Role of Nurse in

Antenatal Care UNIT 3 ANTENATAL AND POSTNATAL EXERCISES

Structure
3.0 Objectives
3.1 Introduction
3.2 Antenatal Exercises
3.2.1 Importance of Antenatal Exercises
3.2.2 Preparation for Antenatal Exercises
3.2.3 Technique for Performing Selected Exercises
3.2.4 Teaching Pregnant Women to Perform Antenatal Exercises
3.3 Postnatal Exercises
3.3.1 Importance of Postnatal Exercises
3.3.2 Preparation for Postnatal Exercises
3.3.3 General Instructions
3.3.4 Technique for Performing Selected Postnatal Exercises
3.3.5 Teaching Pregnant Mother to Perform Postnatal Exercises after Delivery
3.4 Let Us Sum Up
3.5 Answers to Check Your Progress
3.6 Activity

3.0 OBJECTIVES
After going through this unit, you should be able to:
· prepare client for antenatal and postnatal exercises; and
· demonstrate skill in teaching clients to perform antenatal and postnatal exercises.

3.1 INTRODUCTION
Antenatal exercises are those exercises performed by women during pregnancy, which
stimulate circulation and gives a feeling of well being to the clients. Postnatal exercises
are those that are performed after delivery and will help women to regain their former
level of well being.

This unit will tell you what are the different techniques of antenatal exercises and how
you will prepare and teach women to do antenatal exercise.

You will also know what the different techniques of postnatal exercises are and how you
will prepare for postnatal exercises and teach women to perform the postnatal exercises.

3.2 ANTENATAL EXERCISES

3.2.1 Importance of Antenatal Exercises

In this sub-section you will learn about importance of antenatal exercises. Before giving
antenatal exercise you need to prepare pregnant women physicaly and mentally for
exercises. It is very important for pregnant women to have a regular excercise.

A good exercise program is important because it:

· aids circulation
· makes the entire body function well, keeps the mother fit and energetic
· helps to refresh one’s mind
· helps to prevent or ameliorate discomforts such as piles constipation, varicosties and
insomnia.
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3.2.2 Preparation for Antenatal Exercises Antenatal and Postnatal
Exercises

Preparation of the Woman

Explain exercise guidelines and the importance of doing regular exercises unless contra-
indicated.

Do’s

· Consult doctor/midwife before beginning the exercise.

· Perform exercises regularly, plan a regular schedule i.e. at least thrice a week.
· Dress comfortably; wear loose fitting clothes; wear a supporting bra.
· Your increased weight may cause changes in posture and put pressure on the ulnar
nerve.
· Void before exercising.
· Progress slowly.
· Use movements that are slow and deliberate; avoid jerking and bouncing movements;
jogging and running.
· Exercise on a firm surface.
· Drink fluid whenever you feel the need during the exercise and after the exercise.
This prevents dehydration.
· Wear supportive shoes when needed.
· Limit activities to shorter intervals. Exercise for 10-15 minutes, rest for 2-3 minutes,
then exercise for another 10-15 minutes.
· Decrease exercise level as pregnancy progresses.
· Take your pulse every 10 to 15 minutes. If it is more than 140 beats/min. Slow
down until it reaches to the maximum of 90.
· Perform warm-up and stretching exercises which will prepare joints for more
strenuous exercises.
· Rest in left-lateral position for 10 minutes after the exercise.
· Take an increase in the calories to replace those burned during exercises.

Don’ts

· Don’t risk activities such as surfing, mountain climbing and sky diving.

· Don’t do activities that require holding your breath and bearing down.

· Do not continue the exercise if you experience shortness of breath, pain, numbness,
undue cramping, vaginal bleeding or nausea. Report to the doctor/midwife if it
happens.

· Don’t become over heated for extended periods. If the weather is humid, it is best
not to exercise for more than 35 minutes. As your body temperature rises, the heat
is transmitted to the foetus, which can lead to foetal birth defects especially during
the first three months.

· Don’t perform bouncing and jerking movements.

· Don’t perform any exercise flat on your back after fourth month of gestation.

Preparation of the Environment

· Arrange the area i.e., a hard, firm bed, or a mat spread on the floor.

· Ensure privacy.

· Ensure that there is adequate light and ventilation.

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Role of Nurse in 3.2.3 Technique for Performing Selected Exercises
Antenatal Care

The technique for performing selected exercises need to be demonstrated to the woman.
A return demonstration need to be taken by the nurse or midwife who conducts the
teaching program.

The following exercises need to be done regularly, in the antenatal period, if there are no
complications in mother and foetus. Exercises like breathing and relaxation are to be done
during labour, so that it will help in reducing pain and shortening the duration of labour.

The exercises are described as follows:

a) Foot Rotation

Purposes

· To strengthen calf muscles

· To stretch calf muscles
· To decrease calf muscles cramps
Technique
· Sit on the bed or floor with the weight of your body resting on your hands placed
behind on the surface.
· Rotate feet slowly to left in full circles
· Rotate feet to right in full circle
· Repeat 10 times in each direction

Fig. 3.1: Foot rotation

b) Calf Stretch
Purpose
· Improves circulation of legs
· Decreases swelling
· Decreases calf muscles cramps
Technique
· Place feet on a thick book or a block or a step.
· Steady yourself by holding on to something
· Slowly relax and lower heels to the floor
· Stretch calf to a slow count of 10
· Relax
· Repeat 5 times
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 Antenatal and Postnatal
Exercises

Fig. 3.2: Calf stretch

c) Shoulder Rolling
Purpose
· For relaxation of the shoulder
· Strengthens muscles of chest, arm and upper back

Technique
· Squat on the floor
· Rotate right shoulder back in a slow circular motion 5 times
· Rotate right shoulder forward in a slow circular motion 5 times
· Repeat step 2 and 3 for left shoulder
· Rotate both shoulders back and then forward together
· Relax
· Raise shoulders up towards your ears and hold for a count of five
· Relax

Fig. 3.3: Shoulder rolling 39

Role of Nurse in d) Shoulder Rotation
Antenatal Care
· Sit tailor fashion on the floor
· Stretch arms out sideways, at shoulder level
· Hold palms facing downwards
· Slowly turn your palms up, facing upwards
· Keeping your elbows straight, rotate your shoulders and arms till your palms
face the floor again
· Repeat rotation in the other direction
· Perform this 10 times

(a) (b)
Fig. 3.4: Shoulder rotation
e) Spine Rotation
Purpose
To relax stiff joints
Technique
· Stand with head high
· Keep arms outstretched at shoulder level
· Turn head and body to left
· Keep the knees pointing forwards
· Turn to right. Repeat 6 times
f) Abdominal Tightening
· Lie on the back with knee bent
· Place hands on the abdomen
· Take a deep breath through the nose
· Blow the air out, pulling the abdomen in until all the air is gone.

Fig. 3.5: Abdominal tightening

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g) Arm Swinging Antenatal and Postnatal
Exercises
Purpose
· To relax joints of shoulder
Technique
· Stand tall
· Stretch arms forward and upward while raising self on tip toe
· Lower arms in backward direction
· Lower heels
· Repeat 6 times

Fig. 3.6: Arm swinging

The following exercises are to be done regularly in the antenatal period like the ones
described above. You need to teach the women that some of these exercises need to be
performed in the first and second stages of labour.
h) Breathing Exercises
Purposes
· to strengthen muscles of respiration
· to increase maternal and foeto-placental oxygenation
· to reduce the intensity of labour pain
i) Abdominal Breathing
Technique
· lie on the back with hands resting on sides of the abdomen, just below her ribs
· breathe in deeply through the nose
· breathe out slowly, until all the air is gone out
· repeat it 15-16 times/minute for 5 minutes
Note : Increase rate to 20 – 24 times per minute for five minutes daily.
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Role of Nurse in ii) Control Breathing
Antenatal Care
· To be performed regularly in the antenatal period and in the first stage of
labour during contraction

Technique

· Instruct woman to take 2 – 3 normal breaths through her nose

· Ask her to breathe in deeply through her nose
· Count 1 to 10 in mind
· Blow the air out slowly through the mouth, until the air is gone
· Repeat it 2 - 3 times per minute for 5 minutes twice daily

iii) Panting Breathing

Purpose

· To prevent pushing before crowning has taken place in the second stage of
labour when contractions take place and the foetus is to be delivered.

Technique

· Instruct woman to place hands on the chest

· Breathe in and out through the mouth 5 – 6 times in quick succession
· Repeat it after 5 minutes
· Practice it twice daily for 5 minutes

i) Relaxation Technique

Purpose

· To relieve discomfort caused by muscular tension.

· To reduce perception of pain during delivery
· To save energy for the delivery process
· To be performed in the first stage of labour

i) Passive Relaxation
· Instruct woman to lie on her side with right cheek on pillow ( e.g. on right
side ) and place left arm on the pillow
· Breathe in and out throughout the exercises.
· Flex the left knee and place it over the right leg so that all parts of body are
relaxed and supported on the pillow.
· Close eyes and mouth
· Screw facial muscles and relax
· Make a fist with one hand and relax
· Straighten elbow and relax
· Tighten muscles of shoulder and relax
· Repeat with other fist
· Tighten abdominal muscle; relax
· Tighten buttocks; relax
· Tighten leg muscles; relax
· Bend ankle downwards; relax; bend upwards; relax
· Bend knees; relax; straighten knees; relax

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ii) Active Relaxation Antenatal and Postnatal
Exercises
Purpose
· Helps the woman to use her muscles during the delivery process by contracting
the muscles involved in delivery and relaxing the uninvolved muscles when
uterine contraction takes place.
· This exercise is to be performed during the second stage of labour ; when the
uterine contractions takes place.
Technique
· Instruct client to tighten muscles of face and relax the rest of the body lying in
position
· Tighten muscles of both arms and relax rest of the body
· Tighten muscles of both legs and relax rest of the body
j) Pelvic Floor Exercises
Purpose
· To strengthen pelvic floor muscles and provide support for the uterus and pelvic
organs
· Awareness of the muscles of the pelvic floor help to relax the area to speed
delivery of the baby
Technique
· Instruct the client to find the muscles. The pelvic floor muscles are those that
around the urethra, vagina and anus.

Urethra

Vagina

Anus

Fig. 3.7: Pelvic floor exercises

· Ask her to stop the flow of urine before finishing urinating
· Repeat starting and stopping the flow of urine several times, till she can do it
without difficulty.
· Instruct the woman to perform the exercise using the following direction
· Contract (tighten) muscles and hold for a count of five
· Slowly tighten muscles of pelvic floor; hold for a count of three
· Relax
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Role of Nurse in · Quickly tighten the muscles
Antenatal Care
· Relax
· Imagine sucking up water through the birth canal and slowly tighten muscles
· Hold for a few second
· Tighten and imagine sucking the water up higher relax
· Repeat the exercise 5 times
· Do slowly 5 to 6 times daily
k) Pelvic Tilt or Pelvic Rock
Purpose
· Helps to stretch muscles and ligaments in the back preventing or alleviating
backache or strain.
· Improves posture
· Makes abdominal muscles firm
There are many ways of performing this i.e.
i) Back lying
ii) Angry cat
iii) Standing
iv) Side lying
· These can be chosen as per the woman’s comfort
i) Back Lying
This exercise should not be performed after the fourth month of pregnancy:
Instruct woman to
· lie on the back with knees bent
· slowly press the small of the back down until it is flat on the floor
· hold for a count of five
· release
· repeat 5 to 10 times
ii) Angry Cat
Instruct woman to
· kneel on all fours
· keep her back straight
· push the small of her back up which makes the back hump and the pelvis
tucked in
· hold for a count of 5
· return to starting position
· repeat this 5 to 10 times
iii) Standing
Instruct woman to
· Stand resting the back against the wall, placing the feet one foot away from the wall
· Press small of the back against the wall
· Hold for a count of 5
· Release
· Repeat 5 to 10 times

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iv) Side Lying Antenatal and Postnatal
Exercises
Instruct woman to:
· Lie on the side; support head on the arm
· Decrease the lower back curve by tilting the curve in
· Hold for a count of 5
· Release
· Repeat 5 to 10 times

3.2.4 Teaching Pregnant Women to Perform Antenatal Exercises

The antenatal exercises that are taught to the woman can be in the form of teaching
sessions that are planned
The method of teaching could be lecture-cum demonstration and return demonstration
The teaching aids could include
· Demonstration of exercises
· A ‘pamphlet’ could be given for them to refer while they are doing the exercises
· Charts could be used
· Give them a dairy to maintain a record of their exercises Advise the woman to bring
this with her when she returns for check–up
Check Your Progress 1
1) An antenatal woman comes to the Out Patient Department at 34 weeks of gestation
with no complications. She asks you to teach her some exercises that she can
perform to have an easy labour. Which exercises will you teach this woman?
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2) What advice will you give antenatal women regarding ‘don’ts’ of exercises?
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3) List the breathing exercises to be practiced by the mother during antenatal period. What
are the purposes of doing these breathing exercises?
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Role of Nurse in
Antenatal Care 3.3 POSTNATAL EXERCISES
These are the exercises that are performed in the postnatal period, in order to strengthen
floor and abdominal muscles and prevent complications i.e. till six weeks after the birth
of the baby.

3.3.1 Importance of Postnatal Exercises

To strenghten muscles that were during labour or pregnancy i.e. abdominal and pelvic floor
muscles.
The purpose of performing these exercises is to:
· reduce excessive fat.
· maintain figure, shape of breasts and secure adquate milk supply.
· promote woman’s rapid recovery of strength.
· increase general circulation and prevent complications.
· prevent backache.
· prevent genital prolapse and stress incontinence of urine.
· correct posture.

3.3.2 Preparation for Postnatal Exercises

· Explain to the woman the purpose/importance of postnatal exercises.
· Explain the guidelines.
· Describe the procedure.
· Take consent.
· Prepare the area for excercise; i.e. a firm bed or a mat and a pillow.
· Ensure privacy.

3.3.3 General Instructions

i) Before starting and after finishing exercises, the mother must practice deep breathing.
ii) Never hold breath while performing an exercise
iii) Relax all muscles at the finish of each exercise
iv) Exercise must be done in a controlled and rhythmical manner
v) If the mother feels tired after exercise, she should be advised to practice them less
strenuously

3.3.4 Technique of Performing Selected Postnatal Exercises

Head Raising

This is done to provide early strengthening of abdominal muscles that were weakened
during pregnancy:

· Lie on back with arms at sides

· Bend knees so that the feet are flat on the floor.
· Tuck chin to chest.
· Raise head
· Keep chin tucked to the chest
· Lower head

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Trunk Rotation Antenatal and Postnatal
Exercises
This is performed in order to strengthen the abdominal muscles:
· Lie on back
· Flex and pull both knees toward chest
· Place arms resting on floor/bed perpendicular to body.
· Don’t let the feet touch the floor.
· Twist pelvis and both legs to left until bottom leg touches floor.
· Keep knees bent and both shoulders flat on the floor.
· Return pelvis and legs to starting position.
· Keeping knees bent and both shoulders flat on the floor, twist pelvis and both legs to
right until bottom leg touches the floor.
Gluteal Setting
This is performed in order to exercise muscles of the pelvic floor. It will help in
increasing the blood circulation to the perineum thereby enabling rapid healing. It will
also aid in improving the normal tone in the perineal area following delivery.
· Lie on back
· Place arms at side
· Cross legs at ankles
· Squeeze buttocks together
· Tighten large muscles of the seat / buttock
· Squeeze thighs firmly together simultaneously
· Hold five counts
· Relax
· Repeat this exercise
Ankle Exercise
This is performed in order to increase circulation in calf muscles, decrease oedema of the legs
and prevent thrombophlebitis.
· Push toes and ankles downwards
· Reverse position
· Pull toes and ankles up as far as possible
· Repeat the procedure 3 – 4 times
Partial Sit Up
This is done in order to strengthen the abdominal muscles.
· Lie on back
· Place arms at sides
· Bend knees with feet flat on the floor
· Tuck chin to chest
· Raise head and shoulders off floor
· Reach for the knees with hands
· Curl forward only as far as possible without throwing or jerking body forward
· Sit up
· Turn diagonally with both hands reaching to one side of knees
· Repeat reaching to the opposite side
· Slowly and smoothly lower head and shoulders back to starting point
· Relax

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Role of Nurse in
Antenatal Care

Fig. 3.8: Partial sit up

Arm Raising
· Lie on back with arms extended at 90 angle from body
· Raise arms so that they are perpendicular and hands touch
· Lower slowly

Fig. 3.9: Arm raising

Abdominal Breathing
· Lie on back with knees bent
· Inhale deeply through the nose
· Keep ribs as stationary as possible
· Allow abdomen to expand upwards
· Exhale slowly while contracting the abdominal muscles
· Hold for three seconds
· Exhale.

48 Fig. 3.10: Abdominal breathing

Combined Abdominal Breathing and Supine Pelvic Tilt ( Pelvic Rock ) Antenatal and Postnatal
Exercises
· Lie on back with knees bent
· Inhale deeply
· Place back on floor or bed (while still inhaling )
· Exhale slowly but forcefully while contracting abdominal muscles and tightening buttocks.
· Hold for 3 to 5 seconds while exhaling
· Relax

Fig. 3.11: Pelvic rock

Single Knee Roll/Alternate Knee
· Lie on back with right leg straight and left knee flexed.
· Keep shoulders flat
· Slowly roll left knee over to the right
· Touch floor or bed with the left knee
· Go back to the starting position
· Reverse position of legs
· Roll right knee over to the left
· Touch floor or bed
· Return to starting position
· Relax

Fig. 3.12: Single knee roll 49

Role of Nurse in Double Knee Roll
Antenatal Care
· Lie on back with knees bent
· Keep shoulders flat and feet stationary
· Slowly and smoothly roll knees back over to the right until they touch the floor or bed.
· Return to starting position
· Relax

Fig. 3.13: Double knee roll

3.3.5 Teaching Pregnant Mother to Perform Postnatal Exercises after

Delivery
· Planned teaching sessions need to be conducted.
· Place emphasis on the importance of performing these exercises.
· Use lecture cum demonstration and return demonstration as the method of teaching.
· Audio-visual aids could include charts, video-cassettes and a pamphlet which the woman
could carry with her.
· A daily diary may be maintained by the woman which can be brought with them during
postnatal check-up.

Check Your Progress 2

1) List six purposes of postnatal exercises.
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2) Explain the procedure of gluteal setting.
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 Antenatal and Postnatal
3) Why are the following exercises performed in the postnatal period? Exercises
a) Ankle exercises
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b) Gluteal setting
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3.4 LET US SUM UP

The singnificance of doing antenatal and postnatal exercises during antenatal and postnatal
periods by mothers is vital factor, to be remembered by all the women as well as by all
the health care providers. Teaching about these exercises is a part of antenatal care. These
are various techniques of doing these exercises which are described in this unit with
diagramatic representation.

3.5 ANSWERS TO CHECK YOUR PROGRESS

Check Your Progress 1
1) · Abdominal breathing
· Control breathing
· Panting breathing
· Passive relaxation
· Active relaxation

2) · perform activities where you need to hold your breath and bear down.
· perform activities that make you overheated for an extended period.
· perform activities such as surfing, mountain climbing and sky diving.
· do activities that require holding your breath and bearing down.
· continue the exercise if you experience shortness of breath, pain, numbness,
undue cramping, vaginal bleeding or nausea. Report to the doctor/midwife if it
happens
· become over heated for extended periods. If the weather is humid, it is best not
to exercise for more than 35 minutes.
· perform bouncing and jerking movements.
· perform any exercise flat on your back after fourth month of gestation.

3) a) Abdominal breathing
b) Control breathing
c) Panting breathing

Purposes:

· To strengthen muscles of respiration

· To increase maternal and foeto placental criculation.
· To reduce the intensity of labour pain
· Strengthen the muscles of the abdomen and pelic floor
· Reduce excessive fat
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