Journal Club Discussion #17: Preventative OT for New & Expectant Mothers

Hey readers! Happy Mother’s Day! Today my sister and I are taking our mom to an Alice in Wonderland themed tea room for a tea tasting. She loves tea, so I think she will really love it. I hope you are all enjoying your day! In honor of Mother’s Day, I thought that we would read an article about the role of OT in perinatal care. The article is called “Occupational Therapists’ Role in Perinatal Care: A Health Promotion Approach” by Julie Grobbelaar Fernandes. AOTA members can read the article here.

Background Info

There is limited research regarding OT’s role in perinatal care. The healthcare system in the United States is curative in nature, however it would be beneficial for OT to take a preventative approach in perinatal care in order to “[prevent] pain, [increase] function, and [promote] meaningful occupations during pregnancy and the postpartum period” (Fernandes, 2018, n.p.). Currently, OTs only see this population if a new or expectant mother experiences conditions such as carpal tunnel syndrome, De Quervain’s tenosynovitis, or tendinosis of the upper extremity (Fernandes, 2018).

Methods & Participants

The author conducted a literature review and drew conclusions about OT’s role in perinatal care, specifically in the areas of carpal tunnel syndrome, De Quervain’s tenosynovitis, and health promotion.

The Results

Carpal Tunnel Syndrome:

  • Often the cause of hand and wrist pain in pregnancy
  • Symptoms may persist during the postpartum period
  • If left untreated, this may lead to chronic hand weakness, loss of occupational engagement, and peripheral neuropathies (Fernandes, 2018)
  • Maladaptive positioning in the wrist may lead to pain up the kinetic chain in the elbow and shoulder (Fernandes, 2018)

De Quervain’s Tenosynovitis:

  • Common diagnosis among new mothers due to inflammation of the abductor pollicis longus and extensor pollicis brevis (Fernandes, 2018)
  • 3rd most reported upper extremity tendon disease (Fernandes, 2018)
  • New mothers may be less likely to undergo surgery for immediate pain relief due to the recovery period
  • Research supports a multimodal approach rather than just surgery or injection (Fernandes, 2018)
  • “Custom orthoses, patient education, strengthening, postural control, and activity adaptation can reduce the liklihood of developing nerve compression or De Quervain’s” (Fernandes, 2018, n.p.)

Health Promotion:

  • Education on positioning (feeding, carrying, bathing) should be provided during pregnancy as well as after birth
  • Low SES may cause pregnant women not to seek prenatal care and are less likely to have a spouse or partner to support them during pregnancy (Fernandes, 2018)
  • OTs should educate physicians and other health care providers about the value of OT in prenatal and postnatal care for appropriate referral
  • OTs should use the preventative model of care in this population
  • Social media is an opportunity to provide education to the community regarding OTs role in perinatal care and to offer “education on posture, strengthening, positioning, and tips and advice to remain healthy and strong” (Fernandes, 2018, n.p.)
  • OTs can recommend equipment to prevent pain in their new role as a mother as well as an exercise program
  • Promote OT’s role in perinatal care through local legislators, hosting workshops in women’s health, musculoskeletal care, or OBGYN practices, and holding community lectures

FAME Score

Feasibility: A

Appropriateness: A

Meaningfulness: A

Effectiveness: B

What I Think

I think that it is super important for OTs to be involved in preventative perinatal care. Becoming a mother may be one of the most important and meaningful occupations that a woman will ever experience. Furthermore, there is a drastic change in the woman’s roles and occupations that comes along with becoming a mother. Education on preventative positioning and strengthening may deter some of the common musculoskeletal conditions from occurring. Challenge for practicing OTs out there: Educate your coworkers and management team on OT’s role in perinatal care! See if there is a way for you or other OTs to see new and expectant mothers in your place of practice prior to development of carpal tunnel or De Quervain’s Tenosynovitis.

Question of the Week: Do you ever see new or expectant mothers for preventative care? If so, comment down below!

Citation: Fernandes, J. G. (2018). Occupational therapists’ role in perinatal care: A health promotion approach. American Journal of Occupational Therapy, 72, (1-4) doi: 10.5014/ajot.2018.028126

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