Care of the Pregnant Patient

Evaluating and treating a patient during pregnancy can be daunting. Questions about safety and efficacy of evaluation and intervention arise, and most rehabilitation providers do not feel well prepared in working with patients who are pregnant. In a survey of therapists who were members of the American Physical Therapy Association (APTA) Section on Women's Health (SOWH), Krum & Smith (2005) found that "A majority of respondents...had received minimal academic education specific to women's health issues." (p. 31)

This 2-day, beginner-level continuing education course provides a foundation in education specific to caring for the patient during pregnancy. Foundational to diagnosis of the musculoskeletal issues present in the peripartum period is an understand of the amazing changes that occur in the body, and the potential risks and benefits of evaluation and intervention techniques. These physical changes are driven by significant hormonal shifts. Hormones such as estrogen, progesterone, relaxin, oxytocin, and prolactin are discussed, and the effects of these and other hormones, some that are present only during pregnancy, are presented. An understanding of typical hormonal effects can allow a therapist to answer a patient's questions and to provide reassurance about the changes that are experienced during pregnancy or the gestational period.

Some of the musculoskeletal changes and approaches to rehabilitation are like those in the non-pregnant population, yet the potential for risks from interventions such as manual therapies, modalities, and exercise approaches must be understood in order to proceed safely with care of the pregnant patient. Participants will learn about contraindications for modalities such as US, TENS, and the applications of specific exercises within safe postures throughout the gestational period.

Despite the often-held belief that exercise during pregnancy is unsafe, moderate to vigorous exercise (for the patient who is not high-risk) offers many health benefits towards depression, maternal self-image, weight gain, and even offers benefit to the developing child. (Clapp, 2002) The participant will learn about these benefits, exercise recommendations, as well as guidelines from organizations such as the American Congress of Obstetricians and Gynecologists. For conditions that are specific to the peripartum period, such as pregnancy-related pelvic girdle pain or diastasis recti abdominis (a separation of the rectus abdominis at the midline that can occur in more than half of women according to Boissonnault and Blaschak, (1998) and Spitznagle and colleagues (2007)), this continuing education course instructs in risk factors, clinical diagnostic tests, and interventions including use of pregnancy-support belts and braces.

With higher instances of carrying multiples and an increase in high-risk pregnancies, therapists must be familiar with medical screening for the pregnant population. In this course, therapists learn to screen for conditions including thyroid dysfunction, deep vein thrombosis, and pregnancy-related hypertension. Course instructors will also answer your questions about billing and reimbursement for this special population, marketing and the language of obstetrics, special tests during the pregnancy period such as amniocentesis, and preparing the patient for labor and delivery.

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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.