Yoga as Occupational Therapy for Prenatal Mothers on Bed Rest
By Ashley Opp Hofmann
Photo at right: Pregnant women on bed rest particpate in yoga as a way to relax and reduce stress and discomfort.
How can occupational therapy practitioners actively engage clients who are prohibited from being active? At Memorial Hospital and Health System in South Bend, Indiana, Suzanne Makielski, MS, OTR, RYT, CIMI, has found a way to integrate the practice of yoga therapeutically for pregnant women who are on mandatory bed rest in the Special Care Obstetrics Unit. These women are at risk for preterm labor and under close monitoring by nursing staff.
“This is just a really tough population of people to reach,” says Makielski. “They have activity restrictions; they’re not supposed to be up and walking. Going in and doing straightforward exercises has not been very motivating for these women because they don’t really see the point. They are under extreme duress. They’re worried about the chaos brought on by unexpected hospitalization—in many instances their home lives are turned upside down and inside out.” As a result, they can become extremely depressed and experience major psychological stress, which, according to Makielski, the nursing staff have named “ante-partum psychosis.”
“Sometimes their medications cause even more physical discomfort, so hospital staff walk a tightrope to keep these clients as comfortable as possible,” explains Makielski. “Typically, doctors have ordered occupational therapy and physical therapy, but many therapists have felt powerless to help. It’s been hard to captivate these women with a traditional therapeutic program. Using yoga—a mind, body, and spirit practice—has hooked them into doing something that benefits them psychologically and physically, and that can improve their coping skills.”
Serendipity played a part in developing this program, called Gentle Gestures. A massage therapist, Jeff Nixa, was taking one of Makielski’s yoga classes for hospital staff and began providing upper-back massages to some of the women in the Special Care Obstetrics Unit. He approached Makielski about the possibility of extending yoga to them. “A lot of these women feel stressed because they’re on bed rest and they can’t move; they’re uncomfortable,” Makielski explains. “He thought it would be great to offer yoga to them, even if it was just breathing techniques and gentle movements.”
Fortunately, Memorial Hospital has an organizational program that promotes a culture of innovation through WOW! Projects. Using this program, Makielski developed the idea of offering a new occupational therapy approach—one that uses yoga—to women on bed rest to enhance their overall well-being during their hospital stay. Referrals are made for women facing a length of stay of at least 2 weeks.
To kick off the program, Makielski gave in-services to different nursing shifts, including sharing the program brochure she had developed for the patients. Patients now receive brochures at bedside, and nursing staff can answer any questions they have about the program. The Special Care Obstetrics Unit is also developing a lecture series for pregnant women regarding health; and Makielski will participate by presenting information about the Gentle Gestures program as well as infant massage, which she is also certified to teach.
The Stress of Inactivity
The situations of women who wind up in the Special Care Unit vary. “Some have significant health risks, such as obesity, diabetes, high blood pressure, and tobacco use,” Makielski says. “They may be experiencing not only a first pregnancy, but also a multiple pregnancy. In addition, older women are at higher risk during pregnancy. They tend to be continually uncomfortable, severely stressed, and at a greater risk of pneumonia as a result of their inactivity.”
The program uses stress management techniques, such as deep breathing and guided meditation. Women are taught how to connect their breathing with movements in order to prepare for gentle exercises. They practice poses such as eagle arms, tree pose, and cat–cow while reclining or sitting on the edge of the bed. “For me, the program is a discovery of how we can occupy these women and empower them to cope and manage their own well-being while dealing with an extremely difficult situation,” Makielski says.
Juliana Newbill, who is expecting a daughter, was on bedrest at Memorial for over 2 months. Early on, a nurse gave her a Gentle Gestures brochure and explained the program. “After a month, I knew I wanted to participate,” she says. “I think it’s an excellent practice and I applaud Memorial for looking beyond [physical] health concerns and considering the patient’s state of mind.”
Makielski’s program proved to significantly reduce Newbill’s psychological stress. “I was dealing the stress of the unknown. Worse-case scenarios were always racing through my mind and I had a lot of anxiety,” she says. Yoga also helped to relieve a lot of back pain, shortness of breath, and normal pregnancy concerns. And after 2 months on bed rest, “I was afraid my muscles would atrophy,” says Newbill. Her breath capacity improved as well; an inspirometer measured a change from 1500 ml to 2250 ml.
In another case, Makielski worked with a very small woman who was expecting twins and was extremely uncomfortable and stressed because she could not move. Her breath capacity went from 500 ml before intervention to 850 ml after.
One very positive result that should not be overlooked, although it cannot be measured, is the dynamic between the mother and her unborn baby. “Yoga has really helped me to connect with my baby—with my daughter—during this part of my pregnancy,” Newbill says. “I don’t know if it’s the movement, meditation, or relaxation, but I know that I felt closer to her.”
Occupational Therapy or Yoga?
So, the question might come up: Is the program occupational therapy or yoga? “Yoga is just another modality I’m using in my practice that makes therapeutic interventions more appealing, engaging, and meaningful,” Makielski says. And as occupational therapy practitioners know, active engagement in activities leads to a better sense of well-being and in these cases, better health.
Gentle Gestures is still young and very much a pilot program. Makielski intends to continue tracking the mothers’ satisfaction scores and pre- and posttest pain level scores and breathing capacity measures to measure outcomes of her interventions. “The physicians are very supportive and willing to go with the program,” Makielski says.
Seeking innovative and creative ways to improve one’s practice is at the heart of the American Occupational Therapy Association’s Centennial Vision. “We hope to expand the number of women reached with this program—we have about 50 mothers per year who must stay in the hospital for more than 2 weeks—and there’s a tremendous need to provide something beneficial for them while they’re on bed rest,” says Makielski. “Gentle Gestures is one way they can manage their own well-being while in the unit, and later incorporate the experience into their daily routines.”
Ashley Opp Hofmann is AOTA’s senior staff writer.