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Full Course Details: Public course page
Learn more about our guests: Jenna Segraves DPT, MS, NCS, CLT and Rebeca Segraves, PT, DPT
Agenda
Intro (5 minutes)
Breakdown and analysis of journal article (5 minutes)
- 00:00:00 Intro
- 00:01:19 OT Potential Podcast Intro
- 00:02:57 The Problems with Postpartum Care
- 00:03:02 What is Being Done?
- 00:04:25 How Other Conditions are Treated in Acute Care
- 00:04:52 The Call to Action
- 00:05:25 OT and PT’s role in Screening
- 00:07:21 OT and PT’s role in Obstetric Rehabilitation
- 00:09:19 The Interdisciplinary Team
- 00:09:39 Cost Justification for Services
- 00:10:09 Article Conclusion
- 00:10:47 Intro to Jenna and Rebeca Segraves
Discussion on practical implications for OTs (50 minutes)
- 00:13:34 What Ignited Their Passion for OT & PT After Birth
- 00:18:03 The Story of This Commentary
- 00:22:55 Current Reactions to the Commentary
- 00:27:04 Success Stories of Obstetric Rehab Services Being Initiated
- 00:32:33 Assessment Consideration for OTs for After Birth
- 00:35:43 Treatment Considerations for OTs for After Birth
- 00:41:53 Sleep, Nutrition, and Stress Management Interventions
- 00:53:04 Education Considerations for OTs for After Birth
- 01:02:24 3 Steps to Starting an Obstetric Rehab Program
- 01:09:09 Goals for the Future of Obstetric Rehab
Supplemental Materials
- Scoping review of the role of occupational therapy in the treatment of women with postpartum depression
- Pelvic Floor Dysfunction After Childbirth: Occupational Impact and Awareness of Available Treatment
- Amazing interview with therapists from a hospital system in VA: Why we offer OT and PT in the hospital after birth
- Pelvic Health Network
- Certified Perinatal Health Specialist
Article Review
Read Full Text: Initiating Occupational and Physical Therapy in the Hospital After Birth: Access, Reimbursement, and Outcomes
Journal: Journal of Women’s & Pelvic Health Physical Therapy
Year Published: 2023
Maternal deaths are on the rise here in the United States.
We also have a postpartum mental health crisis.
Women comprise 90% of the OT profession, and many of us have personally experienced the inadequate support birthing individuals often receive.
BUT, too few of us have stepped back and asked, “Why aren’t we—with our training in mental health and daily participation—helping women in the hospital after birth?”
Luckily, a growing number of OTs are not only posing this question, but also doing something about it. And, my favorite part of this movement is that it is multidisciplinary—our PT colleagues are advocating for our services as well.
At the center of this push are Drs. Jenna and Rebeca Segraves. Both of these PTs worked on the commentary we are exploring today, and we’re excited to have them join our podcast next week. To give you a sense of their commitment to lifting up postpartum OT, here’s a recent quote from Rebeca:
“My prediction is that occupational therapy will transform maternal health in the United States.”
Let’s dive in…
The problems with postpartum care
The United States is the most dangerous country in the developed world for giving birth. From 2019–2020, the maternal death rate increased by:
- 25% in Black women
- 44% in Hispanic women
- 9.7% in White women
The current standard of care calls for discharge from the hospital 1 day after a vaginal birth and 2 days following a C-section. After that, postpartum women typically receive a single 6-week follow-up with an OB-GYN.
The authors of this study say this standard of care is inadequate.
During their first 6 weeks postpartum, patients are at the highest risk for readmission associated with infection, pre-eclampsia, and cardiovascular conditions—and 57% of maternal deaths occur during this timeframe.
What is being done?
Obstetric care teams have been using early warning outcome measures to alert providers of physiological red flags.
These measures include:
- Modified Early Obstetric Warning Score
- Maternal Early Recognition Criteria
- Modified Early Warning System
- Maternal Early Warning Trigger
But clearly, screens alone are not enough, as mortality rates have continued to increase. A much more holistic and proactive approach is needed.
How other conditions are treated in acute care
In traditional acute care practice, OT and PT are routinely utilized to optimize function and safety, prevent physical and cognitive decline, and reduce hospital admissions.
However, therapy is rarely utilized postpartum—despite the multiple systems impacted by labor and delivery…which leads us to this paper and the authors’ call to action.
The call to action
The 5 authors of this paper—all physical therapists—call for OT and PT inclusion in the maternal care provider team. They believe OTs and PTs can use their discipline-specific perspectives to improve postpartum outcomes.
This commentary offers a framework for developing an acute care obstetric rehabilitation program.
The role of OT and PT in screening
OTs and PTs can screen patients for symptoms related to common causes of mortality as the patients perform activities not typically assessed by other staff—including functional movement and tasks that mimic a patient’s routine in their specific home, community, or work environment.
Cardiopulmonary screening
In addition to screening patients during functional activity that mimics their daily routine, a heart rate recovery assessment should be performed 10 seconds or 1 minute following activity completion. This recovery is a strong predictor of all-cause mortality in both symptomatic and asymptomatic individuals.
Neurological screening
Postpartum individuals are at risk for complications related to eclampsia, stroke, neuropathy, and epidural. These can be associated with neurological injury affecting mobility, judgment, self-care, and newborn care. Obstetric nerve palsy also increases the risk for falling and baby-dropping. Screening and treatment for these conditions is critical.
Mental health screening
1 in 10 postpartum women suffer from perinatal mood and anxiety disorders (PMADs), including depression, anxiety, post-traumatic stress disorder, bipolar disorder, and psychosis. Screening can uncover PMAD risk factors and identify patients who may benefit from occupational therapy to improve recovery and prevent hospital readmission.
Musculoskeletal and pelvic health screening
OTs and PTs can screen for:
- pubic symphysis diastasis
- sacroiliac joint injury
- sacral-coccygeal injuries
- lumbar injury
- pelvic floor muscle impairment
- perineal laceration
The role of OT and PT in obstetric rehabilitation
The primary goals of acute obstetric rehabilitation include:
- Minimizing pain
- Reducing impairments
- Maximizing recovery
- Customizing interventions to address specific functional demands
Here are some ways those goals are achieved:
Diaphragmatic breathing
Acute care interventions that include diaphragmatic breathing enable relaxation, reduce anxiety, and decrease pain.
Comprehensive activity progression
OTs and PTs routinely provide comprehensive activity progression for acute care patients. Postpartum patients may similarly benefit from education on:
- Appropriate abdominal binder donning
- Positioning for self and newborn care
- Bed transfers via log rolling
- Alternative strategies to Valsalva maneuver for toileting
- Body mechanics with newborn lifting
- Safe ambulation
- Scar massage of healed tissue
- Prone lying
- Activity tolerance with vital sign monitoring
- Energy conservation training
Vital sign monitoring
Self management techniques can be taught with a blood pressure monitor and pulse oximeter.
Pain management
Rehab interventions include:
- Down regulation via breathing
- Intra-abdominal pressure management
- Modified body mechanics
- Proper use of abdominal binders
Discharge planning
Education can be provided to patients regarding activity modifications and safe strategies for reducing adverse events during recovery.
The interdisciplinary team
Rehab professionals are well positioned to work alongside nursing, obstetric, and lactation providers. The article includes a helpful table on care coordination that I encourage you to check out!
Cost justification for services
Reimbursement for acute care obstetric rehab can be a perceived barrier to service initiation. To get a program off the ground in your hospital, reimbursement must be explored within your specific payer mix. However, it should be noted that maternity services are often profit-generating, and hospitals are often motivated to increase the attractiveness of their maternity programs
Conclusion
Adding rehabilitation to hospital services after birth establishes a high standard of care for this specialized population.
Providing high-quality, comprehensive postpartum care is an important step toward raising standards across the care continuum. Rehab specialists are encouraged to expand their services to the obstetric population in all settings in order to enhance maternal mental and physical health for pregnant and postpartum individuals.
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