The bedrest debate continues as more and more studies are advocating treatment of the causes of bedrest in lieu of activity restriction. However, there are those that are convinced that bedrest is an effective treatment for preterm labor and prolongs pregnancy. Let’s take a look at the evidence.
For over 25 years, Judith Maloni, RN, PhD researched bedrest and found that the practice has no apparent benefit and has been shown to be harmful to pregnant women. Her publication, “AntepartumBed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth”(1), Maloni denounced the bedrest prescription because there was no evidence to support the practice.
In 2007. NASA released an article which showed that female astronauts in space lost bone mass and muscle mass and strength in as little as 2 weeks of inactivity, and the effects were even more pronounced at 60 days.(2) They recommended that if women do have to be on limited activity for an extended period of time, they should engage in a modified exercise program to maintain bone and muscle integrity.
The World Health Organization and Amnesty International have both denounced the bed rest prescription and have had sharp criticism of the United States-which boasts the highest costs of maternity care than any other country in the world, yet has some of the highest rates of complications, bed rest, interventions, cesarean sections and maternal and infant morbidity and mortality-to rethink their maternity care practices and to bring their maternity statistics in line with the rest of the world.
In 2013, physicians in the American Congress of Obstetricians and Gynecologists began questioning the practice of prescribed bedrest and Christina McCall, MD (3) and Joseph Biggio, Jr., MD (4) both called on their ACOG colleagues to stop the practice of bedrest citing the harm that is poses to pregnant women.
However, bedrest remains a mainstay in obstetrical practice. Here in Austin, the 2 major hospital systems each have large antepartum units which cater to women experiencing pregnancy complications. My colleague Angela Davids, founder of Keepemcookin.com, recently blogged about an article by Drs. Christine Piette Durrance and Melanie Guldi (5) in which the authors concluded after an extensive review of PRAMS (Pregnancy Risk Assessment Monitoring System) data of some 200,000 women, that limited inactivity does reduce preterm birth before 33 weeks by 7.7% and low birth weight infants (weighing less that 1500 grams) by 15.4%.
So what are mamas to think? Should they abandon bedrest? Remain on bedrest? Is there a way to not have to go on bedrest, to not encounter the complications that lead to the bedrest prescription?
At this juncture if you are a mama on bedrest, I WOULD NOT recommend abandoning the care plan that your provider has put into place for you. If you have questions about whether or not bedrest is necessary in your case, speak with your provider and voice your concerns. I am a firm believer that if you have hired (chosen) a provider for services, then you should follow their directions. Now if you are having reservations about being on bed rest, its efficacy and whether or not it is doing harm to you, you must have a candid conversation with your OB and get your questions answered so that you can make an informed decision.
I myself am a proponent of mamas getting off bedrest. I believe the way to do it is to help women to be in the best shape BEFORE they ever think about getting pregnant so that when they are pregnant they are strong and healthy. Many of you reading this may be saying, “Well fat lot of good that does me now!” I sense your frustration. There is nothing we mamas on bedrest do better than second guess ourselves! But what you did in the past (no matter how recent) is of no consequence. As Dr. Maya Angelou eloquently said, “When you know better, you do better.” You know better right now, so begin taking exquisite care of yourself right now! As much as possible,
- Eat healthy, nutrient dense foods.
- Drink lots of water (1/2 your current body weight but in ounces).
- Rest (I know that sounds ridiculous, but many mamas on bedrest are so stressed out they don’t sleep well and don’t rest. Your body is not only maintaining you, it is also growing another fully complete human being. That most certainly deserves a nap!
- Do stretches t keep your muscles supple and limber. (BedrestFitness!)
- Keep your spirits up
I don’t know what is to become of bedrest and the bedrest prescription. I do know for the nearly 1 million women who will experience bedrest, you have to take care of yourself. If you are in the Austin, TX area, look me up! I always enjoy mixing with mamas and would be happy to serve you.
How are you surviving bedrest? Share your tips and comments section below.
Judith Maloni, Ph.D. AntepartumBed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth (Biological Research for Nursing 12(2) 106-124)
Mark Ransford. NASA-Funded Study finds Exercise Could Help Women on Bedrest November 15, 2007
Christina McCall, MD, “Therapeutic” Bed Rest in Pregnancy, Unethical and Unsupported by Data”, vol 121, No.6 June 2013, 1305-1308
Joseph Biggio, Jr., MD.“Bed Rest in Pregnancy, Time to Put the Issue to Rest!” vol 121 No. 6, June 2013, 1158-1160
Christine Piette Durrance and Melanie Guldi. Maternal Bedrest and Infant Health.
Did you know that September is Infant Mortality Awareness Month?
Globally, The United States spends more on healthcare than any other country. Yet, it has worse birth outcomes than many other countries globally. Despite recent declines in infant mortality, the United States ranked 26th among the 29 Organization for Economic Co-operation and Development (OECD) countries in 2010, behind most European countries as well as Japan, Korea, Israel, Australia, and New Zealand (1). The U.S. infant mortality rate of 6.1 infant deaths per 1,000 live births was more than twice that for Japan and Finland (both 2.3), the countries with the lowest rates. Twenty-one of the 26 OECD countries studied had infant mortality rates below 5.0.
Overall in the United States, white infants die at a rate of 5-6/1000 births and Hispanic infants have a similar infant mortality rate. African American Infants die at a rate of approximately 11.4/1000 births. I’m here in Texas and our infant mortality rate for white and hispanic infants is 5.5/1000 births while it is 11.4/1000 for African American Infants. In Travis County (the Greater Austin Area where I live), African American Infants have an infant mortality rate of 11.5/1000 births, whereas white infants have an infant mortality rate of 3.7/1000 births and Hispanic infants 6/1000 births.(2) What is the cause of this disparity?
Researchers and public health officials have numerous speculations as to why the IMR for African American infants is so poor,
- Delayed initiation of prenatal care among African American women
- Lack of access to quality prenatal care
- Lack of insurance
- Preterm labor/Prematurity
- Low birth weight
- Birth Defect
- Maternal health complications
However Dr. Michael Lu, an obstetrician and gynecologist at the David Geffen School of Medicine at UCLA and a professor in the Department of Community Health Sciences and the Center for Healthier Children, Families and Communities at UCLA School of Public Health has proposed other reasons for the birth outcome disparities. In his groundbreaking research paper “Closing the Black-White Gap in Birth Outcomes: A Life-Course Approach“ (3) Dr Lu and his colleagues point to systemic racism in American culture as the underlying cause of the birth outcome disparities. Lu and his colleagues point out that racism passed down through generations, as well as repeated racial slights in the daily lives of African American women has created an allostatic load of stress on African American women that is affecting their overall health, but in particular, their reproductive health and causing the negative birth outcomes we see in African American women and infants. To address these social determinants of health, Lu and his colleagues propose a 12 point Life-Course approach to closing the racial gap in birth outcomes.
- Provide Inter-conception care for women with prior adverse pregnancy outcomes
- Increase access to preconception care for African American women
- Improve the quality of prenatal care for African American women
- Expand healthcare access over the life course for African American women
- Strengthen father involvement in African American families
- Enhance systems coordination and integration for family support services
- Create reproductive social capital in African American communities
- Invest in community building and urban renewal
- Close the education gap
- Reduce poverty among African American families
- Support working mothers and families
- Undo Racism
Lu and his colleagues have presented an approach that not only address issues surrounding pregnancy and childbearing, but also addresses the social issues affecting African American families and communities. Lu makes some very bold statements, ones that some people may be loathe to accept and even less likely to act upon. But as Lu says in his publication,
“We will not close the Black-White gap in birth outcomes without political will to do so. Political will is the ability to command resources to make things happen (i.e. implement the 12 points).”
As the saying goes, “Where there is a will, there is a way!” The question now becomes do we the American people have the will, the actual desire to close this gap?
MacDorman MF, Mathews TJ, Mohangoo AD, Zeitlin J. International comparisons of infant mortality and related factors: United States and Europe, 2010. National vital statistics reports; vol 63 no 5. Hyattsville, MD: National Center for Health Statistics. 2014.
Austin Travis County Health and Human Services Department. Infant Mortality Rate Causes of Death for Travis County, 2000-2011. Data Source, Center for Health Statistics, Texas Department of State Health Services. Texas Behavioral Risk Factor Surveillance System (BRFSS) 2011-2012
Lu, M.C., MD, MPH, Kotelchuck, M., PhD, MPH, Hogan, V., DrPH, Jones, L., MA, Wright, K., PhD, MPH, Halfon, N., MD, MPH. “Closing The Black-White Gap in Birth Outcomes: A Life-Course Approach” Ethnicity and Disease, Volume 20, Winter 2010.
It’s August and that means it’s National Breastfeeding Month here in the United States, and August 1-7, 2015 is World Breastfeeding Week! There is a lot of hubbub about breastfeeding in the US news. Advocates encourage women to reap the benefits of breastfeeding for themselves and their babies, while those less “enthusiastic” about public breastfeeding press for a more austere approach to this timeless practice.
Breastfeeding is a completely natural event and most all animal species breastfeed their young. Mamas of most species will breastfeed their young until the young are mature enough to eat adult food, then breastfeeding stops and the offspring eats with the rest of the pack/herd. Animals get everything nutrient and immune defense they need from their mamas.
Young animals do have an advantage over human infants, though. While most young animals will become mature enough to stop nursing in a matter of months, human infants, if nursed to the extent that nature intended, would nurse for up to 5 years! So I understand it when some mamas say that they don’t want to nurse that long. Breastmilk is a remarkable substance. When a mama breastfeeds, her body miraculously creates breastmilk with just the right nutrient balance, just the right consistency and just the right amount for the growing infant. In fact, as the infant grows, the consistency, composition and amount of breastmilk changes to meet the needs of the growing infant. And while developing the skill and finesse needed to breastfeed with ease does often take some practice, once mastered, mama and baby are free to go without the hassle of worrying about carrying bottles, formula, or worrying about keeping the breastmilk fresh or warming it up for baby to drink.
So when women tell me that they don’t want to breastfeed, I have to admit, I am always a bit taken aback; They want to forgo all those nutrients, all that convenience, all the immune system and developmental benefits…? But we all have to remember, It is a mama’s right to decide what is the best way for her to feed her baby. Yet it is my sincere hope that every woman will at least attempt to breastfeed her infant-even if only for a few weeks-in order to give her baby this most beneficial nourishment.
Why am I such a strong proponent of breastfeeding? Because of its benefits for both mamas and babies.
Research suggests that breastfed babies have lower risks of:
- Childhood leukemia
- Childhood obesity
- Ear infections
- Eczema (atopic dermatitis)
- Diarrhea and vomiting
- Lower respiratory infections
- Necrotizing (nek-roh-TEYE-zing) enterocolitis (en-TUR-oh-coh-lyt-iss), a disease that affects the gastrointestinal tract in pre-term infants
- Sudden infant death syndrome (SIDS)
- Type 2 diabetes
But the benefits don’t stop there. Breastfeeding also has significant benefits for mamas! Breastfeeding leads to a lower risks of :
- Type 2 diabetes
- Certain types of breast cancer
- Ovarian cancer
- In some women, breastfeeding speeds pregnancy weight loss
- Breastfeeding has been associated with reduced rates of Post Partum Depression
While almost all research sources, The American Academy of Pediatrics, The American Academy of Family Practice, The US Centers for Disease Control and Prevention, The World Health Organization and many other national and international organizations recommend breastfeeding exclusively for at least 6 months, but preferably for one year, again, every woman has to make the decision that is best for her and her baby. So that women can make informed decisions, here are some resources about breastfeeding.