2. Maternal Health Well-Being & Beyond Dr Mary Steen Research Fellow in Midwifery RCM/UCLan (joint apt)

3. Introduction Exercising during pregnancy and after birth has many positive effects Exercising during pregnancy and after birth has many positive effects Minimise minor discomforts associated with pregnancy Minimise minor discomforts associated with pregnancy Improve self-esteem and self-image Improve self-esteem and self-image Prepare the body for strenuous exercise Prepare the body for strenuous exercise Speed post-partum recovery Speed post-partum recovery Ref: Hatch et al,1993; Wolfe et al, 1994; Dunkley; 2000 Zeanah & Schlosser, 1993; Horns et al, 1996) Zeanah & Schlosser, 1993; Horns et al, 1996)

4. Introduction (2) A review - women who exercise regularly are more likely to have shorter labours A review - women who exercise regularly are more likely to have shorter labours Less intervention and recover more quickly after birth (ref: Clapp,2000) Less intervention and recover more quickly after birth (ref: Clapp,2000) Safety parameters whilst exercising important (ref: ACOG, 1994) Safety parameters whilst exercising important (ref: ACOG, 1994) Low impact, Pilate-based exercises and relaxation techniques are safe Low impact, Pilate-based exercises and relaxation techniques are safe These can play an important part in promoting and maintaining health These can play an important part in promoting and maintaining health

5. New Initiative An antenatal & postnatal health & fitness programme has been developed An antenatal & postnatal health & fitness programme has been developed Women identified a need for this service Women identified a need for this service Health & Leisure services of the local authority identified the need Health & Leisure services of the local authority identified the need Maternity services in Leeds identified the need to develop a community-based initiative Maternity services in Leeds identified the need to develop a community-based initiative That would promote the normality of childbirth and also meet the governments public health agenda. That would promote the normality of childbirth and also meet the governments public health agenda.

6. Collaboration Liaise with the health & fitness manager at South Leeds Stadium Liaise with the health & fitness manager at South Leeds Stadium Already provided specialised classes for Cardiac Rehab Active Living Already provided specialised classes for Cardiac Rehab Active Living Under a local scheme that involved GPs referring patients to undertake exercise Under a local scheme that involved GPs referring patients to undertake exercise Via a Prescription for Activity Pass Via a Prescription for Activity Pass

7. Prescription for Activity Relatively new idea Relatively new idea Several GPs are involved in the scheme Several GPs are involved in the scheme Concession price of £1.25 Concession price of £1.25 Decided to opt into this scheme Decided to opt into this scheme Midwife referral Midwife referral At the final session of the postnatal classes women receive a Prescription for Activity Pass At the final session of the postnatal classes women receive a Prescription for Activity Pass Women can attend for another 3 months at the concession price. Women can attend for another 3 months at the concession price.

8. Aims of the Initiative To promote health & fitness during pregnancy To promote health & fitness during pregnancy Prepare for Birth Prepare for Birth Maintain health & fitness after childbirth Maintain health & fitness after childbirth

9. Piloted: Successfully piloted in April/May 2004 Successfully piloted in April/May 2004 Women had to attend at least 4 sessions Women had to attend at least 4 sessions Completed an evaluation form: Completed an evaluation form: 10 women (antenatally) 10 women (antenatally) 11 women (postnatally) 11 women (postnatally) Both programmes evaluated very highly Both programmes evaluated very highly Evidence that womens self-esteems had increased Evidence that womens self-esteems had increased

11. Continuation of the programme: The health & leisure services trained the midwife to undertake exercise to music course The health & leisure services trained the midwife to undertake exercise to music course Two of their fitness instructors were funded to undertake Pilate-based exercise training and an antenatal and postnatal exercise course Two of their fitness instructors were funded to undertake Pilate-based exercise training and an antenatal and postnatal exercise course 5 more midwives were funded to undertake the Pilate-based training 5 more midwives were funded to undertake the Pilate-based training

12. Main programme: Main programme: 15 month period (June 2004/Sept 2005) 15 month period (June 2004/Sept 2005) 10 Antenatal sessions: 6 workshop/exercise classes 10 Antenatal sessions: 6 workshop/exercise classes 10 Postnatal sessions: 6 workshop/exercise classes 10 Postnatal sessions: 6 workshop/exercise classes Attendance varied from 6 to 12 women Attendance varied from 6 to 12 women Women had to attend at least 4 of 6 sessions Women had to attend at least 4 of 6 sessions To complete an evaluation form To complete an evaluation form

13. Evaluation of main programme Age Range Antenatal 77 women Postnatal 80 women 15-20 years 2 1 21-25 years 5 5 26-30 years 24 25 31-35 years 32 33 36-40 years 12 13 > 40 years > 40 years2 2

14. Ethnic Groups: Ethnic Group AntenatalPostnatal Black Afro-Caribbean Black African Asian White UK White Other ChineseOther 3 (4%) 4 (5%) 8 (10%) 53 (69%) 5 (6%) 2 (3%) 3 (4%) 9 (11%) 56 (70%) 5 (6%) 1 (1%) 3 (4%)

15. Parity Antenatal (77) Postnatal (80) Primiparas 66 (86%) 68 (85%) Multiparas 11 (14%) 12 (15%) Work Status Not Working 5 (6%) 6 (7%) Full-time 35 (45%) Full-time on M/L 20 (27%) 49 (61%) Part-time 9 (12%) Part-time on M/L 8 (10%) 25 (32%)

16. Exercise before Pregnancy Regular exercise 16 (21%) Occasionally 31 (40%) Never 29 (38%) No answer 1 (1%) 1 (1%)

17. Antenatal workshops – helpful? Womens responses (77) YesNoUnsure No answer Health & Fitness 63 (82%) 4 (5%) 8 (10%) 2 (3%) Diet & Nutrition 60 (78%) 4 (5%) 10(13%) 3 (4%) Preparing for an Active Birth 67 (86%) 2 (3%) 7 (8%) 7 (8%) 2 (3%) Coping with Birth 68 (88%) 1 (1%) 6 (7%) 2 (3%) Managing Emotions & Relationships 63 (82%) 2 (3%) 9 (11%) 4 (5%) After Birth 62 (81%) 3 (4%) 8 (10%) 4 (5%)

18. Postnatal workshops – helpful? Womens responses (80) YesNoUnsure No answer Birth Experience 68 (85%) 4 (5%) 5 (6%) 3 (4%) Diet & Nutrition 62 (77%) 8 (10%) 7 (9%) 3 (4%) Harmful effects of smoking,alcohol,drugs 67 (83%) 2 (3%) 8 (10%) 8 (10%) 3 (4%) Maternal Health (Screening & Contraception) 70 (87%) 1 (1%) 6 (8%) 3 (4%) Managing Emotions & Relationships 63 (79%) 3 (4%) 11 (14%) 2 (3%) Maintaining fitness 64 (80%) 5 (6%) 7 (9%) 4 (5%)

19. Exercise Classes- helpful? No. of women YesNoUnsure No answer Antenatalexercises77 68 (88%) 2 (3%) 5 (6%) 2 (3%) Postnatalexercises80 71 (88%) 0 (0%) 6 (8%) 3 (4%) Intend to continue exercise 80 64 (80%) 1 (1%) 11 (14%) 4 (5%)

20. Womens Views - Antenatal: Very helpful to have a midwife help you exercise who knows what correct exercises to do Very helpful to have a midwife help you exercise who knows what correct exercises to do Every pregnant woman should come to the classes, you meet other pregnant mums and exercise, Tuesdays dont come round fast enough! Every pregnant woman should come to the classes, you meet other pregnant mums and exercise, Tuesdays dont come round fast enough! Im more sure about everything to do with my pregnancy and birth Im more sure about everything to do with my pregnancy and birth I feel good about myself and I have more confidence I feel good about myself and I have more confidence

21. Womens Views - Postnatal I couldnt do my the pelvic floor exercises properly before I can now I couldnt do my the pelvic floor exercises properly before I can now I did some of the exercises in early labour and used the positions I was shown, it really helped I did some of the exercises in early labour and used the positions I was shown, it really helped I was going to have an epidural but after attending the antenatal sessions I opted for a home birth, Im so pleased I did I was going to have an epidural but after attending the antenatal sessions I opted for a home birth, Im so pleased I did I always go home feeling good about myself and fit and healthy I always go home feeling good about myself and fit and healthy I bring my mum as well we both have enjoyed it I bring my mum as well we both have enjoyed it

26. Its Fun

27. Are u doing your Pelvic Floor Exercises?

28. Future Plans The midwife champion started a new role in Sept 2005, The midwife champion started a new role in Sept 2005, Manages to still be involved and when in Leeds goes to the sessions and is available to chat to women and promotes normal birth, health and well-being Manages to still be involved and when in Leeds goes to the sessions and is available to chat to women and promotes normal birth, health and well-being The fitness instructors have continued to undertake the exercise classes and promote active birth The fitness instructors have continued to undertake the exercise classes and promote active birth