Physical Activity in pregnancy: the midwife’s role. Maternity and Midwifery Festival July 14th 2020

Jacque Gerrard MBE

Midwife & PHE Physical Activity Champion

Learning outcomes

• This short session aims to give an overview to midwives, students and support workers about the importance of Physical Activity (PA) and exercise in pregnancy and post birth

• Aims to help you better understand the UK Chief Medical Officer’s guidance on PA for pregnant women and women post birth.

• You will be in a stronger position to advise women how to include PA and exercise into their daily lives

I’m and exercise & PA enthusiast

• My involvement with Physical Activity

• Why I believe it is important for everyone

Why midwives need to advise women about PA in pregnancy:

• Brief advice on PA has been shown to improve clinical outcomes (PHE)

• 1:4 adults would be more active if advised by a HCP

• Adults are at least 20% less active now than in 1960s

• By 2030 it’s predicted that we will be 35% less active

• Being inactive contributes to 1 in 6 deaths in the UK

• Also contributes to approximately 40% of many long-term conditions

• Cost of £7.4 billion across the UK annually

Health Survey for England 2016; Ng SW, Popkin B (2012) Obesity Review; Lee I-M, et al. (2012) Lancet; Wen CP, Wu X (2012) Lancet; Ossa D & Hutton J (2002); Murray et al. (2013) Lancet

Physical activity and the positive impact on health

Adults and children who are active reduce their risk of developing:

• Type 2 Diabetes

• Cardiovascular disease

• Cancers-colon and breast

• Mental health -depression

• Joint and back pain

• Older adult falls

UK Chief Medical Officers physical activity guidelines for pregnancy 2019

Advantages of exercise and physical activity in the pregnant population

• Controls maternal weight gain

• Reduces high blood pressure and the complications this has for pregnancy

• Improves maternal sleep

• Helps prevent gestational diabetes

• Improves maternal mood and mental health

• Improves fitness during pregnancy

UK Chief Medical Officers physical activity guidelines for pregnancy 2019

When should midwives talk to women about PA & exercise in pregnancy

• In the antenatal period

• At booking or as soon as possible after

• At each A/N visit

• Post birth especially regarding PFME

(Image from Best Beginnings PFME video)

Who has heard and read the CMO’s guidance on Physical activity?

What do you know of the CMO’s guidance?

My twitter poll 116 HCP

Yes 22% v No 78%

UK Chief Medical Officers Physical Activity Guidelines for pregnancy 2019

Aim for 150 minutes of moderate intensity activity every week

• If not active then advise to start exercise gradually

• If already active then keep on going

• Encourage muscle strengthening exercise x2 per week

• Women should listen to their body and adapt as pregnancy grows

• DON’T BUMP THE BUMP

• Every activity counts-every minute counts and more is better

Moderate exercise for the pregnant population!

At home:

Stretching

Walking/running on the spot

Leaning against wall

Use work surface for gentle press ups

Up and down stairs

Gardening

Use what’s available at home water bottles etc…Best Beginnings video

Simple arm exercise with water bottlesSafe and easy for women at home

Moderate outdoor exercise

• Walking• Cycling• Running • Ball games• Swimming• Classes• Stretches• No lying flat on back at any

time• Don’t bump the bump

Physical Activity Post Birth150 mins pw

• Start gradually

• At home

• When the woman feels ready

• Don’t rush it

Following birth advise women to:

• Build up to muscle strengthening exercise gradually

• Advise to stay active whilst breastfeeding

• Get out and about with the baby

• Pram pushing

• Pram stretches

• Baby Lifts

Emphasise the importance of PFMEBest Beginnings video

Reassurance & myth busting!

Important to reassure pregnant women that physical activity does NOT increase the risk of:

• preterm birth

• small for gestational age

• large for gestational age

• complications for the newborn baby

• decrease in the Apgar score at 1 minute

Resources for women

• https://www.nhs.uk/conditions/pregnancy-and-baby/pregnancy-exercise/

• https://www.nhs.uk/common-health-questions/womens-health/what-are-pelvic-floor-exercises/

• https://www.nhs.uk/conditions/pregnancy-and-baby/pregnancy-exercise/

• https://www.bestbeginnings.org.uk/pregnancy-and-postnatal-exercise-videos

Best Beginnings Videos for women

Take home messages are:

Try and introduce PA conversation with women at booking and at each AN appointment-1 ,3,5 or more minutes. Every contact counts and advise:• 150 minutes of moderate intensity activity every week AN & PN• If not active, then advise to start exercise gradually• If already active, then keep on going• Reassure women its safe to exercise throughout pregnancy and post

birth• Advise women never to lie in the supine position when exercising• DON’T BUMP THE BUMP

Thank you Questions?