Effects of Bed Rest
Having hyperemesis typically means weeks to months of reduced mobility for much if not all of the day. For some women, it can last throughout much of pregnancy, 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 effects is limited in pregnant women, and even less for women with hyperemesis.
Bed rest adversely affects both the mother and baby during pregnancy and delivery, and will often prolong the mother's recovery. Babies may have reduced vestibular development and exhibit signs of Sensory Processing Disorder.
Unfortunately, many health care professionals are not aware of the debilitating effects of bed rest, 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. It also reduces the physical fitness of a mother for delivery and may increase the need for intervention during delivery.
Physical therapy (PT) during pregnancy may reduce the severity of pain and debility and should be considered on her first hospital admission or when weight loss exceeds 5-10%. Periodic reassessment is helpful, especially if HG persists into late pregnancy.
At a minimum, simple isometric exercises should be taught to the mother to maintain some muscle tone and flexibility as tolerated. Early intervention to minimize the nausea and control vomiting can potentially prevent complications such as atrophy and the need for extended bed rest.
Offsite Research
Judith A. Maloni, PhD, RN, FAAN
Professor Emerita, Frances Payne Bolton School of Nursing
Case Western Reserve University, Cleveland Ohio
"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."
How Can I Help Her
Give her permission to rest as much as possible, especially in the first trimester when sitting up or standing can provoke relentless vomiting. Prolonged nausea and vomiting will leave 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 do this for herself. (Find a new healthcare professional in our Referral Network.)
Every effort to eliminate triggers of 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. The stress she feels will increase her cortisol levels, which means the baby will also be exposed to stress hormones which may adversely affect the baby long-term. (Read research)
Further, it may take time for her to recover and rebuild her energy and muscle strength. Assistance with gentle stretching exercises may 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, especially in late pregnancy when her belly is rapidly growing. 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.
