Mamas on Bedrest: All stressed out with nowhere to go

April 15th, 2010

Mamas on bed rest are at increased risk of going into preterm labor!

Now any woman on bed rest reading this is probably ready to click off. Why am I stating the obvious? Because the answer to my original statement is not what you think. Women who are prescribed bed rest receive the prescription because they have incompetent cervices, pre-eclampsia, gestational diabetes, vaginal bleeding, placental issues, poor fetal growth or some other obstetrical complication. These complications increase a pregnant woman’s risk of going into preterm labor and increase the health risks to both mother and baby.

But consider this: in addition to being at increased risk of going into preterm labor due to an obstetrical complication, women who are on prescribed bed rest-either in the hospital or at home as an outpatient-have an additional increased risk of going into preterm labor due to being on bed rest. The fact of the matter is despite its intention, being on prescribed bed rest is stressful, and it’s this stress that compounds the risk of going into preterm labor.

The Physiologic Effects of Stress

Kathleen Kendall-Tackett, Ph.D., IBCLC is a health psychologist who studies the effects of chronic stress and depression on health. Her websites and have a combination of evidenced based science linking chronic stress and depression as well as very “people-friendly” information on the ameliorating effects of breastfeeding on depression in new mothers.

In the normal stress response, the brain releases chemicals from the hypothalamic-pituitary axis (HPA) which stimulates the adrenal glands to produce adrenaline for “flight/fight” and cortisol to aid in repair from disease or injury. At the same time, the immune system releases chemicals called cytokines that start a cascade of events designed to slow, halt and reverse  inflammation associated with illness or injury.

According to Kendall-Tackett and her colleagues in this emerging field of psychoneuroimmunology, in people under chronic stress, these usually protective mechanisms go haywire. The normal stress reaction is that the brain perceives danger or stress and sends messages to the adrenal glands and immune system to prepare for defense. Once the stress or danger is removed, the HPA gets the message that there is no longer any danger and stops sending out messages to the adrenal glands and the immune systems. The systems reset themselves and stop producing and secreting the protective hormones and chemicals.

In a person under continuous stress, the HPA continuously sends out “stress” messages. The adrenal glands continuously produce and secrete adrenaline and cortisol in response  and as a result  too much adrenaline and cortisol are produced. A similar response occurs in the immune system. Cytokines are produced and released in excess by the immune system in response to the perceived “threat”. The result is a state of chronic inflammation.

Psychoneuroimmunology and Mamas on Bedrest

So what does all this science mean for Mamas on Bedrest? Well, the normal physiology of pregnancy results in elevated levels of cytokines, the chemicals released by the immune system in response to stress, in the third trimester. Accordingly, women in the third trimester of pregnancy are at increased risk of developing depression. Since cytokines remain elevated into the post partum period, this inflammatory response persists and increases the risk of developing post partum depression.

Women on prescribed bed rest are stressed simply by being placed on prescribed bed rest. Add to that stress the time they may spend worrying about their health, the health of their babies, their families, their jobs, their finances, etc… and you can see that they are under additional stress. Their HPA’s are firing like gangbusters telling the adrenals glands and immune system to prepare for battle. Adrenal hormones are present in excess. Cytokines are produced and put out by the immune system in excess. Hence, a woman on bed rest who is stressed is in a heightened state of inflammation. She’s all stressed out with nowhere to go.

But what does this mean for her pregnancy? Researchers have shown that cytokines act on the cervix causing an inflammatory response. This inflammation causes cervical “ripening”, i.e. the cervix to shorten and thin and prepare for delivery of the baby. Hormones secreted from the adrenal glands trigger partuition. If this inflammatory response occurs before 37 weeks of pregnancy, in addition to be at risk for preterm labor due to obstetrical complications, mama is also at risk of preterm labor due to the stress response on her cervix. If she’s already on bed rest for an incompetent cervix this is a “double whammy.” But in combination with other known obstetrical complications, this can become a very serious problem.

But there is good news

When women on bed rest are able to keep their stress levels low, they are able to reduce their inflammatory responses and lower their risks of preterm labor. The psychoneuroimmunologists have also found that DHA, an Omega 3 fatty acid found in fish oils helps lower the inflammatory response. While no one is telling mamas on bed rest to go out and to start taking fish oil (you have to be very careful with supplements during pregnancy. Always consult with your OB or midwife and/or a nutritionist prior to taking any supplements during pregnancy!) this information relates directly to our discussion on eating a healthy, well balanced, whole foods diet.

There is so much more to this story and we will continue the discussion in the subsequent post.

Please share your thoughts on this blog post in the comments section below. Also, please share this vital information with friends and loved ones.

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