pre-eclampsia
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.
It’s my pleasure to introduce to you J. Davis Harte!
October 21st, 2009
It’s my pleasure to introduce to you J. Davis Harte. Davis and I are twitter friends and I have come to truly admire her incredible fortitude. Davis is a Type I (Insulin Dependent) Diabetic who keeps impeccable control of her blood sugars. Still, she could not escape pregnancy complications and prescribed bed rest. But not to worry, Davis and her adorable daughter are just fine! Her is Davis’s story.
“I have a passion for both children and designing interior spaces. Therefore my consultancy business, Paradigm Spaces, rightly focuses on the designing of spaces for children!”
Davis is a time management maven. Davis balances advising commercial design projects while finishing her Master’s Degree in Design and the Near Environment at Oregon State University, teaching undergraduate studios and being a new mom.
After living and (mostly) thriving with insulin dependent diabetes (Type 1) for 33 years, it came as no real surprise to Davis and her OB when she began to display signs of pre-eclampsia. At 34 weeks, she was persuaded to start bed rest. However, having already invested 3 years in her graduate program, a medically complicated pregnancy wasn’t about to arrest her progress! During the last few weeks of her data collection, Davis bent the rules slightly of her prescribed modified bed rest by allowing her mom and husband to drive her to the preschool where she was collecting her data. (These were her only outings aside from regular non-stress tests and growth-scans for about a month!) She monitored her blood pressures at home and was checked regularly by her OB for urine protein levels. Meanwhile, her diabetes management could not have been more well-controlled. She had a final A1C (blood glucose average test) of 5.7 – nearly as good as a person without diabetes. Nevertheless, her baby was estimated at 9lbs 12oz at 37 weeks and the pre-eclampsia was progressing, so she and her husband made the decision to start the induction process. Her beautiful daughter Freya was born on September 16th, 2009, weighing 9lbs 12oz and 21.5 inches long. Not a typical preeclampsia size – but Davis has never done anything typically and she couldn’t be more thankful or proud of the healthy outcome for both herself and her daughter.
To learn more about Davis and her incredible journey with Type I Diabetes, visit http://tudiabetes.com/profile/davissimo
Indications for Bed Rest
September 22nd, 2009Each year some 700,000 (about one in five) pregnant women will be prescribed bed rest, either modified activity or complete inactivity and confinement to bed. While bed rest has been a part of obstetrics for years, there is still controversy as to whether or not bed rest actually helps or is effective against any of the conditions for which it is prescribed.
Bed rest is commonly prescribed for women who:
- Have a multiple gestation; twins, triplets or higher order multiples
- Have an “incompetent cervix”; a cervix that begins to open prior to 37 weeks pregnancy endangering the life of the fetus and/or mother
- Preterm labor or a history of preterm labor; labor that begins before 37 weeks gestation
- History of prior miscarriage, still birth (death in utero) or premature birth (prior to 37 weeks gestation)
- intrauterine growth restriction/retardation (impaired growth)
- Placenta Previa; The placenta presenting first at the cervical opening
- Gestational Hypertension; with or without Pre-Eclampsia(toxemia)
- Gestational Diabetes
- Vaginal bleeding
- Too little amniotic fluid (oligoamnios)
While all of these conditions certainly put mama and baby at risk, to date there is no solid evidence that prescribed bed rest is effective at stopping or improving any of these conditions. In fact, studies to date show that prolonged bed rest and inactivity actually cause a worse overall physical condition to pregnant women-even those considered “high risk”. Women on prescribed bed rest may develop muscle weakness, cardiovascular deconditioning, blood clots, fatigue, drops in blood pressure when standing up, backache, bone loss, changes in metabolism, muscle aches, joint pain, difficulty walking (particularly stairs), difficulty concentrating, dizziness, shortness of breath, insomnia, and weight loss.
What has always struck me is the lack of attention to the emotional and psychological effects that prescribed bed rest has on pregnant women. When I have raised this concern to obstetricians their response typically is many of the psychosocial stressors can be dealt with once mother and baby are physically safe. However, studies have shown that maternal stress and anxiety prenatally can result in significant depression (perhaps leading to post partum depression) as well as mood changes a sense of confinement and loss of control. These psychological stressors can have significant impact on the course of the pregnancy and the health of both mother and baby. Additionally prescribed bed rest affects a pregnant woman’s entire family an can lead to child care problems, strained relationships and financial difficulties.
The next several blog posts will examine the common conditions for which bed rest is prescribed and the “proposed” benefit of bed rest on the condition. We’ll also look at what some research is revealing about bed rest in these situations and how many clinicians are rethinking how and when they prescribe bed rest for their patients.
