incompetent cervix
What Exercises Can I Do With an Incompetent Cervix?
July 1st, 2010I recently received an-e-mail from a mama who had just gone on bedrest with an incompetent cervix at 30 weeks.”What exercises, if any, can I do with an incompetent cervix,” she asked?
An incompetet cervix is one of the more common reasons pregnant mamas are prescribed bed rest. While the rates of incompetent cervix are thought to be low, no one is exactly sure how many women are affected by incompetent cervices during pregnancy. An incompetent cervix can manifest in one of three ways:
- Opening of the cervical os more than 2.5 cm during the second trimester
- Thinning and shortening of the cervix (effacing) in the second trimester or early third trimester
- Thinning or opening (funneling) of the cervical opening closest to the baby
The treatment for incompetent cervix is cerclage (surgically placing a stitch through the cerix to hold it closed), bed rest, or a combination of the two.
Being prescribed bed rest puts a mama at risk for blood clots in the legs, muscle atophy and overall loss of strength and cardiovascular conditioning. Most women who are prescribed bed rest should also be prescribed-or at least advised about-exercises that they can do to maintain muscle strentgth and tone as well as to reduce the physical effects if prolonged inactivity. However, it has been my experience that many women prescribed bed rest receive little or no instruction on what they can do to exercise their bodies while on bed rest. This is due in part because many obstetricians don’t know what types of exercises are safe for women on prescribed bed rest. A lucky few mamas will have a consultation or two with physical therapists. But the vast majority of mamas who go on prescribed bed rest will receive no exercise instruction. For this reason I produced Bedrest Fitness when I was pregnant during my second pregnancy.Bedrest Fitness is a set of modified prenatal exercises designed specifically for pregnant women on prescribed bed rest.
A mama with an incompetent cervix should avoid any movements or exercises that put pressure on the cervix and many women will be instructed to remain recumbant in bed or on the sofa. But if you think about it, that leaves your arms and legs free to move. Mamas on bed rest with an incompetent cervix should perform a variety of arm and leg exercises daily to maintain steady bloodflow and adequate circulation back to the heart-especially from the legs. Leg exercises should include:
- Leg Ab/Adduction exercises
- Passive double knee raises (provided Mama can do them using an exercise band or towel to draw her knees up and not engage her abdominal muscles. If mama feels any pressure in her lower abdomen, these should be avoided!)
- Point/flex of toes to exercise the calf muscles
- Ankle circles
Upper body exercises should include (using a towel or exercise band):
- Modified flies
- Shoulder extensions with arms extended forward and to the sides
- Upright rows
- Bicep curls
- Triceps extensions (if allowed to sit up)
On Bedrest Fitness I included Cat/Cow stretches. Women with incompetent cervices can
actually do these stretches, but in my experience they often are unable to gauge how much pressure they are putting on their cervices. So unless a physical therapist or fitness professional is present, I don’t recommend that mamas with incompetent cervices perform these exercises.The same is true of the modified crunches.
Bed rest can have a profoundly negative (albeit temporary) effect on a mama’s overall physical condition. Depending on how long she was on bed rest prior to delivery and the restrictions she’d been given, a new mama can find herself unable to hold herself upright or to even hold her newborn. But if she engages in a few very simple but targeted exercises while on bed rest, mama will find that she will be less deconditioned after delivery and recover more quickly.
If you or someone you know has been prescribed bed rest during pregnancy, order a copy of Bedrest Fitness. Even if Mama can’t do all of the exercises, she will preserve muscle strength and tone in the areas she does exercise. Mama can also download a free set of lower body exercises, stretches and Kegels when she signs up for the Mamas on Bedrest e-mail list.
Can “The Secret” Benefit Mamas on Bedrest?
April 20th, 2010“You have the power to have whatever you want!”
This is the message of the movie, The Secret. According to the laws of attraction, everything that we are currently experiencing we have brought into our lives or “attracted” with our thoughts. As someone who works with and for high risk pregnant women on bed rest, I have a bit of a problem with this statement. However if this theory is true, then there is no reason that The Secret and laws of attraction can’t be used by mamas on bed rest to help their situations.
First I want to say that I in no way believe that any woman on bed rest “attracted” her high risk situation. Most high risk pregnant women that I know take excellent care of themselves and their unborn babies. Still complications arose and they were put on bed rest for their health and the health of their babies, to prolong their pregnancies and to avoid preterm labor. Despite the fact that I don’t believe women “attracted” their high risk pregnancies, I do think that high risk mamas on bed rest can employ this law of attraction to help themselves and their babies.
All Stressed out…but somewhere to go!
I want to go back to my last post, All stressed out and nowhere to go. In that post I presented ground breaking research by Dr. Kathleen Kendall-Tackett and her colleagues in the field of pychoneuroimmunology. Dr. Kendall-Tackett and others have been able to show that stress puts women at risk for going into preterm labor. The physical reactions to stress create not only the “fight or flight” response from the adrenals but also an inflammatory response in the immune system. Chemicals released by the immune system produce inflammation in many tissues of the body including the cervix. It’s this inflammation that results in cervical ripening (too soon) and preterm labor.
So how can the law of attraction be applied to high risk pregnancy and preterm labor? According to the “experts” in the film, the law of attraction can be used to promote healing. Using the law of attraction and focusing on having a healthy full term baby a mother would bring that to fruition. This is not a new concept. Hypnosis, meditation, prayer, cognitive behavioral therapy and other autosuggestion types of relaxation and behavior modification are supposed to work in much the same way and many studies show that they are effective. But how do they work?
The Law of Attraction and Psychoneuroimmunology
If we go back to psychoneuroimmunology, we see that when a pregnant women (like anyone else) is stressed her brain sends messages to her adrenal glands to produce adrenal hormones for the “flight or fight” response and cortisol to protect against injury. The brain also sends messages to the immune system to put out chemicals to help reduce inflammation or infection in the event of an injury. This “red alert” system is great at protecting the woman in immediate stress, but if she remains in constant stress, these protective measures go askew and start to have negative effects on her body. One way in particular is by ripening her cervix too soon for delivery.
When the pregnant woman in our example begins to apply the laws of attraction, she begins to hold images of herself growing ever larger with her growing baby inside of her. If her cervix is incompetent, she may begin to envision her cervix being tightly closed and at a length that sustains pregnancy and not one the promotes delivery. She’llpromote calm in her surroundings with comfortable clothes and bedding, a comfortable and supportive set up around her bed and a supportive network of family and friends. She’ll envision herself going into labor ONLY on her due date, and the labor and delivery going well without complications. Finally she should envision herself holding her newborn in her arms, healthy and full term.
Again, I cannot say with absolute certainty that The Secret or the laws of attraction that it advocates is effective or that if high risk pregnant women employ the laws of attraction that they will have full term pregnancies and uncomplicated labors and deliveries. However, hypnosis, cognitive behavioral therapy, meditation, prayer and visualization have been scientifically shown to work with other people in other situations. It stands to reason then that it is certainly better for a mama on bed rest to be calm and to think positive thoughts than to dwell on whatever put her on bed rest and the prospect that she may lose her baby.
So if thinking positive thoughts, envisioning a tight cervix, breathing down high blood pressure or positively planning for the future with a happy and healthy full term baby are all methods of employing The Secret, then Mamas on Bedrest-the secret is out!
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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.
