care is limited amongst the audience you will be speaking to, and it seems that they emphasize a sense of community, so maybe there is no great need for these types of services in that population. I was just curious what, if any, recommendations you may have come across in your research.
That was a long question, I know. Believe me when I say I think you have done great work in a very important topic.
Ryan
Gabrielle Scronce
Hi Stephanie,
I hope things are going well in Guatemala!
I am very impressed by the way you present LOTS of important information so clearly and succinctly. I know it can be difficult to narrow things down when the topic is so important but you have only a limited interaction with your audience, and you have overcome this challenge beautifully. I am very interested in hearing about your overall impressions from your experience in Guatemala regarding possible reasons for high maternal and infant mortality. For example, do the women you meet have the amount of access to midwives that you expected? Are there other issues such as maternal weight or nutrition that really stand out to you?