contractions
“O” or Oh no! The effect of bed rest on an intimate relationship
February 4th, 2010During pregnancy intercourse, and more particularly orgasm, can be the most intense a woman has ever experienced. Because of the increase in blood supply during pregnancy, a woman’s perineum and sexual organs are all engorged (filled to the brim) with blood and this engorgement results in heightened sensitivity. Many women report that some of the best sex they’ve ever had was while they were pregnant. And while many may worry about the effects on the growing baby, you’ll be happy to know that an orgasm does not at all harm the baby. Even though the uterus contracts, the growing baby is so well insulated in the amniotic fluid and the strong, muscular uterus they experience mama’s orgasm as a soft ripple in the waters.
Pregnancy can also have a negative effect on a woman’s sexuality. Many women lose all interest in sexual intercourse while pregnant due to hormone fluctuations causing a significant drop in libido. Lack of desire can also be due to the usual aches and pains of pregnancy, fatigue, nausea, the additional weight and change in body configuration leaving many women less than in the mood.
No one can predict how a woman will feel sexually while she is pregnant. Some women who enjoy robust sex lives prior to pregnancy lose all interest once they become pregnant. Likewise, more reserved women may begin initiating sexual intercourse during pregnancy. Even from pregnancy to pregnancy women report variations in their sexual libidos. They may be insatiable during one pregnancy and completely uninterested during the next.
But what about bed rest? Can women on prescribed bed rest engage in sexual intercourse? Unfortunately, most women on prescribed bed rest are advised against engaging in sexual intercourse. Since an orgasm results in rhythmic contractions of the pelvic organs, a woman at risk of preterm labor absolutely must avoid such activity. Even without the added pregnancy intensity, anything that can cause uterine contractions and lead to preterm labor must be avoided. Some indications for bed rest may allow for some sexual activity. Gestational diabetes and hypertension (but not pre-eclampsia) for example, may require modified bed rest yet may allow for (limited?) sexual activity. When a woman is prescribed bed rest, she should ask her obstetrician or midwife specifically what her limitations are when it comes to sexual activity
As we previously established, intimacy is a very important component of an adult relationship. It may seem like a bed rest prescription means the death of intimacy-at least for the duration of the pregnancy. But nothing could be further from the truth! Intimacy is the act of sharing between a couple; spending time enjoying one another, exchanging private thoughts and emotions, engaging in activities that they find mutually enjoyable. This can still happen between a pregnant woman and her partner. Likewise, while intercourse may be prohibited, not all physical contact is taboo. Consider these alternatives:
- a back and shoulder massage
- a foot massage
- brushing each others hair
- deep kissing
Bed rest is not all bad for a relationship. Bed rest may actually usher in a new phase of intimacy for a couple as their efforts to find alternative ways to share intimate moments work to draw them closer.
Bedrest: What’s The Point?
October 23rd, 2009This podcast discusses the rationale for the bed rest prescription, indications for bed rest and new advances in the treatment of high risk pregnancy.
Is Complete Bed Rest Best?
October 16th, 2009Recently someone made the comment that high risk pregnant women should not engage in any sort of physical activity while on prescribed bed rest. I cannot disagree more vehemently! When a pregnant woman is placed on bed rest, not only is she at risk for the usual complications of pregnancy (in addition to the particular risks that landed her on bed rest in the first place!) she then adds an increased risk for deep venous thrombosis (DVT) and embolism, pulmonary complications an muscle atrophy (wasting and loss of strength). This is why I produced Bedrest Fitness, a series of exercises pregnant women can do while on prescribed bed rest.
Numerous research studies have documented that prolonged inactivity is detrimental to health. For this reason, when a person has heart bypass surgery, as soon as they are taken off the ventilator and are breathing on their own, nurses are instructed to get them out of bed and into a chair. This sometimes occurs within in hours of open heart surgery! But the sooner patients sit in an upright position, the sooner they will begin reusing their muscles, taking deep breaths and recovering. The same thing happens for orthopedic patients. Once a hip or knee is replaced, within hours to days, physical therapists begin moving the new joint to aid in healing, range of motion and optimum utilization. Early movemtner lowers the risk of venous blood pooling in the legs , blood clot formation, embolisms (blood clots that dislodge and travel to other areas of the body), pulmonary (lung) collapse, fluid in the lungs and the development of pneumonia. So given these examples (and there are many more such as cancer patients and other surgical patients) doesn’t it seem strange that we tell pregnant women to go sit/lie down for weeks to months at a time???
I am sure that opponents and naysayers will chide me by saying, “Well then YOU take responsibility when a woman loses her baby!” I think that we can all agree that no one wants a pregnant woman to lose her baby (or babies as the the case may be). But I think that it behooves all of us, especially in this era of health care reform, to re-examine how we manage high risk pregnant women and to really ask ourselves, is complete bed rest really best?
In some cases, bed rest really is the answer. If a woman is actively bleeding from her vagina, experiencing contractions indicative of preterm labor or has severe high blood pressure and is at risk of pre-eclampsia then yes, bed rest is indicated and I think that inpatient hospital care is best in these settings. But once the bleeding stops, the contractions stop and her blood pressure is closer to the normal range is it still necessary to completely restrict a woman’s activities? Is it best to send her home without medical supervision? Is it in her and her baby’s best interest for her to remain immobile and inactive?
Researchers are just beginning to look at how high risk pregnant women are managed and are beginning to realize that perhaps restricted activity and modified bed rest are better options. If a woman is able to be up out of bed but sitting with her feet up she can work from home and engage in family activities. But some people still argue this isn’t enough, especially in the case of the incompetent cervix. They argue that the gravitational pull downward requires that a women stay reclined in bed. Again, this may not be the case.
The September 2009 American Journal of Obstetrics and Gynecology published a study, “Prediction of spontaneous preterm birth in asymptomatic twin pregnancies with the use of combined fetal fibronectin (fFn) test and cervical length”. Now first let’s qualify their findings by saying that the mothers in this study were in fact having twins but they were not otherwise high risk, i.e. they didn’t have incompetent cervices. The researchers found that in 155 twin pregnancies examined between 22 and 32 weeks gestation,
- A positive fFN test or a cervical length of <20mm increased the risk of spontaneous preterm birth at <37,<34,<32, <30 and <28 weeks gestation.
- The combination of a positive fFN test result and cervical length <20mm had a significantly higher positive predictive value for delivery at all gestational ages than either test alone.
- A positive fFN test result was a stronger predictor of spontaneous preterm birth than a short cervical length alone.
Although this is one test and on a fairly small, very specific population, we can’t ignore the potential indications. To date many women with multiple pregnancies are placed on bed rest to prolong gestation-regardless if they are having symptoms of preterm labor or other complications. While most mothers of multiples often lower their activity levels later in pregnancy out of necessity, those who wish to remain “restricted” but not “bedridden” may now have a way to determine their risk and potentially avoid bed rest.
Likewise, incompetent cervix is one of the most common reasons women are placed on prescribed bed rest. If a pregnant woman with an incompetent cervix can have a cerclage (sugical stitch placed around the cervix) and if the cervix is not effacing (thinning and shrinking), the fFN test may be used to establish which mothers actually need to be on bed rest because preterm labor is highly probable and which mothers may be able to be on modified bed rest, “house arrest” or simple modified/restricted activity.
Truly more research must be done in this area, but it is exciting to see that people are actually doing work for us high risk mamas. Maybe one day, we’ll be better able to tell who really needs to be on bed rest and who does not.
Mamas on bed rest, if you want to keep moving, try Bedrest Fitness! It’s simple yet effective at helping maintain muscle strength and mobililty. see a clip at www.mamasonbedrest.com.
