Continuous Fetal Monitoring: More Stress on Bed Rest

Introduction: Advances in ultrasound diagnosis have made it possible to detect fetal conditions which may require not only an extended hospitalization, but long periods of continuous electronic fetal monitoring (24 hours/day for weeks), such as monoamniotic twins. These women are subject to unique stressors beyond simple bedrest or a long term hospitalization, adding another burden to an already difficult situation.
Literature Review: More fetal complications can now be detected by a skilled ultrasound operator, providing the opportunity to prevent fetal mortality through continuous surveillance (Bhide & Thilaganathan, 2004; Oyelese et al, 2004). This may require an extended hospital stay, a source of great stress to the mother and family (Thornburg, 2002; Maloni & Kutil, 2000). Continuous electronic fetal monitoring (CEFM) adds another level of stress. Most of the literature examining mothers’ stress is focused on prolonged bedrest or the hospitalization, not prolonged fetal monitoring (Richter, Parkes, & Chaw-Kant, 2007; Heaman, 1998).
Objective: To clarify what aspects of the women’s stay were perceived as stressors and what nursing care the women perceived as helpful and/or stressful while coping with CEFM during their hospitalization.
Methodology: This was a survey study of women who had a hospital stay between 1999 and 2006 which included at least 3 weeks of CEFM. Surveys were sent out with an explanatory cover letter inquiring about what things they considered stressors during the CEFM period, what helped them cope, and which nursing care, actions, or interventions were supportive and which were deleterious.
Data Analysis: Twelve women met the criteria. Five women did not have correct or current addresses in the electronic medical record. Seven surveys were returned (repsonse rate of 100%). The sample was fairly homogenous, consisting largely of women in their mid-30s with a college education. The most commonly identified stressors were sleep interruption and fear for the babies. Others included lack of food choices, the inability to go outside, activity restrictions, maintaining positions in bed to accommodate the monitoring, and parenting while in the hospital. Coping mechanisms identified were “being able to wear my own clothes,” Internet/laptop use, flexible visiting hours, a “countdown” calendar, and being able to decorate their room. Nursing interventions which were helpful included “Kept me company/talked with me/listened to me,” "accommodating," and "kind to me." The most common non-helpful nursing action was “disrupting my sleep.” Although they also understood the necessity, at times they felt the nurses could have done more to protect their sleep. Limitations of the study include the small sample size; however, these women comprise a unique population.
Implications for care/Future research: Women who spend extended periods of time on the fetal monitor require additional support above and beyond what women who require hospitalization alone. Recommended nursing interventions include a high emphasis on techniques to improve/sustain sleep, being flexible in helping women shape their environment, and spending time with them. In order to increase validity and the ability to generalize, future researchers should try and recruit a larger, more heterogeneous population.