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Sunday, September 26, 2010
Title: Exploration of the Postpartum Experience of Women On Long Term Bed Rest for Pregnancy Complications
Discipline: Childbearing (CB), Advanced Practice (AP)
Learning Objectives:
Submission Description:- Identify significance of long term bed rest on antepartal patients hospitalized for complications of pregnancy
- Discuss themes characteristic of postpartum experiences of this population
- Describe recommendations for clinical practice in caring for postpartum women who have been hospitalized for antepartal complications
Purpose
Physical, psychological and social sequelae of bed rest on the high-risk antepartum patient have been documented. Few studies have addressed the care of these patients in the postpartum period. The purpose of this phenomenological study was to explore the postpartum experience of women prescribed long term bed rest in pregnancy, identify themes, and generate knowledge to guide nurses to meet the needs of this population during the postpartum period.
Literature review
Bed rest, one of the most commonly prescribed treatments for high-risk pregnancy, affects approximately 700,000 pregnant women in the United States annually. Bed rest has physiologic and psychosocial implications related to decreased weight bearing, a shift in body fluids and reduced sensory stimulation (Maloni, Margevicius & Damato, 2006). Bed rest affects all body systems, but the musculoskeletal and cardiovascular systems show the most rapid and profound changes. The musculoskeletal system shows signs of loss of muscle mass and atrophy, and bone loss (Maloni & Schneider, 2002). Postpartum muscle weakness, backache, and deep muscle soreness occur in higher frequency in this population (Maloni & Park, 2004; Maloni, 2002). Patients on bed rest lose their ability to respond quickly to blood pressure changes. During both the antepartum and postpartum periods, these women experience cardiovascular deconditioning: orthostatic intolerance, fainting, increased heart rate, syncope, fatigue, shortness of breath (Maloni, 2002).
Psychological effects of long term antepartum bed rest have implications in the postpartum period. Predominant stressors include separation from family, loss of control, feelings of being a burden, and need for privacy (Richter, 2007; Thorman & McLean, 2006; Heaman, 1998). Common symptoms described by patients include fear and anxiety over infant survival, loneliness, boredom, powerlessness, depression, worry about other children, and increased family stress (Schroeder, 1996; Maloni, 2002). Many of these side effects continue for at least 6 weeks into the postpartum period (Maloni, Margevicius & Damato, 2006).
Sample
Purposive sampling was used to obtain in-depth information of relevance. The sample included English speaking patients hospitalized for at least two weeks due to a high-risk pregnancy. Exclusion criteria included fetal/neonatal loss in the current pregnancy.
Methodology
Participants were recruited from the postpartum unit at a 599 bed community hospital with maternal-fetal medicine services and a level III NICU. Written patient consent, approved by the IRB, was obtained. Individual loosely structured interviews, conducted by two clinical nurse specialists, took place between 2 and 5 weeks postpartum. Interviews were audiotaped and transcribed verbatim, and field notes documented observations and impressions.
Data analysis/Interpretation
Data analysis occurred following each interview. Interview content was coded after transcription using inductive analysis. Triangulation techniques were utilized.
Predominant themes included prolonged passive-dependent state and psychological sequelae into postpartum period, the need for authentic caring and anticipatory guidance.
Implications
The study identifies the physical and psychological needs of postpartum women who experienced long term antepartal bed rest. The development of nursing guidelines to meet the unique needs of this population will enhance the quality of care and improve patient outcomes and satisfaction.
Physical, psychological and social sequelae of bed rest on the high-risk antepartum patient have been documented. Few studies have addressed the care of these patients in the postpartum period. The purpose of this phenomenological study was to explore the postpartum experience of women prescribed long term bed rest in pregnancy, identify themes, and generate knowledge to guide nurses to meet the needs of this population during the postpartum period.
Literature review
Bed rest, one of the most commonly prescribed treatments for high-risk pregnancy, affects approximately 700,000 pregnant women in the United States annually. Bed rest has physiologic and psychosocial implications related to decreased weight bearing, a shift in body fluids and reduced sensory stimulation (Maloni, Margevicius & Damato, 2006). Bed rest affects all body systems, but the musculoskeletal and cardiovascular systems show the most rapid and profound changes. The musculoskeletal system shows signs of loss of muscle mass and atrophy, and bone loss (Maloni & Schneider, 2002). Postpartum muscle weakness, backache, and deep muscle soreness occur in higher frequency in this population (Maloni & Park, 2004; Maloni, 2002). Patients on bed rest lose their ability to respond quickly to blood pressure changes. During both the antepartum and postpartum periods, these women experience cardiovascular deconditioning: orthostatic intolerance, fainting, increased heart rate, syncope, fatigue, shortness of breath (Maloni, 2002).
Psychological effects of long term antepartum bed rest have implications in the postpartum period. Predominant stressors include separation from family, loss of control, feelings of being a burden, and need for privacy (Richter, 2007; Thorman & McLean, 2006; Heaman, 1998). Common symptoms described by patients include fear and anxiety over infant survival, loneliness, boredom, powerlessness, depression, worry about other children, and increased family stress (Schroeder, 1996; Maloni, 2002). Many of these side effects continue for at least 6 weeks into the postpartum period (Maloni, Margevicius & Damato, 2006).
Sample
Purposive sampling was used to obtain in-depth information of relevance. The sample included English speaking patients hospitalized for at least two weeks due to a high-risk pregnancy. Exclusion criteria included fetal/neonatal loss in the current pregnancy.
Methodology
Participants were recruited from the postpartum unit at a 599 bed community hospital with maternal-fetal medicine services and a level III NICU. Written patient consent, approved by the IRB, was obtained. Individual loosely structured interviews, conducted by two clinical nurse specialists, took place between 2 and 5 weeks postpartum. Interviews were audiotaped and transcribed verbatim, and field notes documented observations and impressions.
Data analysis/Interpretation
Data analysis occurred following each interview. Interview content was coded after transcription using inductive analysis. Triangulation techniques were utilized.
Predominant themes included prolonged passive-dependent state and psychological sequelae into postpartum period, the need for authentic caring and anticipatory guidance.
Implications
The study identifies the physical and psychological needs of postpartum women who experienced long term antepartal bed rest. The development of nursing guidelines to meet the unique needs of this population will enhance the quality of care and improve patient outcomes and satisfaction.
