The Bedrest Connection

Being told that you need to stay in bed, even if it is for a short time, can come as a shock. Knowing you may have to stay in bed for weeks or even months can seem impossible.

You need to know

• How to make your stay in bed more manageable
• Getting help from family and friends
• Meet your nutritional needs
• Keep comfortable
• Exercise
• Getting back to being active

Here are some suggestions to help make your stay in bed more manageable.

These things will make your bed more comfortable:

• a foam bolster to lean against while you are lying on your side
• a wedge or pillow chair if you will be allowed to sit up for your meals (These two items are sold at form or upholstery stores.)
• extra pillows - one between your knees, another under your stomach when you are lying on your side
• an egg crate mattress to improve circulation and help prevent bed sores
• a fleece pad

These things will make it easier to stay in bed:

• a bell so you don't have to shout for family members
• a telephone and telephone book
• a water pitcher or thermos
• a picnic cooler for your lunch and snacks
• flexi straws so you can drink lying on your side
• cleansing wipes or a damp washcloth in a plastic bag for personal cleanup
• toiletries - hairbrush, comb, mirror, nailfile, scissors, lotion
• a table or cart next to your bed to hold these items

These items will help you pass the time:

• a TV, remote control and VCR
• a radio or tape recorder
• reading material: daily newspaper, magazines, books, professional journals, catalogues, word puzzle books
• small craft projects: knitting, crocheting, embroidery, needle point
• paper and pens or pencils to write letters and make lists
• a hard writing surface: a bed tray, an "able table" (an adjustable bed table) or a record jacket taped to a pillow
• a desk or appointment calendar

To make the day pass more quickly, organize and structure each day

• Wake up with your family.
• Change clothes, even if it is only a different nightgown.
• Comb your hair, put on makeup (if you usually wear it) and get ready for the day.
• Eat three balanced meals at normal meal times and at least one healthy snack.
• Schedule a variety of activities (phone calls, reading, crafts, TV, office work) and naps. It may be hard to concentrate, so keep activities short. If possible, schedule doctor appointments for the same time each week.
• Keep a journal or diary.

When family and friends call, let them help you. They could:

• bring a meal
• grocery shop
• run errands
• do laundry
• water plants
• take an older child on an outing
• visit with you so your family can have a night away

Getting help from family and friends

You have several sources of people who may be able to help you - your family, friends, neighbors, people you work with and members of your church. Some of these people will "come through" and others may not offer any support at all. You may be surprised and disappointed by who does not offer to help. Who does help you depends on a complex combination of:

• how they feel about your situation.
• the amount of time they have to offer
• their own past experiences.
• the messages you give them.

The only areas you can control are the message you send.

If you have been an independent person up to this point, you may find it difficult to be dependent on others and ask for help.

It is important to remember:

• it is critical to your baby that you stay in bed.
• staying in bed means you will need some help.
• you will not be in bed forever, even though it may feel like you will.
• after your baby is born, you will be able to help someone else.
• you probably won't be able to repay everyone, but helping someone else passes on the good deeds you received.
• most people would like to help, but don't know how.
• people do mean they want to help when they say, "Call me if you need anything".

Things you can ask people to do:

• come and keep you company
• collect samples and brochures so you can shop from home
• do laundry
• grocery shop
• straighten up your house
• take care of your other children
• help wrap Christmas/birthday presents
• run errands to dry cleaners, post office, etc.

Meeting your nutritional needs

It is very important to eat well when you are pregnant. It is especially important while you are on bedrest. This is not a time to diet. You need to gain weight. You need an extra 300 calories a day - about the number of calories in 2 ounces of lean meat, 8 ounces of skim milk and a medium-sized piece of fruit. Avoid empty calorie foods like soft drinks, candy and alcohol.

Be sure to eat a variety of foods each day. You need:

Four - 8 ounce servings of milk
Three - 2 ounce servings of meat
Four - servings of fruits and vegetables
Four - servings of starch and grains

A register dietitian or registered nurse can help you decide which foods to add to your meals and snacks. To help make sure you have balanced meals, begin your day with a good breakfast. Eat it at the same time your family does. You might have them eat in your room with you.

To help avoid heartburn:

• eat slowly.
• eat several small meals rather than one big one.
• avoid spicy, fatty food.
• if you are allowed, remain upright one hour after eating.
• drink between meals rather than during the meal if you feel too full.

To help avoid constipation:

• drink plenty of fluids (8 to 12 glasses a day). It helps to keep a glass of cold water handy. You also might enjoy adding lemon for flavor.
• eat high fiber foods like fresh fruits, fresh vegetables, bran, whole grain breads, cereals and crackers.

Now is the time to let friends and family help you with eating well, for yourself and your baby. They are often looking for a way to help. An entire meal that only needs thawing or reheating is especially helpful. Don't be afraid to let then know your favorite foods, foods you crave or foods you are unable to eat.

Keep comfortable

These positions may be helpful in reducing low back pain and fatigue.

1. Backlying - Precaution: After 25 weeks do not lie flat on your back.

1. Place two or three pillows under your knees (avoid pressure behind the knee) and one pillow under your head.
2. Keep your arms at your side or resting on your abdomen.
3. Place a pillow under one hip and another under your upper back so you are not lying flat on your back.

2. Sidelying

1. Lie on your side with your knees bent.
2. Place one small pillow between your knees and one under your head.
3. a small pillow may be placed under your abdomen for support.

3. Modified SIMMs Position (Great for those who normally sleep on their stomachs)

1. Lie on your side with your knees bent.
2. Place one pillow extending from under your head to the center of your chest - but not under your shoulder.
3. Roll forward, lying so that your upper trunk and low back are being supported with pillows.
4. Your upper leg should roll forward so your knee is resting on a pillow
5. Your upper arm is bent forward and may rest on the surface.
6. Your other arm is placed behind your back.

4. Sitting Posture

1. Sit in a chair with a firm but comfortable back support (a small pillow may be used in the low back to give proper lumbar support.)
2. The armrest should not be too low or too high.
3. The seat should support the full length of your thighs.
4. The chair height should be such that your feet are firmly supported on the floor and your knees are not higher than your hips.
5. Sit erect - keep your head and back over your shoulders.

Exercise

Talk with your doctor before starting any exercises.

Energy conservation and bed mobility

1. To move from side to side: Keep your head on the pillow and roll like a log.

2. To sit from lying:

1. a. Keep your head on the pillow and push the "up" button on your bed to raid the head of the bed, if you are in a hospital bed. If you do not have a hospital bed, go directly to the next step.
2. b. Log roll to one side. Use your arms to push to sit (keeping your back straight) while you swing your legs over the edge of the bed. Reverse to lie back down.

3. To place and remove bedpan: Keep your head on the pillow, bend knees and lift your buttocks up; slide bedpan underneath. Reverse process to remove bedpan. For bedpan use, elevate your head slightly, using the electronic bed control.

Caution: when you exercise or move around in bed, keep your stomach muscles relaxed and do not hold your breath.

Comfort Measures

Certain hormones of pregnancy cause muscle and ligament laxity. Because of this, it is important that you avoid positions that cause overstretching or strain at any of your joints. You can feel these strains in your shoulders, neck, hips, pelvis or stomach. In all of your bed positions, try to keep your spine as straight as possible because twisting or sagging of your spine can cause muscle strain. Keep your major joints supported, using pillows or towel rolls as needed.

Use of Pillow or Towel Rolls

Sidelying is the best position for maximum circulation to the uterus and the baby. In sidelying, a pillow under your stomach, between your knees and behind your back can help you avoid strains, by keeping your spine straight and supporting major joints. Do not lie flat on your back. Modified back ly8ing can be done with a pillow under one hip and under upper back.

Exercises to maintain circulation in legs:

Do three times per day, 20 to 25 repetitions each.

Keep one hand on your abdomen to ensure you are not tightening your stomach muscles.

For exercises 1-4, keep legs flat on the bed.

1. Ankle pumps.
2. Foot circles.
3. Tighten and relax knee muscles.
4. Roll knees inward and outward.
5. Bend one knee up toward chest; hold for a count of 5; return to straight position.
6. From bent position (#5, above) slowly lower knee to side; return to straight position.

Muscle toning exercises for arms:

Side lying or modified back lying.

Do 2 to 3 times per day, 10 to 20 repetitions each.

Keep one hand on your abdomen to ensure you are not tightening these muscles

Caution: Keep your head on the pillow at all times.

1. Tuck chin. (push back of head into pillow.)
2. Lift chin toward ceiling, down toward toes.
3. Turn head to right and left. (Don't do if it makes you dizzy)
4. Circle shoulders backwards.
5. Pinch shoulder blades together/relax.
6. Stretch arms down toward knees, one at a time.
7. Trace large letters in the air.
8. Tighten and relax fists.
9. Bend and straighten elbows.

Out of Bed

If you are allowed to get out of bed to go to the bathroom, etc.;

1. Remember, after you go from lying to sitting, rest for a minute; otherwise, if you stand immediately you might get dizzy.

2. Try the following exercises:

1. Sitting tall and taking a couple of deep breaths
2. Chin Tucks
3. Backwards shoulder circles
4. Alternately raising up on heels and toes
5. Relaxation exercises

Getting Back to Being Active

Do not increase activity until instructed to do so by your doctor.

After being on bedrest, any increase in activity is wonderful. It can also be frightening. Here are some suggestions as you become more active.

When you start to be more active:

• you will be weak.
• even a small change in activity can be exhausting.
• rest when needed.
• try any new activity slowly.
• it is normal to have a few contractions just from changing positions.

Add activities over several days. Don't try to do everything at once.

Day 1 - Increase your in-bed stretching, flexing and isometric exercises.
Day 2 - Add sitting up for ½ hour.
Day 3 - Add standing for 15 minutes while you make a simple meal.

You should stop your activity and call if you have 5 contractions in an hour and any warning signs.

When you add activities, remember:

• Keep activities short. Be up 3 times a day for ½ hour instead of once for an hour and a half.
• Don't push yourself. Rest as often as you need.
• When you are tired, you may have more contractions.
• Some days you will be able to do more things than others.
• Plan your activities.
• Don't waste your energy on trips around the house.
• Keep using childcare.
• Don't do a lot of bending and stooping. This includes no vacuuming or dusting furniture.
• When you are resting, save your energy by using your bedside helps like a call bell, TV remote control, water pitcher.
• Your doctor may still recommend no intercourse or breast stimulation.
• Ask specific questions about what you can do.

Call your doctor or nurse if you have any questions about being more active.