Why Bed Rest
Bedrest: What’s the Point?
May 5th, 2011This is podcast discusses the rationale for the bed rest prescription, indications for bed rest and new advances in the treatment of high risk pregnancy. Available as a download only.
Mamas on Bedrest, are you ready for change?
January 31st, 2011This is an addendum to my previous post, “Mamas on Bedrest: Don’t Get out of Bed!”, a response to an article on bed rest published in the January 30th Chicago Tribune.
I have been watching the chatter back and forth on The Chicago Tribune website, on twitter and on facebook. While I am smiling at all this recognition of bed rest, I am a bit surprised at some of the venom coming out in the comments. Ladies, (I’ve not seen any responses from men/dads) I think we all need to step back, take a deep breath and then consider what needs to happen next.
What I am most concerned about is how tightly we are holding onto bed rest. I don’t know if it’s because bed rest is connected to child bearing, something so visceral and intimate for a woman but I want to remind us all that bed rest is simply a treatment, a tool, to help us during pregnancy. Some of the responses I’ve read have elevated bed rest to a spiritual endeavor. Its as if women are wearing their bed rest experiences like badges of honor. Many women are stating, “Bed rest saved my baby.” To that comment I wince. We have no scientific evidence that bed rest cures or treats anything. As Judith Maloni Ph.D aptly put in her publication,
“It is possible that antepartum bed rest might decrease preterm birth but evidence has not yet been found to support that conclusion. Such evidence may be masked by the complex multi-causal and interrelated factors that contribute to preterm birth.”
It is likely that a combination of bed rest, medical treatment, support (and support is critical!) and factors that we don’t yet understand contribute to high risk pregnant women successfully giving birth to healthy babies. But what about the women who go on bed rest and don’t deliver healthy babies or even live babies? What then?
I want to put this out there for everyone’s consideration. Back in the middle ages, physicians used leeches to “bleed out” infection/poison from sick people. If you were ill today and went to your doctor and he/she recommended bleeding with leeches as your treatment, you’d consider them crazy as you sprinted out of their office. We don’t do that anymore because somewhere along the way a physician or researcher either realized the practice didn’t work or, more likely, found something that was more effective.
Likewise, from the 1940’s to the early 1970’s Diethylstilbestrol (DES), a synthetic estrogen, was given to women of child bearing age with the mistaken belief that it would prevent pregnancy complications and miscarriage. We now know that DES not only does not prevent pregnancy complications and miscarriage, but it also damages the reproductive organs of the babies in utero. I have friends whose moms took DES. One has no uterus. One had a bicornate uterus (a skinny uterus with two separate sides, not able to hold a pregnancy). I have a male friend who is infertile (makes no sperm) and the origin was traced back to his DES exposure in utero. DES was a product approved by the US Food and Drug Administration in the 1940’s and was finally ordered off the market in 1975. As new evidence became available, we had to change our thinking and our treatment methods.
Wouldn’t it be nice if the same could be said of high risk pregnancy? The Sidelines Support Network was founded in 1991. Better Bedrest was established in 1995. The work that these organizations have done for high risk pregnant women is nothing less than phenomenal, supporting thousands of high risk pregnant women in 20 years. But it is also a sin and a shame that we can’t say that much else has changed in the care of high risk pregnant women in the 20 years since these organizations were established. In what other medical discipline has there been such slow progress? Not heart surgery. Many bypasses are now being done via incisions in a person’s left side and using arteries from breast and upper arm muscles as opposed to the bone cracking open chest surgeries formerly performed as standard. Breast cancer no longer requires the mandatory, disfiguring radical mastectomy but is often treated with lumpectomy, (much less disfiguring and tissue sparing surgery) chemotherapy and precisely focused radiation. Prostate surgeries today are more frequently performed via minimally invasive DaVinci Robotic surgery than open abdominal surgery. And what about Diabetes? Today many patients receive insulin via minipumps which provide pulses of the medication enabling more evenly sustained blood sugar levels as opposed to half a dozen or sometimes more individual shots daily. Even birth control pills have been radically redesigned and the dosages and release of hormones manipulated such that some only need be taken quarterly or once a year. I could go on with the advances in arthroscopic orthopedic surgeries and Automatic Implanted Cardiac Defibrillators (AICD’s) (which are now so small and compact they fit virtually unnoticed in the small depression below one’s collar bone) and other medical advances but you get the picture. Despite all these amazing medical and technological advances in other medical disciplines, high risk pregnant women are still being treated with bed rest, with no new treatment options proposed or offered in more than twenty years, no improvements in outcomes and no reduction in maternal and infant morbidity and mortality. Isn’t it time for a change?
Bed rest has been shown to have some fairly major negative consequences and yet no one can definitively say that it is helpful. I believe that the truth about bed rest in pregnancy is yet to be elucidated. Until then, I humbly request everyone who is on bed rest, who supports women on bed rest, or who endured bed rest for one or many children:
- Let’s at least be open to the fact that bed rest may not be what we think that it is; it may be better than we believe, it may be more harmful than any of us could have ever expected.
- Let’s be open to the fact that there are likely treatments out there-some sitting idly on a shelf or currently being developed-that may be much better than what we are using now to manage high risk pregnant women.
- Let’s not hold so tightly to our own experiences and to our own work (those of us who support high risk pregnant women) that we resist changes and advances.
Finally, I hope that we can find alternatives to bed rest and that we can vastly improve the way we manage high risk pregnant women. I say this selfishly because I have a beautiful 8 year old daughter and I am concerned about how much of my physiology is in her (i.e. will she experience the same or similar problems I had trying to have children). I certainly hope that in 20 or so years if/when she is having children, if she does have complications, we have something more to offer her than the same inconclusive bed rest prescription that was offered to her mother 28 years earlier.
Mamas on Bedrest: Don’t Get out of Bed!
January 31st, 2011
Sometimes you just know when the s–t is going to hit the fan! Such was the case with this bed rest article published in the Sunday, January 30, 2011 Chicago Tribune, “Value of bed rest for pregnant women questioned.”
I actually thought that I’d be raked over the coals first. I wrote a similar article for Science and Sensibility, the blog for Lamaze International. The article was an editorial review of “Antepartum Bedrest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth” by Judith Maloni, Ph.D. Dr. Maloni is one of the leading researchers in the field of bed rest and this article was a literature review. It covered 69+ research articles on bed rest and found that there is no medical or scientific evidence that bed rest is effective in preventing preterm births. As you can imagine, those of us who work in the field of bed rest support are aghast.
Support for women on bed rest first began in 1991 with Sidelines, founded by Candace Hurley. Hurley herself had been on bed rest with her pregnancies and knew first hand how difficult a task bed rest can be. She started the Sidelines support network to assist other women who ended up in her situation. To date, Sidelines has supported over 100,000 women through the bed rest experience with their one on one phone support and online resources.
In 1995, Joanie Reisfeld founded Better Bedrest . You remember Better Bedrest, don’t you? Mamas on Bedrest & Beyond sponsored a fundraiser for Better Bedrest just last fall. Better Bedrest provides peer support to pregnant women on prescribed bed rest but may be is best known for the microgrants that it provides mamas in need. It’s an awesome organization as well.
One of my favorite support resources is KeepEmCookin’. Founded by Angela Davids, KeepEmCookin’ is an online forum where women on prescribed bed rest can come and share their stories and get support from one another and from Angela. Angela was on bed rest with both her pregnancies and started KeepEmCookin’ after the birth of her son. She has been running the forum for about 3 years.
But a colleague recently reminded me,
“It’s important to heal (from your own experience) and focus on the work”
(Dr. Mimi Poinsett, @yayayarndiva, Thanks for keeping me focused!)
As much as we may all be shocked at what researchers are saying, it is important for us to all take a deep breath, step back and look at the data critically. Read the articles for yourself, look at what the data is saying. Much to all of our dismay, bed rest may not be the panacea it is touted to be. Despite many of the experiences of the founders of the aforementioned organizations and for millions of other women, bed rest may not have had anything to do with their pregnancy outcomes.
Currently there is not strong enough evidence that putting a woman on bed rest with activity restriction prolongs a pregnancy. The research to date states that in acute, emergent situations, women should be put on hospital bed rest and the situation stabilized. However, once a woman is stable and the complication has been “adequately managed” then women should be discharged home and supported there, but should not be placed on full bed rest. (Goldenberg, 2002, 2005). Further, researchers advocate considering alternative models as used in other countries which prescribe activity restriction in home and also provides home care programs (housekeeping, childcare, errands/shopping and medical monitoring).
One thing is very clear, the practice of bed rest needs to come under review. It may be time for clinicians, especially those in the United States, which has some of the highest rates of complications, bed rest, maternal and infant morbidity and mortality in the world (WHO, Amnesty International) to rethink how to manage high risk pregnant women.
One very good thing that is coming from all this flurry of interviews, articles and e-mails is that bed rest and high risk pregnancy are front and center in people’s minds-at least for the moment. When I mention that I support high risk pregnant women on bed rest, so many people are not even aware that women with pregnancy complications are even put on bed rest. Then, they see bed rest as some sort of life of luxury. Nothing could be further from the truth! Bed rest is hard on a mama’s body, it poses risks to the baby (primarily that of being born at low birth weight) it strains mama’s family and can cause significant financial and professional hardship. With these negatives and than an article stating that bed rest is not beneficial, Bed rest Advocates are concerned that women will read the article and simply ignore their bed rest prescriptions.
So let’s just get some things straight. We are not sure if bed rest is efficacious. We know that it causes some harm to a mama’s body, her emotions, disruption to her life and potential harm to the baby. Until there is evidence supporting other treatments, the position of Mamas on Bedrest & Beyond is to continue with the bed rest presciption as your clinician has recommended. Talk candidly with your clinician about your concerns and ask when appropriate: what things can be changed, when your activities can be increased, etc… Finally, utilize all of the support services available-Sidelines, Better Bed Rest, KeepEmCookin’ and of course, Mamas on Bedrest & Beyond.
Want a transformative bed rest experience? Try Bedrest Coaching. E-mail info@mamasonbedrest.com for a 30 minute Bedrest Breakthrough session and experience the power of coaching for yourself!
References
Maloni, J. “Antepartum Bedrest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth.” Biologicial Research for Nursing, 2010 October. 12, (2) 106-124
Goldenberg, R.L. “The management of preterm labor.” Obstetrics and Gynecology, 2002. volume 100, 1020-1037.
Goldenberg, R.L. “Arrested preterm labor. Do the data support home or hospital care?” Obstetrics and Gynecology, 2005. volume 106, 3-5.
Goldenberg, R.L., Cliver, S.P., Bronstein, J., Cutter, G.R., Andrews, W.W., Mennemmeyer, S.T. “Bed rest in pregnancy.” Obstetrics and Gynecology, 1994. volume 84, 131-136.
Goulet, C., Gevry, H., Gauthier, R.J., Lepage, L., Fraser, W., Afia,M. “A controlled clinical trial of home care management versus hospital care for preterm labor.” International Journal of Nursing Studies, 2001. Volume 38, 259-269.
Goulet, C., Gevry, H., Gauthier, R.J., Lepage, L., Fraser, W., Polomeno, V. “Arandomized clinical trial of care for women with preterm labour: Home management versus hospital management.” Canadian Medical Association Journal, 2001. Volume 164, 985-991.
Helewa, M., Heaman, Dewar, D. Community based antenatal home care programme for the management of preterm premature rupture of membranes.” Journal of the Society of Obstetricians and Gynecologists of Canada, 2000. volume 27, 928-935.
Helewa, M., Heaman, M., Robinson, M.S., Thompson, L. “Community based antenatal home care programme for the management of pre-eclampsia: An Alternative.” Canadian Medical Association Journal, 1993. volume 149, 829-834.
Monincx WM, Birnie E, Zondervan HA, Bleker OP, Bonsel GJ. “Maternal health, antenatal and at 8 weeks after delivery, in home versus in-hospital fetal monitoring in high-risk pregnancies.” European Journal of Obstetrics, Gynecology and Reproductive Biology, 2001. volume 94, 197-204.
Stainton, M.C., Lohan, M., Woodhart, L. “Women’s experiences of being in high risk antenatal care day stay and hospital admission”. Australian Midwifery, 2005. volume 18, 16-20.
