"We set out to systematically discover whether the same side effects of inactivity are there for pregnant women on bed rest — and they are," says Maloni.
Maloni found these side effects last well into the postpartum recovery period, just when women most need strength of body and mind to deal with the trials of new motherhood.
Alison Gary spent two months on bed rest in her suburban Maryland home last year after her blood pressure climbed to worrisome levels while she was pregnant with her daughter Emerson. Five months later, the thirty-four-year-old continues to suffer from intense hip
and knee pain, as well as debilitating exhaustion that she attributes to her lack of activity before childbirth. She sprained her foot during labor, likely because of her muscle loss. "I still feel like I am healing from it all, and like I am playing
catch-up for a whole period in my life that was taken from me," Gary says.
Debbie Blucher became pregnant two years ago while living in Switzerland for her husband's job. The couple planned to return home to California to deliver their baby, but then doctors diagnosed Blucher, thirty-seven, with a shortened cervix and placed her on strict
bed rest for ten weeks. She spent three of those weeks alone in a Geneva hospital. "I had no Internet access and no English TV," recalls Blucher. "There was nothing to distract me from my boredom and thinking the worst."
A year after the birth of daughter Madeleine, Blucher still suffers from back pain and is trying to regain her strength. "I was always very athletic," she says. "But [after being on bed rest] I would walk two blocks, and it would take me twenty or thirty minutes shuffling down the street,
out of breath."
The financial cost of bed rest can be extraordinary.In addition to these emotional and physical side effects, the financial cost of bed rest can be extraordinary. Consider lost earnings, hospitalization, medical bills not covered by insurance, transportation, prepared meals, household help and child care.
A 1994 study — the most recent data available — put the annual price tag of bed rest in the U.S. between $266 million and $1.3 billion.
During my bed rest, I took short-term disability at my paper, using up invaluable FMLA-time and forcing my husband and me to endure an untimely blow to our bank account. Luckily we had savings to pay the bills during those lean weeks. Some women are not
so fortunate. And I can't imagine having to cope with bed rest while caring for older children or as a single mother.
This toll on women, their families and the health care system would be worth paying if there were strong evidence to suggest bed rest prevents adverse pregnancy outcomes.
In theory, bed rest improves blood flow to the uterus and reduces pressure on the cervix that might stimulate dilation and contractions.
"The thought is intuitively appealing that when women are more active, they will contract more," says Dr. Hyagriv N. Simhan, a maternal-fetal medicine specialist at University of Pittsburgh Medical Center. "But that fails to recognize the root causes of
premature delivery, which is often caused by bleeding or infection in the uterus. And why those things happen is poorly understood."
Randomized controlled trials — the gold standard in biomedical research — comparing pregnant women on hospital bed rest with those who remained active found there was no difference between the two groups. Bed rest did not prevent miscarriage, preterm birth
or fetal/infant death, says Maloni. Furthermore, there is no research about whether bed rest works to improve infant birth weight or treat placenta previa, preterm rupture of membranes and other high-risk complications of pregnancy.
This uncertainty is reflected in the 2003 guidelines of the American College of Obstetrics and Gynecology, state that "bed rest...(does) not appear to improve the rate of preterm birth and should not be routinely recommended."
