THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Sunday, December 4, 1994 TAG: 9412070632
SECTION: HAMPTON ROADS WOMAN PAGE: 06 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: Long : 279 lines
YOU'RE TWO months pregnant and your blood pressure is skyrocketing.
Or you're four months along and suddenly start having contractions.
Or this is your fourth pregnancy - after three miscarriages.
Or you're having twins, or triplets.
There's only one place you're going for the next few months - to bed.
And we're not just talking about quitting your job and staying home. We're talking about spending the entire day in bed or on the couch, getting up only to go to the bathroom or shower.
No shopping for baby clothes. No decorating the nursery. No cooking, no cleaning. And you better find someone else to care for your 2-year-old.
About one out of every 10 pregnancies is classified as high risk, usually because of the danger of pre-term labor.
The most common cause of pre-term labor - and ordered bed rest - is an incompetent cervix, when the cervix, the neck of the uterus, starts to dilate too soon.
It's the price we pay for walking on two instead of four legs, says Virginia Beach perinatologist Steven L. Warsof, of the Tidewater Perinatal Center, a high-risk obstetrical practice affiliated with Eastern Virginia Medical School.
Most animals support their growing fetus with their stronger abdominal muscles, he said. But for us, the entire weight of the baby is placed on the cervix, which is a tendon, not a muscle.
And the best medicine a doctor can order is gravity - taken continuously while lying in bed or on the couch.
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Within 24 hours of being confined to bed, your muscles start losing their strength and atrophying.
Within a week, you lose 30 percent of your muscle mass.
It's particularly difficult for active women like Hedi Knowlan, who, before her pregnancy, took an aerobics class nearly every day.
This is the third pregnancy for the 39-year-old Virginia Beach woman, who has been on doctor-ordered bed rest since August.
Her first pregnancy ended in a miscarriage at 11 weeks because of a problem with her uterus. After surgery corrected that, she got pregnant again. This time, she was 21 weeks along when she started bleeding. She was hospitalized for a month, but went into premature labor at 25 weeks, due, say doctors, to an incompetent cervix.
The baby, a girl, lived three hours before dying from an infection.
When she became pregnant again last spring, Knowlan expected the bed rest. She'd even cut back her hours at work to part-time, anticipating it would be easier for someone to fill her job if she had to leave.
Sure enough, on Aug. 5, Warsof performed a cervical cerclage, strengthening her cervix with stitches, and ordered her to bed for the duration.
She rotates between her bed and the couch, and most days doesn't even bother to get dressed.
``You read a lot of magazines and books, and watch way too much TV,'' said Knowlen, who expects to deliver a boy in January.
And she cheats. About once a week she and her husband go out to dinner, just so she can escape the house. She even went shopping. She had to. She needed maternity bras and underwear.
Warsof knows his patients cheat. Studies show at least half the women on bed rest are unable to adhere to activity restrictions, either because they needed to do something for themselves or because they think their condition has stabilized.
``It is a rare patient who can comply with the kind of bed rest that's needed,'' Warsof said. He once followed a patient who was supposed to be in bed all around Home Quarters as she tried to hide from him.
``It's difficult because they feel well and they don't see the problem, so they're less motivated to be compliant,'' he said.
That's especially true when they're sent to bed because of high blood pressure, which often has no physical symptoms.
Donna Elliott, 35, has cheated a bit while on her enforced bed rest. She and her husband occasionally go to the Price Club, where he pushes her around in a wheelchair. And after every doctor visit - the only time she escapes the small Virginia Beach apartment that has become her world - they stop for dinner.
Elliott, who is also due in January, has been on mandatory bed rest since October, when her feet turned purple because the baby was positioned so low.
She was working as a rehab aide at a nursing home when Warsof ordered her to bed.
``Let me finish out the month,'' she said. ``It's only two more days.''
To bed, he said.
And she listened. You do that when this is your sixth pregnancy - and you still don't have a child. Two were ectopic pregnancies; the other three she miscarried.
She and her husband had decided not to try again - he even had his vasectomy scheduled - when she found herself pregnant again.
So she was determined to do anything necessary to see this pregnancy through to completion.
That's meant turning her living room couch and coffee table into a command center, with portable phone, remote control, a pile of magazines, her calendar, a calculator and a box of stationary all within easy reach.
The front door is covered with message pads, on which she writes lists and ``honey dos'' for her husband.
``It's very depressing,'' she said, shifting to a more comfortable position on the sheet-covered couch. Little things make it bearable. Like her upstairs neighbor, who comes down and cleans her apartment every week. And her friends from work, who visit and call and who held a baby shower for her.
And, of course, her husband. Who has learned to cook. To separate the laundry. To clean the bathroom.
``I used to bring him breakfast in bed every Saturday and Sunday morning,'' Elliott said with a sigh. ``Now he does it for me.''
It's been difficult financially, too, because the Elliott's depended on her income. But she still gets about five or 10 hours of paperwork in a week, and she applied for and receives the WIC program, a government-funded food supplement program for pregnant and nursing women.
Although she may not think so, Elliott is lucky. She hasn't had to take any medication. Many women at risk for pre-term labor are placed on terbutaline, a drug that relaxes the uterus and stops labor. But it has several nasty side effects, including nervousness, headaches and reduced concentration.
She's also lucky because she's at home. Unlike JoAnn James, 40, who's been at Chesapeake General Hospital for nearly 100 days.
An IV tube attached to her chest pumps heparin, a blood thinner, into her veins to reduce her risk of blood clots. Rubber stockings keep down the swelling in her legs.
But her baby, a girl, is doing just fine so far.
This was not a planned pregnancy, James said. She knew that with her history of blood clots and other health problems, plus her age, she'd have a difficult time if she got pregnant.
``But things happen and you deal with it,'' she said with a resigned shrug. Like losing your income when it makes up more than half of your family's finances. Like only seeing your 17-year-old son a couple of times a week. Like spending Thanksgiving in a hospital bed.
But James isn't one to dwell on the negative. Ask her what it's like to spend three months in the hospital, and she talks on and on about her wonderful nurses. How they got her free television for the duration; how they bring her homemade treats to break up the routine hospital food, gifts for the baby, cards and magazines.
They wanted to paint her stomach like a pumpkin for Halloween, but she wouldn't let them, so they made her a pumpkin costume.
To pass the time, she writes lots of letters to her nieces and nephews, spends hours on the phone with her mother and friends, and every now and then her 15-year-old niece or her son spends the night. ``Then it's like a pajama party,'' she said.
``I'm not hooked on the soaps but I'm getting to be good friends with Oprah,'' she said with a laugh.
The worst thing is not the boredom or the drugs, she said. ``It's not being home. It's not being able to have a normal life. I'd much rather be going to the office.''
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The depression of the bed-bound mother-to-be is no surprise to Karen K. Pharr, director of perinatal nursing at EVMS' division of maternal-fetal medicine.
``We take these very active, healthy women and we change their lives dramatically. We say, you may not do this or this or this. After about a week, they stop worrying about the baby as much and start realizing the control they've lost over their lives. Someone else has to watch their other children, and do their job, and clean their house. And they don't feel bad. They don't feel sick.''
At any given time, said Pharr, her practice has six or seven women hospitalized, usually at Sentara Norfolk General Hospital.
To help those women cope, Pharr created a program she calls ``Club Bed.'' Twice a week, nurses wheel the women out of their rooms into a sunny day room where they join other bed-bound pregnant women for an hour of visiting and education.
Eventually, she hopes to expand the program into a telephone network for women who are home, maybe even linking them via computer.
In California, a woman who was confined to bed during her pregnancy started a national, nonprofit organization called Sidelines to support women in similar positions.
The 2-year-old organization already has 30 chapters throughout the country and is looking for volunteers to start one in Hampton Roads.
Volunteers must have been through a high-risk pregnancy themselves, explained Sue Patetta, coordinator for Sidelines of Northeast Ohio. They are then paired one-on-one with a woman confined to bed and support her through telephone calls or visits.
``They're lonely, isolated, fearful. And no one knows whether or not all this is going to pay off. Those are the real major concerns. It helps to talk to someone who's been through it and survived and come through with a successful outcome.''
Patetta herself was on modified bed rest beginning at 13 weeks. At 25 weeks, she went into premature labor, which doctors managed to delay until her 35th week, when she delivered a healthy, 5-pound-14-ounce daughter.
``The most important thing is to reach out to all offers of help,'' she said. ``And if you don't get it, ask for it.'' ILLUSTRATION: MARTIN SMITH-RODDEN/Staff color photos
Donna Elliott, 35, has been on bed rest since October, when she
discovered that the baby, who is due in January, was positioned too
low. The rehab nurse's five previous pregnancies did not go to full
term.
Heidi Knowlan had to slow down her active life when her doctor
ordered bed rest in August. This is the Virginia Beach woman's third
pregnancy.
Graphic
COPING WITH HIGH-RISK PREGNANCY
Reasons for bed rest:
multiple gestation (more than one baby)
intrauterine growth retardation
placenta previa
malformed uterus
incompetent cervix
pregnancy-induced hypertension
fluid retention
premature rupture of the membranes
pre-term labor
Bed rest may also be advised for women who experience spotting
or bleeding early in pregnancy or bleeding in the last trimester or
who have a history of miscarriage.
Warning Signs
Symptoms of labor (pre-term or otherwise) include:
four or more contractions an hour, less than 15 minutes apart,
while lying down
menstrual-like or abdominal cramps
low backache
pelvic pressure
an increase or change in consistency or color of vaginal
discharge
Major risk factors for pre-term labor
previous pre-term labor or delivery
multiple pregnancy
misshapen uterus
being a DES daughter
abdominal surgery and/or cerclage
cervical change and/or excessive uterine contractions before 33
weeks
serious infection
excessive amniotic fluid
Resources
Sidelines Support Network
714-497-2265
Childbirth Education Association
Has materials and information about confinement during
pregnancy.
703-941-7183
Support Lines, Parents of Premature and High Risk Infants
International, Inc. (PPHRI)
Publishes a newsletter
33 W. 42nd St., Room 1227
New York, N.Y. 10036
Employment Discrimination Intern
Women's Legal Defense Fund
Answers questions regarding discrimination caused by a pregnancy
disability.
202-986-2600
Pregnancy Bedrest: A guide for the pregnant woman and her family.
S. Johnson and D. Kraut. (New York: Henry Holt).
MAKING YOUR CONFINEMENT EASIER TO TAKE
(From Pregnancy Bedrest: A guide for the pregnant woman and her
family. S. Johnson and D. Kraut. (New York: Henry Holt).
CREATE A BED-REST NERVE CENTER
Move your bed to a sunny room near a window.
Have a table within arm's reach stocked with telephone, address
book, telephone directory, radio, Thermos filled with cool and warm
drinks, straws, tea bags, sugar packets, a picnic cooler packed with
nutritious snacks, tissues, hairbrush, mirror, pencils, pads,
monthly calendar, and some way to signal the rest of your family,
either a bell, buzzer or walkie talkie.
Time Management
Force yourself into a routine within the first few days and stick
to it. Schedules should include bathing, changing from nighttime to
daytime clothes, putting on makeup, eating at regular time, taking
naps (preferably earlier in the day), spending time with your other
children.
Read everything, including books that will help you in your
career, child-care books, recipe books, joke books, road atlases
(take a mental vacation), newsletters and newspapers.
Send for every catalog advertised. It may be the only way to get
your shopping done.
Write letters, get a pen pal, enter every contest advertised in
magazines.
Needle crafts are good projects to keep your hands active and
give your eyes a different focus point other than the book or
television screen.
by CNB