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.
Human Papilloma Virus (HPV) is in the news once again. Korean researchers have reported that high risk HPV increases the risk of premature rupture of membranes (PRM) and preterm labor in Korean women. While more studies are needed to determine exactly how HPV causes PROM and preterm labor, the researchers conclude the HPV is a serious risk to pregnant women and their babies.
These researchers knew that Human papillomavirus (HPV) is known to be more prevalent in spontaneous abortions than in elective terminations of pregnancy. Additionally, placental infection with HPV was shown to be associated with spontaneous preterm delivery. Yet to date, no one had looked at HPV prevalence and preterm births, so the researchers studied this question in Korean women.
311 women who gave birth at Korea University Medical Center were the study sample and included 45 preterm deliveries, 50 cases of premature rupture of the membranes (PROM), 21 preeclampsia cases, and 8 gestational diabetes mellitus (GDM) patients. The women were tested for HPV at 6 weeks post partum using the Hybrid Capture II system to detect high-risk (HR)-HPV infection.
The prevalence of HR-HPV infection was 14.1%. Women with HR-HPV infection had a higher incidence of PROM than those without HR-HPV and HR-HPV infection was associated with an increased risk of PROM. The prevalence of preterm delivery, preeclampsia, or GDM was not different between the women with HR-HPV and without HR-HPV.
This is an interesting and important study. While it was not clearly stated when these women became positive for HPV (seroconversion during pregnancy or “newly infected”), the implication that I read is that they were not positive prior to the study. (Would be an interesting fact to know!) In any event, by delivery, 14.1% of these women were infected with the HPV virus and were at increased risk of having PROM. It seems that this data may be translated to women of other cultures (but again, further studies are needed to confirm the results), but the most important fact to note is that HPV infection causes an increased rate of spontaneous abortion and in pregnancies that progress, an increased rate of PROM and preterm labor.
I was not tested for HPV when I was having my kids and I am not sure if it is routinely done today as part of the first prenatal visit screening laboratories. But given this information, I think its important that clinicians screen for HPV at the first prenatal visit and at the post partum visit and that women ask about being screened if they feel that they may be at risk (and even if they are not at risk!!!).
GeumJoon Cho, Kyung-Jin Min, Hye-Ri Hong, SuhngWook Kim, Jin-Hwa Hong, Jae-Kwan Lee, Min-Jeong Oh, HaiJoong Kim Risk “Human Papilloma Virus Infection is Associated With Premature Rupture of Membranes” BMC Pregnancy and Childbirth 2013, 13:173 doi:10.1186/1471-2393-13-173
A mama asked this question and I figured, rather than respond to her privately, I’d reply for the benefit of everyone.
Q: My daughter is 20 months old and I was on strict bed rest from 20 weeks until 36 weeks. My question is, “How long does it take before your muscles get back to “normal”? My leg muscles are still horribly weak. I work out, hike, ride horses and walk a lot. Will my muscles ever return to normal? Has anyone else experienced this?”
Bed rest has been long been known to cause bone loss, muscle weakness and loss and weight loss. The first studies done by NASA to determine the effects of weightlessness on metabolism established that in as little as 60 days, women on severely restricted activity can lose up to half their strength. What’s more, not even dietary changes can help. The NASA study showed that women placed on high protein diet lost even more muscle mass than women who made no dietary changes.
Exercise was the only intervention that NASA found to reverse the negative physical effects of activity restriction. In their study,
The exercise regimen included a 40 to 50 minute aerobic workout two or three times a week and 20-minute strength tprraining sessions two or three days a week. While lying on their backs, the women did multiple sets of thigh and calf exercises using a flywheel device similar to a typical leg press machine at a gym. They also worked out on a vertical treadmill.
While many may balk at the thought of the vigorous exercise prescription recommended by NASA being used for women on bed rest, there really isn’t any reason that women on bed rest can’t participate in modified exercise programs.
So let’s get back to our mama’s question. She is 20 months post partum and still feeling significant muscle weakness. When I reviewed the literature, there is consensus that bed rest does in fact significantly reduce muscle mass and strength, and according to Judith Maloni, PhD, in her publication Antepartum Bed Rest For Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth “the physical changes that occur during bed rest are not resolved by 6 weeks post partum.” Unfortunately, I was unable to find any publications that looked at the effects of bed rest on maternal physical health specifically, and no publications that were able to give a time frame within which a mama can expect to regain her pre-bedrest strength and endurance.
One thing that I have seen coincidentally is that many women come off of bed rest, either just before or at delivery, and want to resume their pre-pregnancy activity levels immediately post partum and feel that something is wrong with them when they are unable to “jump right back” into their pre-pregnancy activities. I always recommend that “former” Mamas on Bedrest ease back into activity. Mamas who were on strict bed rest during their pregnancies for two weeks or more are significantly de-conditioned (the longer the bed rest stint, the more de-conditioned mamas body becomes), and the approach needed to regaining strength and endurance is not unlike that needed to retrain individuals to walk again after a significant injury (i.e. a car accident). People who suffered significant injuries resulting in weeks to months in a coma or in bed take months to years to regain their functionality. While the bed rest prescription does not create the same type of insult to the body physically as a traumatic injury, the effects on the physical function of the muscles and bones is very similar. So much like an injured person must go through weeks to months of physical therapy, Mamas on Bedrest should take a similarly slow, gradual, step by step incremental approach to regaining their pre-pregnancy physical strength and endurance. They may choose to work out with a personal trainer, a physical therapist or in a class specifically designed for post partum mamas, with emphasis on mamas who have been on prescribed bed rest.
So how can Mamas on Bedrest avoid or at least reduce the deconditioning they may experience as a result of bed rest? They must exercise while on bed rest! While the NASA study had the astronauts using flywheel cycles and weight, mamas on bed rest can perform modified stretches and strength training right from their bed. We put together a full set of exercises and stretches in our Bedrest Success Kit, yours free when you subscribe to our monthly e-newsletter (The upper right hand corner of this page!!), as well as several samples of exercises on the Mamas on Bedrest Youtube Channel.
So good luck Mamas! Let me know how this post helped you in the comments section below. I am eager to hear your success stories and other questions! You can also send e-mail to firstname.lastname@example.org if you prefer a private correspondence.