comfort

Mamas on Bedrest: To end the bedrest debate, we need more healthy mamas!

September 22nd, 2015

Greetings Mamas!!

The bedrest debate continues as more and more studies are advocating treatment of the causes of bedrest in lieu of activity restriction. However, there are those that are convinced that bedrest is an effective treatment for preterm labor and prolongs pregnancy. Let’s take a look at the evidence.

For over 25 years, Judith Maloni, RN, PhD researched bedrest and found that the practice has no apparent benefit and has been shown to be harmful to pregnant women. Her publication, “AntepartumBed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth”(1), Maloni denounced the bedrest prescription because there was no evidence to support the practice.

In 2007. NASA released an article which showed that female astronauts in space lost bone mass and muscle mass and strength in as little as 2 weeks of inactivity, and the effects were even more pronounced at 60 days.(2) They recommended that if women do have to be on limited activity for an extended period of time, they should engage in a modified exercise program to maintain bone and muscle integrity.

The World Health Organization and Amnesty International have both denounced the bed rest prescription and have had sharp criticism of the United States-which boasts the highest costs of maternity care than any other country in the world, yet has some of the highest rates of complications, bed rest, interventions, cesarean sections and maternal and infant morbidity and mortality-to rethink their maternity care practices and to bring their maternity statistics in line with the rest of the world.

In 2013, physicians in the American Congress of Obstetricians and Gynecologists began questioning the practice of prescribed bedrest and Christina McCall, MD (3) and Joseph Biggio, Jr., MD (4) both called on their ACOG colleagues to stop the practice of bedrest citing the harm that is poses to pregnant women.

However, bedrest remains a mainstay in obstetrical practice. Here in Austin, the 2 major hospital systems each have large antepartum units which cater to women experiencing pregnancy complications. My colleague Angela Davids, founder of Keepemcookin.com, recently blogged about an article by Drs. Christine Piette Durrance and Melanie Guldi (5) in which the authors concluded after an extensive review of PRAMS (Pregnancy Risk Assessment Monitoring System) data of some 200,000 women, that limited inactivity does reduce preterm birth before 33 weeks by 7.7% and low birth weight infants (weighing less that 1500 grams) by 15.4%.

So what are mamas to think? Should they abandon bedrest? Remain on bedrest? Is there a way to not have to go on bedrest, to not encounter the complications that lead to the bedrest prescription?

At this juncture if you are a mama on bedrest, I WOULD NOT recommend abandoning the care plan that your provider has put into place for you. If you have questions about whether or not bedrest is necessary in your case, speak with your provider and voice your concerns. I am a firm believer that if you have hired (chosen) a provider for services, then you should follow their directions. Now if you are having reservations about being on bed rest, its efficacy and whether or not it is doing harm to you, you must have a candid conversation with your OB and get your questions answered so that you can make an informed decision.

I myself am a proponent of mamas getting off bedrest. I believe the way to do it is to help women to be in the best shape BEFORE they ever think about getting pregnant so that when they are pregnant they are strong and healthy. Many of you reading this may be saying, “Well fat lot of good that does me now!” I sense your frustration. There is nothing we mamas on bedrest do better than second guess ourselves! But what you did in the past (no matter how recent) is of no consequence. As Dr. Maya Angelou eloquently said, “When you know better, you do better.” You know better right now, so begin taking exquisite care of yourself right now! As much as possible,

  • Eat healthy, nutrient dense foods.
  • Drink lots of water (1/2 your current body weight but in ounces).
  • Rest (I know that sounds ridiculous, but many mamas on bedrest are so stressed out they don’t sleep well and don’t rest. Your body is not only maintaining you, it is also growing another fully complete human being. That most certainly deserves a nap!
  • Do stretches t keep your muscles supple and limber. (BedrestFitness!)
  • Keep your spirits up

I don’t know what is to become of bedrest and the bedrest prescription. I do know for the nearly 1 million women who will experience bedrest, you have to take care of yourself. If you are in the Austin, TX area, look me up! I always enjoy mixing with mamas and would be happy to serve you.

How are you surviving bedrest? Share your tips and comments section below.

 

References

Judith Maloni, Ph.D.  AntepartumBed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth (Biological Research for Nursing 12(2) 106-124)

Mark Ransford. NASA-Funded Study finds Exercise Could Help Women on Bedrest November 15, 2007

Christina McCall, MD, “Therapeutic” Bed Rest in Pregnancy, Unethical and Unsupported by Data”, vol 121, No.6 June 2013, 1305-1308

Joseph Biggio, Jr., MD.“Bed Rest in Pregnancy, Time to Put the Issue to Rest!” vol 121 No. 6, June 2013, 1158-1160

Christine Piette Durrance and Melanie Guldi. Maternal Bedrest and Infant Health.

Mamas on Bedrest: Will it Ever End??

March 2nd, 2015
Photo of Tommy's Winter Deck

The view of my cousin’s deck.

This winter has definitely been one for the books. Each time that I call my parents who live just outside of Boston, there is a similar refrain, “Will it ever end??”

Sound familiar?

Much of the United States has had a record breaking winter either because of freezing temperatures or because of record snow fall. Just when folks think they have seen the last, the mercury drops another few degrees or another 8-12 inches of snow falls.

When I speak with folks back home all they say is “Will this ever end? Will I ever be able to freely walk out of my home? Will the roads ever clear so that more than one care can pass at a time? When will life get back to “normal”?

Sound Familiar??

Bedrest is like a long, cold, winter. It’s here and you really can’t do a thing about it, yet on the grand scheme of things, it’s really not that long at all! Think of it this way. If you and your baby each live to be 80 years old in your respective lives, out of that cumulative 160 years of living, bedrest will account for no more than about 20 weeks. Now I know that 20 weeks is a long time, especially when you are on bed rest, but when placed beside 80 or even 160 years, it’s but a blip in time. Perspective is everything!

Bedrest, like winter isn’t immediately going away, so what can you do to make it more comfortable?

1. Extra Comfort in Bed. I highly recommend a body pillow if you don’t already have one. I also recommend one of those cylinder pillows for under your knees/calves. These pillows properly positioned will provide your spine and hips with support to alleviate pressure and avoid bed sores and body aches.

2. Good Food. By this I don’t only mean tasty food, but nutritious food. It is soo easy to reach for candy and cookies and other snacks when you are “laying around doing nothing” (hardly). But pregnancy and Bedrest both actually alter your metabolism and you don’t want to overload your system. Pregnancy slows digestion so that your body can remove the maximum nutrients from foods for you and the baby. This often results in feeling bloated and sometimes constipation.

In terms of your overall metabolism, because you are not moving about, your cardiac (amount of blood your heart is pumping) output changes and you may note swelling in your hands and feet because the heart is not circulating your blood as efficiently as if you were moving about. So to offset these and other changes, it’s really important that you drink a lot of water to stay hydrated and to keep your body systems moving (especially heart and kidneys) and eat nutrient dense-but not calorically dense-foods. Lean cuts of meat, lots of fresh fruits and vegetables and whole grains will nourish you and your growing baby.

3. Books, Magazines and Movies. You’ll have lots of time to catch up on your reading, so gather up all those books you’ve been meaning to read and have at it! Also, if you have a Kindle, Nook, or other e-reader, you can purchase and even rent e-books to pass the time. (Why not get your copy of “From Mamas to Mamas: The Essential Guide to Surviving Bedrest”? It’s available for immediate download on Amazon.com and has even more tips for Bedrest Success.)

If you are a member of Amazon Prime, you can also download movies, television series and other videos. Some require a small fee, yet many are free. If you don’t like the selection on Amazon.com, There is Netflix and Hulu as well as innumerable music websites.

4. Computer/Tablet. Today there is absolutely no reason to be completely isolated while on bed rest. There are numerous online communities (Join Us, Mamas on Bedrest on Facebook!!) as well as online websites with tools, tips and all the baby gear you could possibly want! Best of all, with a few simple key strokes, you are fully in the mix!

5. Phone A Friend. Your phone will most definitely be your friend and a major means of communication so be sure that it is within easy reach. Yes the internet is probably top contender for communication these days, what with SKYPE and FaceTime and other visual means of communication. However, there is still nothing better than hearing a loving voice on the other end of the line reminding you that you are loved and supported (especially if those folks are like my mom and not on line!).

Funny how the list of things that make for a Better Bedrest are also many of the same things that are making this winter bearable for my New England family! Winter will soon be over and so will Bedrest and come this spring, many of you will sit on your respective porches, decks and balconies, babies in arms, and marvel at the lovely flowers that poked through the once frozen ground. It really is amazing how life goes on!

 

Get even more tips on surviving Bedrest in our e-book guide, “From Mamas to Mamas: The Essential Guide to Surviving Bedrest”

How are you “weathering” Bedrest? What are YOUR essentials? Share in our comments section below

Mamas on Bedrest: Why I’m so thankful I had my 2 high risk pregnancies

November 24th, 2014

Happy Thanksgiving Mamas!

Thanksgiving is upon us and Christmas, Hanukkah, Kwanzaa are not far behind!

I know that many of you will spend these holidays on bed rest and that is a bummer to say the least. I wasn’t on bed rest during the holidays with either of my pregnancies, but was on restricted activity with my son so I do have a bit of an idea of what you are going through.

For me, the more major complications came when I was delivering, especially with my daughter. For those of you who know my story, you know that I bled heavily after I delivered my daughter. (They didn’t write hemorrhage in my chart as technically I didn’t bleed enough to have hemorrhaged. Go figure!) After my daughter was delivered via emergency c-section at 36 weeks and 6 days, she was whisked away to the nursery because she was having trouble breathing and had fluid on her lungs. Meanwhile my uterus was atonic. It wasn’t contracting and was sluggish and spewing blood like a punctured water balloon. Once my daughter was delivered, all hell broke loose in the delivery suite! Staff members started walking briskly hither and yon and there was a steady clang as new instruments were dumped onto the operating tray from their sterile packages. The former chatter that had been going on as my daughter was being delivered ceased. The room became eerily silent and from over the blue veil, I could see the very intent and focused eyes of my doctor as she contemplated what she needed to do and gave orders.

For a while, things didn’t go very well. Every time she tried to stitch up my uterus, blood shot upward like Old Faithful Geyser. As I laid there, I thought, “I can’t believe that after all I went through to have this baby, I may not make it to raise her.”  I had had surgery to remove uterine fibroids prior to becoming pregnant with my daughter because I had had a miscarriage and they thought that the fibroids were the cause. I had taken progesterone prior to that surgery and had blown up like a ballon. But the surgery went well and I was pregnant 3 weeks later.  However, by 6 weeks of pregnancy, I was sick as a dog and could not hold down a thing so I stopped eating. As time went on, I was able to eat about 10 things; applesauce, ginger ale, hot dogs, oatmeal, apples…but as late as 32 weeks, I had only gained 10 lbs. I felt sick the entire 9 months and didn’t get relief until the day after my daughter was born.

The intense nausea wasn’t the only problem. At about 14 weeks, I began spotting. Panic set in as I feared the worse-I was losing another baby. My OB did a thorough check and we never did find out why I was spotting, but it eventually stopped. At about 20 weeks, I started having cramping. I told my OB who said they were Braxton Hicks. This being my first pregnancy, I trusted what she said and kept going. But she did begin to mention bed rest and I knew that this wasn’t a good sign. I talked this over with my then husband who was traveling internationally for work. I also alerted my mother and mother in law to see if they could fly in to help me out. But at subsequent office visits my daugther was quiet so we held off on bed rest (Despite the fact that she seemed to be always looking for the exit!!) I was forbidden from traveling outside of Austin at 28 weeks and just kind of laid around after that. I went into active labor at 36 week 6 days and my daugther was coming fast so I was admitted and she was delivered.

Things went much better for my daughter and I once she was on the outside. I got pregnant 2 years later and lost that pregnancy at 9 weeks. Devastation. I really wanted another baby, but I was 39 and both my OB and husband were thinking I had better quit while I was ahead! After grieving the loss of this pregnancy for 9 months, I made a pact with my husband that whatever was in progress when I turned 4o we’d go with it. And if I was pregnant and lost that child, We’d stop. Well, my son was born healthy and hefty at 7lbs 2 oz at 39 weeks via c-section. I was 40 years and 4 months old when I gave birth to him! While his pregnancy and delivery were much less complicated, I most certainly did not bounce back after having him. In fact, I still felt pretty crappy 3 years after I had him! After checking blood work, physical exams and saliva tests, I was diagnosed with hypothyroidism-finally. Once my thyroid hormone was replaced, I felt much better. I never really returned to my pre-pregnancy state and have been since diagnosed with perimenopause. I have since settled into this “new normal”.

So why am I telling you all of this? Because these pregnancies changed me. They changed my outlook on life as a clinician and as a woman. I was a physician assistant prior to getting married and having babies and my entire demeanor had been detatched and matter of fact. It’s how I had been trained. “Don’t get too emotionally attached to your patients,” I was told by attending physician after attending physician at Duke University Medical Center where I did my PA training. Oh how this changed as I lay on the table, watching my own blood spew upwards! I had been trained to use words and phrases like, “You’ll experience some discomfort after the c-section.” Discomfort my a–! I was in major pain! And as for “being a bit emotional” from the hormones-I was a raging BITCH! I vaccerated between fear and panic and intense melancholy. Looking back, I probably had antepartum depression with my daughter and I definitely had post partum depression after I miscarried between pregnancies. Neither was diagnosed and quite frankly, no one ever asked me how I was doing emotionally. Looking back I am amazed that I came through those years as “sane” as I am (sic). But after each pregnancy, I vowed that no other woman would have to go through what I was going through-and at the very least, she wouldn’t have to do it alone as I did.

I am thankful for my pregnancy experiences. I don’t know if I would have been as thankful a mom if I had breezed through pregnancy. I was on a mission to “get it done”, and pregnancy and childbearing are so much more that checking something off a “to do” list. Arrogantly, I had seen women labor and struggle through pregnancy and often thought, “Geez, she’s making such a big deal out of something so natural!” Oh Yeah, the arrogance of ignorance!!! It’s so easy to be caviler when you’re not the one on the table doing the work! And it’s because I did lay on the table and truly believed that I would die without holding my daughter that I feel so deeply for you all. They tell us not to feel in our medical training, but I just can’t imagine how clinicians are expected to care otherwise? You have to feel to care.

This Thanksgiving, you may not feel so thankful for being on bed rest and that’s okay. But one day down the road, you’ll be able to look back and see the blessing in this time. For me, it’s Mamas on Bedrest & Beyond. I never would have started this service had I not so wanted it for myself when I was “going through”. I am so thankful for all of you mamas who stop by and allow me the great honor of being a little bitty part of your lives in one of the most important times in your lives. I stand with you and I stand for you and I am here because I was once where you are now. Happy Thanksgiving and may you all be richly blessed!

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