Bed rest during pregnancy: implications for nursing.

Research on nonpregnant individuals reveals that bed rest produces numerous adverse physical and psychosocial effects. Evidence shows that bed rest affects pregnant women in the same manner. This article provides an overview of the history of bed rest, research on the side effects of bed rest, and a discussion of the research that has been conducted on these side effects during pregnancy. Also discussed are implications for providing antepartum, intrapartum, and postpartum nursing care.

Home care of the high-risk pregnant woman requiring bed rest.

Home-care treatment of the high-risk pregnant woman often includes bed rest. Bed rest therapy has various physiologic and psychosocial side effects that generally are not recognized or treated. This article provides suggestions for providing comprehensive nursing antepartum and postpartum care of the pregnant woman requiring home bed rest and her family. Resources available to assist in this care are detailed.

Nurse advocacy for selective versus routine episiotomy.

Although episiotomy is one of the most commonly performed surgeries, little scientific support exists for this procedure. Furthermore, the suggested advantages of routine episiotomy are challenged easily and the surgery is not without risks. Adverse effects arising from episiotomy include an increased incidence of severe lacerations, blood loss, pain, delayed healing, dyspareunia, psychologic trauma, and medical cost. Nurses can assist women in avoiding perineal trauma resulting from unnecessary episiotomy through patient education, patient advocacy, and direct care.

Expectant grandparents class.

An expectant grandparents class was initiated in an attempt to bridge the communication gap observed between new parents and grandparents. Rather than focus on "how to grandparent," the goal of the class was to acquaint grandparents with changes in maternity and pediatric practices so that the grandparents might understand the parenting framework from which their daughter or son operated. Thus, tension might be reduced between the generations and support encouraged. More than 200 grandparents attended. A description of class content and grandparent response, which can be used as a guide for establishing classes, is provided.

Antepartum bed rest: effect upon the family.

OBJECTIVE: To identify the effects of antepartum bed rest upon the family. DESIGN: Descriptive, retrospective survey. PARTICIPANTS: A national random selection of 89 women who had been prescribed antepartum bed rest in the hospital or at home and who contacted a high-risk pregnancy support group for information. MAIN OUTCOME MEASURE: An open-ended questionnaire. RESULTS: Families experienced difficulty assuming maternal responsibilities, anxiety about maternalfetal outcomes, and adverse emotional effects on the children. Child care was managed by various people across time. Child care problems included negative reactions from the children, concern about the quality of the provider, and maternal worry about care. Families also experienced financial difficulties, the majority of which were not compensated by insurance or work benefits. Almost all, 96.6%, families received some type of support during bed rest. Instrumental support was the most commonly received; however, emotional support was considered the most helpful. The least helpful type of support was that which was unreliable. The primary providers of support to the family were parents and family, followed by friends. The women reported that health care providers offered minimal support to the family. CONCLUSION: Despite support, antepartum bed rest creates difficulties that affect the entire family and its finances.

Transforming prenatal care: reflections on the past and present with implications for the future.

The current model for delivery of prenatal care was developed more than 100 years ago. Evidence suggests that this model is no longer appropriate for meeting national health objectives or for meeting the needs of a diverse population of pregnant women. This article provides a historical overview of prenatal care; describes the current system for care delivery and problems associated with it; and suggests strategies for transforming care into an effective, comprehensive model.

Antepartum support group for women hospitalized on bed rest.

PURPOSE: To identify the themes of discussion spontaneously voiced during an antepartum support group by high-risk pregnant women who were hospitalized on bed rest. DESIGN: Descriptive and exploratory, using content analysis. METHODS: Support groups were held weekly in a tertiary level hospital in a Midwestern state. The convenience sample consisted of 27 women hospitalized for treatment of either preterm labor, incompetent cervix, placenta previa, premature rupture of membranes, or multiple gestation. The group, which was led by the investigator, was unstructured and nondirective. Process recordings of women's spontaneous verbalizations were made during each of 13 antepartum support group sessions. RESULTS: The women identified seven discussion themes: methods of coping, concerns about family, negative emotions, relationships with caregivers, psychosocial losses associated with bed rest treatment, side effects of medical treatments, and concerns for the safety for self and/or fetal health. CLINICAL IMPLICATIONS: An unstructured support group that provides women on hospital bed rest with an opportunity to talk in a confidential and supportive environment may be an important antepartum nursing intervention in helping them cope.

Bed rest and high-risk pregnancy. Differentiating the effects of diagnosis, setting, and treatment.

Current research on high-risk pregnancy frequently has confounded the effects of diagnosis, setting, and treatment. Studies of pregnancy bed rest have demonstrated a beginning attempt to differentiate the influences of confounding variables and, similar to high-risk studies, have found that depression, anxiety, other disturbing emotions, and separation from family are common side effects. It is likely that some of the effects previously attributed to high-risk pregnancy may be either caused or heightened by activity restriction. This article identifies the major issues to be considered when studying high-risk pregnant women. Furthermore, it suggests that, if activity restriction must be prescribed, the adverse effects of treatment upon both the women and her fetus should be considered in the decision making process.

Preventing intravasation in women undergoing hysteroscopic procedures.

Hysteroscopic procedures, which are an alternative to hysterectomy for surgical treatment of menorrhagia and uterine fibroids, place women at risk for intravasation of uterine distention fluid. Intravasation can produce fluid overload, pulmonary edema, congestive heart failure, and electrolyte imbalances. To examine risk factors for and evaluate nursing interventions to decrease the incidence of intravasation, the researchers compared mean arterial pressures (MAPs) and intrauterine pressures (IUPs) in two groups of women undergoing elective outpatient hysteroscopic procedures. The experimental group consisted of 20 women in whom fluid infusion pump pressures were maintained below the women's MAPs. The control group consisted of 20 women whose fluid infusion pump pressures were set at random. Distention fluid deficits and the total infused distention fluid volume differed significantly between the two groups, supporting the study hypothesis that maintaining equilibrium between women's IUPs and MAPs decreases the risk of uterine distention fluid absorption into the vasculature and fluid overload complications. Perioperative nurses need to monitor women's MAPs before and during hysteroscopic procedures and maintain fluid infusion pump pressures at or below women's MAPs to decrease the potential for intravasation.

The content and sources of maternal knowledge about the infant.

The author's purpose was to explore the knowledge that a primiparous mother acquires during the first 14 days postpartum about caretaking and personal characteristics of the infant. The study also examined the sources of this knowledge. The convenience sample consisted of 33 healthy, married, middle-class women. For caretaking knowledge, on postpartum days 1-6, mothers learned most about feeding, and on days 7-13 about administering daily care. For personal knowledge, on day 1 mothers learned most about infant physical characteristics and on days 2-13 about infant activity. Mothers acquired significantly more personal knowledge about their infant than caretaking knowledge, both daily and across the 2 weeks. Knowledge acquisition was highest during hospitalization. Maternal use of self was the dominant source for learning; however, nurses were the primary source for caretaking knowledge during hospitalization.

Parent support through telephone consultation.

Parents of young children are known to need special support but few communities have made such support widely available. Bright Beginnings Warmline, a free non-medical telephone service in Pittsburgh, Pennsylvania, was established to provide informational and emotional support for caregivers, with emphasis on parents of children from birth to 5 years of age. The goals of the Warmline are to offer callers sensitive, knowledgeable support and to reduce several specific conditions known to be associated with child maltreatment. This paper describes the Warmline, including its history and rationale, goals and methods of operation. An analysis of the calls made to the Warmline by mothers of infants one month of age and younger is also presented.

Fathers' experience of their partners' antepartum bed rest.

PURPOSE: To survey paternal worries, concerns, stresses, or problems and the type of support received by men whose partners were prescribed antepartum bed rest at home, or in the hospital, or both. DESIGN: Descriptive retrospective. A national subsample of 59 men whose mates were on pregnancy bed rest were randomly selected in 1995 from a nonrandom select sample of individuals who had contacted a bed-rest support group for information. METHODS: The Paternal Bed Rest Questionnaire of open-ended questions designed to detail paternal concerns, stresses, and supports was mailed to gathers. RESULTS: Major problems for fathers were assuming multiple roles, managing emotional responses, and caring for their partner. The major paternal worry was for the health of mate and fetus. Coping strategies included using tangible assistance; altering cognitive, behavioral, and emotional responses; and verbalizing worries. Fathers reported receiving little assistance from health care providers. CONCLUSIONS: Fathers experience extreme stress when pregnancy bed rest is prescribed for a mate. Family-centered care should include care of the partner whose mate is at high-risk. Interventions that reduce paternal worry and provide emotional and tangible support are needed.

Early suckling and prolonged breast-feeding.

We determined the duration of breast-feeding for 362 full-term infants of middle- and upper-class mothers. The median duration of breast-feeding was five months for infants whose mothers elected to postpone physical contact (n = 94), four months for infants whose mothers elected early physical contact but later suckling (n = 82), and 8.5 months for infants whose mothers elected to suckle during early contact (n = 186). The rate of decline of breast-feeding was significantly slower for infants who were suckled early than for those who were first suckled later. The association between early suckling and prolonged breast-feeding was not affected by the infant's gender or maternal parity.

Neuromuscular control of childbirth-prepared women during the first stage of labor.

To evaluate the neuromuscular control of Lamaze-prepared women during the first stage of labor and to identify the factors which influenced control, 94 women were studied. The women were categorized into two groups: class-taught and self-taught. A tool was devised to evaluate neuromuscular control. The study revealed that class-taught women exhibited a significantly higher degree of neuromuscular control, more frequent practice patterns, and a greater ability to make goal-directed statements about their labor than the self-taught women. The data also demonstrated an association between practice and control and goal directedness and control.

Prescription of activity restriction to treat high-risk pregnancies.

The purpose of this study was to determine by two groups of physicians the use of pregnancy bed rest, the types of activity restriction prescribed, if there is variability in prescription, and if side effects of this treatment are observed. A national survey of 44 directors of maternal fetal medicine (MFM) and a random selection of 47 practicing obstetricians certified by the American College of Obstetricians and Gynecologists (ACOG) was conducted. The survey contained questions about home and hospital bed rest and whether or not side effects of bed rest were observed. Physicians were also asked to indicate the type/degree of activity restriction prescribed for 16 diagnostic scenarios for women with mild hypertension, chronic hypertension, incompetent cervix, preterm labor, premature rupture of membranes, placenta previa, and twin pregnancy. Repeated measures analysis of variance was used to analyze the type of activity restriction prescribed at 20, 24, 28, 32, and 36 weeks' gestation. Results reveal that bed rest was prescribed extensively (89%-93%), but few any physical and psychologic side effects. Physicians in both groups demonstrated marked variability in prescribing the location (home or hospital) and the severity of activity restriction even when treating the same condition. MFM directors were significantly more likely to treat pregnancy-induced hypertension (p < 0.01) and placenta previa with hospital bed rest (p < 0.05). ACOG physicians preferred to prescribe either home or hospital bed rest across all diagnostic scenarios, whereas the prescription by MFM directors related more to the individual diagnosis than to a general preference. Choice of location of bed rest and the severity of activity restriction appear to be functions of physicians' practice style.

Validation of infant behavior identified by neonatal nurses.

Nurses observe that the behavior of an occasional full-term healthy newborn is "unusual," "different," "funny," or "not like the others." This study was designed to determine whether infants identified by nurses as suspect behaved differently from those identified as normal. Suspect infants scored significantly lower on the Brazelton Neonatal Behavior Assessment Scale than their matched controls. No dysfunction was common across the entire suspect group. Although nurses accurately predicted suspect infant behavior, they did not identify the specific Brazelton dimensions on which infants demonstrated worrisome behavior. The results indicated that nurses are reliable sources of information about infant behavior and can be valuable aids in screening infants in need of further assessment. In addition, the data provided tentative insight into the methods nurses use to make clinical judgments. Finally, the results pointed to the possible limitations of the medical model of infant assessment and demonstrated that nurses' empirical knowledge is amenable to measurement and testing. Additional research is necessary to determine if and under what circumstances infants who behave suspiciously are at risk.