As Piglet points out in Pooh's Little Instruction Book,
"It is hard to be brave when you're only a very small animal." And when
you are pregnant with a very small baby, and things go awry, it is even
harder to be brave.
Many mothers who have gone through a high-risk pregnancy describe it as one of their worst experiences. There are the logistics of coping with work and family while trying to protect the life of their unborn child. There is loneliness, as quite often "high-risk" translates into hospitalization or bed rest. But most of all, there is fear. Often, the complications of such a pregnancy are a matter of life or death, either for the mother or the baby.
Some women go into pregnancy knowing they are in a high-risk category, because of a pre-existing condition like diabetes, being pregnant with multiples or complications with a previous pregnancy. But for many other women, the experience is a surprise, as a seemingly healthy pregnancy suddenly becomes precarious.
Darcy Carr, M.D., an assistant professor of obstetrics and gynecology at the University of Washington, says the hypertensive disorders are among the most serious. Learning of them is often upsetting for patients. Severe preeclampsia, for instance, usually develops in late pregnancy but sometimes occurs much earlier and may require a pre-term delivery. Characterized by a rise in blood pressure, swelling and kidney problems, preeclampsia requires hospitalization, "often for several weeks, often away from family and friends," Carr says.
The logistical challenges
The severity of the condition dictates how each family must respond. If hospitalization is necessary, a mother might face the immediate challenge of child care for siblings. Is a spouse or other family member able to care for children? If not, the scramble is on to find hired help, whether an in-house sitter or a day-care center.
Pregnant moms placed on home bed rest may also need help caring for other children. For a mother to truly limit her movement, chasing after other kids is not realistic and could be dangerous for her and the unborn baby.
For professional mothers, work often takes a sudden backseat to immediate health issues. As with child care, the amount of responsibility a mother continues to shoulder depends on the specific health risk and how much activity the doctor will allow. Is working a few hours a day sitting in front of a computer safe? Is any amount of driving safe? Of course, different employers have different disability policies. Any discussions a working mother has with supervisors and human resources departments should include specifics of her doctor's orders.
Finally, there is housework. Hospitalization means outsourcing that work. But even home bed rest may force big changes. Family and friends can often help with cleaning, shopping and errand running. Or, if money allows, a mother may opt to hire out certain jobs. Many grocery stores, dry cleaners and other stores do home delivery. And, a bedridden mother with access to the Internet can expect to become a proficient online shopper.
The health challenges
If not hospitalized, a mother may find herself responsible for home monitoring of her condition. That might mean monitoring of uterine contractions. Or, for the roughly 4 percent of pregnant women in the U.S. that the American Diabetes Association says are diagnosed with gestational diabetes, it can mean sampling one's own blood several times a day and making dietary changes.
Carr encourages patients on bed rest to talk with their doctors and nurses about physical therapy. "Instruction in resistance exercises for arm and leg muscles might ward off potential side effects of bed rest, such as blood clotting and muscle atrophy," Carr says.
The emotional challenges
Moms may need to cope with feeling isolated. Email and phone calls with friends can help. But often, even those meaning well do not truly understand the fear, anger or guilt. To an outsider, the thought of bed rest might sound a lot like a vacation.
Find a support system: The national support network, Sidelines, (see Resources below) is one valuable resource for mothers dealing with complicated pregnancies. Moms can be matched with a trained, local volunteer who has been through a similar situation. There are regular online chat sessions. And, the group's Web site and magazine also have helpful information and poignant articles.
Melissa Papesh of Gig Harbor recently spent four weeks on home bed rest. She remembers how vulnerable she felt emotionally. "When my husband would come home from work, if he didn't say 'hello' to me right away, I would just break down."
As difficult as this period was, Papesh says that her relationships with family and friends deepened because she learned to lean on others. By providing meals, running errands or helping care for her 3-year-old daughter, "Everybody had to come together" she says. "Even when they thought they were only helping a little bit."
And now that she can cradle her healthy baby son in her arms, "Grant is the product of a lot of people's love," Papesh says.
Hilary Benson, a mother of three, lives in the Seattle area. Her work has appeared in ParentMap and Seattle Magazine and on KING-TV.
- Sidelines -- A national support network for women and their families experiencing complicated pregnancies and premature births.
www.sidelines.org or call 888-447-4754 (HI-RISK4)
- When Pregnancy Isn't Perfect, by Laurie A. Rich
- Days in Waiting: A Guide to Surviving Pregnancy Bedrest, by Mary Ann McCann
- The Pregnancy Bed Rest Book: A Survival Guide for Expectant Mothers and Their Families, by Amy E. Tracy
- And Mommy's on Her Side, by Heidi Morse Travis (for children)
- Preeclampsia -- www.preeclampsia.org
- Gestational diabetes -- www.diabetes.org/gestational-diabetes.jsp