frequently asked questions

My OB says I'll be put on bedrest at 26 weeks. Is that normal?
There is a sizeable percentage of OBs who put their multiple moms on bedrest between 24 - 28 weeks as a preventative measure, even if they aren't showing any signs of problems. But most doctors wait until there's some reason.

I've been having a lot of contractions lately, but I don't know if they're real, or just Braxton Hicks. How can I tell them apart?
You can't. The main difference between BH and "real" contractions is that real ones cause cervical change. Your doctor is the only one who can tell you if this is happening, through a vaginal exam, or a few other tests which help in predicting pre-term labor. These include measuring the cervix through vaginal ultrasound, measuring vaginal fetal fibronectin, and measuring estradiol in saliva. For more details, see the Terbutaline FAQ.

Be sure you're aware of the other symptoms of pre-term labor:

• Diarrhea
• Low back pain
• Abdominal cramps
• Pelvic pressure
• An 'intuitive' feeling that something's not right.

What does "modified bedrest" mean?
Full bedrest means just that-- bathroom privileges, and maybe a shower every few days. In addition, you may be told to spend most of your time on your left side (this position increases blood flow to the uterus). Modified bedrest generally means there's more flexibility. You may be allowed to sit up for meals, for example. Or given a specific recommendation for the number of hours you should spend lying down.

Be sure to clarify your limits with your doctor, who's the one who knows why you're on bedrest in the first place!

I'm worried about muscle atrophy. What can I expect?
In some cases, you may be able to do some mild toning exercises, but please check with your doctor first! And listen to your body. If you feel an increase in contractions, stop!

I was on bedrest for 4 months and definitely saw a decrease in muscle tone and strength. I believe it takes about 3 months of inactivity before there's a noticable difference in strength. The good news is it takes much longer for total atrophy (longer than you'll be pregnant)! :-)

I read a book called "When Pregnancy Isn't Perfect" (Laurie A. Rich) that has a list of isometric exercises to do while on bedrest. I talked to my ob and showed him the book and he approved of my doing them daily. The top two reasons for doing exercises (from my ob and from the above- mentioned book) were to keep circulation going in the lower extremities (prevention of blood clots in the legs and retention of water/swelling of the ankles and legs) and to keep pelvic and upper leg muscles toned for the birth process itself. Also can't hurt just to rid yourself of some of the kinks from lying on your side so much and just passing the time! While in the hospital for weeks 30-34, my ob actually asked a physical therapist come to my room who provided hand weights and another exercise routine.

Is there such a thing as brain atrophy??
You may be experiencing one of the less pleasant symptoms of pregnancy-- a general inability to concentrate. And yes, you may find that bedrest increases this feeling, especially if you are also on any tocolytics. While it's not permanent (honest!), you may find that normal brain functions don't return until your twins are sleeping through the night....

Some of this may be related to the feeling of isolation; that you don't know what's going on in the world. Here's where the internet can help. For starters, you can make a point of checking one of the major news sites every day. Even if you go to, say, CNN.com, and immediately head for their travel section, make sure you take a look at the headlines. This way, you don't have to feel completely out of touch.

You can also benefit from the many virtual communities out there. The Twins List is a great place to start. Not only can you get the advice and support of others who've been through bedrest, you'll also learn more about what's ahead! ;-) You can also go to some of the sites which host mailing lists, like OneList.com. Type in the topic of your choice, and you'll find mailing lists to go with it.

Many of the parenting sites listed in the resources section also have chat rooms. Even if you're not the type who generally likes chatting with a number of people you don't know and can't see, you may find that this is just the sort of virtual outing that makes the time pass and gives you something to think about. The Sidelines chats are specifically geared towards women on bedrest.

What are tocolytics?
Tocolytics are drugs which are given to halt pre-term labor (PTL). Some of the most common are Terbutaline (Brethine), nifedipine (aka Procardia), and magnesium sulphate. Magnesium sulphate is also used in the treatment of pre-eclampsia/eclampsia. For some stories from women who were treated with terbutaline and mag sulphate, click here.

For more information on terbutaline, see the terbutaline FAQ. A FAQ on mag sulphate is in the works.

What are the steroid shots for?
When there is an indication that the babies will be born early, the doctor may prescribe a round of steroid injections. The steroids appear to speed lung development, so that even if the babies are born early, their lungs have a greater chance of being mature.

I am a L&D nurse at a tertiary care centre that does ~5500 deliveries per year. We offer a course of injected steroids to anyone with a threatened premature delivery. The research is quite strong that steroids before 32 weeks have a profound impact on fetal lung maturity. We use both betamethasone and dexamethasone. ... I also received them at 29 weeks gestation when I was threatening prem labour.
*****
Joan MacNeil, RN, BScN, IBCLC
macneil@ns.sympatico.ca

For more stories and experiences with steroids, click here.