This is podcast discusses the rationale for the bed rest prescription, indications for bed rest and new advances in the treatment of high risk pregnancy. Available as a download only.
Recently a doula had a client who was placed on activity restriction for placenta previa. While aware of the diagnosis, she was unsure what it meant for hear management of her client. Mamas on Bedrest & Beyond was pleased to offer her this information and a few suggestions for management.
Placenta Previa: What is it and how common is it?
Placenta Previa occurs when the placenta develops within the uterus and covers the opening of the cervix. It occurs in about 1/200 pregnancies. If detected in the 1st or 2nd trimester of pregnancy and a patient is asymptomatic (i.e. not bleeding) often nothing is done and mama is carefully monitored. What often happens is that as the uterus grows, the placenta moves up and away from the opening of the cervix. However, if placenta previa is noted later in pregnancy and is accompanied by bleeding and/or contractions, mama is often placed on bed rest (if she is actively bleeding, in the hospital) and she is closely monitored.
Classification of Placenta Previa
Management of Placenta Previa depends on the degree of the previa.
Marginal Placenta Previa. If the previa is marginal, i.e. close to the cervical opening but not actually blocking it, then not much is done (especially if mama is not bleeding). At the time of delivery, the OB will have to determine if a c-section is necessary or if it is safe for mama to deliver vaginally.
Partial Placenta Previa. If the previa is partial, i.e. partially blocking the cervical opening, then mama may be placed on activity restriction or bed rest and watched closely. It is imperative that mama’s activities be limited so that the placenta is not torn resulting in bleeding. If Mama is bleeding, then the OB will try to stabliize the bleeding and then determine if immediate delivery is necessary.
Complete Placenta Previa. If the previa is complete, i.e. completely blocking the cervical opening, mama may be placed on activity restriction or on bed rest. In either case she will be closely monitored. If she begins to bleed, her OB will likely have to do an immediate c-section. However, if mama is not bleeding, the baby is stable and there are no other complications, mama will be monitored and the pregnancy allowed to continue to term. If mama and baby can make it to term and the placenta does not relocate itself away from the cervical opening, then the baby will be delivered via c-section. If mama is bleeding and that bleeding can’t be stopped, mama will be admitted to the hospital, given steroid shots to mature the baby’s lungs if needed (if she is not at term) and then delivered via c-section as soon as she and the baby are stable.
Discussion and Management
It was really nice to see that this doula’s client was placed on activity restriction, sitting with her feet elevated and avoiding any pelvic pressure or anything inserted vaginally, rather than placed on bed rest. Additionally, this woman should avoid sexual activity because an orgasm will cause uterine contractions which could lead to bleeding and/or preterm labor.
As with many of the “indications” for bed rest, bed rest has not been shown to be effective in prolonging pregnancy. In the case of this client, since she is not actively bleeding, and the assumption is that she is not in danger of imminently going into labor where rupture and hemorrhage of the placenta could be deadly for both mama and baby, then by all means restrict her activity. But putting her on bed rest is not likely going to alter the position of the placenta in this case. We also know that prolonged inactivity such as bed rest creates additional problems (physical and emotional) to mamas and often has no bearing on the pregnancy duration.
A caveat to this situation is that if mama is someone who can’t be trusted to limit her activity and would be likely to go into preterm labor, then yes, she may have to go on bed rest (but then again, would she stay put unless hospitalized???).
A doula or other pregnancy support professional will want to keep mama comfortable, but also provide a bit of movement and muscle stimulation to prevent complete deconditioning. Clients we’ve had in this situation have benefited from:
- Regular prenatal massage by a trained prenatal massage therapist to help maintain circulation and to avoid pooling of blood and lymph fluids in the extremities that can result in swelling.
- Careful positioning of mama when seated or reclining to avoid putting pressure on any one area causing pain and or sores.
- Passive and/or light resistance exercises for the upper body and passive exercises of the lower extremities. Examples can be found on the Bedrest Fitness DVD.
Placenta previa can become a medical emergency, but with proper management and support, mama and baby can safely go to term and do just fine. While bed rest may be indicated in many cases, it is not necessary in all cases and has to be determined on an individual basis.
For information on how to do passive/assisted exercise with mamas on bed rest, send an e-mail to firstname.lastname@example.org.