by Jeri Alper, RN, MSN
We have all had days where the idea of staying in bed under the covers seemed extremely appealing. Unfortunately, for many pregnant women, bed rest during pregnancy is not a luxury, but a medical mandate.
Although bed rest is controversial because the benefits have not been clearly documented in the scientific literature, as many as 20 percent of all pregnant women are confined to a week or more in bed. Preterm labor is the most common condition for which bed rest is prescribed. The rationale for bed rest is that decreasing your activity may help keep your cervix closed, prolong your pregnancy, and increase the likelihood of a healthy baby. Other medical indications are:
- Unexplained bleeding, where bed rest may help to reduce the bleeding.
- High blood pressure, in which rest may actually reduce your blood pressure.
Even though no proof exists, many medical providers believe bed rest is worth the "effort" because it is not harmful. In my opinion, bed rest is not an intervention without side effects. However, armed with knowledge, support, and determination, it is one you can endure.
Bed rest does not mean the same thing for every woman. Variabilities are dependent on each woman, her medical complications, and her healthcare provider. Bed rest may mean 24 hours a day in bed (strict bed rest). Other women may be allowed to get up only to use the bathroom (bed rest with bathroom privileges). For others, limited activity may be prescribed (rest periods in bed with shower privileges, car rides to the doctor, and the ability to make lunch, for example). It is extremely important that you clarify with your healthcare provider your exact activity level. Some specific questions to ask are:
- Can I sit up?
- How long will I be on bed rest?
- Can I use the bathroom or take a shower?
- Can I drive at all or be a passenger?
- Am I able to do any household chores? Which ones?
- Can I eat my meals at the table or at the couch?
- What level of sexual activity is safe?
- Can I work at home?
For a more detailed checklist, contact Sidelines National Support Network (see Resource Organizations at the end of this article).
Bed rest seems like a wonderful concept until it is an edict from which you cannot stray. The novelty of lounging in your PJs with a romance novel fades quickly, and the realities of confinement and isolation begin to set in. Although it sounds like an oxymoron, bed rest can make you exhausted. Inactivity causes you to tire more easily and more often. In addition, you may feel sore and achy from remaining in the same position for an extended period of time. Realize that while you are on bed rest, your emotions will run the gamut from shock to anger and from fear to hopefulness. Although all of these feelings are normal, they can be overwhelming. You may find it helpful to speak with a therapist who specializes in high-risk pregnancies or contact a support group.
Tips to maintain your health and your peace of mind
- Obtain information: Knowledge will help you feel more in control. Find out exactly which activities are allowed and which are not.
- Organize your environment: Items to keep nearby include: telephone and telephone book; tissues; TV and VCR with remote controls; laptop computer; cooler or mini-refrigerator for beverages, snacks, and lunch; books on tape; magazines and catalogues; notebook and pen for questions and to-do lists; and a cassette/CD player.
- Maintain a routine: A schedule will also help you feel more in control. Keep regular times for visits, naps, and activities.
- Pamper yourself: Use body lotion; have a manicure; arrange for your hairdresser to come to your bedside; get a massage (check with your healthcare provider first); purchase pretty pajamas; and wear makeup if you usually do.
- Stay connected: Keeping in touch with others will help you from feeling isolated. Have a friend come over for lunch as often as you feel up to it. Invite friends over who are good listeners and who can bring their own food; write letters; e-mail; write in a journal; and reach out to other moms on bed rest either via telephone or the Internet (see Resources).
- Ask for help: You will need the support of your family and friends to get through this difficult time. Ask someone to fold a load of laundry; bring in the mail; collect take-out menus; drive a child to an after-school activity; go to the library; or run an errand.
- Use delivery services: Many supermarkets, drugstores, and dry cleaners will deliver items. Take advantage of these services.
- Practical Items: The following items will make your life on bed rest somewhat easier: a large wastebasket; wet wipes; cups with lids and flexible straws; an ironing board for a bedside table; a mini-refrigerator; a bathtub chair if you are allowed to shower; an egg-crate mattress; and a mechanical "arm" to reach far away items. In addition, keep a bag packed for unexpected trips to the hospital.
- Reach out to your mate: This is a stressful time for both of you. Partners now have two jobs: maintaining their jobs and taking care of you. Give them a daily hug and a pat on the back; encourage them to take an occasional vacation day from work to ease the stress; spend some daily time alone with your partner; and be creative about bedside romance, (e.g., candlelight dinners, a gentle massage or a picnic dinner).
- Taking care of the children: Most important, reassure your children that you will not be on bed rest forever. Get a large calendar and have them help you mark off each day with an "X." Arrange for weekend play dates at your house when your partner is around; send notes to the teacher and school director about transportation arrangements; prepare a list of telephone contacts and doctor's appointment dates; set up a standard conference call with the teacher to discuss issues and upcoming events; go through your child's schoolbag to check for notes and homework assignments; and schedule time alone with each child to talk about their day, help with homework, and play.
- Explore medical coverage: Call the Human Resources Department at your company. The company's maternity-leave or disability-leave program may cover part or all of your salary while you are on bed rest. Contact your insurance company or HMO to find out what services will be covered while you are on bed rest. Some companies may pay for a home health aide, physical therapist or even a massage therapist. Your healthcare provider may need to write a letter of medical necessity; however, it is worth looking into.
- Keep fit: With your healthcare provider's approval, do some exercises in bed, such as leg lifts, calf stretches, and upper body exercises with light weights. Exercising promotes circulation, keeps your muscles in shape, and may help your mood. You may want to consult a physical therapist or a fitness professional who is certified in exercise during pregnancy.
- Bond with your baby: Although some women are afraid to become too emotionally vested in the baby for fear of a loss, it is important to remember that the majority of women on bed rest deliver healthy babies. Use some of this time to bond with your baby.
Helpful service and support organizations
- Sidelines National Support Network is a nonprofit organization that provides support, education and advocacy to women with high-risk pregnancies. It has community-based chapters throughout the country. All of Sidelines' volunteers are women who have experienced a complicated pregnancy. Call for a referral to a local chapter, and request a patient packet and a copy of Left Sidelines magazine.
- Keep Em Cookin is an educational organization that gives pregnant women the greatest opportunity to prevent preterm birth by providing them with the most current information on high-risk pregnancy and by offering online community support for women on pregnancy bed rest.
- Mothers of Supertwins (MOST). A nonprofit organization devoted to education and resources for families expecting triplets or more.
- Twins Magazine, 800-328-3211. A publication for families of multiple births.
- Triplet Connection. A nonprofit organization providing information and resources to families expecting triplets or more.
- National Organization of Mothers of Twins Clubs (NOMTC), 877-540-2200. A nonprofit nationwide support group for parents of twins and higher multiple-order children.
- March of Dimes Birth Defects Foundation, 914-428-7100. A nonprofit organization dedicated to improving the health of babies by reducing birth defects and infant mortality.
- American College of Obstetricians and Gynecologists (ACOG), 202-638-5577
If you are reading this article because you have a friend or relative on bed rest, here are a few suggestions from the sidelines:
- Bring her some lotion or hand cream (instead of chocolate).
- Call/email her often.
- Send her a card.
- Fluff her pillows.
- Buy her the latest best selling book.
- Bring her a bottle of flavored sparkling water.
- Remind her of the wonderful thing that she is doing!
Being confined to bed during your pregnancy is a difficult assignment. Although you may feel bored and unproductive, please keep in mind that this may ultimately be the most productive, courageous, and fulfilling task you complete. Hang in there!
Jeri Alper is a healthcare consultant specializing in the area of Women's Health. She completed her undergraduate and graduate degrees from the University of Pennsylvania. As a registered nurse and nurse practitioner, Ms. Alper has extensive experience in the field of high risk obstetrics and infertility. In this capacity, Ms. Alper provided education to patients regarding preterm labor and assisted in the management of their high risk pregnancies. Additionally, Ms. Alper was the Administrator of the Mount Sinai Assisted Reproductive Technologies Program for three years.
Copyright © Jeri Alper. Permission to republish retained by Pregnancy.org.