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Is Bed Rest Really Necessary? Maybe Not.

This weekend I read an important article in the Chicago Tribune that delves into the risks and benefits of putting pregnant women on bed rest: It’s definitely worth reading, especially if you are high risk, but here’s the gist:

Bed rest is prescribed by 95% of obstetricians to as many as 700,000 women each year. It can last for many months, cause women to lose their jobs and experience other serious personal and emotional hardships and yet there is little evidence supporting its usefulness in preventing preterm birth or other complications.

Bed rest involves staying in bed or having your mobility severely restricted for some period of time, often weeks or months towards the end of pregnancy. Full-on bed rest means no getting out of bed ever, except to go to the bathroom.

Risk factors that can prompt obstetricians to recommend bed rest include vaginal bleeding, pregnancy with multiples and high blood pressure. But, writes Julie Deardorff for the Tribune,

“…experts say there’s little evidence that immobility leads to better outcomes for those women. And although bed rest is often assumed to be a safe intervention, it can be a physical, emotional and financial nightmare for expectant mothers, especially those who don’t have strong support systems.”

The American College of Obstetricians and Gynecologists (ACOG) states that “bed rest, hydration and pelvic rest does not appear to improve the rate of preterm birth and should not be routinely recommended.”

The Cochrane Database, considered the Gold Standard when it comes to medical research, found, in 2004,  that pregnant women should not be systematically prescribed bed rest “due to the adverse effects that bed rest could have on women and their families, and the increased cost for the healthcare system.”

But why do so many doctors do it? Maybe it’s an old-fashioned practice that is hard to get rid of. But, according to Deardorff, its more likely because doctors find they have no other options. Bed rest doesn’t have to be cleared by insurance companies, and it may fend off malpractice suits.

Part of the reasoning for bed rest is that it can prevent premature birth– the baby is not putting pressure on the cervix –but, according to a maternal-fetal expert interviewed for the article, “there’s no evidence-based way to keep someone from delivering prematurely.” By putting so many women on bed rest, he continued, “we’re ruining lives, at least temporarily.”

Some women notice that contractions go away when they rest and lie down. But experts point out that  contractions are not necessarily meaningful when it comes to preterm birth. Contractions can happen throughout pregnancy without actually dilating the cervix. And most preterm births occur in women WITHOUT “risk factors.”

Women on bed rest can become achy, unable to sleep, sore, and their muscles can start to atrophy. They may need physical therapy after the baby is born. But the hardest part is usually the psychological strain. The isolation can be devastating. A woman on bed rest also feels, and basically is, dependent on her partner or others for so much. She’s unable to work in many cases. She’s unable to take care of older kids, if there are any. Plus the anxieties about her pregnancy tend to be heightened. Don’t move!

Sometimes women are put on bed rest if they have a weak cervix that could open before the baby is ready to be born. This is called “incompetent cervix” and it happens in about 1% of all pregnancies and is responsible for 5-10 % of all preterm births. But most women who have this condition can be treated with cerclage– a surgical procedure that essentially sews the cervix up and prevents it from opening. Some women are put on bed rest because there are signs of labor and the response is just, get into bed, don’t do anything.

Though devastating to some moms, the instinct to lie down and stop working can be a welcome prescription for others, especially if it isn’t for that long. These women may feel they are protecting their babies. Or at least getting some semblance of control over something that feels so out of control. Or they may have been working really, really hard and could use two weeks on the couch, not lifting a finger.

Mamas On Bedrest, a website started to help support pregnant women who are semi or fully immobilized and or concerned about their high-risk pregnancies, posted the following facebook update today:

“[I] was interviewed by a reporter for the Chicago Tribune. The article came out yesterday and while I could see what she was trying to do, she kind of missed the boat. The article ended up being very one sided and could be interpreted by women to ignore their OB orders and go off bed rest. A dangerous decision indeed! I’ll share a broader perspective of the article in tomorrow’s blog post. For now, check out the link.”

As soon as Mamas On Bed Rest posts a more official response I’ll add it here. [The post is now up, you can read it here.] I’ll be curious to read another side to this story, as the recommendation from ACOG and evaluation by Cochrane and other experts certainly is compelling in favor of limiting this practice.

Julie Deardorff wrote a follow-up to her article with ideas for supporting women on bed rest. You can read it here.

Have any of you been on bed rest? What was the reasoning/ Do you think it helped? What was the hardest part?

photo: Goldberg/Flickr

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