Care of the Pregnant Patient: Part 2

Unless there are medical reasons to avoid it, pregnant women should be
advised to exercise moderately for at least 30 minutes on most, if not
all, days. Ongoing, moderate, low-impact weight-bearing exercise during
pregnancy can contribute to normal, on-time delivery and improve the
likelihood of giving birth to a healthy, heavier baby.

Unless there are medical reasons to avoid it, pregnant women should be advised to exercise moderately for at least 30 minutes on most, if not all, days. Ongoing, moderate, low-impact weight-bearing exercise during pregnancy can contribute to normal, on-time delivery and improve the likelihood of giving birth to a healthy, heavier baby. Exercise helps women feel better and the calories burned help prevent too much weight gain. In my experience, exercising regularly before becoming pregnant, and staying in shape while pregnant, may also help prevent painful separation of the pubis symphysis, also known as diastasis symphysis pubis. Exercise can help pregnant women avoid gestational diabetes – a form of diabetes that sometimes develops during pregnancy. It can help build the stamina needed for labour and delivery. Exercise enhances well-being and promotes early recovery after labour and delivery. It’s also worth mentioning that exercise can be very helpful in coping with the postpartum period – exercise can help new mothers keep “baby blues” at bay, regain their energy and lose the weight they gained during pregnancy.

Pregnancy Exercise Tips

• Don’t exercise for longer than 30 minutes at a time.
• Always include a 10-minute warmup and a 10-minute cool-down period (in addition to the 30 minutes of exercise).
• Pregnant women should not exercise to exhaustion – being fatigued is okay.
• Avoid forced, passive stretches, such as reaching for your toes. Pregnancy hormones make your joints looser, so overstretching – which can cause a muscle injury – is a greater risk during pregnancy. Also, avoid sudden jerking or bouncing movements or quick changes in position.
• Limit aerobic activity to the low-impact variety, especially if you weren’t exercising regularly before getting pregnant. Brisk walking, swimming, and riding a stationary bicycle are good choices. Keep it moderate (30 minutes per day), particularly if you weren’t exercising before.
• Ensure weight training is done under proper guidance.
• Measure your heart rate at peak activity to be sure you are not exceeding 140 beats per minute.
• Avoid overheating: drink plenty of water, and don’t exercise in hot,
• humid conditions.
• Do lots of Kegel exercises (before and after the birth) to tighten the muscles around your vagina and anus. From Day 1 after the birth, try to do Kegels every time you feed your baby so it is easier to remember. To isolate these muscles, imagine you are trying to stop yourself from passing urine. Hold the contraction of these muscles for as long as you are able, remembering to breathe, and then relax. Repeat the exercise up to 10 repetitions each time, two to three times a day.
• Avoid activities that put you at high risk for injury, such as horseback riding or downhill skiing.
• Avoid sports in which you could get hit in the abdomen (for example, softball).
• Especially after the third month, avoid exercises that require you to lie flat on your back for an extended period of time since this can reduce your heart rate, lower your blood pressure, cause dizziness, and may reduce blood flow to baby.
• Never scuba dive because it can cause dangerous gas bubbles in the baby’s circulatory system.
• Before starting any new exercise routine, always check with your health-care provider.
• Stop exercising immediately and consult your midwife or doctor if any of the following symptoms occur during or after exercise:

• bleeding
• cramping
• faintness and/or dizziness
• elevated blood pressure
• severe joint pain

Building A Pregnancy Practice
Establishing clear lines of communication with the midwives, doulas, prenatal educators, and medical professionals involved in the care of pregnant women in your community is imperative. Of course, this is easiest when you have the appropriate pregnancy-specific training, or when you are expecting your own baby! It is a good idea to send each a brief letter explaining who you are, what you do, and a summary of current chiropractic care in pregnancy research or a few carefully chosen articles. (The ICPA website is a great resource if you don’t know where to start!). And, in our clinic, we follow up with a phone call to each health practitioner involved in pregnancy care a week or two later, to see if they have any questions. We also give a small Christmas gift basket to each radiology, medical, midwifery and massage therapy clinic in our area to keep our centre on the radar!

Sending a brief letter or report to your expectant parents’ other caregivers, just like a specialist, is also a wonderful marketing tool that serves to educate the other practitioner as to what chiropractic care can do for their patients, and keeps you in their field of vision. For an example, visit the Canadian Chiropractic Association website (www.ccachiro.org ) to learn more about the letters on the CCA’s “Building DC-MD Relationships” CDs. Avoid use of overly technical terminology, such as names of orthopedic tests and chiropractic-specific language, as many really do not understand and may discount your reports as gibberish.

Writing and submitting articles to your local publications, such as newspapers, as well as sending each health practitioner a copy of your in-house newsletter, also helps to establish your role as a pregnancy-care expert. Giving them a subscription to the ICPA’s Pathways magazine can also be useful.

We have pregnancy-specific “New Patient Intake Forms,” as well as a note on our regular new patient intake forms that indicates they should ask for a pregnancy form if they are expecting. In my multidisciplinary clinic, we also offer other pregnancy-specific services such as pregnancy massage, pre-natal yoga, homeopathy, and Hypnobirthing™ courses. It will take time to establish yourself as the chiropractic-pregnancy expert in your community, so work to open the lines of communication and then be prepared to receive the professional referrals. Persistence and patience is crucial!

The Pregnancy-perfect Office
Several things make your office more comfortable and inviting, and help make expectant parents more likely to refer their friends and family to be checked. Having a family-friendly waiting area and adjusting rooms, with toys and books for older children in the family, as well as baby toys for the after-pregnancy care, helps. Posters stressing the importance of chiropractic care in pregnancy, infancy and childhood are up on our walls.

We always have healthy snacks, water and stickers handy. We have a lending library with many pregnancy and chiropractic, nutrition, breastfeeding and natural health-care books, magazines and other information resources available to borrow. We also keep a binder of current research articles; have lots of handouts and brochures; and maintain information on available community resources such as pre-natal yoga and other exercise classes, bellies-and-babies groups and parent-tot groups.

We strive to make the waiting area comfortable for breastfeeding by displaying a breastfeeding-friendly sticker on the window, having comfy chairs and extra pillows, and making a private room available if required. Also, we give the mom-to-be a small baby gift – worth around $20 or so – after the 35th week of pregnancy. This will include a few things for baby: for example, a onesie, natural skin-care products and a small toy; something for mom (usually healthy chocolate), information on post-natal recovery and information on chiropractic care for infants and children. We also make sure she has our after-hours contact information in case she needs an adjustment during labour. We also emphasize the importance of the post-delivery checkup to help her body heal more quickly and to start baby off right!