Try to RelaxJennifer Bails
The heavy bleeding sent me to the hospital in hysterics nearly two months before my due date. That’s where I learned my cervix had shortened and thinned almost completely, a warning sign my body was gearing up for labor way too early.
After a steroid shot to accelerate my daughter’s lung development, the obstetrician gave me pills to prevent contractions and another more bewildering prescription – bed rest. “We don’t know if this really helps prevent preterm delivery,” he told me. “But let’s try everything we can to keep her cooking in there as long as possible.”
So without further questions or second thought, I went to bed, lying on my left side to keep pressure off my uterus and prevent labor. And all at once, I went from being an independent, go-getting newspaper reporter and compulsive runner to a bedridden patient completely out of control of her body and life.
Each day I got up only to shower and brush my teeth, use the bathroom as necessary, and in an occasional fit of guilt-producing recklessness, pour myself a bowl of cereal downstairs. My husband did his best to pick up the slack around the house, and friends and family visited when they could. But even a nightstand brimful of good novels and bad romantic comedies couldn’t distract me from the fear and uncertainty.
Minutes, hours, entire days passed when all I did was cry and imagine the worst. I spent the restless winter nights in the black hole of my bedroom pleading with my swollen belly as I watched it rise and fall, trying to will my defiant womb into compliance. The medication made me jittery and flushed. My bones and muscles ached from the lack of activity. Time passed imperceptibly, but somehow my maternity leave was evaporating before I could even stroke my baby’s downy head or inhale her sour breath.
I have never felt more alone.
Ironically, I wasn’t. Each year, an estimated 700,000 – or one in five – pregnant women in the United States are placed on bed rest for just about every obstetrical complication imaginable. It is a standard way to treat preterm labor, threatened miscarriage, preeclampsia, multiple fetuses, low or high amniotic fluid levels, pregnancy-induced hypertension, premature rupture of membranes and incompetent cervix, among other conditions.
For what purpose? None, according to Judith Maloni, Associate Professor at Case Western Reserve University’s Bolton School of Nursing, who has produced most of the major research about pregnancy bed rest and received the first National Institutes of Health grant on the topic.
For more than a decade, Maloni has been calling on doctors to stop prescribing bed rest routinely to pregnant women. “The body of evidence shows that bed rest has minimal or no benefit,” she says. “That might be no big deal if bed rest didn’t hurt you, but it does.”
Maloni’s early studies took a cue from NASA and Russian aerospace scientists, who began to put people on bed rest in the early 1940s to investigate the potential consequences of weightlessness during long-term space flight.
The problems they observed in their subjects were dramatic, like muscle weakness and atrophy, indigestion, bone loss, dizziness, blood clots, fatigue and fainting. Then there were the psychological side effects such as increased stress, anxiety, sense of isolation, sleep disturbance, boredom and depression.
“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.”
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.”
Likewise, “The Future of Children” report by the David and Lucile Packard Foundation reviewed the research on bed rest in twin pregnancies and concluded “that in the absence of proof of the effectiveness of bed rest, its use should be curtailed sharply.” I will never know if I helped avert a real threat to my baby’s life.
Yet Maloni’s research shows about ninety percent of American obstetricians still prescribe bed rest in some form, continuing to believe in its value despite mounting evidence to the contrary. “Doctors aren’t trying to do the wrong thing, but it takes a long time to change conventional wisdom,” says Dr. Simhan.
Maloni believes change might only come if insurance companies stop paying for bed rest-related medical expenses – or if women empower themselves to ask their doctors the right questions about the efficacy of bed rest and its side effects. At the very least, she says, pregnant women placed on bed rest should get a second opinion from a perinatologist (an expert specializing in high-risk pregnancies) and ask their doctor for a comprehensive physical assessment and rehabilitation program after childbirth.
“I’ve never told a woman not to go on bed rest – that’s an individual question that people have to answer with the help of their physicians,” Maloni says. “Instead, I just keep calling on the professions of nursing and medicine to incorporate scientific evidence into their practice and change the model of care.”
For as long as doctors keep prescribing bed rest, pregnant women like myself – terrified and vulnerable – will listen.
Author and English literature professor Sarah Bilston was placed on bed rest during her first pregnancy for low amniotic fluid, an experience that inspired her bestselling novel Bed Rest, and its sequel, Sleepless Nights, to be published this August. When doctors prescribed Bilston bed rest again during her second pregnancy, she briefly considered not complying, but couldn’t go through with it.
“I knew all the studies from my research for the book,” Bilston says. “But when your child’s life is on the line, what woman is going to do anything other than what she is told to do by her doctor? If they had asked me to stand on my head for six months, I probably would have done that, too.”
Blucher agrees – and now has a positive outlook about her time spent on bed rest. “When you are lying there day after day in a fight with your emotions, bed rest can be the hardest thing,” she says. “But I just look at Maddy – she’s an amazing, healthy kid – and it puts everything into perspective.”
After spending four weeks on bed rest, my obstetrician was no longer worried about my baby’s birth weight and allowed me to walk again and even return to work. A week later, Ilyssa was born full-term and healthy, weighing 5 pounds, 11 ounces.
I suppose I will never truly know if I helped avert a real threat to my baby’s life. And of course I’d do it again if that’s what the doctor orders the next time around. But should most women ever have to? Probably not. Let’s hope one day medicine agrees.