1. 2007 Postpartum Physical Activity and Depression Louise Daw BSc, PARC Consultant Hiltrud Dawson RN, BTech (specialty nursing), IBCLC

2. Introductions/housekeeping To mute and un-mute your phone please press *6 Please do not put your phone on hold Who is on the call? – name, organization, title Who the presenters are: Louise Daw & Hiltrud Dawson

3. What is PARC? The Physical Activity Resource Centre provides services that are intended to support capacity-building, knowledge- sharing and learning opportunities. Typical PARC services include providing: information on physical activity consultation on physical activity issues assistance in the preparation of workshops and meetings review of physical activity-related materials training for physical activity promoters managing physical activity programs

4. Workshop Outline Orient physical activity promoters to what the research says Provide the latest information from the Best Start Resource centre on post partum depression Provide an inventory of resources, programs and tools available to new moms An opportunity to discuss challenges and network with other health promoters

5. Active Living Postpartum Rediscovering the “M” in “MCH”: maternal health promotion after childbirth The science and practice of health promotion after childbirth is less well developed except for breast feeding and family planning Walker LO, Wilging S. JOGNN 2000;29:229-236

6. Why should we promote health in the postpartum? Reduce the risk of developing heart disease, obesity and other lifestyle-related diseases. Improve women’s health and well-being in the immediate postpartum period.

7. Better understanding of women’s health promotion in the 1 st postpartum year is an essential step in addressing this neglect in maternal health.

8. Influence on early post-natal life Infants who were fed breast milk or who were breast fed longer had lower risk of overweight in adolescence Parental feeding patterns Parental activity patterns Obese mother – Obese child Maternal influence as care-giver

9. If maternal-child interaction is a significant initiating factor in the obesity epidemic, will the prevention of excessive weight gain in mother during pregnancy and subsequently less weight retention postpartum lead to lower rates of obesity in successive generations? Active living during pregnancy & postpartum?

10. Guidelines form American College of Obstetricians and Gynecologists for exercise during postpartum period, 2003 Rapid resumption of activities has no adverse effects, but a gradual return to former activities is advised Medical Screening – PAR Q Med X for pregnancy: www.csep.ca to download four page documentwww.csep.ca Guidelines are the same for adult as for pregnant or postpartum woman: from Canada’s Physical Activity guide www.paguide.comwww.paguide.com

11. Fetal Origins (Oken & Gillman, 2003) In utero environment has profound effect on lifelong health Higher birth weight = higher BMI Lower birth weight = higher BMI

12. Fetal Origins of Obesity Trouble on both sides of the birth weight spectrum In utero environment has profound effect on lifelong health Higher birth weight = higher BMI Lower birth weight = higher BMI BMI Birth Weight  Assumption of patterning  Stimulus at critical period of development has lasting effect Oken & Gillman 2003

13. Exercise in postpartum period Many physiological and morphological changes remain from four to six weeks after delivery Is very individual – some women can begin back as soon as two days after birth Hormones fluctuate leading to body imbalances

14. Activity & breastfeeding Important to continue breastfeeding Obese women tend to breastfed less often and shorter duration Best to nurse before exercised to avoid discomfort from engorged breasts. Avoids potential problems with increased acidity of milk secondary to any build up of lactic acid

15. Important exercises Kegel exercises Pelvic tilts Shoulder rotations Half crunches Walking What feels right for new mom

16. Examples of post-natal muscle conditioning exercises Using baby for post- natal activities Using baby as resistance tool (carefully!!) Have fun interacting with baby when doing push-ups (Active Living During Pregnancy, CSEP, 1999)

17. Barriers to activity for new moms ? others ?

18. Inventory of resources There are many resources available that provide courses, information and specific groups, classes for new moms. As health promoters it is important to support new mothers in overcoming their barriers Working with new moms is an important part of the health equation for developing a lifelong activity plan for new families

19. Returning to activity Return to being active after pregnancy has been associated with decreased postpartum depression Only if exercise is stress relieving and not stress provoking BJ Sports Medicine 2003 :37

20. Best Start Resource Centre Ontario’s maternal, newborn and early child development resource centre A key program of the Ontario Prevention Clearinghouse Part of OHPRS

21. Best Start Resource Centre Offers: Consultations Training Networking Referrals Resources

22. Postpartum Mood Disorders – what are they? A mood or anxiety disorder with symptoms developing within the first year after the birth of a baby Most common time to develop is 2 weeks – 4 months Most commonly recognized: - PP depression: 10 - 15%, about 26% in adolescents - PP anxiety: 4 – 6% - PP obsessive compulsive disorder: 3% PP psychosis is an emergency condition occurring 1 – 2 in 1000 usually in the first few weeks after the birth of the baby

23. PPMD – Treatment Most effective treatments: psychotherapy anti-depressants Other treatments Support groups Telephone support Hormone therapy

24. PPMD – Prevention No effective prevention yet identified Promising strategies: –Earlier treatment –Flexible postpartum care –Using self-care strategies to increase physical, emotional and mental well-being

25. PPMD – Self-Care Strategies Developing realistic expectations of motherhood Developing a good social support network Adequate sleep and rest Good nutrition Physical activity Social interaction

26. Best Start: Ontario’s Maternal, Newborn and Early Child Development Resource Centre Phone: 416-408-2249 or 1-800-397-9567 www.beststart.org Best Start Resource Centre is a key program of the Ontario Prevention Clearinghouse and is funded by the Government of Ontario.

27. For more information contact: Hiltrud Dawson h.dawson@beststart.org 416 408 6908 or 416 408 2249 ext 2250 or 1 800 397 9567 ext 2250 Fax 416 408 2122 or 1 800 824 4611

28. PARC’s contact information: Visit www.ophea.net/parcwww.ophea.net/parc Louise Daw PARC Consultant louise@ophea.org 519.646.2121