The importance of physical rehabilitation in pregnancy

Pregnancy and childbirth are the most important and delicate moments of a woman life. The body, bodily functions and its emotional areas undergo some changes to allow a child's development and then the childbirth. The change more visible during this period is the pregnancy weight gain about 10-12 kg. Pulmonary capacity changes slightly; the diameter of the chest increases by 5-7 cm and the diaphragm rises up about 4 cm. While arterial pressure decreases slightly, venous pressure increases in the lower limbs. Abdominal muscles strained gradually until they reach their maximum during the end of pregnancy. This causes reduction of their strength and consequently decreases contracting ability. The center of gravity of the human body (due to the uterus and breast increase) relocates and the woman undergoes posture changes to keep the balance. Lumbar pain is another frequent phenomenon in pregnancy. Women generally complain of low back pain, but frequently the pain diffuses on the bottom, and on the feet. It relates to the changes of body position and its intensity increases during sitting or standing for a long time. Varicose veins are present in pregnancy due to the increased weight of the uterus that presses inferior cava vein and thus increases pressure in the veins of the legs. They become visible by the end of the second quarter and the third quarter of pregnancy. The symptoms vary from a slight foot weightiness to a severe pain during upright position. During pregnancy occurs the weakness of the pelvic floor muscles (the low part of abdomen). The constipation in pregnancy and the large weight gain favor the weakness of pelvic floor muscles and consequently the woman after childbirth may have control problems of urethral and anal sphincter(involuntary loss of urine or stool). Women also complain of joints pain in the hands and feet, a frequent cause of waking at night and nervousness. This condition is the result of syndromes such as carpal tunnel syndrome or thoracic outlet syndrome, caused by postural changes, fluid retention in the body and hormonal influence. The following of a regular and adequate physiotherapeutic program through the control of a professional physiotherapist will prevent negative consequences during the pregnancy because regular physical exercises help to:
-facilitate the natural birth process -recover the previous physical form of the body -prevent urinary incontinence after childbirth -avoid low back pain -keep a comfortable posture during daily activity and during sleep -good oxygenation of the fetus -good control of the breathing -improve the venous circulation in the lower limbs -treat and prevent gestational diabetes(GDM) - improve the psychological condition
A training program to improve health during pregnancy, should starts gradually, avoiding strain of pregnant women. Pregnant women are advised to wear wide clothes and comfortable shoes or sneakers that support the ankle and sole of the foot. Pregnant women should periodically interrupt the therapy for receiving liquids to avoid the risk of dehydration. Contact sports like martial arts, football, volleyball, etc should be avoided by the program. Exercise with weights are used to improve abdominal muscle tone and upper part of the trunk, without straining lumbar muscles. Physical exercises are not recommended in women who have disorders such as high blood pressure, vaginal bleeding, premature births in the past, twin pregnancy, fetal growth retardation in the uterus, heart disease etc. Walking about 20 to 30 minutes during the day, three days a week and preferably one day break between physical exercise days helps to maintain a good posture and to relax a pregnant woman. Yoga should become a routine training for the physical and mental state of pregnant woman that helps them to strengthen muscles that will be used during childbirth and also improve breathing. Yoga classes are ideal places where pregnant women feel unite and support each other. Stretching muscle exercise, neck and arm rotation movement, cycling movement of legs are recommended 3 times a day. Kegel exercises reinforce the pelvic floor muscles and prepare them for the childbirth process. They also help to fasten healing process of perineal tissue and increase sphincter elasticity for a good control of urination and defecation.Dancing is a fantastic and fun exercise during pregnancy. It’s recommended at least 20 minutes three times a week for a maximum benefit. Water aerobics and swimming are considered as the most appropriate fitness during pregnancy that helps releasing birth pain, facilitating the process of birth, removing stress and learning rhythmic breathing. It recommended 30 minutes to 1 hour swimming routine about 3 times a week.
The most efficient position during sleep is sidelined on the left. This sleep way improves blood circulation and nutrition to the baby and helps the kidneys to clean the body of impurities and liquids. Finally, they will have less pain in the legs, arms and hands. Sleeping sidelined on the right, does not damage the mother or the baby, but is less beneficial. Sleeping on the back makes the whole weight of the increased uterus goes to the back muscles, intestines and a numerous blood vessels, causing back pain, hemorrhoids, delay in digestion and blood circulation problems. Changing positions during the night is not a problem for a pregnant woman. She should focuses on a comfortable rest of the body and mind and not to stay awake from the fear of a bad position. A diet enriched with protein, vitamins, minerals, dietary fiber, or potassium would be the best supplementary of these councils to fulfill the physical and mental welfare.