Maternal Health Well-Maternal Health Well-Being & BeyondBeing & Beyond

Dr Mary SteenDr Mary Steen

Research Fellow in Midwifery Research Fellow in Midwifery RCM/UCLan (joint apt)RCM/UCLan (joint apt)

IntroductionIntroduction

Exercising during pregnancy and Exercising during pregnancy and after birth has many positive effectsafter birth has many positive effects

Minimise minor discomforts Minimise minor discomforts associated with pregnancyassociated with pregnancy

Improve self-esteem and self-imageImprove self-esteem and self-imagePrepare the body for strenuous Prepare the body for strenuous

exerciseexerciseSpeed post-partum recoverySpeed post-partum recovery

Ref: Hatch et al,1993; Wolfe et al, 1994; Dunkley; 2000Ref: Hatch et al,1993; Wolfe et al, 1994; Dunkley; 2000 Zeanah & Schlosser, 1993; Horns et al, 1996)Zeanah & Schlosser, 1993; Horns et al, 1996)

Introduction (2)Introduction (2)A review - women who exercise A review - women who exercise

regularly are more likely to have shorter regularly are more likely to have shorter labourslabours

Less intervention and recover more Less intervention and recover more quickly after birth quickly after birth (ref: Clapp,2000)(ref: Clapp,2000)

Safety parameters whilst exercising Safety parameters whilst exercising important important (ref: ACOG, 1994)(ref: ACOG, 1994)

Low impact, Pilate-based exercises and Low impact, Pilate-based exercises and relaxation techniques are saferelaxation techniques are safe

These can play an important part in These can play an important part in promoting and maintaining healthpromoting and maintaining health

New InitiativeNew InitiativeAn antenatal & postnatal health & fitness An antenatal & postnatal health & fitness

programme has been developedprogramme has been developedWomen identified a need for this serviceWomen identified a need for this serviceHealth & Leisure services of the local authority Health & Leisure services of the local authority

identified the needidentified the needMaternity services in Leeds identified the need Maternity services in Leeds identified the need

to develop a community-based initiativeto develop a community-based initiativeThat would promote the normality of childbirth That would promote the normality of childbirth

and also meet the governments public health and also meet the governments public health agenda.agenda.

CollaborationCollaboration

Liaise with the health & fitness Liaise with the health & fitness manager at South Leeds Stadiummanager at South Leeds Stadium

Already provided specialised classes Already provided specialised classes for ‘Cardiac Rehab’ ‘Active Living’for ‘Cardiac Rehab’ ‘Active Living’

Under a local scheme that involved Under a local scheme that involved GP’s referring patients to undertake GP’s referring patients to undertake exerciseexercise

Via a ‘Prescription for Activity’ PassVia a ‘Prescription for Activity’ Pass

Prescription for Activity Prescription for Activity

Relatively new ideaRelatively new idea Several GP’s are involved in the schemeSeveral GP’s are involved in the scheme Concession price of £1.25Concession price of £1.25 Decided to opt into this schemeDecided to opt into this scheme Midwife referral Midwife referral At the final session of the postnatal classes At the final session of the postnatal classes

women receive a ‘Prescription for Activity’ women receive a ‘Prescription for Activity’ Pass Pass

Women can attend for another 3 months at Women can attend for another 3 months at the concession price.the concession price.

Aims of the InitiativeAims of the Initiative

To promote health & fitness during To promote health & fitness during pregnancypregnancy

Prepare for BirthPrepare for BirthMaintain health & fitness after Maintain health & fitness after

childbirthchildbirth

Piloted:Piloted:

Successfully piloted in April/May 2004Successfully piloted in April/May 2004Women had to attend at least 4 Women had to attend at least 4

sessions sessions Completed an evaluation form:Completed an evaluation form:10 women (antenatally)10 women (antenatally)11 women (postnatally)11 women (postnatally)Both programmes evaluated very highlyBoth programmes evaluated very highlyEvidence that women’s self-esteems Evidence that women’s self-esteems

had increasedhad increased

Continuation of the Continuation of the programme:programme:

The health & leisure services trained The health & leisure services trained the midwife to undertake exercise to the midwife to undertake exercise to music coursemusic course

Two of their fitness instructors were Two of their fitness instructors were funded to undertake Pilate-based funded to undertake Pilate-based exercise training and an antenatal exercise training and an antenatal and postnatal exercise courseand postnatal exercise course

5 more midwives were funded to 5 more midwives were funded to undertake the Pilate-based trainingundertake the Pilate-based training

Main programme:Main programme:

15 month period (June 2004/Sept 2005)15 month period (June 2004/Sept 2005) 10 Antenatal sessions: 6 workshop/exercise 10 Antenatal sessions: 6 workshop/exercise

classesclasses 10 Postnatal sessions: 6 workshop/exercise 10 Postnatal sessions: 6 workshop/exercise

classesclasses Attendance varied from 6 to 12 womenAttendance varied from 6 to 12 women Women had to attend at least 4 of 6 sessionsWomen had to attend at least 4 of 6 sessions To complete an evaluation formTo complete an evaluation form

Evaluation of main Evaluation of main programmeprogramme

Age RangeAge RangeAntenatalAntenatal 77 women77 women PostnatalPostnatal 80 women80 women

15-20 15-20 yearsyears

22 15-20 15-20 yearsyears

11

21-25 21-25 yearsyears

55 21-25 21-25 yearsyears

55

26-30 26-30 yearsyears

2424 26-30 26-30 yearsyears

2525

31-35 31-35 yearsyears

3232 31-35 31-35 yearsyears

3333

36-40 36-40 yearsyears

1212 36-40 36-40 yearsyears

1313

> 40 > 40 yearsyears

22 > 40 > 40 yearsyears

22

Ethnic Groups:Ethnic Groups:

Ethnic GroupEthnic Group AntenatalAntenatal PostnatalPostnatal

Black Afro-Black Afro-CaribbeanCaribbean

Black AfricanBlack African

AsianAsian

White UKWhite UK

White OtherWhite Other

ChineseChinese

OtherOther

3 (4%)3 (4%)

4 (5%)4 (5%)

8 (10%)8 (10%)

53 (69%)53 (69%)

5 (6%)5 (6%)

2 (3%)2 (3%)

2 (3%)2 (3%)

3 (4%)3 (4%)

3 (4%)3 (4%)

9 (11%)9 (11%)

56 (70%)56 (70%)

5 (6%)5 (6%)

1 (1%)1 (1%)

3 (4%)3 (4%)

ParityParity Antenatal Antenatal (77)(77)

Postnatal Postnatal (80)(80)

PrimiparasPrimiparas 66 (86%)66 (86%) 68 (85%)68 (85%)

MultiparasMultiparas 11 (14%)11 (14%) 12 (15%)12 (15%)

Work StatusWork Status

Not WorkingNot Working 5 (6%)5 (6%) 6 (7%)6 (7%)

Full-timeFull-time 35 (45%)35 (45%)

Full-time on Full-time on M/LM/L

20 (27%)20 (27%) 49 (61%)49 (61%)

Part-timePart-time 9 (12%)9 (12%)

Part-time on Part-time on M/LM/L

8 (10%)8 (10%) 25 (32%)25 (32%)

Exercise before PregnancyExercise before Pregnancy

Regular exerciseRegular exercise 16 (21%)16 (21%)

OccasionallyOccasionally 31 (40%)31 (40%)

NeverNever 29 (38%)29 (38%)

No answerNo answer 1 (1%)1 (1%)

Antenatal workshops – Antenatal workshops – helpful?helpful?

Women’s Women’s responses (77)responses (77)

YesYes NoNo UnsureUnsure No No answeanswerr

Health & FitnessHealth & Fitness 63 (82%)63 (82%) 4 (5%)4 (5%) 8 (10%)8 (10%) 2 (3%)2 (3%)

Diet & NutritionDiet & Nutrition 60 (78%)60 (78%) 4 (5%)4 (5%) 10(13%10(13%))

3 (4%)3 (4%)

Preparing for an Preparing for an Active BirthActive Birth

67 (86%)67 (86%) 2 (3%)2 (3%) 7 (8%)7 (8%) 2 (3%)2 (3%)

Coping with Coping with BirthBirth

68 (88%)68 (88%) 1 (1%)1 (1%) 6 (7%)6 (7%) 2 (3%)2 (3%)

Managing Managing Emotions & Emotions & RelationshipsRelationships

63 (82%)63 (82%) 2 (3%)2 (3%) 9 (11%)9 (11%) 4 (5%)4 (5%)

After BirthAfter Birth 62 (81%)62 (81%) 3 (4%)3 (4%) 8 (10%)8 (10%) 4 (5%)4 (5%)

Postnatal workshops – Postnatal workshops – helpful?helpful?

Women’s Women’s

responses (80)responses (80)YesYes NoNo UnsureUnsure No No

answeanswerr

Birth ExperienceBirth Experience 68 68 (85%)(85%)

4 (5%)4 (5%) 5 (6%)5 (6%) 3 3 (4%)(4%)

Diet & NutritionDiet & Nutrition 62 62 (77%)(77%)

8 (10%)8 (10%) 7 (9%)7 (9%) 3 3 (4%)(4%)

Harmful effects of Harmful effects of smoking,alcohol,drsmoking,alcohol,drugsugs

67 67 (83%)(83%)

2 (3%)2 (3%) 8 (10%)8 (10%) 3 3 (4%)(4%)

Maternal HealthMaternal Health(Screening & (Screening & Contraception)Contraception)

70 70 (87%)(87%)

1 (1%)1 (1%) 6 (8%)6 (8%) 3 3 (4%)(4%)

Managing Emotions Managing Emotions & Relationships& Relationships

63 63 (79%)(79%)

3 (4%)3 (4%) 11 11 (14%)(14%)

2 2 (3%)(3%)

Maintaining fitnessMaintaining fitness 64 64 (80%)(80%)

5 (6%)5 (6%) 7 (9%)7 (9%) 4 4 (5%)(5%)

Exercise Classes- helpful?Exercise Classes- helpful?

No. of No. of womenwomen

YesYes NoNo UnsureUnsure No No answeanswerr

AntenatAntenatalal

exerciseexercisess

7777 68 68 (88%)(88%)

2 (3%)2 (3%) 5 (6%)5 (6%) 2 (3%)2 (3%)

PostnataPostnatall

exerciseexercisess

8080 71 71 (88%)(88%)

0 (0%)0 (0%) 6 (8%)6 (8%) 3 (4%)3 (4%)

Intend Intend to to continue continue exerciseexercise

8080 64 64 (80%)(80%)

1 (1%)1 (1%) 11 11 (14%)(14%)

4 (5%)4 (5%)

Women’s Views - Antenatal:Women’s Views - Antenatal:

‘‘Very helpful to have a midwife help you Very helpful to have a midwife help you exercise who knows what correct exercise who knows what correct exercises to do’exercises to do’

‘‘Every pregnant woman should come to Every pregnant woman should come to the classes, you meet other pregnant the classes, you meet other pregnant mums and exercise, Tuesday’s don’t come mums and exercise, Tuesday’s don’t come round fast enough!round fast enough!

‘‘I’m more sure about everything to do with I’m more sure about everything to do with my pregnancy and birth’my pregnancy and birth’

‘‘I feel good about myself and I have more I feel good about myself and I have more confidence’confidence’

Women’s Views - PostnatalWomen’s Views - Postnatal

‘‘I couldn’t do my the pelvic floor exercises I couldn’t do my the pelvic floor exercises properly before I can now’properly before I can now’

‘‘I did some of the exercises in early labour and I did some of the exercises in early labour and used the positions I was shown, it really helped’used the positions I was shown, it really helped’

‘‘I was going to have an epidural but after I was going to have an epidural but after attending the antenatal sessions I opted for a attending the antenatal sessions I opted for a home birth, I’m so pleased I did’ home birth, I’m so pleased I did’

‘‘I always go home feeling good about myself I always go home feeling good about myself and fit and healthy’and fit and healthy’

‘‘I bring my mum as well we both have enjoyed I bring my mum as well we both have enjoyed it’it’

It’s FunIt’s Fun

Are u doing your Pelvic Floor Are u doing your Pelvic Floor Exercises?Exercises?

Future PlansFuture Plans

The midwife ‘champion’ started a new The midwife ‘champion’ started a new role in Sept 2005, role in Sept 2005,

Manages to still be involved and when in Manages to still be involved and when in Leeds goes to the sessions and is Leeds goes to the sessions and is available to chat to women and available to chat to women and promotes normal birth, health and well-promotes normal birth, health and well-beingbeing

The fitness instructors have continued to The fitness instructors have continued to undertake the exercise classes and undertake the exercise classes and promote active birthpromote active birth