HEALTH

Women’s Health Pregnancy, Birth & Beyond!

Latha Balasundaram heads the Physiotherapy Department at Fernandez Foundation. She is also a Lamaze Certified Childbirth Educator, Lactation Counsellor and Pelvic Floor Specialist. She has done her Master’s in Physiotherapy in Adult and PaediatricNeurology but over the years developed an interest for working in the field of Physiotherapy catering to Women’s Health and Paediatrics. In the last 13 years of her experience apart from working in the area of Adult Musculoskeletal issues and Paediatric Rehabilitation, she has treated women with various conditions experienced through Antenatal and Post-natal period. She also has worked with numerous women to maximize their chances of attempting and experiencing a normal vaginal birth. Through her work as a Pelvic Floor Specialist, she contributes to the less talked about problems that women face in their post-natal period and in older women such as pelvic organ prolapse, chronic pain and incontinence issues.

Apart from being passionate about working as a Physiotherapist, she also finds her work with implementing and teaching the Lamaze curriculum for Child Birth Education classes at Fernandez Foundation and supporting new mother’s as a Lactation Specialist, very gratifying. She works passionately in multiple areas supporting women and empowering them in their journey leading to pregnancy, birth and beyond!

What are Lamaze childbirth classes all about? Is it fad or faff? Lamaze education is a series of classes that help women to be confident, trust their innate ability to give birth and make informed decisions about pregnancy, birth, breastfeeding and parenting. Its philosophy teaches that birth is normal, natural and healthy. It is a series of classes that address pregnancy birth and beyond. No matter how much we prepare and read, it always helps to have an open mind to what unfolds in its own unique way. So anything which gives you this as a take-home message is a great thing!

While this focuses at a natural birth, not all will have a normal vaginal birth. Do these couples take this as a disappointment? There will be at least 10-15% of women who will have a medical or an emergency need of a Cesarean section which is beyond anyone’s control. Childbirth classes will always help in giving information about their rights and healthy birthing practices of a birthing couple. They understand if a particular outcome or action was medically necessary which can be lifesaving or was an unnecessary one. It helps a birthing couple make informed choices towards their decisions in pregnancy and birth which empowers them and allows them to have an open mind to be at peace with the unfolding of their own unique birth story irrespective of the mode of birth. This peace is essential in giving them a good head start to be confident parents.

There are so many myths about pregnancy especially surrounding activity and exercises. How can you convince people about pregnancy fitness? The benefits of excising in pregnancy have been studied and researched extensively. Our lifestyle has transitioned from doing labored physical day to day work to more sedentary ones, hence making exercise a necessity for the wellbeing of a mother and child. An exercise program must be designed to work on the flexibility, strength especially of core muscles and functional fitness of moms to be. Increased blood supply to the baby and improved heart function, releasing good hormones to beat stress and anxiety, better regulation of weight gain, decreased pain in the pelvic girdle, low back, improved posture awareness, reduced risk and management of gestational diabetes and hypertension and a more positive body image as well are some of the benefits.

Are there any situations where a woman is expected not to exercise or perform a specific kind of exercise regime? A woman can do any activity she is accustomed to in her pregnancy that she has always been doing but to a lesser intensity. Since the 1sttrimester is usually associated with exhaustion, nausea and vomiting it may be best to hold back exercises until then. Bleeding, low lying placenta, cervical incompetence, history of miscarriages, carrying multiples, have high blood pressure can be some of the reasons where women are said to modify or exercise with precaution, supervision and monitoring of a physical therapist.

As a Physiotherapist working for women’s health, what are the problems across different age groups? Women need to give more importance to their health and not keep it on the back burner. The common issues in women range from obesity, PCOS, infertility,

HEALTH | where leading a healthy lifestyle with diet, exercise and mindfulness become crucial. On the other end pregnancy-related pains like pelvic girdle dysfunction, mechanical back pain due to changing posture, and hormone, frequent cramps and muscle catch. Post-pregnancy we see a large number of mom’s struggling with joint stiffness, pains, struggling to deal with weight gain, mummy tummy called diastasis recti, decrease in urinary control amongst others.

How can Physiotherapy help in cases of loss or decrease of urine control? Not just loss of control over urine but even in loss or decrease in fecal control seen post-birth following trauma or stress to the pelvic floor muscles as well as pelvic organ prolapse which is more commonly seen in the age group over 50 years. It can be a very debilitating condition creating physical and emotional trauma making even the most outgoing women prisoners of their own home. Pelvic Floor Specialists can help a long way in rehabilitation of these conditions. Helping these women use their pelvic floor muscles and core muscles appropriately, sometimes taking the help of tools and machines like an EMG biofeedback machine, electric stimulator for pelvic floor activation or kegel cones. All of these can improve the outcomes in women to a large extent and help in their wellbeing.

How can painful intercourse be resolved? If painful intercourse follows a vaginal birth where there was a cut or tear then healing can cause some bands or points that can be painful. These can be worked on by simple techniques of gentle intra-pelvic pressure and scooping massage over the triggered muscles with a gloved finger or sometimes using tools like pelvic wands or vaginal dilators to relieve the same. Other conditions where these techniques can help is a chronic pelvic pain syndrome, vaginismus etc along with psychological help can also be benefitted.

What role does a physiotherapist play in this Covid-19 era? It is important to understand that any infection/inflammation to the lung causes scaring and decreased lung expansion. This in turn causes an increase in the work of breathing and shortness of breath. There are lots of asymptomatic people who display mild symptoms. These people will largely need lung expansion exercises like pursed lip breathing, breath holds, intensive spirometer training, diaphragmatic breathing exercises done regularly while monitoring their oxygen saturation levels.

What about the severely affected Covid patients? Severely affected people will need rehabilitation to recover from the effects of ventilation /oxygen support and prolonged bed rest. Apart from impaired lung function they may experience severe muscle weakness, joint stiffness, fatigue, limited ability to do daily tasks and psychological issues. A physiotherapist can contribute in all these areas based on a good assessment and rehabilitation program specific to the patient.

How do post-Covid patients recover? Up to 10-15 %, recovering patients can end up with post-viral fatigue syndrome. If you feel you are not improving or if the activity makes you feel worse, it could be postviral fatigue syndrome. They will need to see a physiotherapist to get assessed and come up with different management strategies to rehabilitate.