July 2017: Pregnancy & Neonatal

Spotlight on Aquatics, Pregnancy & Neonatal

The pool is custom-made for treating prenatal & neonatal concerns

Recent publication which show how water works for pregnancy & neonatal care

It’s a glorious time of life – pregnancy. But the aches and pains and real musculoskeletal limitations that accompany pregnancy can make 9 months of bliss turn into 9 months of sorrow. Therapists have many skills which they bring to the therapeutic table for the patient with pregnancy related complications. By offering both land and water, a therapist can amplify the strengths — or minimize the weaknesses of — either environment. There are many compelling reasons for choosing to treat a patient in water, not the least of which may be patient preference. 

Historically, aquatic exercise in warm water has never been considered a popular method to combat pregnancy-related woes because of some poorly sourced publications on the dangers of immersion in “hot tub” water during the first trimester of pregnancy.  However, aquatics and pregnancy is a natural fit. First of all, individuals who are unable to weight bear easily or comfortably under gravity’s full brunt, can easily do so when immersed to chest-level in water. Second, individuals who choose to not exercise regularly on land, due to pain, fatigue or other factors, may be willing to do so in the water. Third, the pool harnesses the effects of hydrostatic pressure. This pressure pushes fluid out of the legs and prevents it from pooling in the legs, a common occurrence during pregnancy. This same pressure creates additional blood flow to the abdomen and (presumably) the uterus. Lastly, the movement freedom which occurs during immersion is incredibly freeing, psychologically. Immersion in water has even been used in hospitals with high risk pregnancies as a means to allow the patient to move without increasing the risk of labor. 

It is important to understand that not every pregnant woman belongs in every pool. Pools with excessively warm temperatures (warmer than thermoneutral, 93-94, in particular) must understand the risk for overheating with exercise. Pools with poorly ventilated natatoriums create an elevated risk for inhalation of disinfection byproducts, which would have an unknown effect on the fetus. Lastly, mothers who choose to labor and – even – deliver in water have a whole additional set of precautions to consider. That said, there are few environments more enticing than the pool for the expectant mother.

But what about the newborn? Immersion has a place for this patient as well. Picture the Neonatal Intensive Care Unit. To a newborn baby, life must appear exceedingly loud, bright and painful. Aquatic therapy (known as neonatal hydrotherapy) can be performed right there on the NICU unit. It is somewhat similar to swaddled bathing which is a technique used by nurses, but it has the added twist of purposeful movements. The goals of neonatal hydrotherapy are to improve sucking, enhance sleep and reduce pain. And studies have shown…. Immersion in warm water, coupled with facilitated movements by a skilled therapy, does just that.

RECENT ANNOTATED REFERENCES

Pregnancy

Agopian, a. J., Lupo, P. J., Canfield, M. a., & Mitchell, L. E. (2013). Swimming pool use and birth defect risk. American Journal of Obstetrics and Gynecology, 209(3), 219.e1–9. http://doi.org/10.1016/j.ajog.2013.04.033

Allen, R., Bonsack, C., Meyer, S., & Ruhl, C. (2016). A Model Practice Template for Hydrotherapy in Labor and Birth. Journal of Midwifery & Women’s Health, 62(1), Epub ahead of print. http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12587/

Bacchi, M., Mottola, M. F., Perales, M., Refoyo, I., & Barakat, R. (2017). Aquatic Activities During Pregnancy Prevent Excessive Maternal Weight Gain and Preserve Birth Weight. American Journal of Health Promotion, Epub ahead of print. http://doi.org/10.1177/0890117117697520

Backhausen, M. G., Katballe, M., Hansson, H., Tabor, A., Damm, P., & Hegaard, H. K. (2014). A standardised individual unsupervised water exercise intervention for healthy pregnant women. A qualitative feasibility study. Sexual & Reproductive Healthcare : Official Journal of the Swedish Association of Midwives, 5(4), 176–81. http://www.sciencedirect.com/science/article/pii/S1877575614000585 

Barakat, R., Perales, M., Cordero, Y., Bacchi, M., & Mottola, M. F. (2017). Influence of Land or Water Exercise in Pregnancy on Outcomes. Medicine & Science in Sports & Exercise, Epub ahead of print. http://doi.org/10.1249/MSS.0000000000001234

Cordero, Y., Mottola, M. F., Vargas, J., Blanco, M., & Barakat, R. (2015). Exercise is associated with a reduction in gestational diabetes mellitus. Medicine and Science in Sports and Exercise, 47(7), 1328–1333. Retrieved from http://oa.upm.es/41183/1/INVE_MEM_2015_227386.pdf

da Silva, J. R. J. R. J., Borges, P. S. S., Agra, K. F., Pontes, I. A., Alves, J. G. B., J.R., da S. J., … Alves, J. G. B. (2013). Effects of an aquatic physical exercise program on glycemic control and perinatal outcomes of gestational diabetes: study protocol for a randomized controlled trial. Trials, 14(1), 390. https://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-14-390

Fleming, N. (2016, January 22). Aquatic Exercise Manual For Pregnancy. California State University. Retrieved from http://scholarworks.csun.edu/handle/10211.3/160053

Gayiti, M.-R.-Y., Li, X.-Y., Zulifeiya, A. K., Huan, Y., & Zhao, T.-N. (2015). Comparison of the effects of water and traditional delivery on birthing women and newborns. European Review for Medical and Pharmacological Sciences, 19(9), 1554–8. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26004591

Hakiki, I. N., Palupi, P., & Handayani, M. (2017). The Effectiveness Of Warm Water Therapy On Low-Back Pain During Pregnancy In Public Heath Center. UI Proceedings on Health and Medicine, 2, Epub ahead of print. http://proceedings.ui.ac.id/index.php/uiphm/article/view/145 

Iglesias Constante, S. M. (2014). Review of the efficacy of aquatic exercise during pregnancy. Metas de Enfermería. Retrieved from https://dialnet.unirioja.es/servlet/articulo?codigo=4712213&info=resumen...

Intveld, E., Cooper, S., & van Kessel, G. (2010). The Effect of Aquatic Physiotherapy on Low Back Pain in Pregnant Women. International Journal of Aquatic Research {&} Education, 4(2), 147–152. Retrieved from https://scholarworks.bgsu.edu/ijare/vol4/iss2/5/

Jonsdottir, S. (2010). Barriers to the Use of Hydrotherapy in Labor. MCN, the American Journal of Maternal Child Nursing, 35(4), 241. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1552-6909.2009.01065.x/full

Juhl, M., Kogevinas, M., Andersen, P. K., Andersen, A.-M. N., & Olsen, J. (2010). Is swimming during pregnancy a safe exercise? Epidemiology (Cambridge, Mass.), 21(2), 253–258. http://journals.lww.com/epidem/Abstract/2010/03000/Is_Swimming_During_Pr...

Krivonogova, T. S., Gerget, O. M., & Agarkova, L. A. (2010). Effect of respiratory and aqua-gymnastics on the adaptive potential of pregnant women]. Voprosy Kurortologii, Fizioterapii, I Lechebnoi Fizicheskoi Kultury, (6)(6), 25–29. Retrieved from http://europepmc.org/abstract/med/21381327

Newnham, E., McKellar, L., & Pincombe, J. (2015). Documenting risk: A comparison of policy and information pamphlets for using epidural or water in labour. Women and Birth: Journal of He Australian College of Midwives, 28(3), 221–227. http://doi.org/10.1016/j.wombi.2015.01.012

Nicholls, S., Hauck, Y. L., Bayes, S., & Butt, J. (2016). Exploring midwives’ perception of confidence around facilitating water birth in Western Australia: A qualitative descriptive study. Midwifery, 33, 73–81. https://linkinghub.elsevier.com/retrieve/pii/S026661381500279X

Rosales, S., Ortiz-Prado, E., Alarcón, D., Rosales, D., & Iturralde, A. L. (2017). A Retrospective Study of Maternal and Neonatal Outcomes Following Conventional and Water Birth in Ecuador. Global Journal of Health Science, 9(4). http://www.ccsenet.org/journal/index.php/gjhs/article/view/58713

Schitter, A. A. M., Nedeljkovic, M., Baur, H., Fleckenstein, J., & Raio, L. (2015). Effects of passive hydrotherapy WATSU (WaterShiatsu) in the third trimester of pregnancy: results of a controlled pilot study. Evidence-Based Complementary and Alternative Medicine, Epub ahead of print. http://doi.org/10.1155/2015/437650

Sechrist, D. M. D. D. M. D. D. M., Tiongco, C. C. G., Whisner, S. M., & Geddie, M. D. (2015). Physiological Effects of Aquatic Exercise in Pregnant Women on Bed Rest. …  Therapy In Health …, 29(3), 330–339. http://doi.org/10.3109/07380577.2014.982314

Silveira, C., Pereira, B. G., Cecatti, J. G., Cavalcante, S. R., & Pereira, R. I. (2010). Fetal cardiotocography before and after water aerobics during pregnancy. Reproductive Health, 7(1), 23. http://doi.org/10.1186/1742-4755-7-23

Stan, E. A. (2014). Pregnancy and aquatic aerobic activity. Sport & Society/Sport Si Societate, 14, 260–268. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=s...

NEONATAL

Agopian, a. J., Lupo, P. J., Canfield, M. a., & Mitchell, L. E. (2013). Swimming pool use and birth defect risk. American Journal of Obstetrics and Gynecology, 209(3), 219.e1–9. http://doi.org/10.1016/j.ajog.2013.04.033

Edraki, M., Paran, M., Montaseri, S., Nejad, M. R., & Montaseri, Z. (2014). Comparing the effects of swaddled and conventional bathing methods on body temperature and crying duration in premature infants: a randomized clinical trial. Journal of caring sciences, 3(2), 83. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134173/

Gayiti, M.-R.-Y., Li, X.-Y., Zulifeiya, A. K., Huan, Y., & Zhao, T.-N. (2015). Comparison of the effects of water and traditional delivery on birthing women and newborns. European Review for Medical and Pharmacological Sciences, 19(9), 1554–8. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26004591 

McManus, B. M., & Kotelchuck, M. (2007). The effect of aquatic therapy on functional mobility of infants and toddlers in early intervention. Pediatric Physical Therapy, 19(4), 275-282. http://journals.lww.com/pedpt/Abstract/2007/01940/The_Effect_of_Aquatic_...

Pillai Riddell, R. R., Racine, N. M., Turcotte, K., Uman, L. S., Horton, R. E., Din Osmun, L., ... & Gerwitz-Stern, A. (2011). Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev, 10. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006275.pub2/full

Rosales, S., Ortiz-Prado, E., Alarcón, D., Rosales, D., & Iturralde, A. L. (2017). A Retrospective Study of Maternal and Neonatal Outcomes Following Conventional and Water Birth in Ecuador. Global Journal of Health Science, 9(4). http://www.ccsenet.org/journal/index.php/gjhs/article/view/58713 

Sweeney, J. K. (1983). Neonatal hydrotherapy: an adjunct to developmental intervention in an intensive care nursery setting. Physical & Occupational Therapy in Pediatrics, 3(1), 39-52. http://www.tandfonline.com/doi/abs/10.1080/J006v03n01_03

Sweeney, J. K. (2003). Feeding proficiency in preterm neonates following hydrotherapy in the NICU setting. Pediatr Phys Ther, 15, 63.
    
Sweeney, JK 2007, ‘Neonates and infants at neurodevelopmental risk,’ Neurological rehabilitation, 5th edn, St Louis: Mosby, pp. 303-356.
    
Vignochi, C. M., Teixeira, P. P., & Nader, S. S. (2010). Effect of aquatic physical therapy on pain and state of sleep and wakefulness among stable preterm newborns in neonatal intensive care units. Revista Brasileira de Fisioterapia (Sao Carlos (Sao Paulo, Brazil)), 14(3), 214–220. Retrieved from http://www.scielo.br/scielo.php?pid=S1413-35552010000300013&script=sci_a...

Zhao, S., Xie, L., Hu, H., Xia, J., Zhang, W., Ye, N., & Chen, B. (2005). A study of neonatal swimming (water therapy) applied in clinical obstetrics. The Journal of Maternal-Fetal & Neonatal Medicine, 17(1), 59-62. http://www.tandfonline.com/doi/abs/10.1080/14767050400028782