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DETERMINING THE RECREATIONAL HEALTH PRACTICES BY PREGNANT WOMEN IN SELECTED ANTENATAL CLINICS

CHAPTER ONE

INTRODUCTION

1.1    Background to the Study

Pregnancy is the development of one or more offsprings, known as an embryo or fetus, in a woman’s uterus. This spans a period from fertilization of the female sex cell by the male sex cell to the birth of the offspring. This period is also called gestation period. The cells undergo rapid division and growth according to Jukic, Baird, Weinberg, McConnaughey and Wilcox (2013) such that in eight weeks it becomes stable and big enough to be called a fetus. The continous growth of this fetus results in physiological changes in the pregnant woman.

Shrock (2008) stated that during the childbearing period, from conception through postpartum recovery, a woman’s body undergoes extensive changes which frequently necessitate many adoptations. Physical and hormonal changes occur gradually throughout the nine months of pregnancy, and these are reversed in a matter of weeks during postpartum recovery. Skeletal tissue, muscle and connective tissues, blood volume, cardiac output, body weight and posture are affected. The effect it has can bring positive or negative impact on the unborn child and/or the mother.

Pregnant women are usually exposed to care during pregnancy. Such care is termed antenatal or prenatal care. Such care is usually given by trained personnel in hospitals,  primary health centres or by traditional birth attendants. Ante – natal care is thus defined by World Health Organization (WHO, 2003) as the provision of special care for women during pregnancy through the public health service. Until the second half of the 20th century, pregnant women were only given maternity care during delivery.  There used to be very high level of maternal and child mortality until care was given to pregnant women in the course of the pregnancy. This development according to WHO was stimulated by the realization that maternal mortality due to puerperal sepsis, haemorrhage and obstructed labour had declined substantially during the early years of the 20th century. Today further understanding of obstetrics and gyneacology has improved upon services given to women in antenatal clinics. Good care during pregnancy is important for the health of the mother and the development of the unborn baby.

Pregnancy is a crucial time to promote healthy behaviour and parenting skills. Ante-natal care also provides women with appropriate information and advice for a healthy pregnancy, safe childbirth, and postnatal recovery, including care of the newborn, promotion of exclusive breastfeeding and assistance with deciding on future pregnancies in order to improve pregnancy outcomes. An effective ante-natal care package depends on competent health care providers in a functioning health system with referral services and adequate supplies of routine drugs and laboratory support. Different health practitioners have different packages for antenatal care. The new World Health Organization’s model of antenatal care separates pregnant women into two groups,  those likely to need only routine ante-natal care and those with specific health conditions or risk factors that necessitate special care. For the first group, a standard programme of four antenatal visits is recommended with additional visits should conditions emerge which require special care. The World Health Organization (2003) guidelines are also specific as regards the timing and content of antenatal care visits according to gestational age. The guidelines stipulate that “only examinations and tests that serve an immediate purpose and that have been proven to be beneficial should be performed”. These examinations include measurement of blood pressure, testing of urine for presence of sugar and protein and blood test to detect anaemia. Routine weight and height measurement at each visit is considered. Some packages include the use of recreational activities like exercises and games for the pregnant women.

According to Hoeger and Hoger (2010) during pregnancy the body experiences dramatic physiological and psychological changes which is natural, inorder to remain healthy, the pregnant woman must indulge in regular physical activities called exercise. According to Hornby (2010), exercise is an activity requiring physical effort done to improve health, it is a physical or mental activity that is done to stay healthy or become stronger. Exercise session in antenatal clinic should be designed to stimulate interest in the physical changes occurring to promote body awareness and to facilitate physical and mental relaxation.

According, to Makinde, Adeyemo and Ogundele (2014), the professional health workers need to carefully design recreational and physical exercise programme to enable the pregnant woman remain healthy. Recreational health practices do wonders for the woman during pregnancy. It helps to prepare her for childbirth by strengthening her muscles and building endurance (Ministry of Health, Brazil 2001). Green (1993) also discussed about breathing and relaxation exercises that were widely used and were most successful for the relief of labour pain and to enhance better emotional wellbeing. The health of the mother and that of the fetus is improved when the mother performs some simple exercises during pregnancy. Exercise has been known scientifically and physically to promote blood circulation to the mother and the fetal vital organs such as the brain, liver and heart etc., exercise also improves pelvic bone and muscle tone thus enhancing normal safe delivery of the baby during labour (Dianne & Myles, 2004). Shrock (2008) observed that as more pregnant women engage in demanding occupations, physical activities, and sports, the obstetrician and midwives who take care of them must become knowledgeable about the physical changes of pregnancy and the effects of exercise on the mother and fetus. Because prevention is the best approach to health care, understanding both the bodily stresses that may result from pregnancy changes and the means to prevent unnecessary problems enables health care to be instituted early in pregnancy and continued through the postpartum period. Therefore a properly organized antenatal care classes would have a physiotherapist or midwife teach pregnant women the rudiment of recreation during pregnancy, telling them the benefits derivable and the limits they should go. Such benefits include that recreational exercise improves blood circulation, strengthens the pelvic floor muscles and prevent backaches (Dianne & Myle, 2004).

Recreational Health activities according to McLean, Hurd and Rogers (2005) are activities often done for enjoyment, amusement, or pleasure and which are considered to be of health benefit to the individual undergoing it. Recreation as defined by Boye (2009) is any form of free activity that an individual performs at his or her leisure hours. It could be done indoors or outdoors and it could be passive or active. Recreation can be done for mental, physical, emotional and social development, recreational health activities have been found to be of immense benefit to both the pregnant woman and the unborn child.

It is one aspect for the care givers to recommend the recreational practices and it is another for pregnant women to adhere to it. Adherence would depend on several factors of which an awareness of the benefits is one. A study carried out among pregnant women attending antenatal clinic by Sarfraz, Islami, Hammed, Hasan and Ahmad (2013) showed that 95.2% of the women agreed that physiotherapy has positive role in ante-natal care although only 30% were currently following the exercise programme. Where awareness is lower, adherence to the exercise would be very much lower.

Another very important aspect of recreational practices by pregnant women undergoing antenatal care clinics is that of monitoring. Makinde et al (2014) found that 294 (58.8%) of respondents in their study wanted prenatal exercise to be performed by the expert while 116 representing 23.3% of the total respondents did not prefer expert to perform exercise for them.

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