Page Six P H Y S I O T H E R A P Y October, 1956. THE V A L U E OF A N T I - N A T A L E X E R C I S E S B y EILEEN E. G U N T E R , D ip lo m a o f P hysical E d u c a tio n , B ergm an O ste rb e rg P .T . C ollege, D a rtfo rd , K e n t, E n gland. L e c tu re r S u b -D e p t. P h y sio th e rap y , W itw a te rsra n d U niversity. MA N Y v aried article s have been w ritte n o n the c o n ­tro v ersia l su bject o f exercise fo r a n te -n a ta l p atients. The B ritish Journal o f Gynaecology a n d O bstetrics, F e b ru a ry , 1956, re p ro d u c e d statistics d ra w n up by th e M iddlesex H o s p ita l, E n g la n d , o f th e w o rk d o n e in th is field. In view o f th e co m m e n ts m ad e in this article, fro m w hich it w o uld a p p e a r, a n te -n a ta l exercise was o f little o r n o value in re la tio n to len g th o f la b o u r o r the incidence o f c o m p li­ c atio n s o f la b o u r, it w as decided to c a rry o u t a n investiga­ tio n o f th e p a tie n ts a t T h e Q u een V ic to ria H o s p ita l w ho h a d a tte n d e d a n te -n a ta l classes. T h e in v estigation briefly w as based o n b o o k e d deliveries a t th e H o s p ita l o c c u rrin g fro m 9 /1 0 /5 4 to 31 /7 /5 6 . S ta tis­ tics a re p ro d u c e d o f 150 p a tie n ts , a ll prim agravidae, picked a t ra n d o m o u t o f 2,500 p a tie n ts w ho h a v e a tte n d e d a n te ­ n a ta l classes a t th e Jo h a n n e s b u rg G e n e ra l H o s p ita l. C o m ­ pa riso n s a re m a d e w ith a n eq u iv a len t n u m b e r o f pa tie n ts, also prim agravidae, w hose deliveries o c cu rre d d u rin g the sam e p e rio d o f tim e, b u t w ho d id n o t a tte n d classes. A n te -N ata l C lasses. P a tie n ts b o o k e d a t a n te -n a ta l clinic, w ith th e d o c to rs p erm ission, w ere invited to a tte n d a n te -n a ta l classes fo r exercise, v o lu n ta rily , having re a c h e d th e ir 2 0th— 25th week o f pregnancy. T h e tec hniques w hich a re ta u g h t a re based largely on th o se a d v o c a te d by th e late M rs. H elen H e a rd m a n , special a tte n tio n being d e v o te d to c o rre c t bre ath in g , re la x a tio n and exercise o f a ll m uscle g roups. T h e p a tie n ts w ere n o t segregated in to g ro u p s according to th e stages o f p re g n an c y th ey h a d re ac h ed , b u t kept to g eth e r. N e w p a tie n ts a t th e ir fo u rth m o n th o f pregnancy d id th e sam e exercise as th o se in th e ir seventh o r eighth m o n th , because it w as felt th a t each ind iv id u a l exercised w ith in th e ir ow n ability. Six weeks before th e p a tie n ts babies a re due, th e M o th e rs a tte n d a se p a ra te class fo r a re h ea rsa l o f la b o u r to educate th e m physically a n d psychologically fo r la b o u r. T hus c o m p le te confidence in b o th them selves a n d th o se present a t th e ir confinem ents is o b tain e d . T h e S taff resp o n sib le fo r these classes w ere a ble to a tte n d a n u m b e r o f confinem ents d u rin g th e la tte r p a r t o f 1954 a n d 1955. I t w as fo u n d to be o f g re at assista n ce to the p a tie n ts d u rin g th e first stage o f lab o u r. T h is w as d iscon­ tin u e d due to n u m b ers o f p a tie n ts a n d lack o f staff. T h e n u m b e r o f classes a tte n d e d by ind iv id u a l p a tients d u rin g th e ir pre g n an c y is a g o o d d eal m o re th a n n um bers o n w hich p revious statistics a re based. I t is fe lt th a t this h as a n im p o rta n t b earing o n th e re su lts achieved. C L A S S IF IC A T IO N O F P R IM A G R A V ID A E . A G E . T Y P E O F D E L IV E R Y . A ge N o rm a l Vertex D elivery % S p o n ta n eo u s F a c e to Pubes F o rc e p s E x tra c tio n B reech C a e sa re a n R e se ctio n °//o T o ta l W U n d e r 20 .... 5 2 1 1 9 X w 20 — 29 .... 105 1 8 2 3 11930 — 39 .... 16 2 1 1 20HH CC O v er 40 1 1 2 m T O T A L 127 8 4 -7 1 12 4 6 15-3 150 H w U n d e r 20 .... 37 4 1 1 43 5 hH 20 — 29 .... 78 5 5 2 90O U 30 — 39 .... 5 5 1 4 15 H W O v er 40 — 2 2 C X. ^ w T O T A L .... 120 8 0 0 14 7 9 2 0 0 150 E xe rc ised Group: 1st Stage L a b o u r— 8 h rs. 21 m ins. 2 nd Stage L a b o u r 32 m ins. 3 rd Stage L a b o u r 10 m ins. W ithout E xercise Group: 14 hrs. 19 m ins. 30 m ins. 13-5 m ins. T O T A L D I F F E R E N C E : 15/ S ta g e Labour: 5 hrs. 58 m ins. less la b o u r fo r th e exercised g ro u p . F R E Q U E N C Y O F A T T E N D A N C E A T C L A S S E X E R C IS E I N R E L A T IO N T O A V E R A G E L E N G T H O F L A B O U R . N o . o f C lass A tten d a n ce s U n d e r 20. N o . o f P a tie n ts A verage L ength L a b o u r 20 — 29. N o . o f P a tie n ts A verage L ength L a b o u r. 30 — 39. N o . o f P a tie n ts A v erag e L en g th L a b o u r 1— 9 C lasses 2 11 h rs. 29 m. 16 7 hrs. 9 m. 4 14 hrs. 34 m. 10— 14 2 8 hrs. 14 m. 42 8 hrs. 45 m. 3 14 hrs. 29 m. 15— 19 3 8 hrs. 6 m. 31 8 hrs. 28 m. 4 9 h rs. 22 m. 20— 24 — — 6 8 h rs. 15 m. 1 5 hrs. 40 m. 25— 29 — — 6 9 hrs. 17 m. 1 5 hrs. 10 m. 30— 35 — — 1 14 hrs. 16 m. — A v e r a g e L a b o u r 7 9 hrs. 13 m. 102 8 hrs. 43 m. 12 11 hrs. 21 m. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) October, 1956. P H Y S I O T H E R A P Y Page Seven D E T A IL E D T A B L E A V E R A G E L E N G T H O F L A B O U R . N o rm a l D eliveries. P o ste rio r P re se n tatio n s: " A v e ra g e L.engili o f L ab o u r. A (TP U n d e r 20 A ge 20— 29 Age 30— 39 Age O ver 40 First Stage .... Second Stage T hird Stage .... hrs. m . 8 42 0 24 0 7 hrs. m . 8 0 0 33 0 10 hrs. m. 10 34 0 35 0 12 hrs. m. 3 30 0 46 0 11 T o t a l L a b o u r ^ W IT H O U T E X I 9 13 5R C IS E : 8 43 11 21 4 27 First Stage .... Second Stage T hird Stage hrs. m . 12 30 0 26 0 15 hrs. m. 13 42 0 31 0 13 hrs. m. 9 0 0 46 0 12 hrs. m. T o t a l L a b o u r _ 13 11 14 21 9 58 — F R E Q U E N C Y O F A T T E N D A N C E A T C L A SS E X E R C IS E . N o rm a l D eliveries. Possible A tte n d a n c e s .... 1— 9 10-14 15-19 2 0-24 25-29 O ver 30 N o . C l a s s e s P a t i e n t s A tt e n d e d .... 23 46 38 7 7 1 C O M P L IC A T IO N S O F P R E G N A N C Y A N D U n d e r 20 20— 29 30—39 O ver 40 T o ta l W ith E xercise 1 6 2 — — W ith o u t E x er­ cise ............ 6 10 2 — 20 C O M P L IC A T IO N S O F L A B O U R . W ith E xercise 4 53 8 — 65 W ith o u t E x e r­ cise ............. 16 53 6 — 75 Incidence o f Prolonged L ab o u r: W ith E xercise 1 9 1 — 11 W ith o u t E x er­ cise ............. 3 7 2 _ 12 P ost-partum H a em o rrh a g e. O ver 10-ozs.: U n d e r 20 20— 29 30— 39 O ver 40 T o ta l W ith E xercise 13 L' 2 ' 15 W ith o u t E x er­ cise ............ 10 17 3 30 U n d e r 20 20— 29 30— 39 O ver 40 T o ta l W ith E xercise 1 2 — 3 W ith o u t E x er­ cise ............. 2 3 1 — ■ 6 C a esare an R esections: U n d e r 20 20— 29 30— 39 O ver 40 T o ta l W ith E xercise 1 3 1 1 6 W ith o u t E x e r­ cise ............ 1 2 4 2 9 Discussion: A n te -n a ta l exercise is p ro v e d o f e x tre m e value in re la tio n to the a v era g e length o f la b o u r by th e fact th a t th e exer­ cised g ro u p o f p a tie n ts h a d six h o u rs less l a b o u r th a n the non-exercised g ro u p in first stage la b o u r. I t is o f g re at interest th a t the o ld e r p a tie n ts w ith the g re a te r a m o u n t o f exercise h a d very m uch sh o rte r la b o u r. I t w o u ld th ere fo re seem a p p a re n t th a t th e o ld e r th e p a tie n t th e g re a te r th e th e n eed fo r exercise. E xercise also w o u ld a p p e a r to h a v e a n effect on b o th th e c o m p lica tio n s o f p re g n an c y a n d lab o u r. I n all cases th e exercised g ro u p h a v e benefited. H a lf th e n u m b e r o f p a tie n ts h a d c o m p lica tio n s o f p regnancy, a n d th e sam e figure o f p o s t-p a rtu m h a em o rrh ag e . T h e p r o p o rtio n a te figures in b o th exercised a n d n o n ­ exercised p a tie n ts w ho h a d tea rs a n d e p isio to m ie s is a t a n extrem ely high level a n d th e re fo re re q u ire s fu rth e r extensive in v estigation. B earing in m in d th a t a fair p e rce n ta g e a re d u e to fo e ta l d istress, p ro lo n g e d la b o u r o r u te rin e in ertia, a larg e p ro p o rtio n o f exercised p a tie n ts re q u ire e p isiotom ies d u e to tig h t p e ro n eu m s. ' ’• P re v io u s statistics, in p a rtic u la r th o se d ra w n u p by the M iddlesex H o s p ita l have been b ased o n figure w here th e a v era g e a m o u n t o f exercise given (average a tte n d a n c e d u rin g pre g n an c y — five classes) is very m uch less th a n the atte n d a n c e s o f th e p a tie n ts u p o n w hich these figures a re based, (average a tte n d a n c e d u rin g pre g n an c y — fifteen classes). I t is felt th a t th is has a rriost im p o rta n t b e arin g on the resu lts achieved. S U M M A R Y . E xercise is o f value to a n te -n a ta l p a tie n ts d e m o n s tra te d in th e T a b le o f A verage L en g th o f L a b o u r. 6 % o f th e p a tie n ts in th e exercised g ro u p experienced c o m p lica tio n s o f p re g n an c y as a g ain st 12% in th e non-exercised g roup. T h e o u tsta n d in g figures fo r th e c o m p lica tio n s o f la b o u r a re firstly, th a t 7 % less p a tie n ts in th e exercised g ro u p h a d la c e ra tio n s a n d episio to m ie s a n d 10% less o f th e sa m e g ro u p w ith larg e p o s t-p a rtu m h a e m o rrh a g e s .. I t is n o t p o ssible a t th is ju n c tu re to p ro d u c e figures show ing th e effects o f exercise on th e m o th e r p o st-n a ta lly . B ro a d ly how ever, th e to n e o f th e a b d o m in a l m uscles in p a rtic u la r, are generally g o o d a n d th e p o stu re n a tu ra lly g o o d , to o . P hysical a n d psy c h o lo g ic al e d u c a tio n a re th e re fo re c o n ­ sidered to be o f g re at im p o rta n c e a n d an in te g ral p a r t o f th e w o rk by th e p h y sio th e ra p ist fo r.th e e x p ec ta n t m o th e r. I w o u ld like to express m y deep a p p re c ia tio n to D r. J. H . G e a r fo r his in v alu a b le help, a lso to th e sta ff o f the Q u een V ictoria H o sp ita l. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )