Feasibility of pilates for pregnant women: A randomised trial.

OBJECTIVE: To investigate the feasibility and preliminary effects of Pilates exercises in primigravida women. DESIGN: Single-blind randomized controlled feasibility trial. SETTING: Community Pilates classes. PARTICIPANTS: Low-risk pregnant women. INTERVENTIONS: Pregnant women were randomly assigned to Pilates exercises (experimental) group for 6 consecutive weeks or usual antenatal care, the control group. MAIN OUTCOMES: The primary outcome was feasibility of Pilates classes. Secondary outcomes included quality of life, pain, and mobility. RESULTS: 21 women were recruited to the trial. Eleven were randomly allocated to the experimental group and 10 to the control group. Retention of participants was excellent for the Pilates group (100%) compared to 70% in the control group. There were no adverse events. The Pilates group showed greater gains in quality of life on the SF-12 from the pre-test (M = 81.0, SD = 11.8) to the post-test (M = 83.3, SD = 8.52) compared to the control group (pre-test M = 69.78, SD = 15.9) (post-test M = 68.1, SD = 16.05) (Wald Chi-Square = 5.597, p = 0.018). Although the duration of labour was shorter in the Pilates group (Mdn = 215, IQR: 279 min) than usual care (Mdn = 458.5, IQR: 305 min), the difference was not statistically significant. There were no significant differences between groups for pain, mobility, abdominal separation, urinary continence, analgesia, or the mode of birth. CONCLUSIONS: Modified Pilates appears feasible and safe for low-risk pregnant women. Further research is needed in on this topic.

Pilates for low risk pregnant women: Study protocol for a randomized controlled trial.

BACKGROUND: Pilates has growing appeal to pregnant women, as a form of exercise and relaxation. It is purported to benefit lumbo-pelvic stability, as well as motor control, strength and endurance. Some suggest that modified Pilates exercises may assist low risk pregnant women to enjoy a healthier pregnancy and prepare for the physical demands of labour and birth. The feasibility and safety of Pilates during pregnancy is poorly understood. We describe the protocol for a feasibility study designed to compare a midwife-led 6-week community-based Pilates intervention with standard antenatal care. METHODS: A convenience sample of 30 low-risk pregnant women will be recruited from private obstetric clinics in Melbourne, Australia. Participants shall be randomly allocated to a six-week, 1-h weekly Pilates exercises group session or to usual care. The Pilates exercise class will have a warm-up phase, Pilates exercises, breathing exercises, and a cool down phase. Exercises have been designed to prepare for active birth. The primary outcome will be feasibility of implementation, determined by recruitment, retention, adherence and safety. Secondary outcomes include women's health (quality of life, pain, mobility for daily activities, lower extremity performance, abdominal separation, continence) and labour and birth outcomes (duration of first stage and second stage labour, analgesia used, mode of birth). Validated questionnaires will include the Quality of life 12-item short form survey; Pregnancy Mobility Index, and International Consultation on Incontinence Questionnaire. Lower extremity performance and abdominal separation will also be measured. DISCUSSION: This trial will provide preliminary data regarding the feasibility and safety of Pilates exercise in healthy pregnant women. It will also provide preliminary outcome data used to inform the design of a future large scale, multi-centre RCT. TRIAL REGISTRATION: This clinical trial has been registered with the Australian and New Zealand Clinical Trials Registry 2016 (ACTRN12616000809437).

Pilates program design and health benefits for pregnant women: A practitioners' survey.

BACKGROUND: Little is known about recommendations for safe and appropriate instruction of Pilates exercises to women during pregnancy. The aim of this study was to examine Pilates practitioners' perspectives regarding Pilates program design for pregnant women. We also sought to elucidate their views on the potential benefits, restrictions and contraindications on Pilates in pregnancy. METHODS: A cross-sectional survey was performed. Pilates practitioners were invited to participate via email. Participants were surveyed about their experience and views on: screening processes in alignment with The American College of Obstetricians and Gynecologists (ACOG) (2002) guidelines; (ii) optimal exercise program features and (iii) physical and mental health benefits of Pilates for pregnant women. RESULTS: The survey was completed by 192 Pilates practitioners from a range of settings. Practitioners reported conducting formal screening (84%) for safety in pregnant women prior to commencing Pilates classes. Most did not routinely seek medical approval from the woman's general practitioner. Divergent views emerged regarding the safety and benefits of Pilates exercises in the supine position. Mixed opinions were also generated regarding the effects of spinal flexion exercises, single-leg stance exercises and breathing manoeuvres. There was little agreement on the optimal frequency or dosage of exercises. Views regarding absolute contraindications to exercise differed from The American College of Obstetricians and Gynecologists (ACOG) (2002) guidelines which cautioned about the dangers of persistent bleeding, premature labour, pre-eclampsia, placental praevia and incompetent cervix. The most frequent reported physical and psychological benefit of Pilates was improving pelvic floor strength (12%) and improved social wellbeing (23%). CONCLUSIONS: The study highlighted wide variations in practice for Pilates exercises with pregnant woman as well as low adherence to clinical practice guidelines. Further evidence is required to advise on appropriate screening and individualized Pilates programming, particularly for women with medical conditions during pregnancy.

Communicating out loud: Midwifery students' experiences of a simulation exercise for neonatal resuscitation.

Midwifery students feel unprepared to deal with commonly encountered emergencies, such as neonatal resuscitation. Clinical simulation of emergencies may provide a safe forum for students to develop necessary skills. A simulation exercise, for neonatal resuscitation, was developed and evaluated using qualitative methods. Pre and post-simulation questions focussed on student confidence and knowledge of resuscitation. Data were analysed using a thematic analysis approach. Pre-simulation questions revealed that most students considered themselves not very confident/unsure about their level of confidence in undertaking neonatal resuscitation. Most correctly identified features of the neonate requiring resuscitation. Post-simulation, students indicated that their confidence and knowledge of neonatal resuscitation had improved. Themes included: gaining confidence; understanding when to call for help; understanding the principles of resuscitation; tailoring simulation/education approaches to student needs. Students benefits included improved knowledge, confidence and skills. Participants unanimously suggested a program of simulation exercises, over a longer period of time, to reinforce knowledge and confidence gains. Ideally, students would like to actively participate in the simulation, rather than observe.

Development and evaluation of a simulation exercise to prepare midwifery students for neonatal resuscitation.

BACKGROUND: Simulation provides opportunities for midwifery students to enhance their performance in emergency situations. Neonatal resuscitation is one such emergency and its management is a major concern for midwifery students. OBJECTIVES: This project aimed to develop and evaluate a simulation exercise, for neonatal resuscitation, for 3rd year midwifery students. DESIGN: A quantitative survey design was employed using questions from two previously validated questionnaires: (1.) Student Satisfaction and Self-Confidence in Learning and (2.) the Clinical Teamwork Scale (CTS). SETTING: Australian university. PARTICIPANTS: 40 final year midwifery students were invited to participate and 36 agreed to take part in the project. RESULTS: In pre-simulation questionnaires, students reported low levels of confidence in initiating care of an infant requiring resuscitation. Most anticipated that the simulation exercise would be useful to better prepare them respond to a neonatal emergency. Post-simulation questionnaires reported an increase in student confidence, with 30 of 36 students agreeing/ strongly agreeing that their confidence levels had improved. Nonetheless, an unexpected number of students reported a lack of familiarity with the equipment. CONCLUSIONS: The single simulation exercise evaluated in this project resulted in improved student confidence and greater knowledge and skills in neonatal resuscitation. However, deficits in handling emergency equipment, and in understanding the role of the student midwife/midwife in neonatal resuscitation, were also noted. For the future, the development and evaluation of a programme of simulation exercises, over a longer period, is warranted. This approach may reduce stress and better address student learning needs.

Pilates Method for Women's Health: Systematic Review of Randomized Controlled Trials.

OBJECTIVE: To critically analyze the benefits of Pilates on health outcomes in women. DATA SOURCES: CINAHL, MEDLINE, PubMed, Science Direct, SPORTDiscus, Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Trials, and Web of Science. STUDY SELECTION: Databases were searched using the terms Pilates and Pilates Method. Published randomized controlled trials (RCTs) were included if they comprised female participants with a health condition and a health outcome was measured, Pilates needed to be administered, and the article was published in English in a peer-reviewed journal from 1980 to July 2014. DATA EXTRACTION: Two authors independently applied the inclusion criteria to potential studies. Methodological quality was assessed using the PEDro scale. A best-evidence grading system was used to determine the strength of the evidence. DATA SYNTHESIS: Thirteen studies met the inclusion criteria. PEDro scale values ranged from 3 to 7 (mean, 4.5; median, 4.0), indicating a relatively low quality overall. In this sample, Pilates for breast cancer was most often trialed (n=2). The most frequent health outcomes investigated were pain (n=4), quality of life (n=4), and lower extremity endurance (n=2), with mixed results. Emerging evidence was found for reducing pain and improving quality of life and lower extremity endurance. CONCLUSIONS: There is a paucity of evidence on Pilates for improving women's health during pregnancy or for conditions including breast cancer, obesity, or low back pain. Further high-quality RCTs are warranted to determine the effectiveness of Pilates for improving women's health outcomes.

Final year students' experiences of the Bachelor of Midwifery course.

AIM: : the aim of the study was to explore the experiences of final year Bachelor of Midwifery students. BACKGROUND: earlier research indicates that midwifery students experience a number of difficulties and concerns during their studentship. These difficulties can lead to a lack of confidence and poorer integration and socialisation into the profession. Ultimately, poorer integration may lead to dissatisfaction and attrition from the profession. METHODS: a qualitative approach, informed by interpretative phenomenological analysis (IPA), was used in this study. Ten completing Bachelor of Midwifery students participated in in-depth interviews and reflected on their experiences over their three year course. Data were subjected to IPA analytic steps as proposed by Smith and Osborn (2008). KEY FINDINGS: demographics revealed that participants were generally aged more than 35 years and worked 16 hours or less per week. Most had two or more children and lived with a spouse/partner. Four main themes emerged from the analysis: (1) a challenging start; (2) coming to terms with course requirements; (3) developing strategies; and (4) overall satisfaction with the course. Participants generally considered that their individual strengths and determination helped them to negotiate the many challenges they encountered during the course. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this study indicates that students undergo a process of adjustment as they travel through the Bachelor of Midwifery course. The most critical transition phase appears to occur in the first year and students may require additional supports to assist their socialisation into both the university and their course. Particular needs identified include return to study skills for mature-aged students and counselling and support group needs generally. The provision of such supports may assist with the retention of students within the course and may contribute to overall student satisfaction.