Making the most of bed rest

If you find yourself reading this section chances are that you are at risk of being placed on bed rest with your pregnancy, have been placed on bed rest, or are supporting someone on bed rest.  There are a variety of medical situations that might cause your doctor to recommend bed rest for some portion of your pregnancy. If your medical history, including previous pregnancies, might point to a medical complication, your doctor might recommend bed rest. Even if your medical history is clear and you experience no symptoms, your doctor may require bed rest if the results of a test or procedure indicate a medical complication or if your baby's growth is determined to be poor.

Common pregnancy complications that often result in bed rest include high blood pressure (including pregnancy-induced hypertension, preeclampsia, and eclampsia), vaginal bleeding (including placenta previa and placental abruption), premature rupture of membranes, premature labour, cervical changes (such as incompetent cervix and cervical effacement) and being pregnant with multiples.

Definition: Bed rest is when your medical practitioner recommends you limit your activities, and spend time confined in bed.

Bed rest can be critical to furthering your pregnancy and it is very important to understand exactly what your medical practitioner has prescribed for you. Bed rest comes in a variety of “packages” which include:

Full or Strict Bed Rest

Full bed rest is when your medical practitioner recommends you remain in bed full time, except to use the toilet, and some are allowed to have a brief shower. Your medical practitioner may recommend you complete full bed rest in hospital. This is to ensure you are able to remain in bed, and hospitalisation ensures supports and resources rally around you by way of childcare if you have other children, and that other family/friend/community supports assist with the general running of your household. Hospital bed rest is required if you require medical treatment or monitoring, are attempting to stall labour, or have experienced Pre-term Premature Rupture Of Membrane (PPROM) which is a loss of amniotic fluid and places you and your baby at risk of infection.

Partial or Modified Bed Rest

Partial bed rest usually requires you to finish working, driving and completing household chores (yay!) Partial bed rest allows you some time on your feet during the day to complete essential tasks i.e. making yourself a simple meal, however you should ask your medical practitioner for specifics about the time you are allowed on your feet and the types of activities that are acceptable. Exercise, stair climbing, lengthy trips outside your house are the types of activities which you will likely be asked to avoid. The types of questions you may want to consider asking are:

  • Can I get up to use the bathroom?
  • Can I get up to prepare quick meals or to do light chores?
  • Can I take a bath or shower?
  • What position should I be in while I'm resting?
  • Can I go to work or work from home?
  • Is driving OK?
  • How much walking is safe?
  • How much and what kind of sexual activity is OK?
  • What activities can I do to increase blood circulation safely?

Scheduled Resting

Scheduled resting is when your medical practitioner requests you spend a certain amount of time each day resting, with as minimal interruptions to this rest as possible. It is hoped this type of resting will prevent partial or full bed rest. It may require you to limit your work day and or rest for set hours each day. Ask your medical practitioner to be very specific about the type of rest he/she is prescribing.

The Benefits

It is widely accepted that bed rest can significantly lengthen pregnancy, which is why this age old practice continues today. It is important not to underestimate the benefits of bed rest, and follow the bed rest set out by the medical practitioner. Bed rest can be very challenging as the demands or everyday life tempt you out of bed, but it is important once you have accepted this advice to make the most of this time. Significantly some women who are placed on bed rest in the early stages of pregnancy, are able to lengthen their pregnancies significantly often with the addition of increased monitoring and medical treatment for the identified complication/condition.  Women with pregnancy conditions related to high blood pressure may be placed on bed rest to decrease stress, both physical and emotional, with the hope of lowering their blood pressure. Vaginal bleeding can be aggravated by activity, lifting, or exercise, so bed rest also might be used to reduce bleeding. Women having premature labor and contractions also may be restricted because activity and stress can aggravate these conditions.

The Challenges

The length of time you are on bed rest has a variety of implications, including how long you will experience this change in routine, whether you can remain at work and the subsequent financial impacts this may have, adjustment for other family members and the additional pressure this may place on your partner and other family members. Significantly if you have other children you may be faced with relying on others to provide care to them, and in the case of hospitalisation seeing them for considerably less time as is dictated by hospital visiting hours, and the amount of time they will tolerate visiting you in hospital. It is important to remember during these stressful times full of changes in routine and adjustment to the roles within the family that it is not forever, an end is in sight (hopefully as you reach full term in your pregnancy).

Children

Children will respond to your reduced lack of activity in a variety of ways depending on “package” of bed rest and their age and stage of development. Chances are these changes may happen all of a sudden and give you very little time to assist with their adjustment to the new routine and roles within the family. Try to explain the situation to them in a way they understand if you can. It is not uncommon with small children to see changes in their behavior including becoming quiet and perhaps a little withdrawn, tantrums, refusal to move through their routine, mimicking your symptoms ie they have a sore tummy too.  Some children may regress in their behavior e.g. toilet training may stall or regress.

There are a number of strategies you can put in place to assist, particularly small children who don’t understand what is happening and don’t understand the situation is time limited. These strategies include giving them a consistent new routine and care givers, seeing Mum everyday if possible in hospital, finding the activities that can be done together with Mum on the bed e.g. reading books, playing with favourite toys, watching favourite shows together. It is important to be patient and tolerant during this time because smaller children don’t have the ability to understand why such sudden changes have occurred in the family or that they are time limited. It’s important to reassure them that Mum is ok, that she just needs lots of “rest”. Many parents avoid linking the baby to bed rest, as some small children may then feel resentful towards the new baby when he/she arrives.

Coping with Bed Rest

Making the adjustment to the bed rest you have been prescribed can require some quick planning and drawing in extra supports to make this time manageable. The types of supports and resources you may want to consider are:

Supports and Resources

  • Family/Friends – identifying anyone who may be able to assist with meeting the household needs including house work, child care, meal preparation and shopping etc.
  • Community Supports – Organisations such as Miracle Babies Foundation can provide practical and emotional support through the Nurtureline (national 24 hour family helpline) and NurtureTime (in hospital parent to parent support). Other organisations such as local Childcare providers, Nanny agencies or on-line sites, and before and after school care may assist in filling in gaps in care for your children. You may be eligible for Centrelink benefits depending on your circumstances, contact your local Centrelink office to enquire.
  • On-line support – a number of on-line support organisations and information are  for parents which can provide practical information and emotional support as you connect with those on a similar journey to your own.
  • Hospital supports- for those on hospital bed rest you may be able to access support from hospital Social Workers, Psychologists, Chaplaincy, and the day to day care from midwives (who are often great listeners) cannot be underestimated. Ask your medical team or midwife to refer you for support. Hospital Social Workers can provide emotional support as well as practical assistance accessing childcare, benefits with Centrelink and financial aid.
  • Maternity Leave Benefits – check with your employer what your entitlements are. Some employers will start paying maternity leave a set time before the baby is expected to be delivered (not the due date, but expected delivery date).

Routine

Creating a daily and weekly routine on bed rest can assist in making the days more manageable. Whilst it may seem strange to consider initially, having a routine and some sense of control, in what is otherwise a situation outside of your control can really provide comfort and peace of mind. Your daily routine may consist of a plan for meal times, shopping online (yes ladies retail therapy can still prevail, especially if you do not have some of those much needed baby items), reading, contacting friends and family by phone or social media, a shower (if allowed), watching TV, having visitors and writing in a journal.

Emotional Impact

Bed rest whilst aiming to reduce stress, can sometimes cause emotional stress depending on the “package” or rest you have been recommended. Being anxious about yours and your baby’s health, changes to your role in the family, finishing work before you planned, spending time in hospital, coping with boredom and lots of “thinking time” are normal and can be difficult. It’s important to identify and access your support network during this time. Don’t be afraid to ask for help. Don’t be afraid to ask LOTS of questions of your medical practitioner, nursing staff and community supports as the more information you have the less stress you will likely experience. Your imagination may be “creative” during this time so it’s important to check your concerns. It’s also helpful to create a plan for managing the bed rest time as soon as possible, as well as establishing your routine.

It is not uncommon to experience some grief during this time as your pregnancy as not progressed as you expected it would. Loss of a chance at a “normal” pregnancy, parenting small children, intimacy with your partner, getting those maternity photo’s done, being unable to attend important events, and the sense that life is out of your control are all normal senses of loss. It’s important to talk to your loved ones or professionals about these feelings. Sometimes the act of talking about them is therapeutic, however is these thoughts linger or become consuming it’s important to access professional support. If you are in hospital you can ask to speak to a Social Worker or Psychologist. If you are at home you can contact help lines such as Miracle Babies Nurtureline 1300 622 24324 or Lifeline 13 11 14

Catch Up

Bed rest is an excellent opportunity for:

  • Reading parenting books
  • Starting a journal
  • Medical preparations
  • Exploring childcare options
  • Researching baby names
  • Having friends visit if you feel well enough
  • Reading those books you haven’t found time to
  • Shopping online for the baby
  • Write thank you cards if you have had a baby shower
  • Identifying a Paediatrician if you don’t have one
  • Asking to speak with a Neonatologist about prematurity if there is a chance your baby may spend time in the Neonatal Intensive Care Unit (NICU).
  • Identifying local mothers groups /  play groups you might like to attend

Your Body and Recovery

Spending less time on your feet is going to have some impacts on your body you may not have thought of. It is very common to decondition and experience muscle wasting with the lack of activity. Therefore it is very important to be gentle and patient with your body once you are back on your feet and off bed rest. Simple tasks you would have completed without thinking about it, can now feel tiring. There are many groups in the community for new Mum’s who provide gentle exercise classes with a focus on reconditioning, also your local hospital may provide these classes. Your hospital may have a Physiotherapist who can assist you with a plan to recondition, and may provide you with aids to assist in your recovery e.g. compression wear to assist your stomach muscles to go back to where they came from! You are at greater risk of Deep Vein Thrombosis with reduced activity, your medical practitioner may request you wear compression stockings and use blood thinning medication to prevent these.

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