Running head: AT HOME BED REST


At Home Bed Rest: A Viable Option for Arrested Preterm Labor? Jennifer Rose Chamberlain College of Nursing NR 450: Capstone Course Summer B 2010

et al. While there are several treatment modalities for preterm labor. However.. Other complications can be life-threatening for the baby. as cited in Sprague. There are numerous complications that can occur during pregnancy with varying levels of severity. these patients . such as nausea and heartburn. Complicating between 8% and 10% of all pregnancies (Goulet. 2001). 2005). others are not so fortunate. One such serious complication is preterm labor. excluding delivery (Yost. mother. 2005). & Leveno. Bloom. 2005). pose little risk to baby or mother. Preterm labor is defined as the presence of persistent increased uterine contractions associated with progressive cervical changes before the 37th week of pregnancy (Goulet. 1998. It is assumed that bed rest. obstetric teaching has said hospitalization for the purpose of rest to prolong pregnancy was the best course of action (Yost et al... once the threat of immediate delivery has passed (Maloni. it is reported that more than 90% of obstetricians recommend bed rest to avoid preterm labor and other pregnancy complications. Some. treat it adequately and prevent its recurrence (Goulet. especially hospitalized bed rest... eat well. The goal of preterm labor management is to promptly 2 diagnose the condition. 2003). 2001). McIntire. Once stabilized after an acute episode of preterm labor. or both. preterm labor is the primary cause for hospital admission during pregnancy. rest. And while some women go through their entire pregnancy without any difficulty. enforces decreased physical activity and therefore prevents preterm labor (Yost et al.AT HOME BED REST At Home Bed Rest: A Viable Option for Arrested Preterm Labor? Pregnancy is one of the most life changing events a woman can experience. Basic pregnancy education has been the same for a long time. Cohen & Cane. despite being in the hospital. when pregnancies became complicated. 2001). et al. and complete activities in moderation. et al.

Istwan. Morrison et al. (2004) found that when interventions were necessary. should be instructed to remain at home and stay in bed as much as possible with the exception of showering. current clinical status. patients should have telephone access to a perinatal nurse 24 hours-a-day. to allow antenatal management of patients to occur outside the hospital as much as possible. as well as assistance in coordination of required social services (Morrison et al. and second. 7 days-aweek for assessment and intervention. therefore. daily risk assessment. 2004). More than half of the women in each group were able to continue their pregnancy .. (2004). to provide early detection of signs and symptoms of preterm labor therefore allowing time for proper treatment. Goulet et al. Along with bed rest.AT HOME BED REST require little if any skilled nursing care.patient management of women with arrested preterm labor can provide heightened surveillance of a high risk group of patients. obstetric history and living arrangements. and ambulating to the bathroom and living area (Yost et al.. 2004). determine whether heightened surveillance can occur as inpatient or outpatient (Ambrose. first. Collins. the goal is to prevent preterm labor from recurring while prolonging the pregnancy as long as possible. (2001) found no significant difference in gestational age at birth. as well as the birth weight between the two groups. home external uterine activity monitoring. Factors such as prescribed treatments. & Stanziano. When comparing women managed for preterm labor at home versus the hospital setting. patient education. Rhea. 90% of the time a patient¶s complaint could be resolved with nursing interventions. there are two 3 goals to outpatient preterm labor management programs. out patient monitoring should include. It then begs the question of whether bed rest can be accomplished at home and still prolong pregnancy? Out. According to Morrison et al. When managing a woman with arrested preterm labor. Patient¶s discharged to outpatient care. 2005).

which concluded that out- 4 patient management of arrested preterm labor had no appreciable effect. a 2004 study by Ambrose et al. Ambrose et al. while hospital based care should be reserved for women experiencing serious conditions needing intense medical surveillance and nursing care. found the incidence of delivery before 34 weeks was significantly higher in the inpatient group resulting in a higher percentage of infants admitted to the NICU.5" . Based on the information available in the literature. (2005) also concluded that hospitalization is unnecessary in the management of women with arrested preterm labor. (2004). there are some studies that show improved pregnancy outcomes with home management of preterm labor.AT HOME BED REST beyond 38 weeks and there was no difference in the number of deliveries before 37 completed weeks (Goulet et al. (2004) and Ambrose et al. beneficial or deleterious. (2005). a higher birth weight and fewer Neonatal Intensive Care Unit (NICU) admissions in the outpatient group when compared to the hospitalized group (Morrison et al. (2001) concluded women with arrested preterm labor can be managed at home. 2004). As a result of these findings. (2004) also found a one pound higher birth weight in infants born to women in a preterm labor outpatient management group when compared to the inpatient group. on pregnancy outcomes while hospitalization offered no additional advantages. concluding that home management is an effective and appropriate option. Goulet et al. Similarly. 2001).. The study also showed a significantly higher gestational age at delivery. (2004) both show improved pregnancy outcomes with home management versus hospital management. One can speculate Formatted: Indent: First line: 0. it was found that preterm labor home services show benefit in the early diagnosis of preterm labor. In a study by Morrison et al. Due to a higher gestational age. Yost et al. In contrast. Similar findings are in a study by Yost et al.. The above studies of home versus hospital management of women with arrested preterm labor show no difference in the pregnancy outcomes. The studies by both Morrison et al.

The prescription of bed rest for pregnancy complications developed from a lack of any other alternative treatment. perhaps leading to an earlier termination of pregnancy (Ambrose et al. While there is much research on both the physiological and psychological effects of bed rest on the non-pregnant person. . Belizan & Bergel (2010) go as far as saying there is no evidence that bed rest. are not well controlled in both the amount and type of bed rest that is prescribed (Maloni. it also has a psychosocial and economic impact as well (Sprague. However more recent studies have shown in this case.. health care providers should not routinely prescribe bed rest. 1998. Sosa. yet it is one of the least studied. 2004). ³doing something´ may bring the worse outcome. is beneficial in preventing preterm birth. they would rather do something than offer nothing (Sprague. 2003). daily management along with increased testing and related maternal stress. 2003). Despite what is known today about the consequences of bed rest. Althabe.AT HOME BED REST from these findings that women hospitalized for preterm labor management received more active. Bed rest in pregnancy is one of the most commonly prescribed interventions to improve pregnancy outcomes. 2003). and the studies that are done. Sosa (2010) argues that due to the potential adverse effects on women and their families. research on pregnant women is limited. Not only does bed rest have adverse physiological and psychological effects. as cited in Sprague. 5 providers continue to disagree on the use of this intervention in pregnancy. either at home or in the hospital.

5". Don't add space between paragraphs of the same style.AT HOME BED REST 6 Formatted: Indent: First line: 0. Line spacing: Double .

Gynecologic. Line spacing: Double Formatted: Normal. Goulet. Althabe. Art. Journal of Perinatology. Don't add space between paragraphs of the same style.. (2004). DOI: 10. A.. Fernando.. (2001). D. 542-549. et al. Rhea. 33(5).. M. José M. Issue 1.1002/14651858.. Lemay.CD003581. & Neonatal Nursing. The Journal of Maternal-Fetal and Neonatal Medicine. Eduardo. Collins.pub2... Cochrane Database of Systematic Reviews 2004. N. Rhea. C... . D. 985-991. Frequency of nursing. 515-519. J. Retrieved from MEDLINE with Full Text database. Istwan. Clinical and economic 7 Formatted: Normal. Bed rest in singleton pregnancies for preventing preterm birth. Jones. Gevry. A randomized clinical trial of care for women with preterm labour: home management versus hospital management.AT HOME BED REST References Ambrose. 16. H. 164(7). Morrison. & Stanziano. Retrieved from MEDLINE with Full Text database. L. Gauthier. Don't add space between paragraphs of the same style. G. Centered. J. No.: CD003581. Sprague. A. CMAJ: Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. physician and hosptial interventions in women at risk for preterm delivery. Roberts. Sosa. J.. (2004). 102-105. 24. The evolution of bed rest as a clinical intervention. W. (2003).. Istwan. N. G. Journal of Obstetric. Retrieved from MEDLINE with Full Text database. R. S.. Line spacing: Double outcomes of preterm labor management: inpatient vs outpatient. Retrieved from MEDLINE with Full Text database. Retrieved from CINAHL with Full Text database. Fraser. Bergel. Belizán.. & Stanziano.. Lepage.. Claudio.

(2005).. Formatted: Indent: Left: 0". N. Bloom.5".. Line spacing: Double . D. K.. S.AT HOME BED REST 8 Yost. Retrieved from MEDLINE with Full Text database. 106(1). McIntire. Hospitalization for women with arrested preterm labor. Obstetrics & Gynecology. 14-18. & Leveno. Don't add space between paragraphs of the same style. Hanging: 0.

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