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.
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TGIF and Happy Memorial Day weekend! This weekend marks the official start of summer in many areas of the northerm hemisphere. As promised, below you will find resources for taking great care of your legs to prevent blood clots from forming while on bed rest. I am giving a HUGE shout out to Mama on Bedrest Sarah for posing the following question to me on our community Facebook Page:
“Any suggestions as alternatives for compression stockings? I can’t do anything that increases abdominal pressure but can’t afford the compression stockings. I do get up several times a day but only to get water and use the bathroom. But I’m still worried about dvt.”
This is a FANTASTIC question and one that all Mamas on Bedrest should be concerned about. Pregnancy in and of itself increases a woman’s risk of developing a blood clot in her legs due to elevated levels of estrogen which enhance blood clotting. (Same thing they worry about when women are on the pill!) Add in bed rest inactivity and Mamas on Bedrest are prime candidates for deep venous thrombosis (DVT) or blood clots to form in the legs and then travel to the heart, lungs or brain to do deadly damage.
Sarah was prescribed compression stockings and that is an excellent recommendation-except they are expensive. Compression stockings can cost anywhere from about $80 on up. They are typically only available by prescription. So what is Sarah and other Mamas like her to do?
1. Exercises. I produced an entire video blog showing how to do leg exercises on bed rest as well as how to massage the lower legs.
2. Massage. While rubbing your own legs is good, Oh much better it feels to have someone do it for you! If your partner is willing, have him/her gently massage your lower legs. (see vlog for details). If you have access to a prenatal massage therapist in your area, or a really good massage therapist who knows lymphatic drainage techniques, a professional massage would be even better!
3. Support hose. Now I can’t speak for other areas of the country, but it is heating up here in Texas and the thought of wearing compression stockings or even support hose is daunting. However, if they are lifesaving-what’s a bit of heat? Sarah mentioned that she could not afford the compression stockings. However, she could do the next best things and wear support hose. These do place a bit of a squeeze on the legs, but not nearly the amount of pressure Compression stockings do. Hence, they are cheaper. Good brands that I know of are Gold Toe and Jobst. I highly recommend ordering products from Special Addition Maternity and Nursing boutique here in Austin if you can’t find products in your locale. They have an entire online shop and you can actually call and they can help you get fitted OVER THE PHONE!!! They can tell you (or a friend or family member) how to measure your legs and then help you select products that will suit your needs and purse!
4. Drink plenty of water. Contrary to what you may be thinking, Staying hydrated will actually help reduce swelling. You body won’t feel like it needs water and hold onto water so tightly (i.e. swell). Also, lowering or avoiding salt altogether is also helpful.
5. Make sure your prenatal supplements are really working for you and your legs in particular. Leg cramps, restless legs and blood clots are all very common during pregnancy. When you have the proper balance of vitamins and minerals in your diet, you are less likely to experience these leg problems or you will experience them to a lesser degree. To avoid leg cramps, restless leg syndrome and blood clots, make sure you have plenty of the following nutrients in your diet:
Calcium. Calcium aids in muscle relaxation allowing certain molecules into your muscle tissue.
Magnesium. Like Calcium, magnesium also aids in muscle relaxation and works in concert with Calcium. Many vitamins will include both minerals either in a 2 to l ratio (Calcium to Magnesium) or will have the minerals present in equal amounts.
Vitamin D. Vitamin D aids in calcium absorption as well as decreases overall inflammation that may be occurring. While many prenatal vitamins contain vitamin D, few if any meet the newly suggested requirements of up to 4000IU recommended by the March of Dimes and the Institute of Medicine for pregnant women.
Fish Oils-Fish oils contain essential Omega 3 and Omega 6 Fatty Acids which help prevent blood clots. However, if you have any sort of clotting disorder or bleeding disorder, you may need to avoid this supplement. Check with your doctor to see if it is safe for you to take fish oils.
Was this information helpful to you? If so, let me know in the comments section below. Do you have other tips and solutions to leg problems during pregnancy? Submit those in the comments section below as well. If you have specific questions, feel free to e-mail me at firstname.lastname@example.org. If you want to discuss more, you can schedule a Complimentary 30min Bedrest Breakthrough session.
Be well Mamas and Happy Memorial Day (In the US!!)