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.
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.
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: firstname.lastname@example.org)
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.
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.
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.