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A/600/4528

VRQ

UV30314

Principles of antenatal and postnatal physical activity

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UV30314Principles of antenatal and postnatal physical activity

The aim of this unit is to provide you with the relevant knowledge and understanding of the principles underpinning antenatal and postnatal physical activity.

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GLH

Credit value

Level

Observation(s)

External paper(s)

15

2

3

0

0

On completion of this unit you will:

Learning outcomes Evidence requirements

Principles of antenatal and postnatal physical activity

1. Understand the key considerations of working with antenatal and postnatal clients

2. Understand the physiological and biomechanical changes associated with pregnancy

3. Understand the key components of exercise programming for antenatal and postnatal clients

1. Knowledge outcomes There must be evidence that you possess all the knowledge and understanding listed in the ‘Knowledge’ section of this unit. This evidence may include projects, assignments, case studies, reflective accounts, oral/written questioning and/or other forms of evidence.

2. Tutor/Assessor guidance You will be guided by your tutor/assessor on how to achieve learning outcomes in this unit. All outcomes must be achieved.

3. External paper There is no external paper requirement for this unit.

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Achieving knowledge outcomes

Developing knowledge

You will be guided by your tutor and assessor on the evidence that needs to be produced. Your knowledge and understanding will be assessed using the assessment methods listed below:

• Observed work performance• Witness testimony/statements• Audio-visual media • Evidence of prior learning or attainment• Written questions• Oral questions• Assignments• Case studies• Professional discussion• Employer-provided question papers and

tests• E-assessment.

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Knowledge

Outcome 1

Understand the key considerations of working with antenatal and postnatal clients

You can: Portfolio reference /Assessor initials*

a. Justify the importance of having an up-to-date first aid qualification and engaging in regular CPD when working with antenatal and postnatal clients

b. Explain the importance of checking insurance arrangements and undertaking a thorough risk assessment prior to working with antenatal and postnatal clients

c. Explain common antenatal problems relevant to exercise participation and how to respond to them

d. Identify the absolute and relative contra-indications to exercise in pregnancy

e. Clarify the warning signs whereby women should stop exercising during pregnancy

f. Identify the complications and considerations affecting the resumption of postnatal exercise

g. Clarify the inappropriateness of using babies as a resistance or weight during exercise

h. Evaluate sources of information and advice on working with antenatal and postnatal clients

*Assessor initials to be inserted if orally questioned.

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Outcome 2

Understand the physiological and biomechanical changes associated with pregnancy

You can: Portfolio reference /Assessor initials*

a. Explain the changes that occur to the musculoskeletal system during pregnancy

b. Explain the changes that occur to the cardiovascular system during pregnancy

c. Explain the changes that occur to the respiratory system during pregnancy

d. Explain the metabolic changes that occur during pregnancy

e. Explain the changes that occur to the endocrine system during pregnancy

f. Describe the extent of body system changes and the implications on those undertaking exercise

*Assessor initials to be inserted if orally questioned.

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Outcome 3

Understand the key components of exercise programming for antenatal and postnatal clients

You can: Portfolio reference /Assessor initials*

a. Explain the benefits of exercise to antenatal and postnatal clients

b. Explain the types of physical activity that are generally recommended during and after pregnancy

c. Explain the types of physical activity that should be avoided during and after pregnancy and the reasons for avoiding these

d. Describe the importance of resuming postnatal activity on an individual, gradual and progressive basis

e. Evaluate general stretching for antenatal and postnatal clients

f. Explain the importance of abdominal and pelvic floor exercises and how to teach these

g. Describe how to check for abdominal separation and the safest and most effective way to rehabilitate the post-birth abdominal wall

*Assessor initials to be inserted if orally questioned.

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Outcome 1: Understand the key considerations of working with antenatal and postnatal clients

Unit content

This section provides guidance on the recommended knowledge and skills required to enable you to achieve each of the learning outcomes in this unit. Your tutor/assessor will ensure you have the opportunity to cover all of the unit content.

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Importance of having an up-to-date first aid qualification: Higher risk exercise environment, increased risk of injury, greater probability of needing first aid skills, to be able to deal with an emergency situation, CPD to keep up-to-date with current concepts, research and thinking.

Health and safety: Assess risk on individual basis, thorough consultation process, consider all variables, instructors to have appropriate training/qualifcations to work with this specific group, must have appropriate insurance.

Common antenatal problems: Risks and symptoms of pelvic girdle pain (including the hypermobile woman, knee, back and shoulder pain, fatigue and interrupted sleep patterns), effects on co-ordination, balance, concentration and memory, and response to actions – respond to problems on a one to one basis, offer alternatives and additional equipments, alter intensity, reduce repetitions, change positioning, reduce complexity, offer resources for balance/support, reinforce teaching points, repeat demonstrations, break down demonstrations/exercises into smaller components, observe and watch for signs of problems.

Absolute contra-indications: Haemodynamically significant heart disease, restrictive lung disease, incompetent cervix/cerclage, multiple gestation risk for premature labour, persistent second or third trimester bleeding, placenta praevia after 26 weeks

gestation, premature labour during the current pregnancy, ruptured membranes, pregnancy induced hypertension, symphysis pubic dysfunction.

Relative contra-indications: Severe anaemia, unevaluated maternal cardiac arrhythmia, chronic bronchitis, poorly controlled type I diabetes, extreme morbid obesity, extremely underweight (body mass index <12), history of extremely sedentary lifestyle, intrauterine growth restriction in current pregnancy, poorly controlled hypertension/pre-eclampsia, orthopaedic limitations, poorly controlled seizure disorder, heavy smoker.

Warning signs: Vaginal bleeding, dyspnoea before exertion, dizziness, headache, chest pain, muscle weakness, calf pain or swelling (need to rule out thrombophlebitis), preterm labour, decreased fetal movement, amniotic fluid leakage, poorly controlled thyroid disease.

Complications/considerations: Involution of the uterus, placental site healing and lochia (bleeding), secondary post-partum haemorrhage, air embolism, thrombosis, infection (breast, uterine, urinary tract or caesarean wound site), pelvic floor trauma, sensation loss, pelvic dysfunction, caesarean section, abdominal muscle separation, back or coccyx pain, pelvic girdle pain, pelvic torsion or instability, knee pain, carpal tunnel syndrome, anaemia, establishment of breastfeeding, postnatal anxiety and depression, separation anxiety (from baby), extreme fatigue.

Outcome 1: Understand the key considerations of working with antenatal and postnatal clients (continued)

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Inappropriateness of using babies as resistance or weight: Health and safety implications, ethical issues, disruption to class, distress to baby, risk of harm to baby (e.g. shaking of brain, impact).

Information and advice: Internet sources, journals, books, guidelines (Royal College of Obstetricians and Gynaecologists), Skills Active, Register of Exercise Professionals, National Health Service (NHS), ACOG (American College of Obstetricians and Gynaecologists).

Musculoskeletal system: Weight gain, ligamentous laxity, joint instability (hips, sacro-iliac, symphysis pubis, pelvis), lumbosacral spine), postural changes, muscular imbalances (abdominal wall, lower back, upper back, neck, chest and shoulders), effects of weight gain (knees, feet and ankles), biomechanics (feet, change in centre of gravity), balance, abdominal, uterus and pelvic changes, breast development, effects of musculoskeletal changes on exercise.

Cardiovascular system: Blood volume, cardiac output, stroke volume, heart rate, oxygen consumption, haemoglobin, iron levels, total peripheral resistance, blood pressure, effects of cardiovascular changes on exercise.

Respiratory system: Lung function, hyperventilation of pregnancy, tidal volume, respiratory rate, effects on the diaphragm, oxygen cost of breathing, effects of

respiratory changes on exercise.

Metabolic changes: Insulin resistance, substrate utilisation, hypoglycaemia, effects of hypoglycaemia, metabolic demands of pregnancy, effects of metabolic changes on exercise.

Endocrine system: Hormonal changes (estrogen, relaxin and progesterone), hormonal effects, effects on exercise (e.g. relaxin is still present six months postnatal).

Length and implications: Length of specific changes, trimester 1 (0-12 weeks), trimester 2 (13-28 weeks), trimester 3 (28-40 weeks), implications and considerations for exercise during each trimester, changes that occur during each trimester, postnatal implications.

Outcome 2: Understand the physiological and biomechanical changes associated with pregnancy

Outcome 3: Understand the key components of exercise programming for antenatal and postnatal clients

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Benefits: Reduction of common pregnancy complaints (leg cramps, oedema, carpal tunnel syndrome, high and low blood pressure, constipation, haemorrhoids, varicose veins, gestational diabetes), improved posture and body awareness, better functional movement and pelvic floor muscle function, possible reduction in lower back pain, weight control, maintenance of cardiovascular and strength fitness levels, improved maternal wellbeing (better sleep patterns, less anxiety and depression, improved ability to cope with stress), possible reduction of labour length and birth complications, easier resumption of postnatal activity.

Recommended types of physical activity: Recommended exercise duration, frequency and type, muscles to strengthen (scapula retractors, lumbar paravertabrals, gluteus maximus and medius, quadriceps, abdominals, pelvic floor), relaxation and stress management programmes, group exercise modes (low impact aerobics, step training – step no higher than 10 cm, yoga, pilates, water based exercise, cycling), modified resistance training exercises, offer alternative exercises and positions, exercise after second trimester (do not lie supine, rotations, twisting, isometric exercises).

Types of physical activity to be avoided: Excessive twisting and turning activities, breath holding activities, asymmetrical weight bearing activities, one-legged activities, prolonged standing static exercise, high intensity physical activities, hip abduction, supine exercise after the first trimester, vigourous or exhaustive exercise, contact sports or exercise at risk of abdominal trauma, heavy weights,

excessive breaststroke, exercises that cause pain.

Reasons for avoiding physical activity: Dizziness, high blood pressure, hip adduction (pubic synthesis disfunction, risk of damage to fetus).

Importance of resuming postnatal activity on individual, gradual and progressive basis: Always resume as a newcomer to fitness, allow time to assess capabilites, identification of any complications from pregnancy, forward flexion work with caution/abdominal work, diastis recti (separation of abdominal wall).

Stretching: Types of stretching, general guidelines, muscles to stretch (levator scapula, thoracolumbar area, hip flexors, iliotibial band, piriformis, hamstrings, hip adductors, gastrocnemius, soleus), stretching should be gentle, possibility of excessive flexibility due to the hormone relaxin, relaxin present till six months postnatal.

Abdominal and pelvic floor exercises: Structure and function of the abdominals and pelvic floor, transverses abdominis and spinal stabilisation, importance of pelvic floor for bladder, bowel, sexual function, control and relaxation of labour and alignment of hip and sacroiliac joints, teaching pelvic floor exercises (cueing, routines), teaching pelvic floor exercises independently prior to integration with other abdominal and pelvic stabilisation exercises.

Abdominal separation (diastasis recti): Defining abdominal separation, testing for abdominal separation (knees bent, feet flat on floor, place two fingers across the abdomen around the tummy button area

Outcome 3: Understand the key components of exercise programming for antenatal and postnatal clients (continued)

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and gently apply pressure, ask client to slowly raise head and shoulders off floor and hold, ensure no holding of breath, lower with control, if gap appears to be wider than two fingers try three fingers and repeat test (any more than two fingers, no forward flexion until gap reduces).

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Notes Use this area for notes and diagrams