Antepartum Bed Rest: Maternal Weight Change and Infant Birth Weight

Despite lack of evidence for effectiveness, obstetricians in the United States prescribe antepartum bed rest for more than 700,000 women per year. However, in nonpregnant samples, bed rest treatment produces weight loss. This study assessed maternal weight change (gain) during antepartum hospitalization for bed rest treatment; compared appropriateness of infant birth weights for gestational age, race, and gender; and determined whether maternal weight change predicted infant birth weight. The convenience sample for this longitudinal study consisted of 141 women with high-risk pregnancies who were treated with hospital bed rest. Weekly rate of pregnancy weight change by body mass index was compared with Institute of Medicine recommendations for rate of pregnancy weight gain. Infant birth weight was compared with current US infant birth weights for matching gestational age, gender, and race. Weekly antepartum weight change was significantly lower than Institute of Medicine recommendations (P < 0.001). Infant birth weights were also significantly lower than the national mean when matched for each infant’s gestational age, race, and gender ( P < 0.001). Maternal weight change predicted infant birth weight ( P = 0.05). Bed rest treatment is ineffective for improving pregnancy weight gain. Lower infant birth weights across all gestational ages suggest that maternal weight loss during bed rest may be associated with an increased risk of fetal growth restriction. A randomized trial comparing women with high-risk pregnancies who are ambulatory with those on bed rest is needed to determine whether bed rest treatment, underlying maternal-fetal disease, or both influence inadequate maternal weight gain and poor intrauterine growth.

Multiple Gestation: Side Effects of Antepartum Bed Rest

The birth rate for higher order multiples has dramatically increased in recent decades. Multiple gestation pregnancies are considered to be at high obstetric risk. Antepartum bed rest is often prescribed to offset complications despite the lack of evidence for its effectiveness in preventing complications. This longitudinal repeated-measures study identified side effects of antepartum bed rest treatment for 31 hospitalized women with twin or triplet gestation. Maternal weight gain and infant birth weight were recorded. Antepartum stressors were measured by the Antepartum Stressors Hospital Inventory, and depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Antepartum and post-partum side effects of bed rest were also assessed by the Antepartum and Postpartum Symptom Checklists. The weekly rate of maternal weight gain during hospitalization was significantly less than recent recommendations for multiple gestation weight gain (t =– 2.14,p = .04). Infant birth weights were appropriate for gestational age. There were fewer than expected small-for-gestational-age infants. Concerns regarding family status and separation from family were the major antepartum stressors. Women reported a high number of symptoms during bed rest (M= 22), which did not significantly change across 2 weeks. CES-D scores for depressive symptoms were high on antepartum hospital admission. Postpartum symptoms were initially high but had significantly declined by 6 weeks: F(1, 27)= 15.68, p = .00. These findings suggest that interventions are needed to reduce antepartum maternal weight loss, stress, physiologic and psychosocial symptoms, and depressive symptoms, as well as reduce postpartum symptoms of maternal morbidity.

Web recruitment and internet use and preferences reported by women with postpartum depression after pregnancy complications

Nearly one million women each year have pregnancy complications that cause antepartum and postpartum anxiety and depression. This exploratory study determined 1) feasibility of using social media to recruit women with depressive symptoms following high risk pregnancy, 2) women's barriers to treatment, 3) use of online resources for assistance with PPD, and 4) preferences for internet treatment. Among a national sample of 53 women, nearly 70% had major depression. Common barriers were lack of time and stigma. Over 90% of women would use the internet to learn coping strategies for PPD. Women expressed interest in web-based PPD treatment and identified desired characteristics of an intervention.

Effect of Postpartum Practices of Doing the Month on Chinese Women’s Physical and Psychological Health

The purpose of the study was to describe Chinese women’s postpartum physiological and psychological health and adherence to “doing-the-month” practices. A descriptive repeated measures design was used, with data collected at 3 days and 6 weeks postpartum. The convenience sample consisted of 198 healthy childbearing women with a term birth. Maternal physical health was measured by the Six-Minute Walk (endurance), Chair Stand test (muscle strength), severity of physical symptoms, and physical health subscales of SF36v2. Maternal psychological health was measured by the Edinburgh Postnatal Depression scale. Adherence was measured by the Adherence to Doing-the-Month Practices questionnaire. Aerobic endurance and lower-body muscle strength improved significantly across time ( p < .001) but remained suboptimal for maternal age. Women who delivered by Cesarean section had significantly poorer physical health than those who had a vaginal delivery. Physical functioning significantly increased, but general health and role limitations due to physical health significantly decreased over time. Postpartum physical symptoms decreased in number and severity. Depression increased over time ( p < .001). Adherence to doing the month was negatively correlated with aerobic endurance and positively correlated with depression at 6 weeks ( p < .05). These findings challenge the assumption that practices of doing the month are healthy for Chinese women’s recovery after childbirth. Research-based evidence needs to be integrated into doing-the-month practices. Education of Chinese women and families, whether living at home or abroad, is needed about the adverse health effects of doing the month. Routine screening for postpartum depression is also advised.

Lack of evidence for prescription of antepartum bed rest

Antepartum bed-rest treatment is based on assumptions that it is both effective and safe for mother and fetus. However, research indicates, that bed-rest treatment is ineffective for preventing preterm birth and fetal growth restriction, and for increasing gestational age at birth and infant birthweight. Studies of women treated with pregnancy bed-rest identify numerous side effects, including muscle atrophy, bone loss, weight loss, decreased infant birthweight in singleton gestations and gestational age at birth, and psychosocial problems. Studies conducted by aerospace scientists who have used bed rest as a model for the study of weightlessness in space using nonpregnant individuals report similar results. Antepartum bed-rest treatment should be discontinued until evidence of effectiveness is found.

Antepartum bed rest for pregnancy complications: efficacy and safety for preventing preterm birth

Preterm birth is the major maternal-child health issue across developed nations and the leading cause of perinatal mortality and morbidity. Of all deaths of infants <1 year of age in the United States in 2005, 68.6% occurred in infants born prior to term. Although the preterm birth rate in European countries is 5-7%, the U.S. preterm birth rate is 12.7%, representing an increase of 9% since 2000. Antepartum bed rest/activity restriction (ABR/AR) has been a mainstay of treatment to prevent preterm birth for the past 30 years prescribed for nearly 1 million women in the United States annually, despite a lack of evidence for its effectiveness. In fact, there is increasing evidence that ABR causes several adverse physiologic and psychological side effects among women and their infants. Unfortunately, these findings have had little impact on clinical practice. This integrative review of literature provides a comprehensive analysis of the evidence for the practice of prescribing ABR and its physiologic, behavioral, and experiential side effects. It also presents a model to guide continuing research about the effects of maternal bed rest as well as evidence supporting the use of home care with bed rest, a different, safe, and feasible model of prenatal care for treating women with pregnancy complications used particularly in other countries. Finally, suggestions to improve the health of high-risk pregnant and postpartum women and their infants are provided.

Correlates of negative and positive mood state in mothers of twins

Relationships between parenting distress, social support, and sense of competence and negative and positive maternal mood were assessed in 162 mothers with twins younger than 2 years. Women with lower satisfaction scores on the sense of competence scale reported higher negative mood (adjusted R(2) = 21.7%, p < .001). Women with lower parenting distress and higher efficacy scores on the sense of competence scale reported higher positive mood (adjusted R(2) = 39.4%, p < .001). Neither instrumental nor subjective social support contributed to variance in maternal mood. Interventions should be aimed at decreasing parenting distress and increasing sense of competence for mothers of twins.

Postpartum Symptoms After Antepartum Bed Rest

OBJECTIVE

To determine the type and frequency of postpartum symptoms during recovery from antepartum bed rest treatment across 6 weeks postpartum.

DESIGN

Longitudinal repeated measures study.

SETTING

Three perinatal tertiary care hospitals in two cities in the Midwest.

PARTICIPANTS

One hundred six postpartum women who had a singleton high-risk pregnancy and were treated with antepartum bed rest.

MAIN OUTCOME MEASURES

A Postpartum Symptom Checklist assessed physiologic and psychological symptoms.

RESULTS

Women reported 12.5 symptoms at 2 days postpartum, but symptoms rapidly declined at 1 week. Ninety-three percent reported a mean of 6.6 symptoms at 6 weeks postpartum. Symptoms that continued to be reported at 6 weeks by at least 40% of women were fatigue, mood changes, tenseness, difficulty concentrating, back muscle soreness, dry skin, and headache. Women who had a cesarean delivery reported significantly more symptoms than those who had a vaginal delivery (p = .006). Length of maternal bed rest was significantly correlated with the number of symptoms at postpartum weeks 1, 2, 4, 5, and 6.

CONCLUSION

Postpartum symptoms decreased across time but reveal an underlying morbidity that is not resolved by 6 weeks postpartum.

Smoking cessation counseling for pregnant women who smoke: scientific basis for practice for AWHONN's SUCCESS project

OBJECTIVES

To review the literature addressing smoking cessation in pregnant women. To develop the project protocol for the Association of Women's Health, Obstetric and Neonatal Nurse's (AWHONN) 6th research-based practice project titled "Setting Universal Cessation Counseling, Education and Screening Standards (SUCCESS): Nursing Care of Pregnant Women Who Smoke." To evaluate the potential of systematic integration of this protocol in primary care settings in which women seek care at the preconception, pregnant, or postpartum stages.

LITERATURE SOURCES

Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included low-birth-weight infants and effects of prenatal smoking on the infant and the effects of preconception and prenatal smoking cessation intervention on premature labor and birth weight.

LITERATURE SELECTION

Comprehensive articles, reports, and guidelines relevant to key concepts and published after 1964 with an emphasis on new findings from 1996 through 2002. Ninety-eight citations were identified as useful to this review.

LITERATURE SYNTHESIS

Tobacco use among pregnant women and children's exposure to tobacco use (secondhand smoke) are associated with pregnancy complications such as placental dysfunction (including previa or abruption), preterm labor, premature rupture of membranes, spontaneous abortions, and decreased birth weight and infant stature. Neonates and children who are exposed to secondhand smoke are at increased risk for developing otitis media, asthma, other respiratory disorders later in childhood; dying from sudden infant death syndrome; and learning disorders. The "5 A's" intervention and use of descriptive statements for smoking status assessment were synthesized into the SUCCESS project protocol for AWHONN's 6th research-based practice project.

CONCLUSIONS

The literature review generated evidence that brief, office-based assessment, client-specific tobacco counseling, skill development, and support programs serve as an effective practice guideline for clinicians. Implementation and evaluation of the guideline is under way at a total of 13 sites in the United States and Canada.

Reducing the risk for preterm birth: evidence and implications for neonatal nurses

The incidence of preterm birth has been slowly rising despite advances in obstetric health care. Neonatal nurses have ongoing contact with women who have had a preterm birth and, thus, who are at high risk to have another preterm birth. This article discusses current evidence about reducing risk for preterm birth. Although preterm birth cannot always be prevented, preconception care can help identify and modify maternal risk and promote optimal health before conception. Quality prenatal care, as defined by the Institute of Medicine, consists of continuing risk assessment, health promotion, and interventions to modify medical and psychosocial risk. When these 3 components are consistently applied, they may confer some protection against preterm birth. Women at highest risk for preterm birth need to seek prenatal care from an expert in maternal-fetal medicine. Women also need to learn about the common, subtle signs of preterm labor so they can recognize symptoms and quickly seek treatment. Neonatal nurses can provide critical information and anticipatory guidance to women at risk for preterm birth so they can make sound decisions about future pregnancies.

Measurement of antepartum depressive symptoms during high-risk pregnancy

This methodological study was designed to replicate three previous studies of depressive symptoms, compare assessment of antepartum depressive symptoms among high-risk pregnant women using three standardized instruments, and evaluate the psychometric properties of the instruments. The sample consisted of 89 high-risk pregnant women treated with bed rest, of whom 37 remained hospitalized at 4 weeks. Depressive symptoms were measured by the Multiple Affect Adjective Checklist Revised (MAACL-R) Dysphoria construct, the Profile of Mood States (POMS) Depression scale, and the Center for Epidemiologic Studies Depression Scale (CES-D) across antepartum hospitalization. Internal consistency, test-retest reliability, and convergent validity were high. Depressive symptoms were high on admission as measured by all three instruments and significantly decreased across time when measured by the MAACL-R and POMS.

Implementing evidence-based practice: reducing risk for low birth weight through pregnancy smoking cessation

In 1989, the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) developed a research utilization program to integrate evidence into practice areas where there were large discrepancies between research evidence and clinical practice. The current program, renamed Research-Based Practice (RBP), uses translational research methods to build from evidence such as that in the Cochrane database and to create protocols for integration of research directly into clinical practice. This article describes the development of the sixth project (RBP6), in which an evidence-based protocol to address smoking in pregnancy was integrated into clinical practice. The protocol includes screening women using descriptive statements and integrates the 5 As (ask, advise, assess, assist, arrange) into prenatal and postpartum care at every visit. By integrating smoking cessation counseling into care, nurses may reduce the risk of low birth weight among pregnant women in both the United States and Canada.

Inactivity: symptoms associated with gastrocnemius muscle disuse during pregnancy

This longitudinal study assessed change in gastrocnemius muscle metabolism across antepartum bed rest and recovery during the first 6 weeks postpartum as well as symptoms during recovery. The convenience sample consisted of 65 pregnant women, hospitalized on bed rest for a mean of 24.8 days (range 5-70 days). A dual wavelength hemoglobin/ myoglobin spectrophotometer and ergometer assessed muscle reoxygenation times after plantar flexion exercise from hospital admission through 6 weeks postpartum. The Postpartum Symptom Checklist assessed symptoms of muscle deconditioning. The time for gastrocnemius muscle reoxygenation after exercise significantly increased across antepartum bed rest (t = -2.1, P <.05) and significantly decreased during the 6-week postpartum period (t = 1.83, P <.05). Women who were on bed rest prior to hospital admission had significantly higher reoxygenation scores upon enrollment (t = -8.6, P <.05). Symptoms of postpartum muscle soreness, deconditioning, and difficulty with mobility were reported. Postpartum assessment and rehabilitation are needed to facilitate recovery and prevent long-term injury.

Dysphoria among high-risk pregnant hospitalized women on bed rest: a longitudinal study

BACKGROUND

While approximately 700,000 women experience pregnancy complications and are treated with bed rest in the hospital each year, little is known about negative affect in these women.

OBJECTIVES

The study purpose was to describe dysphoria, a composite of symptoms of negative affect across the antepartum and postpartum and to identify the relationship between dysphoria and the length of pre-admission home bed rest, hospital bed rest, and maternal and fetal/neonatal indices of risk.

METHODS

The convenience sample for this longitudinal repeated measures study consisted of 63 high-risk pregnant women admitted on antepartum bed rest to one of three university-affiliated hospitals. Women were included if they were diagnosed with (a) preterm labor, (b) premature rupture of membranes, (c) incompetent cervix, (d) placenta previa, (e) placental abruption or multiple gestation, and (f) did not have a psychiatric disorder. The Multiple Affect Adjective Checklist-Revised (MAACL-R) was used to assess dysphoria. Obstetric risk status was assessed by both the Hobel and Creasy Risk Assessment tools.

RESULTS

Dysphoria was highest upon hospital admission and decreased significantly across time (F (5) = 23.58, p <.001). Positive Affect-Sensation Seeking significantly increased across time (F (5) = 53.16, p <.001). Dysphoria scores were significantly greater for those with highest Hobel obstetric risk scores (F (1, 60) = 4.53, p =.037). Antepartum dysphoria was not correlated with gestational age upon hospital admission, length of bed rest, or Creasy risk status. However, gestational age at birth was significantly correlated with postpartum dysphoria.

DISCUSSION

The stimulus for antepartum dysphoria is unclear. However, postpartum dysphoria appears to be related to indicators of the infant's state of health at birth.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Physical and psychosocial side effects of antepartum hospital bed rest

The purpose of this study was to describe the physical and psychosocial effects of antepartum hospital bed rest on pregnant women and to determine whether the symptoms exhibited differed from those exhibited by pregnant women not on bed rest. Women on complete bed rest (n = 10) had greater gastrocnemius muscle dysfunction, weight loss, and dysphoria than women on partial bed rest (n = 7) or no bed rest (n = 18). Separation from family was the greatest hospital stressor. Postpartum recovery from the side effects of bed rest was prolonged and included symptoms of muscular and cardiovascular deconditioning. The severity of side effects appeared to be directly related to the degree of severity restriction.

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.

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.

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.

Extra early mother-infant contact and duration of breast-feeding

We tested the hypothesis that extra early physical contact between mother and infant is associated with prolonged breast-feeding. Healthy, advantaged mothers and their healthy, mature, vaginally-delivered, firstborn infants were randomly assigned to receive either regular contact (N = 39) or extra early contact beginning approximately one-half hour after delivery (N = 39). Fifty-three (68%) of the 78 infants were breast-fed. Age at which complete weaning occurred was known for 50 (94%) of the 53 infants. Prolonged breast-feeding was not significantly associated with extra contact. Suckling during extra early contact was associated with greater incidence of breast-feeding at two months (p less than 0.001) and three, four and five months (0.10 greater than p greater than 0.05) for male and female infants combined.

Extra early physical contact and aspects of the early mother-infant relationship

We tested the hypothesis that extra early physical contact between mother and infant enhances aspects of their early relationship. Healthy, middle-class mothers and their healthy, firstborn, singleton infants delivered vaginally at full-term were randomly assigned to receive either regular contact (RC; N = 39) or extra early physical contact (EC; N = 39) following delivery. RC infants remained in cribs beside their mothers' beds, while EC infants and mothers had a mean of 46 min of physical contact in the recovery room. There was no difference between EC and RC subjects for the following outcome measures: amount of time mothers chose to have infants with them during the postpartum hospital stay; quality of mother-infant interaction at two days and one month; concern mothers expressed for the infant at one month; mothers' perception of their postpartum adjustment; mothers' perception of the infant at two days and one month, and of the infant's temperament at eight months; and extent of mothers' assisting with and soothing the child during a physical examination at 13 months. EC children cried significantly less during the examination at 13 months. These findings do not support the hypothesis that extra early physical contact between mother and infant enhances their relationship.

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.