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Bed Rest

"I would encourage women with HG to be upright rather than flat when resting and to get on their feet as much as possible. Some weight bearing on their bones and muscles is good so their muscles don't get weak (i.e. atrophied). This means walking around the room or standing with weight on their feet for at least five minutes once an hour or every two hours for 10 minutes... While these women may find resting helpful, in order to prevent muscle weakness and weight loss, it would be wise to walk around the room as suggested above."

Judith A. Maloni, PhD, RN, FAAN;
Associate Professor at the Bolton School of Nursing
Case Western Reserve University, Cleveland Ohio.

Having hyperemesis typically means at least a few weeks of laying down for much if not all of the day. For some women, it can last months, especially if effective medications are not given in sufficient doses. Few understand the incredible impact extended bed rest can have on a woman psychologically and physiologically. The research on adverse affects is limited for pregnant women, and even less for women with hyperemesis. Thus, many health care professionals are not aware of the debilitating effects, especially when a mother is also suffering from the misery of nausea and vomiting. Not only do these mothers become depressed and lethargic, but they quickly lose muscle mass and body weight which can deplete their energy and result in significant pain. This can complicate the course of HG and may worsen her symptoms. It is unknown if this will make her delivery experience more difficult, but it may make it more uncomfortable. She may also have a prolonged recovery and require more assistance with child care and home responsibilities for several months. The adverse effects on the mother are related to the duration and severity of her illness.

Some women receive physical therapy (PT) during pregnancy and derive some benefit. Others receive no therapy during or after pregnancy and struggle with chronic pain and discomfort for months that could potentially be lessened or eliminated. At a minimum, the mother should be taught simple exercises to maintain muscle tone and flexibility as much as possible. Ideally, she would receive a PT consult on her first admission for rehydration or when weight loss exceeds 5-10% of her pre-pregnancy weight, and then be reassessed with each admission, including delivery if her symptoms are prolonged. This would potentially lessen the impact of her being inactive.

How You Can Help Her

To help these mothers, it is best that you give her permission to rest as much as possible. In the early months, some women find that sitting up or standing can provoke relentless vomiting. This may last for a few weeks or even several months, leaving her exhausted and depressed. Help her by making sure she is getting the best care possible by educating yourself on hyperemesis and her treatment options. If she is not improving, take her to a different health care professional. She may be too sick to make these decisions for herself. (Find a new healthcare professional in our Referral Network)

Every effort to eliminate triggers of her vomiting and nausea is critical to her physical and emotional health. If she has children at home that she is unable to care for, it is very important that she have help. It is likely that she will be unable to help with house work and other responsibilities for some time. She may feel guilty and stressed and need reassurance, understanding and help from those around her. It may take time for her to recover and rebuild her energy and muscle strength. Assistance with stretching exercises may also be helpful, especially when she is weak or later in pregnancy when her joints are looser. Weeks of being inactive put her at risk for injury if she is not careful. Give her as much support as she requires and know that this is temporary and she will likely be forever grateful for your presence during this very stressful and potentially traumatic time.

 

Offsite Research:

Antepartum bed rest: effect upon the family.
Maloni JA, Brezinski-Tomasi JE, Johnson LA.
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106-4904, USA. (e-mail: jam44@po.cwru.edu)
Journal of Obstetric, Gynecology & Neonatal Nursing 2001 Mar-Apr;30(2):165-73.

Families experienced difficulty assuming maternal responsibilities, anxiety about maternal-fetal outcomes, and adverse emotional effects on the children. Child care was managed by various people across time. Child care problems included negative reactions from the children, concern about the quality of the provider, and maternal worry about care. Families also experienced financial difficulties, the majority of which were not compensated by insurance or work benefits. Almost all, 96.6%, families received some type of support during bed rest. Instrumental support was the most commonly received; however, emotional support was considered the most helpful. The least helpful type of support was that which was unreliable. The primary providers of support to the family were parents and family, followed by friends. The women reported that health care providers offered minimal support to the family.
 

Bed rest from the perspective of the high-risk pregnant woman.
Gupton A, Heaman M, Ashcroft T.
Faculty of Nursing, University of Manitoba, Winnipeg, Canada.
Journal of Obstetric, Gynecology & Neonatal Nursing 1997 Jul-Aug;26(4):423-30.

Stressors were grouped into situational (sick role, lack of control, uncertainty, concerns regarding fetus's well-being, and being tired of waiting), environmental (feeling like a prisoner, being bored, and having a sense of missing out), and family (role reversal and worry about older children) categories. Two main mediators of stress were social support and coping. Families, friends, and professionals were perceived as sources of support. Women used coping strategies, such as keeping a positive attitude, taking it 1 day at a time, doing it for the baby, getting used to it, setting goals, and keeping busy. Manifestations of stress were evidenced by adverse physical symptoms, emotional reactions, and altered social relationships.
 

Perceptions of bed rest by women with high-risk pregnancies: A comparison between home and hospital.
Heaman M, Gupton A.
Winnipeg Community and Long-Term Care Authority, University of Manitoba, Canada.
Birth 1998 Dec;25(4):252-8.

Bed rest had a significant emotional and social impact on pregnant women and their families in both settings. Overall, bed rest in hospital seemed to be associated with more sources of stress than at home. In hospital, women had to cope with separation from home and family, lack of privacy, hospital discomforts, and incompatible roommates, whereas women at home struggled with role reversal and the temptation to do more activity than was recommended. Stressors not unique to but exacerbated by hospitalization included concerns about the children, a sense of missing out, a sense of confinement and being a prisoner, boredom, feelings of depression and loneliness, and negative impact on the relationship with their partner.
 

Fathers' experience of their partners' antepartum bed rest.
Maloni JA, Ponder MB.
University of Wisconsin-Madison, School of Nursing 53792-2455, USA.
Image the Journal of Nursing Scholarship 1997;29(2):183-8.

Major problems for fathers were assuming multiple roles, managing emotional responses, and caring for their partner. The major paternal worry was for the health of mate and fetus. Coping strategies included using tangible assistance; altering cognitive, behavioral, and emotional responses; and verbalizing worries. Fathers reported receiving little assistance from health care providers. CONCLUSIONS: Fathers experience extreme stress when pregnancy bed rest is prescribed for a mate. Family-centered care should include care of the partner whose mate is at high-risk. Interventions that reduce paternal worry and provide emotional and tangible support are needed.
 

Home care of the high-risk pregnant woman requiring bed rest.
Maloni JA.
University of Wisconsin-Madison, School of Nursing 53792.
Journal of Obstetric, Gynecology & Neonatal Nursing 1994 Oct;23(8):696-706.

Bed rest therapy has various physiologic and psychosocial side effects that generally are not recognized or treated.
 

Impact of maternal activity restriction for preterm labor on the expectant father.
May KA.
Nursing Science Program, Vanderbilt University, Nashville, TN 37240.
Journal of Obstetric, Gynecology & Neonatal Nursing 1994 Mar-Apr;23(3):246-51.

Fathers reported high levels of worrying immediately after diagnosis of their partners' preterm labor and initiation of activity restriction. Later, fathers also reported distress related to responsibility for child care, household management, and maintaining a supportive environment for their partners. Fathers reported few sources of personal support and little or no contact with health professionals during their partners' activity restriction.
 

Physical and psychosocial side effects of antepartum hospital bed rest.
Maloni JA, Chance B, Zhang C, Cohen AW, Betts D, Gange SJ.
School of Nursing, University of Wisconsin, Madison.
Nursing Research 1993 Jul-Aug;42(4):197-203.

Women on complete bed rest (n = 10) had greater gastrocnemius muscle dysfunction, weight loss, and dysphoria than women on partial bed rest (n = 7) or no bed rest (n = 18). Separation from family was the greatest hospital stressor. Postpartum recovery from the side effects of bed rest was prolonged and included symptoms of muscular and cardiovascular deconditioning. The severity of side effects appeared to be directly related to the degree of severity restriction.
 

Updated on: Oct. 29, 2016

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