Maternal Health Well-Being

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Maternal Health Well-Being Beyond

• Dr Mary Steen
• Research Fellow in Midwifery RCM/UCLan (joint apt)

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Introduction

• Exercising during pregnancy and after birth has
  many positive effects
• Minimise minor discomforts associated with
  pregnancy
• Improve self-esteem and self-image
• Prepare the body for strenuous exercise
• Speed post-partum recovery
• Ref Hatch et al,1993 Wolfe et al, 1994
  Dunkley 2000
• Zeanah Schlosser, 1993 Horns et al,
  1996)

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Introduction (2)

• A review - women who exercise regularly are more
  likely to have shorter labours
• Less intervention and recover more quickly after
  birth (ref Clapp,2000)
• Safety parameters whilst exercising important
  (ref ACOG, 1994)
• Low impact, Pilate-based exercises and relaxation
  techniques are safe
• These can play an important part in promoting and
  maintaining health

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New Initiative

• An antenatal postnatal health fitness
  programme has been developed
• Women identified a need for this service
• Health Leisure services of the local authority
  identified the need
• Maternity services in Leeds identified the need
  to develop a community-based initiative
• That would promote the normality of childbirth
  and also meet the governments public health
  agenda.

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Collaboration

• Liaise with the health fitness manager at South
  Leeds Stadium
• Already provided specialised classes for Cardiac
  Rehab Active Living
• Under a local scheme that involved GPs referring
  patients to undertake exercise
• Via a Prescription for Activity Pass

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Prescription for Activity

• Relatively new idea
• Several GPs are involved in the scheme
• Concession price of 1.25
• Decided to opt into this scheme
• Midwife referral
• At the final session of the postnatal classes
  women receive a Prescription for Activity Pass
• Women can attend for another 3 months at the
  concession price.

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Aims of the Initiative

• To promote health fitness during pregnancy
• Prepare for Birth
• Maintain health fitness after childbirth

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Piloted

• Successfully piloted in April/May 2004
• Women had to attend at least 4 sessions
• Completed an evaluation form
• 10 women (antenatally)
• 11 women (postnatally)
• Both programmes evaluated very highly
• Evidence that womens self-esteems had increased

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Continuation of the programme

• The health leisure services trained the midwife
  to undertake exercise to music course
• Two of their fitness instructors were funded to
  undertake Pilate-based exercise training and an
  antenatal and postnatal exercise course
• 5 more midwives were funded to undertake the
  Pilate-based training

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Main programme

• 15 month period (June 2004/Sept 2005)
• 10 Antenatal sessions 6 workshop/exercise
  classes
• 10 Postnatal sessions 6 workshop/exercise
  classes
• Attendance varied from 6 to 12 women
• Women had to attend at least 4 of 6 sessions
• To complete an evaluation form

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Evaluation of main programmeAge Range
Antenatal 77 women Postnatal 80 women
15-20 years 2 15-20 years 1
21-25 years 5 21-25 years 5
26-30 years 24 26-30 years 25
31-35 years 32 31-35 years 33
36-40 years 12 36-40 years 13
gt 40 years 2 gt 40 years 2
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Ethnic Groups
Ethnic Group Antenatal Postnatal
Black Afro-Caribbean Black African Asian White UK White Other Chinese Other 3 (4) 4 (5) 8 (10) 53 (69) 5 (6) 2 (3) 2 (3) 3 (4) 3 (4) 9 (11) 56 (70) 5 (6) 1 (1) 3 (4)
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Parity Antenatal (77) Postnatal (80)
Primiparas 66 (86) 68 (85)
Multiparas 11 (14) 12 (15)
Work Status
Not Working 5 (6) 6 (7)
Full-time 35 (45)
Full-time on M/L 20 (27) 49 (61)
Part-time 9 (12)
Part-time on M/L 8 (10) 25 (32)
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Exercise before Pregnancy
Regular exercise 16 (21)
Occasionally 31 (40)
Never 29 (38)
No answer 1 (1)
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Antenatal workshops helpful?
Womens responses (77) Yes No Unsure No answer
Health Fitness 63 (82) 4 (5) 8 (10) 2 (3)
Diet Nutrition 60 (78) 4 (5) 10(13) 3 (4)
Preparing for an Active Birth 67 (86) 2 (3) 7 (8) 2 (3)
Coping with Birth 68 (88) 1 (1) 6 (7) 2 (3)
Managing Emotions Relationships 63 (82) 2 (3) 9 (11) 4 (5)
After Birth 62 (81) 3 (4) 8 (10) 4 (5)
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Postnatal workshops helpful?
Womens responses (80) Yes No Unsure No answer
Birth Experience 68 (85) 4 (5) 5 (6) 3 (4)
Diet Nutrition 62 (77) 8 (10) 7 (9) 3 (4)
Harmful effects of smoking,alcohol,drugs 67 (83) 2 (3) 8 (10) 3 (4)
Maternal Health (Screening Contraception) 70 (87) 1 (1) 6 (8) 3 (4)
Managing Emotions Relationships 63 (79) 3 (4) 11 (14) 2 (3)
Maintaining fitness 64 (80) 5 (6) 7 (9) 4 (5)
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Exercise Classes- helpful?
No. of women Yes No Unsure No answer
Antenatal exercises 77 68 (88) 2 (3) 5 (6) 2 (3)
Postnatal exercises 80 71 (88) 0 (0) 6 (8) 3 (4)
Intend to continue exercise 80 64 (80) 1 (1) 11 (14) 4 (5)
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Womens Views - Antenatal

• Very helpful to have a midwife help you exercise
  who knows what correct exercises to do
• Every pregnant woman should come to the classes,
  you meet other pregnant mums and exercise,
  Tuesdays dont come round fast enough!
• Im more sure about everything to do with my
  pregnancy and birth
• I feel good about myself and I have more
  confidence

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Womens Views - Postnatal

• I couldnt do my the pelvic floor exercises
  properly before I can now
• I did some of the exercises in early labour and
  used the positions I was shown, it really helped
• I was going to have an epidural but after
  attending the antenatal sessions I opted for a
  home birth, Im so pleased I did
• I always go home feeling good about myself and
  fit and healthy
• I bring my mum as well we both have enjoyed it

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Its Fun
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Are u doing your Pelvic Floor Exercises?
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Future Plans

• The midwife champion started a new role in Sept
  2005,
• Manages to still be involved and when in Leeds
  goes to the sessions and is available to chat to
  women and promotes normal birth, health and
  well-being
• The fitness instructors have continued to
  undertake the exercise classes and promote active
  birth