Camp Bedrest Day 21: A look at the Physical Aspects of Deconditioning by Bedrest

Here we are on Camp Bedrest Day 21, doing really well and excited about the possibility of assuming my reclined position back at home next weekend. The past few days I've been blessed with a bevy of visitors- friends, family -- and Grant even snuck Kellydog in for a visit to my surprise! Time still ticks by slowly here in the hospital, especially after dinner until around lunch time, but I took up a few new hobbies learning to "Arm Knit" scarves and blankets on YouTube  and starting a "Bedrest Book Club" with some other bedbound mamas I've met on the forums. I also have been absolutely spoiled by old friends and new ones I have yet to meet with gifts to keep me occupied and brighten some of the darker days--- thank you!!!

As an overly-active young woman (is almost 31 still young? ehhhhh) one of the biggest issues I have been facing since my bedrest "sentence" is balancing the health and wellbeing of my unborn baby and minimizing my own physical deconditioning. Any woman who has had a baby can attest to the fact that pregnancy and labor alone do a number to your strength and conditioning, but adding being immobile for a month, and we are beginning to face a real challenge. I need to be physically able to care for my children when this is said and done.

Each year, 1,000,000 mothers-to-be in the United States are placed on some level of reduced activity at some point in their pregnancy. While bedrest is a hot topic amongst physicians globally, universally it is agreed upon that inactivity and bedrest are unnatural states for the human body.  Except for extreme circumstances (like being 2 cms dilated at 24 weeks!) most doctors, including the American college of Obstetrics and Gynecology, encourage reduced activity but not full bedrest due to the harsh side effects for anyone at risk of premature labor. 

According to a study done by the University of Florida in 2003, the average rate for deconditioning of muscles is "1-3% per day, in 3-5 weeks looking at 50% decrease in muscle strength." According to a 1993 study by the NIH, other major concerns include pain from having muscle fiber and connective tissue in a shortened position over a longer period of time (I can barely flex my feet... my calves are so tight and I cannot use bands or do isometric exercises as these engage my core which could cause contractions and further dilation). After about 3 weeks of bedrest (where I am now) the connective tissue around my joints and muscles is becoming dense instead of loose which means once I get off bedrest, I will have challenges walking, balancing and overall mobility. Today I weighed in 3lbs lighter than when I first arrived. 3 lbs may not sound like much, but my body composition has quickly transformed from being muscle to all fat (and muscle weighs more than fat)-- and this is during a period of pregnancy when I should be gaining about 1lb per week. Working daily on basic physical therapy exercises (ankle rolls, one foot at a time, while not engaging my core) has helped, and I honestly don't feel as weak as the numbers tell me I should. 

In addition to muscular deconditioning, the biggest issue I have been facing is "disuse osteoperosis" caused by lack of gravity, weight bearing exercises and muscle activity on the bone mass--essentially everything we are doing to keep the baby inside me is weakening my bones. Pathophysiologically, bedrest patients see an increase in the excretion of calcium into the urine - which makes kidney stones a major risk factor (something I have lots of experience with unfortunately-- 15-30% of patients on bedrest for more than 5 weeks have had to be treated for kidney stone pain due to incomplete bladder emptying- I believe this statistic calculates the number for those using bedpans and not having restroom privileges though). According to the UFL study, after 12 weeks of bedrest bone density is decreased by up to 50% - causing increased risk for broken bones - especially in labor (interestingly 9.5lb Gracen broke my tailbone during our 23 hours of labor... so I'm also prepared for this ha!) 

Cardiovascularly, bedrest patients typically see an increase in resting heart rate of about 4-15 beats within their first 3-4 weeks; and a decrease in blood volume (5% in 24 hours, 10% in 6 days and 20% in 14 days) which is why the fetal monitoring non-stress-test is so important as a pregnant woman's body is supposed to be doubling the amount of blood volume during this period. I've become fascinated with my monitoring sessions. Blood clots are another major concern, but fortunately technology has assisted here with the awesome "moon boot" SEDs I wear 23 hours a day. I also do hourly training on my peak flow meter to maintain an ample lung capacity (something crucial when it comes time to push!)

So, that is basically where I am at- becoming crippled but for a great reason. As my pregnancy progresses, I will be encouraged by the doctors to do greater activity as the risk of me decomposing will begin to outweigh extra time for the baby to cook. Crazy!