Knowing how to safely examine and treat the patient who is pregnant is the goal of this 2-day beginner-level course. For the orthopedic-based practitioner, this course will solidify safe practice with pregnant clientele. For the non-orthopedic practitioner, this course will provide a foundation for working with the client experiencing common pregnancy-related conditions. The course will open with brief case scenarios that highlight the difference between examination/evaluation in the pregnant vs. non-pregnant population. Review will be provided of pregnancy-related terminology: fertilization, trimesters, medical testing/interventions, imaging, and medications. The participant who completes this course will be able to differentiate between false labor and progressive labor and describe fetal positions and stages of labor and birth. Understanding typical hormonal and systemic changes during pregnancy will be provided, included pregnancy effects on the endocrine, metabolic, cardiovascular, pulmonary, immune, neurologic/sensory, integumentary, gastrointestinal, urinary/renal, reproductive, and musculoskeletal systems.

Examination considerations and modifications specific to pregnancy will be provided, as well as specific questions to ask during history taking and strategies for identifying red flags in pregnancy. Safe positions during the examination/treatment, common posture/gait/balance changes during pregnancy, and common biomechanics and sleep positioning training are described. The participant will learn what modalities and manual therapy techniques are safe or precautioned during pregnancy. Examination, evaluation, and treatment of common pregnancy complaints will be reviewed during lecture and lab for the lumbar, pelvic, and hip region. An introduction in lecture and lab to diastasis rectus abdominis, pelvic floor dysfunction, breathing, and deep core assessment/treatment will be provided (covered in more detail during the postpartum course). All pelvic floor techniques will be instructed externally (no internal examination/treatment at this course).

To prepare the pregnant client for labor and birth, this course will offer instruction on perineal stretching, hip and trunk flexibility activities, TENS for labor, partner massage, and stress reduction techniques during labor. Doula and labor support and childbirth class options will be described. Practice during lab of positional consideration with sEMG biofeedback will help the participant guide patients in labor and birthing positions, including consideration for positional strategies for women with pre-existing musculoskeletal problems.

An introduction to high risk pregnancy and activity restriction levels (such as “bed rest”) is provided. On the other hand, instructing patients in fitness and exercise during pregnancy is also discussed in relation to American College of Obstetricians and Gynecologists (ACOG) guidelines, with ideas for specific types of exercise modification during pregnancy. The course concludes with discussion of marketing and billing needs for providing care for the pregnant population.

Audience:

This continuing education seminar is targeted to physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals. Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.

Prerequisites: None

Are you interested in expanding your practice to treat prenatal patients? Herman & Wallace has put together a Pregnancy and Your Pelvic Floor marketing presentation to help you underscore the importance of prenatal physical therapy.

References

Boissonnault, J. S., & Blaschak, M. J. (1988). Incidence of diastasis recti abdominis during the childbearing year. Physical Therapy, 68(7), 1082-1086.
Clapp, J. F. I. (2002). Exercising through your pregnancy. Omaha, Nebraska: Addicus Books, Inc.
Krum, L., & Smith, S. (2005) Educating physical therapists in women's health: recommendations for professional (entry-level) and post-professional curricula. Journal of Physical Therapy Education. 19(2), 31-41.
Spitznagle, T., Leong, F., & Van Dillen, L. (2007). Prevalence of diastasis recti abdominis in a urogynecological patient population. International Urogynecology Journal & Pelvic Floor Dysfunction, 18(3), 321-328.