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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. Currently, I know of no research that supports the use of severe activity restriction (bed rest) for treating HG. 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. Unfortunately, many health care professionals are not aware of the debilitating effects, especially when the woman is also suffering from dehydration and malnutrition. Not only do these women 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 contribute to its severity. The resulting sequelae may affect both the mother and baby during pregnancy, and will often continue to affect the mother postpartum by prolonging recovery.

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 minimized or eliminated. Ideally, a woman would receive a PT consult on her first admission for rehydration or when weight loss exceeds 5-10%, and then be reassessed with each admission, including delivery if HG lasted into late pregnancy. This would potentially lessen the impact of inactivity, provided the prescribed care was realistic and implemented by the mother. At a minimum, simple exercises should be taught to the mother to maintain muscle tone and flexibility as much as possible. Every effort should be made to keep her symptoms as controlled as possible to maximize her mobility and energy levels. Early intervention to minimize the nausea and control vomiting can potentially prevent complications and the need for extended bed rest.

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Offsite Research:

Antepartum bed rest: effect upon the family.
Maloni JA, Brezinski-Tomasi JE, Johnson LA.
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.

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.

An overview of the issues: physiological effects of bed rest and restricted physical activity.
Convertino VA, Bloomfield SA, Greenleaf JE.
Physiology Research Branch, Clinical Sciences Division, Brooks Air Force Base, TX 78235, USA.
Medicine and Science in Sports and Exercise1997 Feb;29(2):187-90.

Reduction of exercise capacity with confinement to bed rest is well recognized. Underlying physiological mechanisms include dramatic reductions in maximal stroke volume, cardiac output, and oxygen uptake. However, bed rest by itself does not appear to contribute to cardiac dysfunction. Increased muscle fatigue is associated with reduced muscle blood flow, red cell volume, capillarization and oxidative enzymes. Loss of muscle mass and bone density may be reflected by reduced muscle strength and higher risk for injury to bones and joints. The resultant deconditioning caused by bed rest can be independent of the primary disease and physically debilitating in patients who attempt to reambulate to normal active living and working. This symposium presents an overview of cardiovascular and musculoskeletal deconditioning associated with reduced physical work capacity following prolonged bed rest and exercise training regimens that have proven successful in ameliorating or reversing these adverse effects.

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.

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.

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. This article provides suggestions for providing comprehensive nursing antepartum and postpartum care of the pregnant woman requiring home bed rest and her family.

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: Mar. 24, 2010