Chapter 11 E-materials
Appendix 11.1 Glossary
Braxton Hicks: spontaneous painless contractions of the uterus. These usually occur in the third trimester and are sometimes called ‘practice contractions’
Breech presentation: fetus head is at the uterine fundus (top of the uterus) and the baby’s buttocks lie over the maternal pelvic outlet
Embryo: term from conception to 8 weeks of pregnancy
Fetus: term for the growing baby after it is 8 weeks old
Full-term delivery: occurs after a gestational age of 37 weeks
Human gestational period: lasts approximately 40 weeks and is split into 3 trimesters each lasting 3 months in duration
Hyperemesis gravidarum: excessive morning sickness – usually occurs in first trimester, but in some pregnancies will continue longer
LSCS: lower segment caesarean section
Puerperium: the 6–8 weeks following birth
Rectus abdominus divarication: separation which occurs between the two recti abdominus muscles
SVD: spontaneous vertex delivery
Case Study 11.1
Pubic pain
| Aggravators | Easers |
|---|---|
| Walking for 30 minutes | Reduced pain after rest |
| After swimming | Less pain on her work days |
| Worse at the end of the day | |
| Sexual intercourse | |
| Sit to stand – sharp pain | |
Lower back pain
| Aggravators | Easers |
|---|---|
| Bending forward to pick up toddler | Curling up in a ball |
| Bathing toddler | Ibuprofen used to help, but doesn’t want to take it now pregnant |
| Car journeys more than hour and a half | |
Significant points from the assessment
• Posture: Increased lumbar spine lordosis, locks knees in standing and poor abdominal tone.
• Forward flexion in standing demonstrated little lumbar spine flexion, movement gained from hips.
• Anterior–posterior palpation of lumbar spine demonstrated pain from L1–5.
• Limited hip abduction due to pubic pain and tight abductors.
Treatment session one
• Discussed and explained the reason for back and pelvic pain in pregnancy and focused on postural changes that occur.
• Taught pelvic tilting in sitting and standing using a wall in standing to gain concept of ‘flattening out’ the lower spine.
• Re-educated postural alignment in standing with a long mirror to provide proprioception. Focused on soft knees, finding pelvic neutral, gentle lower abdominal activity, relaxed shoulders.
• Performed a pain-free hold relax technique on hip abductors//gained increased pain-free range of hip abduction.
• Taught a gluteal muscle strengthening exercise as a home exercise programme and advised to avoid breast stroke legs when swimming. To try freestyle legs with a float in the arms or a float between the legs and breast stroke arms.
Treatment session three
• Sarah reported that the pubic pain was much improved. She reported that it was now a 2/10 at the end of the day. She no longer had pain on sit to stand as she was squeezing her gluteal muscles as she stood up – a technique she had learnt in the back care class.
• She had also learnt how to perform a pelvic floor exercise in the back care class and was tightening her pelvic floor muscles as she lifted her son and found she could stop a leak of urine.
• She reported that the back pain was much better, however it felt very stiff at the end of the day and it was difficult to bath her son.
