The results have proven that the application of adapted massage, Shiatsu, and stretching programs on postpartum women over the course of the first eight weeks after birth three sessions per week during the first four weeks, and two sessions per week during the following four contributes to the acceleration of the process of returning to normal physical and emotional parameters and to the improvement of their self-esteem, successfully preventing the postnatal depression.
Introduction Once the baby is born, the woman's status is suddenly changed, finding herself facing new challenges and being in the situation where she has to offer marathon training and meniscus tear love and affection to her child, responding to the child's need for dependence. For a successful adaptation to the new situation, the mother needs support and mental balance. Once this sudden change happened, the woman is completely taken in by her role as mother, and does not find the marathon training and meniscus tear, during the postpartum period, for her role as woman, wife, daughter, friend, etc.
Gabr, Mirela Damian, Cristian Popa
For these reasons, "the new mother needs emotional support from her family and husband and from health care specialists, in order for her to be able to go through this period and to be in an optimal state that would allow her to respond appropriately to her own needs and the ones of her child and family" Niţescu,p. The birth of a child represents a total change of the priorities, the child stepping into the forefront of the family life, becoming the mother's main preoccupation.
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If the mother is the only carer for the child, in a short time she will end up feeling exhausted and unsupported. The marathon training and meniscus tear is a period of bonding between mother and child, during which the foundations for their relationship are laid. That is why the mother's mental balance is important, because the child can feel her emotional states and can react accordingly.
This period is characterized by a process of returning to the normal physical and emotional parameters that have changed over the course of the pregnancy. After birth, because of the physical modifications occurred during the pregnancy, the mother's self-esteem is diminished, this contributing considerably to the postnatal depression.
Studies regarding the postpartum rehabilitation proved that "the use of massage in the first postnatal 8 weeks resulted in muscle relaxation, an improvement of blood and lymphatic circulation, stress reduction, pain diminishing, a reduction of adipose tissue, improvement of skin elasticity and hormonal regulation a decrease in the quantity of estrogen and progesterone, and of cortisole, an increase in the quantity of oxytocine, a reduction of dopamine and serotonin, associated with depression, the balance of adrenaline and noradrenaline" Obstrone, Material and methods This research started from the hypothesis stating that the use of massage, of Shiatsu, and of stretching can contribute to the acceleration of the recovery process, returning to the normal mental-physical parameters, including rebuilding the selfesteem and preventing the postpartum depression.
The study comprised 8 postpartum women, aged between 25 and 35, who gave normal births; 4 of them benefited from massage, Shiatsu and stretching sessions, while the other 4 were only tested initially and finally, in order to compare the results.
In order to assess the mental-physical functional status of the postpartum women, the following tests were used, initially and finally: the Vass scale, the Hettinger test, the measurement of the body weight, the calculation of the Body Mass Index, and the Self-esteem Questionnaire ETES - L Echelle Toulousaine d Estime de Soi Mruk,p.
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The postpartum women in the experimental group have benefited in the first 4 weeks of 3 adapted sessions of massage, Shiatsu and stretching per week, and in the following 4 weeks, of 2 sessions per week, each with a duration of approximately minutes.
Results and Discussions In order to present the results, the average scores for the subjects in both groups were calculated, so that a comparison can be possible. The progress of lumbar pain in the subjects from the two groups In the experimental group subjects, the lumbar pain diminished close to zero, while in the control group subjects, at the end of the 8 weeks, the pain was still present Fig. Without benefiting from massage, shiatsu and stretching, the control group postpartum women regained their joint mobility, balance and muscle strength less so than the experimental group ones Fig.
The body weight being an indicator that can contribute more to a low selfesteem, when the weight is above the desired limits, had a very good progress in the experimental group postpartum women, who have lost This situation was reflected also in the progress of the Body Mass Index Fig. Progress of the average score recorded for joint mobility and balance Figure 3.
Progress of body weight Figure 5. Progress of Body Mass Index The assessment of the self-esteem was done based on the values in Table 2. The initial self-esteem assessment highlighted the fact that all postpartum women had a low and very low self-esteem. At the end of the experiment, the experimental group subjects had a higher self-esteem for the emotional self and a normal one for the other components Table 3, Fig.
Average scores and standard deviation for self-esteem and its five aspects Mruk,p. Progress of the average score for self-esteem SUBSCALE Initial testing Final testing Average score and assessment - experimental group Average score and assessment - control group Average score and assessment - experimental group Average score and assessment - control group Emotional self 6 low 6.
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Progress of self-esteem in the experimental group subjects Figure 7. Progress of self-esteem in the control group subjects Discussions According to some sources, "approximatively 1 out of 8 women has long term postpartum depression baby blues during the weeks and months after birth" Rovența, Considering the high number of these cases, the authors of this study believe that the improvement of self-esteem and through that the prevention of postpartum depression is a goal that can be reached through the use of massage and complementary techniques.
There are no previous studies referring to the use of massage and complementary techniques for the improvement of self-esteem in new mothers, which is why a comparison between the results of this study and other results is impossible.
Conclusions The use of massage, shiatsu and stretching contributed to the improvement or even curing all disorders that were initially identified during the visual and palpatory examination poor skin elasticity, sensitivity disorders, stretch marks, circulatory disorders, etc. The subjects' range of motion, balance and muscle strength returned to normal parameters due to the effects that massage, shiatsu and stretching had on the functional properties of the muscles.