NEEDS DURING BED REST IN HIGH RISK PREGNANCY: A NARRATIVE REVIEW

Pooja Mishra 1 , AS Agasthiya 2 , Dr.Nageshwar V 2 and Dr. NV Munninarayanappa 3 . 1. M.Sc Nursing Final Year, Teerthanker Mahaveer College of Nursing, Teerthanker Mahaveer UniversityDelhi Road, Moradabad, India 2. Assistant Professor, TeerthankerMahaveer College of Nursing, Teerthanker Mahaveer University Delhi Road, Moradabad, India 3. Principal, TeerthankerMahaveer College of Nursing, Teerthanker Mahaveer University Delhi Road, Moradabad, India ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


Introduction:-
Hippocrates first used bed rest as a therapy and is very commonly recommended intervention in high risk pregnancy despite of known physiological and psychological side effects (Sprague, 2004). Over 1 million pregnant women in a year are identified with obstetrical complications and nearly 700,000 among them are treated with bed rest. A recent guideline (2012) from The American College of Obstetricians and Gynaecologists of the management of preterm birth states that the use of routinely recommended activity restriction should be avoided, as the therapy has not been shown to be effective.
A high risk pregnancy is one which is complicated by one or more factors that adversely affects the outcome of pregnancy -maternal or perinatal or both. The types of complications that make a pregnancy high risk include: premature rupture of membranes, preterm labor, placenta previa, diabetes, multiple gestation, hypertension, suspected fetal growth retardation& vaginal bleeding (Maloni, 2010).
Most of the high risk mothers undergo "bed rest" that is limited ambulation of not more than 1-2 hours per day with use of bathroom and bathing permitted (Science Daily,2014). Pregnancy complicated with high risk conditions is a very tough situation for pregnant woman, as the usual adaption to pregnancy is disturbed. Now the woman has to adjust with different situation caused by her high risk condition (Heaman, 1998). Hospitalized high risk pregnant women during bed rest expressed their concerns about family, another children, household works and financial issue that put more psychological pressure on these women (Granheim&Lundman, 2004).
Antenatal hospitalization is associatedwith several numbers of stressors, such as separation fromfamily, home and boredom. Some specific stressorssuch as bed rest, lack of activity, hospitalization,tests and treatments, feelings of uncertaintyand lack of control is experienced by high-riskpregnant women.Depression, anxiety and other stressful feelingsduring prenatal period easily lead to more severediseases which may be sometimes harmful to the mother, fetusand the expectant newborn"s health (Qiao et al., 2009) This activity restriction disturbs the natural process of pregnancy with several problems and thus the mother develops some specific needs to cope with this situation, which needs to be understood and managed by the health care professionals.
To address the issue and to identify the needs of high risk pregnant women on bed rest, this narrative review was undertaken so that it would help the health care professionals to understand and manage these needs as well as to provide comprehensive health care to high risk pregnant women during bed rest.

ISSN: 2320-5407
Int. J. Adv. Res. 5(5), 218-227 220 Types of Participants:-High risk pregnant mothers, family members, hospital staff, antenatal women at risk of delivering low birth weight baby, non-pregnant women and women with normal pregnancy.
Settings:-Private midwifery clinic, obstetric care clinics, private hospitals, public health centres and university hospital.
Outcomes:-Understanding the needs and problems experienced by high risk pregnant women during bed rest.
Approach for conducting the narrative review started with search for literature that are related to the topic "Needs during bed rest in high risk pregnancy". Following initial search a total of 36 articles were found related to different conditions of high risk pregnancy. A total of 28 articles were excluded out of which 13 were abstract, 6 were systematic reviews, 8 were not useful and one was dissertation. The remaining 8 were relevant to the topic and included for this review. It consists of 5 qualitative and 3 quantitative studies which were conducted in South Africa, Iran, Mexico City, France, United States, Danish&Dallas.  The study says that pregnant women with high risk conditions are prone to have depression and perceive their relationship as less satisfying with the family members. So, effective support and psychiatric consultation are needed for the high risk antenatal mother to reduce the stress level and for better outcome of pregnancy.

Review of all the 8 studies resulted in four main categories:-
The first category of results found from the lived experiences of hospitalized pregnant women who were interviewed and data analysis revealed some themes under which the needs can be categorized. These themes are: need for improved environment, need for social support, assistance with emotional adaptation, accepting of hospitalization, need for consultation on different problems like physical, psychological and marital (Kent et  The third category of results had identified that antenatal women with high risk condition on bed rest has high level of stress, anxiety and depression and lower level of spiritual well-being. So they develop some supportive needs which will help them to cope with the situation (Villar et.al, 1991 The last category found the ineffectiveness of psychosocial support during bed rest in high risk pregnancy and it does not improve the health status of women and fetus ( Villar et al., 1991).
Analysis of the results can be mainly categorized in three themes: need for consultation on different problems, need for emotional and social support and needs to reduce stress and anxiety.

Need For Consultation on Different Problems:-
This need of mother should be fulfilled by consulting on various problems which a high risk pregnant woman feels during bed rest. This includes need for consultation on different problems like physical, psychological, marital, acceptance of hospitalization, confidence in activity restriction, helpless and dependent state.

Discussion:-
The findings of present review were that bed rest during high risk pregnancy is a crucial time for pregnant women. High-risk pregnant conditions leads to long duration of hospitalization, as strict bed rest is better followed in a hospital. Data attained from review emerged in three themes: need for consultation on different problems, need for emotional and social support and needs to reduce factors of stress and anxiety.
Two studies have clearly identified the needs of the mother during bed rest and they are need for improved environment, social support, assisting with emotional adaptation, accepting of hospitalization, consultation on different problems like physical, psychological and marital (Kent et  Two of the studies revealed that specific support is needed during bed rest in high risk pregnancy but, the findings of these studies were that psychosocial support during bed rest in high risk pregnancy was ineffective and it did not improved the health status of women and foetus (Denis et al., 2012, Villar et al., 1991 Limitations:-The search that was carried out was within a publication period of 1991-2016. Due to financial constraints, the review is limited to the full text articles free to be accessed because neither translators nor paper articles costs were feasible. Only four databases were used to carry out this literature review.

Conclusion:-
Bed rest interrupts the natural process of pregnancy due to which high risk pregnant mother may sometime feel isolated. During prolonged hospitalisation, the patients develop social, environmental, emotional and adaptation needs and found it difficult to accept prolonged hospitalisation. During hospitalization, the high risk pregnant women have high level of stress and anxiety and worries. The explored themes would help the nurses to identify the needs of high risk pregnant women during bed rest and provide comprehensive care to meet them.