GOVERNMENT COLLEGE OF NURSING, INDORE

DEMONSTRATION ON
ANTENATAL ASSESSMENT& ANTENATAL EXERCISE

SUBMITTED TO: - SUBMITTED BY:-

RESPECTED
MRS. A. RAM MA’AM MS.BHUMIKACHOUHAN
MRS. U. PORWAL MA’AM M.SC NURSING PREVIOUS YR
MRS. MANAROMA MA’AM GOVT. COLLEGE OF NURSING

MRS. K.VINCIENT MA’AM

GOVT. COLLEGE OF NURSING
DATE OF SUBMISSION:-
NAME OF STUDENT - MS. BHUMIKA CHOUHAN
CLASS - M.SC (N) PREVIOUS YR

NAME OF THE SUPERVISOR - MRS A. RAM MA’AM ,

MRS. U. PORWAL MA’AM
MRS. MANAROMA MA’AM,
MRS. K.VINCIENT MA’AM
SUBJECT - MIDWIFERY & OBSTETRICAL
NURSING

TOPIC - ANTENATAL ASSESSMENT& EXERCISE

DATE -

TIME -

DURATION - 45 MINUTES

VENUE - P.C.SETHI HOSPITAL INDORE

METHOD OF TEACHING - DEMO,LECTURE CUM DISSUSION

A.V. AIDS - PPT,A.V AIDS,CHARTS

LANGUAGE - HINDI AND ENGLISH

TOTAL STENGTH -

PREVIOUS KNOWLEDGE - WE ALL ORIENTED ABOUT THE

“ANTENATAL ASSESSMENT &
ANTENATAL EXERCISE”
GENERAL OBJECTIVES:-

At the end of the demonstration, the group will be able to know about the antenatal
assessment and antenatal exercise.

SPECIFIC OBJECTIVES:-

After the completion of the demonstration the group will be able to understand the
following:
- Introduce Antenatal assessment & antenatal exercise
- Define Antenatal assessment & antenatal exercise.
- Explain aim & objective antenatal assessment & antenatal exercise.
- Explain the purpose of antenatal examination & antenatal exercise.
- Explain the procedure in antenatal examination.
- Explain the antenatal exercise in detailed .

DEMONSTRATION BASED ON ROY’S ADAPTATION THEORY

& 14 BASIC NEEDS
DEMONSTRATION:- ANTENATAL ASSESSMENT

 INTRODUCTION:

 Systematic examination end advice given to a woman during pregnancy it's

called antenatal care.
 Actually prenatal care is the care in continuum that start before pregnancy and
end at delivery and the Postpartum period.
 Antenatal care comprise:
 Careful history taking and examination(general and obstetrical).
 To carry out necessary investigation.
 Advice given to pregnant women.

 DEFINATION:

Antenatal assessment means is ‘to evaluate’ i.e. here we gather the information of
client status and it identifies the specific needs of a client by which better care can be
given to the client and her developing fetus. That means ,it is the systematic
supervision(examination & advice)of a woman during pregnancy. So,it is the
foundation stone for antenatal care.
 AIMS AND OBJECTIVE:

AIMS:

1. To promote and maintained good physical, mental and emotional health of the
mother.
2. To ensure a mature, healthy and alive baby.
3. To prepare mother for labor, lactation and subsequent care of child.
4. To detect early and treat promptly high risk condition (medical, surgical or
obstetrical) that may endanger life of the mother and baby.
5. To prevent and detect and to treat at the earliest any untoward complication that
may arise.
6. To reduce maternal morbidity and mortality.
7. To give required healthy education to the mother.

OBJECTIVE:

1. To screen the ‘high risk’ cases.

2. To prevent or to detect and treat at the earliest any complications.
3. To ensure continued medical surveillance and prophylaxis.
4. To educate mother about the physiology of pregnancy and labour by
demonstration charts and diagrams so that fear is removed and psychology is
improved.
5. To discuss with the couple about the place,time and mode of delivery and care
of newborn.
6 . To motivate the couple about to the need of family planning.

 PURPOSE:

1. To promote and maintain physical examination.

2. To detect the high risk condition of the mother and fetus.
3. To prevent or to detect treat any complication at the earliest.
4. To ensured continued medical surveillance and prophylaxis.
5. To teach the women regarding importance of antenatal visit,diet,exercise and rest.
6. To prepare the mother for labour and educate about family planning.
7. To clarify all her doubt associated child-bearing and child-rearing to reduce fear
and anxiety.
PROCEDURES IN ANTENATAL EXAMINATION:

A. Set -up of an antenatal clinic.

B. Assess antenatal mother.
1. Registration and history taking.
2. Head to toe “physical examination”.
3. Obstetrical examination \abdominal examination.
4. Vaginal examination.
C. Detect mother with high risk pregnancy.
D. Antenatal education including education on Diet, Breast care.
E. Describe the antenatal exercise in detailed.

1.Set -up of an antenatal clinic:

 Facilities required to conduct examination are :

 A room with proper lighting. There should be window for ventilation.
 Temperature room should be according to season.
 Examination table with bed length mattress, mackintosh and bed sheet spread on
it and a pillow for comfort of the woman.
 Facility for the women to pass urine.

 IDEALLY- ANC VISIT’S:

 First 28 weeks – once a month
 Up to 36 weeks – twice a month
 There after weekly till delivery.

Minimum – 4 ANC visits

 1st visit – around 16 weeks
 2nd visit – between 24 and 28 weeks
 3rd visit – at 32 weeks
 4th visit – at 36 weeks.
 Article Required :

 Examination table/ bed for the comfort of the women

 Fetoscope/ Doppler/ Stethoscope to hear the fetal heart song.
 Thermometer to take temperature.
 Measuring scale/ tape to taking height.
 Measuring tape to measure abdominal girth.
 Sphygmomanometer to measure blood pressure.
 Weighing machine to measure weight of mother.
 Watch to count pulse, respiration & fetal heart rate.
 TPR tray and torch to take vital sign.
 Screen & Drapping sheet to maintain privacy.
 Extra pillow for comfort of women.
 A covered glass of water & glucose powder.
 Soap to hand-wash
 History sheet/ Case book to write the history, assessment including general &
obstetrical assessment.

 Step of procedure:

 Explain procedure and provide essential information and establish rapport.

 Have gentle approach and matter of fact attitude.
 Have all equipments necessary for the procedure in proper place to avoid
interrupting the examination.
 Ensure privacy for examination without unexpected intrusion. (gown and drapes
may be given).
 Environments should be comfortably warm and pleasant. (examiner must warm
hands).
 Ask patient to empty bladder and obtain urine specimen.
 Keep all article ready in examination room to save the time.
 Explain the procedure to mother to reduce anxiety.
 Blood examination of CBC and hemoglobin and urine examination (for albumin
and glucose) are done.

1. Assess antenatal mother :

A. Registration and history taking : During women first visit to antenatal

clinic, registration is done and antenatal card is made. It is also important to
obtain base line information to assess health status of the women, screen out high
risk case and formulate the plan subsequent management.

 General information of the mother.

 History of present pregnancy.
 Event of trimester.
 Past medical history.
 Family history
 Socioeconomic background
 Menstruating history.
 Marital history.
 Dietary pattern.
 Past obstetrical history.
 Present pregnancy.
 Prenatal visits.
 Previous gynecological problems.

B. Head to toe “physical examination” : The initial physical examination

provides a baseline for assessing equipment changes. Each examiner develops a
routine for proceeding with the physical examination. Most choose head to toe
progression.

 General Condition

 Built: - May be obese/average/thin. Obesity is associated with multiple medical

illness like hypertension, cardiac illness and diabetes.

 Gait: - Normal/ any abnormality. Some changes in gait is normal features in late
pregnancy.

 Appearance:- May be depressed, tired and lethargic. Pregnancy being a high

stress phase in the life of woman.
 Height- Short stature in pregnant women is regarded as a high risk factor
because of its association with small pelvis.

 Weight-Weight is an important parameter to be recorded at every visit

preferably on the some machine. Stationary or decreasing weight is found in
IUGR. Rapid gain in weight of more that 0.5kg week is one of the manifestation
of pre-eclampsia.

 Vital sign:These must be recorded at each visit. At first visit in first trimester a
baseline data regarding vitals should be obtained and compared with subsequent
reading to detect any changes at the earliest that might occur during pregnancy.

 Temperature
 Pulse
 Respiration
 Blood Pressure

 Skin :
 Color
 Temperature
 Texture
 Ulcer
 Edema

 Head : Scalp for cleanliness, infection and infestation and pediculosis.

 Eyes : Sclera & conjunctiva for pallor, sign of jaundice and eye for evidence of
infection.

 Nose:-Infection and blockage, discharge,deviated nasal septum (DNS) .

 Mouth: - Observe cracked lips, tongue for pallor, glossitis, (vitamin

deficiency), teeth and gums for dental carries and tonsils for tonsillitis.

 Ear:- See for infection, blocking and wax.

 Neck:- Observe neck veins, thyroid glands, lymph glands for any abnormalities.

 Upper extremities:- For any bony abnormality.

 Lower extremities: - Homan’s sign (calf muscle on dorsiflexion of the

foot) identify vein thrombosis. edema may be associated with preeclampsia,
anaemia,& vericous vein.

Back:- Back is to be examined for lardosis scoliosis and kyphosis.

 Examination for breast:- Breast should be examined for size, symmetry,

dimpling, leision, masses, areas of thickening, tenderness, areas of inflammation,
presence of scars. Nipple should be examined for their development (whether
inverted, underdeveloped or cracked), discharge, crushing, and presence of scars,
lymph node are assessed for size condition and tenderness.

 Normal changes in breast during pregnancy

a) 3-4 weeks- pickling, tingling sensation (stimulated by ovarian hormones
i.e. oestrogen and progesterone.
b) 6weeks -- enlarged and tense
c) 8weeks -- surface veins are visible
d) 8weeks -- Montgomery’s tubercles appear
e) 12 weeks -- darkening of the primary areola
f) 12 weeks -- fluid can be expressed
g) 16 weeks -- colostrums can be expressed
h) 16 weeks -- secondary areola appears

a) Flat (nipple does not protrude with stimulation) 

b) Retracted (nipple pulls back slightly)
c) Inverted (nipple pulls inward when compressed)

C. Obstetrical examination \abdominal examination.

 Objectives :
 To diagnose the lie, presentation and position of the foetus.
 To detect cephalopelvic disproportion
 To know whether the pelvis is adequate or not.
 To detect any abnormality twins, hydramnias, mal presentation etc.

 Abdominal examination:-

Preliminaries :
 Woman must evacuate bladder to aid her own comfort and for examination to be
reliable
 Woman to lie in dorsal position with thigh and knee slightly flexed. Elevate the
head of the examination table slightly.
 Maintain privacy, exposing only abdomen.
 Examiner to stand on the right side of the patient.
 Examiner to wash and warm hands before touching the abdomen.
 Examiner arms and hands should be relaxed. Use pads not the tip of the fingers.
 Move hands in a stroking motion in order to avoid contractions.

 Steps in abdominal examination

 Inspection:

 Shape - Check whether the uterine shape is ovoid or longitudinal or transverse

or oblique
   Size - Appropriate to the weeks of pregnancy or not?
 Skin Changes - look for
 Striae Gravidarum - (The brown and silvery lines all over the abdomen and)
 Linea Niagra - (the pigmented line from the symphysis pubis to umblicus)
   Cullen's Sign - Bruishing discoloration around the umblicus
      Scars - Any incision scars present or not
     Contour of the abdomen- The general contour of the entire abdominal
wall is observed. The contour should be checked carefully for distention and note
must be made as to whether any distention is generalized or localized to a portion
of the abdomen. Similarly, the flanks should be checked for any bulging
   Check for visible foetal - Movements if not visible, confirm with the
mother about the foetal movement

 Palpation:

 Abdomen for - growth (gestational age estimated by fundal height

measurement) , movements, Fetal parts, No. of fetus, lie, position, presentation
and engagement.

Step 1: Measure the fundal height keep the ulnar border of curved left hand on
woman’s abdomen parallel to symphysis pubis.
 Start  from  xiphisternum  and  gradually proceed towards symphysis pubis lifting
the hand between each step till a bulge / resistance of uterine fundus is felt.
 Mark the level of fundus.

 Measure the fundal height by inch tape it is measured by the inch tape each cm is
week.
Estimation of gestational period from the height of fundus of uterus:-
The fundus assumes different height in the abdomen at different periods of gestation.

1. 12 weeks – Level of symphysis pubis.

2. 16 weeks – Half way between symphysis pubis and umbilicus.
3. 20 weeks – 1-2 fingers breadth blow the umbilicus.
4. 24 weeks – Level of umbilicus.
5. 28 weeks – 1/3rd of the way between umbilicus and xiphoid process. (3 finger
breadth above the umbilicus )
6. 32 weeks – 6 finger bread th above umbilicus.
7. 36 weeks – level of the xiphoid process.
8. 40 weeks – slightly below the level at 36th week, if lightening occurs.
 Measure the abdominal girth by encriclingthe women’s abdominl with a tape
measure at the level of the umbilical.
 Normally the measurment is 2 inch (5 cm) less than the week of gestation.
 e.g 32 inches at 34 weeks gestation. Measurements more than 100cm (39 1/2
inches) is abnormal at any week of gestation.

Step 2: Leopold’s maneuvers -Obstetric grips:-It includes four grips

1. Fundal grip
2. Lateral grip
3. Pelvic grip
4. Pelvic gripPelvic Grip I /Superficial pelvic grip and  Pelvic Grip II / Deep
Pelvic Grip
5. Engagement of the head
1.  Fundal Palpation / Fundal Grip (1st maneuver) - Helps to determine
lie and presentation of fetus.

2.  Lateral Palpation / Lateral Grip (both Right and left lateral)2nd

maneuver - Helps to locate fetal back and limbs.

1.   Pelvic Grip I / Pawlik Grip (4 th maneuver) -Helps to determine

whether head or breech is presenting at pelvic brim. Whether the presenting part
is engaged / fixed / free.
4.  Pelvic Grip II / Deep Pelvic Grip(3rd maneuver) - Helps to know the
degree of flexion of head.

Check or ask for Foetal Movements

 Normally 10-12 foetal movements should be felt by the pregnant woman in a

day.Fetal movement are reliable sign of foetal well - being.
 These are felt around 18-22 wks of pregnancy (felt earlier in multigravida than
primigravida).

5). Engagement of the head:- Diagnosis fetal head requires judgment in

assessing the clinical findings and manual skill. An engaged head is one in which the
biparital diameter has passed through the pelvic brim.

 Auscultation:
 After20 week of pregnancy the uterine wall to hearth fetal heart sound.
 Normal FHR is 120 – 160 beats per min.
 Best heard on the side of the back of the fetus.
 In vertex presentation FHS is best heard midway between the line joining the
umbilicus and the anterior superior iliac spine on the side of the back.
 In breech presentation FHS is heard above the umbilicus (Fetal Heart Sound).
 Count the FHS for one full minute FHR (Fetal Heart Rate).
 FHS is heard over the abdomen by stethoscope / fetoscope after 24 weeks of
pregnancy.

D ) Vaginal Examination:

1) Early pregnancy - Help to detect period of gestation.

2) Later pregnancy - Pelvic assessment is made in respect of foetal head.
3) Conformation of presenting part in obese or hydramnios.
4) To detect any prolapse of uterus, cervical fibroid or operative scar in vagina.
5) During labour to determine the cause in prolong labour, the cervix and dilatation
of the cervical OS, presence of bag of water, level of presenting part,
presentation, position, degree of moulding and if any abnormalities.
6) In case of hydramnio, breech presentation and in multi parous where chance for
prolapse of cord is more common.

2. Detect mother with high risk pregnancy:

 Vaginal bleeding
 Swelling of face & finger
 Continuous headache
 Abdominal pain
 Vomiting
 High fever
 Fast/ difficult breathing
 Continuous abdominal pain

3. ) Antenatal education :
a) DIET:
i. Need to eat one extra meal a day during pregnancy.
ii. Take milk & dairy product like curd, butter milk, panner these
iii. are rich in calcium protein and vitamin.
iv. Green leaf vegetables are a rich source of iron & folic acid.
v. For non-vegetables ,meet, egg, chicken, fishes.

- Rich source of important nutrients:

“A well balanced diet consisting of a variety of food help in the growth

of the baby and prevents anemia”.

b) Hygiene:
C).Bowel:
 Avoid constipation.
 Regulation of diet taking plenty of fluids ,vegetables & milk.

D).Clothing & Shoes:

E).Travel:
 F).Rest & sleep:
 Adequate rest gives you physical & mental relaxation which is good for both
you & the baby.
 Have 8 hours of sleep at night & at least 2 hours rest during the day.

G). Dental carry:

Oral
problem

Gingivitis Dental
carries
Increase
tooth mobility
H).Sexual Inter costal:

The mother should be advised to avoid coitus during the first three month and the
last two month. In the first three month it increase the risk of abortion.

I). Breast care-:

Breast preparations during pregnancy consist of following three exercises.

1. NIPPLE ROLLING- Roll the nipple between two finger like radio dial
to help toughen the nipple before it exposed to the infant sucking.
2. Massage breast- Massage breast gently using both hands. It provides
stimulation prior to manual expression of colostrums’.
3. Manual Expression of colostrum- Colostrum (the sticky, clear
pregnancy and prior to lactation) can be expressed. Hold the breast between
thumb and fingers (leaving areola) push the breast in towards the chest and
then squeeze the fingers in together.

J). Immunization:

k) Drugs:

IRON FOLIC ACID (IFA) TABLETS

ANTENATAL-EXERSICE:-

“The key mantras in your journey of motherhood”

INTRODUCTION:
Antenatal exercise help to develop a good posture and relieve minor dis comfort,
backache, constipation and insomnia.

Exercises during pregnancy is most important for the health of both mother and the
baby antenatal exercises done during pregnancy. It not only relief pregnancy - related
aliments but it also help to cop during antenatal, intranatal, post natal period.

Antenatal exercises aim at improving the physical and psychological well-being of an

expected mother for labor and preventing pregnancy-induced pathologies by various
physical means. It generally includes low impact aerobic
exercises and stretching exercises.

DEFINITION: These are systematic exercise to help the pregnant women adapt
the physical changes in her body during pregnancy and to tone up the muscles that
will be stretched or stressed during pregnancy.

Purpose :

 To develop a good posture.

 To reduce constipation & insomnia.
 To alleviate discomfortable, postural back ache & fatigue.
 To ensure good muscles tone& strength pelvic supports.
 To develop good breathing habits, ensure good oxygen supply to the fetus.

Advantages of Antenatal Exercise :

 Reduces morning sickness.

 Reduces insomnia, anxiety and stress.
 Reduces other pregnancy-related complaints, eg: fatigue, leg cramps, oedema
of extremities, etc.
 Prevents excessive weight gain during pregnancy.
 Improves muscle strength.
 Maintains muscle length and flexibility.
 Improves posture.
 Enhances relaxation.
 Prepares for physical demands of labour.

Guide lines for exercises during pregnancy

 Maintain adequate fluid intake.

 Warm up slowly, use stretching exercises but avoid over stretching to prevent
injury to ligaments.
 Avoid jerking or bouncing exercises.
 Be careful of loose throw rugs that could slip& cause injury.
 Exercises on regular basis (three times per week).
 After first trimester, avoid exercises that require supine position.
 Wear loose fitting, breathable clothing and supportive shoes: avoid overheating
your body while you are exercising.

Contraindications/ Indication:
 Vaginal bleeding.
 Sever anemia.
 History of preterm labor,
 Extreme over or under weight.
 Hypertension, heart, lung, thyroid diseases.

Precautions:

 Exercises should be performed under supervision.

 Avoid supine lying more than 5 minutes after 3 months of gestation.
 Do not change positions quickly.
 Stay hydrated at all times (before, during and after workouts).
 Follow proper warm-up and cool-down process.
 Ensure bladder emptying before workouts.
 Avoid exercises which demands higher balancing and different groups of
muscles.

1st Trimester Exercises(1 to 12 weeks)

 Walking
 Pranayam
 Anulom vilom pranayam
 Brahmari
 Warm up exercises
 Meditation
 Kegel’s Exercise
 Hamstring Exercise
 Shavasana / Corpse pose
 Palm Tree pose / Tadasana
 Garbh sanskar (Mantras / Ayyat / shlokas)

2nd Trimester Exercises(13 to 26 weeks)

 Trinonasana / Angle pose

 Setubandasana (Bridge pose)
 Virabhadrasana (Warrior Pose)
 Cat Pose
 Chair Pose (Utkatasna)
 Wall sliding
 Pelvic rocking / tilting
 Lunges
3rd Trimester Exercises (27 to 40 weeks)
 Butterfly pose / Titliasana

 Dancing pelvic exercise

 Birthing ball exercise

 Squats

 Hip rotation

 Guided Imagery

First trimester exercises

1. Walking :

 Walking during pregnancy improves your fitness and strengthens your heart and
blood vessels. Walking could also help you tone your muscles.

 Walking on a flat, even surface is one of the most gentle, low impact forms of
exercise.

 Walking in a calm, natural setting can also help promote well-being and
relaxation.
 During the first trimester, people can gradually build up to taking 30-minute
walks three to five times per week, if they choose ,taking a few 10-minute walks
every week..

 Anyone who is taking prolonged walks or jogs should be sure to wear supportive
footwear that fits correctly.

Benefits Of Walking During Pregnancy

The following are the possible benefits of walking during pregnancy  

1. Helps reduce back pain
2. Helps relieve constipation
3. Reduces the need for cesarean delivery
4. Reduces the risk of gestational diabetes
5. Reduces the risk of preeclampsia
6. Helps prevent excess weight gain
7. Reduces the risk of blood clots
8. Promotes postpartum weight loss.

2. Pranayam:
Deep breathing exercises

1. Helps you connect to the womb directly and consciously.

2. Help you slow down the pacing mind and help to lengthen the breath consciously.

Precautions

1. Don’t hold your breath in pregnancy.

2. Inhale and exhale as long as it’s comfortable.

3. Best done when empty stomach.

3. Anulom vilom pranayam

Anulom vilom (alternate nostril breathing)

Benefits:

1. It provides ample oxygen to the mother’s body as well as to the baby.

2. More oxygen can relieve joint and muscle pain that a pregnant woman may
experience.

3. Prevents anxiety and stress.

4. Breathing exercise can also be very helpful during labor.

Precautions:

1. Pranayama should be done under the expert guidance and on an empty stomach.

2. Do it slowly but breathe in such a way that air should go into the lungs and not into
the stomach.
3. Do not practise immediately after having your food. Keep a gap of three to four
hours between your food and pranayama practice. Always practise pranayama in the
fresh air.

4. Do not overdo, as it may cause fatigue.

5. Good for pregnant women, but should not overstrain.

4. Brahmari

Bhramari Pranayama (bee humming)

Benefits:

1. Facilitates easy and trouble-free childbirth.

2. Reduces cerebral tensions, anger, anxiety and insomnia. Blood pressure is also
normalized with this.

Precautions:

1. There are no precautions for this, except start practising three times and then
increase to five, 11 or more.

2. Best done when empty stomach.

5. Warm up exercises

A. Leg rotation
Foot and Ankle Exercises :

 Sit on chair with your back against your seatback with one ankle and turn foot
upwards and downwards. Each up and down is as one time, repeat 10 times.
 Repeat the ankle to draw inward and outward circle circular movement counted
as one time.
 Repeat the same step at the other ankle.
 Ankle exercise helps to reduce leg swelling and varicose vein thus alleviating the
problems of leg cramps.

B. Neck Rotation :

 The neck rotation exercise stretches neck muscles.

 Lie on the floor with a phone book or other thick book under your head, then
slowly turn your head from side to side, holding position for 10 to 30 seconds on
each side.
 Your head should not be tipped forward or backward, but should be in
comfortable position. You can keep your knees bent to keep your back
comfortable during this exercise.
 Repeat it for 3-5 times.

6.Meditation
Most moms-to-be spend a lot of time worrying about their developing baby. But
remember, it’s just as important during the next nine months to tune in to someone
else’s cues: your own.

Meditation can help you listen to your voice, your body, that small heartbeat — and
help you feel refreshed and a bit more focused.

Some of the benefits of practicing meditation include:

 better sleep

 connecting to your changing body

 anxiety/stress relief

 peace of mind

 less tension

 positive labor preparation

 lower risk of postpartum depression

Doctors and scientists have studied the benefits of meditation on pregnant women and
they have shown that it can help moms-to-be throughout pregnancy and especially at
birth.

7. Kegel’s Exercise :
 Purpose : To strengthen the pelvic floor muscles which helps prevent urine
leakage during a laugh, cough, or sneeze.

 Position : Any position, sitting, standing, or lying down.

 Movement Technique : Contract your pelvic floor muscles as you would to

stop urine for 3 seconds and then relax quickly so only do five to ten repetitions
at a time. Do not hold breath anytime, breathe normally while doing this
exercise. This exercise can be done during a variety of daily activities, such as
sitting in a meeting, while waiting at a traffic light, while talking over the phone,
etc.

8 .Hamstring exercises

Aim

 To strengthen your back, gluteals and hamstring muscles.

Equipment Required: A firm but not hard surface such as an exercise mat
Technique :

 Start by resting on your hands and knees, with your back flat and abdominal
muscles squeezed in tightly.

 With your foot flexed, extend your leg straight behind you.

 Keeping your back flat, lift your left leg up until it is level with your back, and
hold for several seconds

 Lower your leg.

 Repeat this action several times on the one side.

 Change legs and repeat.

 Start with five repetitions each side, and increase to 20 as you get fitter

9. Shavasana /Corpse pose

After doing all these process, give your body the rest it deserves by milting into a
shavasana or corpse pose. You can lie down on one side and place a bolster/ pillow
b/w your legs or extra comfort.

 Relaxes the body and repairs cells. This helps self-healing which is vital, as
pregnant women should avoid taking pills.

 Relieves stress tension and anxiety.

 Helps regulate blood pressure.

10. Palm tree pose /Tadasan

 Tadasana is one of the fundamental poses of prenatal yoga which works wonders
on pregnant women. It helps in aligning your body and improves balance,
especially since your centre of gravity shifts with the growing baby.

 Start by standing with your feet hip-width apart and your toes pointing straight.
Join your hands together close to your heart, with your fingers pointing upwards.
Close your eyes and breathe in and out slowly and steadily. You can also extend
your hands above your head and arch your back if you feel comfortable doing it.

11. Garbh Sanskar

(Mantras /Versus /Ayyat /Shlokas) Music

Garbh sanskar states that a baby can respond to music while in mother’s womb. In
fact, ancient literature says that a baby starts hearing and responding to its
surroundings from fourth month of pregnancy. This is why the mother should listen to
melodious music which clams her. Soft and spiritual songs or mantras and shlokas are
said to be beneficial for both the mother and the child.

 Reading calming or spiritual books

 Keeping the mind relaxed and happy

 Consuming herbal ghee during pregnancy

 Channel your creativity

Second trimester Exercises

12. Trikonasana /Angle pose

Yoga during pregnancy is vital as it help in reliving stress, anxiety and stiffness in
your body. This extended triangle pose has the power to relieve you from any
backache and stiffness in the neck. Besides, this type of Asana also help in reliving in
digestion.

 Maintains physical and mental balance. Especially useful for pregnant women
since their center of gravity shifts.

 Stretches and opens the hips which can be a big help during delivery.

 Reduces back pain and stress.

13. Setubandasana (Bridge pose)

 Lie on the floor on your back, and place your feet close to your butt, knees
pointing up. On every inhalation, raise your hips off the ground into a bridge pose
and pull your pelvic floor up. Trying to squeeze everything down there as hard as
you can, “zipping it up”. 

 On every exhalation, replace your hips on the ground and RELAX everything. 

 Do 10 repetitions synchronizing the movements with your breathing. 

 This is a slightly modified version of the famous Kegel exercises but I would like
to emphasize on really relaxing everything on each exhale ( you want a toned but
relaxed pelvic floor for a good delivery). And as a bonus, the bridges are good to
work on your glutes.
 14. Virabhadrasana (Warrior pose)

This pose is excellent for pregnant women during the first and second trimesters to
help build leg strength to support the growing baby. During the third trimester, the
pose is likely to become more challenging as your body's sense of balance changes (in
part due to the hormone relaxin.

 Improves balance in the body.

 Tones the arms, legs and lower back.

 Increases stamina.

15. Cat & Camel exercise( Pose) :

Purpose: To strengthen abdominal muscles, improve posture, reduce back strain,

and for mother not comfortable lying on their backs or experience supine hypotensive
syndrome.

Position : Hands and knees.

Movement Technique : While exhaling slowly, pull abdomen in and push lower
back up. Tuck chin down. Then slowly relax until your back is flat. Do not let your
back arch.
 16. Chair pose (Utkatasna)

 Strengthens thigh and pelvic muscles.

 Stand erect with feet 12 inches apart. Keep your feet parallel to each other.
Inhale for 2 seconds and raise your heels and arms at shoulder level, palms
facing down simultaneously.

 Exhale slowly; sit in squat pose, on your toes. If not comfortable standing
on your toes, stand normally keeping feet flat on the ground.

 Keeping your hands in the same position, inhaling, get up slowly and stand
on your toes.Exhale, hands down and heels down simultaneously.

17. Wall sliding

Purpose :
 To reduce leg cramps and strengthen the arm muscles.

Position :
 Stand against a wall with your elbows and wrists against the wall.

Movements Technique:
 Slowly slide your arms upward as high as you can while keeping your elbows and
wrists against.
 18. Pelvic rocking /tilting

This exercise will strengthen your pelvic floor muscles.

How to Do It:
 Lay on your back, bend your knees and keep your feet on the floor.

 Move your pelvis forward and press the small gap of your back into the floor.

 Relax your muscles and rest for a few seconds.

 Repeat this as many times as you are comfortable.

Benefits of Doing Pelvic Tilt Exercise in Pregnancy

Exercise has many benefits, and during pregnancy, there is no exception. If you are
looking for a nudge to start exercising, the benefits of doing pelvic tilt exercises
during pregnancy are as follows:

 It will help to prevent or treat gestational diabetes.

 Helps in improving your mood.

 Aids in toning the muscles, in improving strength and endurance.

 Improves stamina and energy.

 Helps to improve your posture.

 Aids in improving your sleep.

 Constipation, bloating, swelling and backaches.

 Helps to improve your ability to cope with labour, and some women even use
pelvic tilts to induce labour.

 Will help your body get back in shape faster after delivery.

 Standing
This exercise will require you to lean against a wall, and doing it daily will strengthen
your pelvic muscles.

How to Do It:
 Touch your bottom, shoulders and head to a wall.

 Press the small gap of your back towards the wall while breathing in deeply.

 Exhale and slowly relax.

 Repeat the exercise at least ten times.

19. Walking Lunges Exercise :

 To begin a walking lungs stand upright with or without weights in your hands.
Now take a lunge forward while never letting your knee go ‘over’ your toe.

 Once at the bottom of the lunge (not touching the floor), push off with the back
foot and then approach the standing position.

 Repeat with the other leg. Make sure to breath out on the way up and breathe in
on the actual lunge.
Third trimester Exercises

20. Butterfly pose / Titliasana

 Improves flexibility in the hip and groin region.

 Stretches the thighs and knees, relieving pain.

 Alleviates fatigue.

 Helps facilitate smooth delivery when practiced until late pregnancy.

21. Goddess pose

 Goddess pose is great for opening your hips while at the same time strengthening
your legs. Doing this pose daily can make labor easier because it keeps you open
and holding it for minutes at a time prepares your body for being in this position
during labor. I hold this pose for 5 minutes everyday while I'm doing dishes,
cooking or drying my hair. It's easy to multitask with this one."
 22. Dancing pelvic exercise

 Exercises can help strengthen the hip external rotators, improving stability and
preventing injuries in the hips, knees, and ankles. Strong hip external rotators can
also reduce knee pain and lower back pain.

 Stretches can help to improve hip external rotator flexibility and range of motion.

23. Birthing ball exercises

1. Wall Squat

 Place an exercise ball between your lower back and a solid wall or steady surface,
Smith says. Stand feet slightly wider than hip-width apart and bend your knees to
slowly lower yourself into a squatting position, using the ball as support.

 Push back up to a standing position and repeat.

2. Ab Crunch

 While lying on your back for standard crunches : Sit upright on an exercise ball
and walk your feet forward so they are just in front of your knees.

 Continue taking small steps until your lower back touches the ball. Your feet
should remain flat on the ground with knees bent, and your body should be at an
incline with hips lower than your shoulders.

 Make sure the ball is on a non-slip surface, or against the wall and stop if you feel
any discomfort.

3. Pelvic Floor Exercises

 Sit on the ball with a straight spine. Contract your pelvic muscles, as you would
to stop the flow of urine. Hold for a few seconds, and then release and repeat.

 “Be sure not to hold your breath!” Smith says.

4. Ball March

 Sit on the ball with your feet firmly planted on the floor. Exhale and draw your
belly button towards your spine as you slowly lift one knee without letting the
ball or your hips move.
 Slowly place your foot back down and repeat on the other side. Keep alternating
sides for 10 repetitions. (Don’t forget to breathe!)

5. Ball Bridges

 “Labor requires a lot of hip and gluteus strength, so training these muscles is
important!” Stamas says. (This move may be too challenging or uncomfortable
later in pregnancy, she advises.)

 Start by sitting on the floor with your upper back against the ball. Push up
through both of your feet and lift your hips off the floor towards the ceiling, as
high as you can comfortably go without arching your back.

6. Kneeling Ball Roll-Outs

 Start in a high kneeling position with your hands on the ball. Keeping your back
straight, roll the ball forward until you can feel your core engaging. Hold for
three seconds, then roll the ball back in.

 “Only go out as far as your abdominal muscles can stabilize without bulging,”
Stamas says.

7. Back and Upper Body Stretch

 “The chest and abdomen often get really tight in pregnancy, so this can be a great
stretch!” Stamas says. Kneel on the floor, hinge forward at your hips, and rest
your arms on the ball.

 Gently rock the ball to one side until a stretch is felt. Hold here while breathing
into the opposite side of your rib cage for 30 seconds. Repeat on the other side.

8. Ball Circles

 Sit on the ball with your feet firmly planted on the floor, slightly wider than hip-
width apart. Move your hips in a circular motion to “draw” small circles on the
floor with the ball.

 Do 10 repetitions clockwise, then repeat counter-clockwise.

9. Figure-8

 Sit on the ball with your feet firmly planted on the floor, slightly wider than hip-
width apart. Move your hips as if you’re drawing a figure eight on the ball.

 This move is great for opening up your pelvis.

 24. Squats

 The king of pregnancy exercices. The rule should be “squat any time, anywhere
and as much as you want”.

 I recommend for this workout 10 to 15 repetitions. You can put a chair behind
you if you’re afraid of falling back, or squat in front of a wall placing your hands
on it for more stability. You can also squat while cooking, brushing your teeth,
waiting in line (really it’s up to you!).

25. Hip rotations

Directions:
 Stand with your weight centered, feet about a foot apart, knees relaxed

 Flex or bend in your hip sockets, so your bottom tilts back, then inhale

 Exhale and squeeze the gluteal muscles

 Press the bottom of the pelvis forward and tilt the top back

 Release and return to starting position (center photo)

 Start with 3 sets of 5 and progress to 3 sets of 10

 This action warms muscles and fascia that control the pelvis, improving internal
relaxation necessary for baby to move down.

26. Guided Imagery

CONCLUSION :

 Antenatal assessment and antenatal exercise is the key to

modification of outcome to the mother and the newborn.

 Prevention and management of pain, complication, bleeding, infection

during before and after labour.

 Antenatal assessment is a essential aspect of health care delivery for

improving pregnancy outcome by this services we can detect high risk
pregnancy and we can direct them for proper management.
 Antenatal exercises are very effective in decreasing adverse effect and
severe pregnancy and labour complication in elderly primigravida and
their offspring. The results might provide the basis for clinical studies
on the use of exercise in antenatal care for elderly primigravida.

BIBLOGRAPHY

1) Datta D.C. (2004),’’Text book of obstetrics’’,6th ed .New central book

agency (P) LTD New Delhi.

2) Jacob Annamma,(2019) ‘’Acomprehensive textbook of midwifery &

gynecological nursing”5th ed. Jaypee brothers medical publishers New
delhi.

3) J.B.Sharma (2015).” Midwifery & gynaecological nursing “ 1st ed.

Avichal publishing company New delhi
4) Kumara neelam, shivani Sharma (2017)”A textbook of midwifery &
gynecological nursing”4th ed. S. Vikas and company (medical
publisher)

5) Bhaskar nima (2019) “Midwifery & gynaecological nursing” 3rd ed.

Emmess publisher.