Why Bed Rest

Mamas on Bedrest: “Why Wasn’t I Prescribed Bedrest???”

January 26th, 2015

Hello Mamas.

I received the following inquiry from a Mama on Bedrest:

“Hi. I’m 24 weeks along and on my last prenatal visit, my OB noted that my cervix was short. After ultrasound evaluation, he determined that a cerclage was needed. I had the cerclage placed, but my OB has not put me on bed rest. I asked if I should limit my activity and he said only if I felt contractions or otherwise uncomfortable. 

Most other women that I know who have been in this situation were prescribed bed rest. I’m really nervous that something will go wrong and I will lose my baby. What should I do?”

This is an excellent question!! First and foremost, a Mama should always listen to and follow her health care provider’s recommendations. I say this because you have “contracted” with this person to care for you and your unborn child. It only makes sense that you follow their recommendations. Now, if you find that you disagree with your health care provider on many or at least one major decision, I suggest you first talk with your health care provider and ask why they have chosen the treatment plan that they are implementing. Make sure that you understand the ENTIRE rationale behind their decision, and that you understand and are comfortable with the treatment plan going forward, including potential adverse outcomes.

If you are still uncomfortable after speaking candidly with your health care provider, I suggest getting a second opinion. Sometimes having another assessment of your situation will put your concerns to rest. Also, sometimes another person can explain things differently so that they make more sense to you and ease your mind.

Finally, if you have spoken with your health care provider and not gotten the answers that satisfy you, and you have consulted with another provider and gotten a second opinion-regardless of whether they agree or disagree with your original health care provider, you may want/need to change providers. Now I don’t say this lightly. Changing providers mid-pregnancy is most certainly not optimum, however, if you are really feeling uncomfortable with your current provider, it is in your best interest (and that of your baby’s) to work with a provider in whom you implicitly trust, with whom you feel completely comfortable and who will consult with you every step of the way making sure that you are included in treatment decisions, that you understand all treatment decisions and with whom you can speak to freely and as often as you need. If you don’t feel completely comfortable with your health care provider and feel anxious and uncomfortable with his/her treatment plan, then you may need to consider a change. But again, I highly suggest you do all that you can to work with this person who already knows you and your case.

Now, if it isn’t a conflict with your provider and you are just concerned that you should be on bed rest and they haven’t prescribed it, trust your health care provider as they are doing you a HUGE service not placing you on bed rest if it isn’t medically indicated. In our e-book, “From Mamas to Mamas:The Essential Guide to Surviving Bedrest” I spent an entire chapter discussing how bed rest is not an evidence-based treatment and that many, many obstetricians, maternal-fetal medicine specialists and many of the medical societies caring for pregnant women and their babies are urging providers NOT to prescribe bed rest, but to instead treat the pregnancy complication without the activity restriction. It sounds like this obstetrician is doing just that. What our mama should now do is at her next prenatal visit, ask her health care provider to explain to her EXACTLY why s/he did not prescribe bed rest, what s/he expects to happen with cerclage alone, what other treatments they will implement if the cervix continues to shorten to prevent preterm birth and what she can do to improve her pregnancy outcomes. In this way, Mama will have all the information she needs to take exquisite care of herself and her baby-and hopefully have all her fears and anxieties addressed and “laid to rest.”

 

What was your response to being put on bed rest or not being prescribed bed rest? Share your experience below in our comments section.

If you want to learn more about Bedrest not being an evidence based treatment for the prevention of preterm labor and preterm birth, read all about it in our e-book, From Mamas to Mamas: The Essential Guide to Surviving Bedrest” available for immediate download from Amazon.com.

Mamas on Bedrest: Am I a Bedrest “Benedict Arnold”?

January 12th, 2015

Good Morning Mamas!

Last week I had the pleasure to be interviewed for a podcast and I think I shocked the interviewer when I lead off with,

“I must begin by saying that bed rest is not an evidence based treatment, meaning that there is no scientific or medical proof that bed rest prolongs pregnancy or prevents poor birth outcomes.”

I know that I freaked out the interviewer a bit and she quickly moved the conversation onto indications for bed rest and what women should look for, and if there is anything that mamas can do to prevent being put on bed rest. I had to smile to myself.

I know that my stance on bedrest is unique and to some, it may seem like I am a “Benedict Arnold” when it comes to bed rest. So I want to clear the air. I never professed to be a proponent of bed rest. I am, always have been and always will be a staunch supporter of pregnant mamas! My sole mission in life is to ensure that every pregnant mama has all the tools, information and support that she needs to be able to have a healthy pregnancy. I chose to focus on Mamas on Bedrest after having 2 very high risk pregnancies myself and finding no support online, in the literature or in my local community. But let me reiterate: I am not one to run about saying that women should be put on bed rest. Nope. My goal is to provide the best care and support possible to pregnant women on prescribed bed rest, but to ultimately to be “put out of the bed rest business” because bed rest is no longer needed.

So does this mean that I think women should ignore their bed rest prescriptions? Absolutely not! When a woman begins prenatal care with an obstetrician or midwife, she enters into a legal agreement where the health care provider agrees to do everything within his/her professional expertise and within the accepted medical practices to ensure she has a safe and uncomplicated pregnancy and ends up with a healthy baby. Mamas on the other hand, agree to follow the guidance and instructions of their healthcare provider, working in concert with them to ensure that they have safe uncomplicated pregnancies and healthy babies at birth. If your health care provider recommends that you go on bed rest, you should go on bed rest. Why? Because they believe that is the best way that they can take care of you and your baby, and that is what you are paying them to do! So evidence based or not, you must abide by your agreement and follow the instructions of your health care provider.

Now that is not to say that you can’t ask questions. Ask your health care provider why they want to put you on bed rest? Is it strict bed rest or modified activity? Can you sit on the sofa or are you restricted to bed? What do they hope will happen with you being on bed rest? Yes, a healthy term pregnancy, but what else? What are the potential complications of being on bed rest? Of your condition?? Mamas, you must be an integral part of your health care team, and that means being fully informed about all that is going on.

So I hope this clears the air. I am not a proponent of bed rest and I do hope that it is abolished in favor of targeted treatments for the conditions for which bed rest is prescribed. New tests and treatments are already available for the detection and screening of pre-eclampsia  and incompetent cervix or cervical insufficiency.  Hopefully other tests and treatments for other conditions are in the research pipelines. For now, many obstetricians and gynecologists still prescribe bed rest and if yours is one of them, heed their instructions and come to Mamas on Bedrest & Beyond for support to thrive on your bed rest journey!

Got questions about your bed rest journey? Comments about this post? Post them below in the comments section. We’d love to hear from you.

Mamas on Bedrest: The World Is Watching-and Questioning Bedrest

September 8th, 2014

Bedrest is in the news again! This time via Great Britain, in the online  News Report “The Daily Mail”.

Citing research presented at the 2014 Society for Maternal Fetal Medicine annual conference held February 3-8, 2014, The Daily Mail reports,

“Bed rest during pregnancy could harm your baby: ‘Putting your feet up increases risk of blood clots, diabetes, depression and having a smaller newborn,’ warn experts”

This is not news. As seen in our book, “From Mamas to Mamas: The Essential Guide to Surviving Bedrest”, many physicians, researchers, writers and pundits have questioned the bed rest prescription. THERE IS NO EVIDENCE THAT IT IS EFFECTIVE and THERE IS EVIDENCE BEDREST CAUSES HARM TO MAMAS AND BABIES. As such, there is an increasing demand to stop the practice.

I want to be very clear here. There are instances and situations in which bed rest is ABSOLUTELY the right thing to do. When a woman presents in preterm labor with high blood pressure, spotting or amniotic fluid leaking, in the acute period until she is stable, medical care and yes, bed rest, are indicated. What is being questioned is the extended periods of inactivity-lasting weeks to months. In these cases, when there isn’t any acute medical intervention being done, obstetricians and researchers are questioning placing a woman on bed rest “just in case”.

Co-author of the cited study Anthony Sciscione, of the Delaware Centre for Maternal and Fetal Medicine, said: ‘There is no evidence bed rest improves outcomes.”

But there is evidence that bed rest can be harmful for mamas and babies.  Here are health complications associated with prolonged inactivity as a result of bed rest:

 

Muscle and bone loss. This ‘deconditioning’ can start after only a few days and there is a lack of information on its effect on pregnant women. (See our resources on this!)

Increases the risk of developing blood clots in the legs – and raises the chance that clots will move to the lungs, which can be fatal. Such clots are more common among pregnant women, so limiting physical activity may compound these risks.

Increases a woman’s risk of gestational diabetes. The Society said that being admitted to hospital for problems during pregnancy has been associated with a higher chance of this condition. It pointed to studies which have shown that patients who are put on bed rest when not pregnant tend to develop high blood sugar levels, a key risk factor for diabetes.

Increases the risk of anxiety and depression, perhaps because of the forced inactivity. (Also think lonliness and isolation)

Loss of income due to inability to work and has been linked to having a baby with a lower birth weight.

 

But we all know this and I have written extensively on this subject in this blog. And thankfully folks are listening. I realize that many mamas are attached to the notion that bed rest saved their baby’s life and I am not here to discount that. What I am here to report, and what I am hoping for, is that rather than simply putting a woman on bed rest and with that prescription increasing her risk for other health problems, I (and many others) advocate for finding solutions to the complications that result in the bedrest prescription. It’s exciting to see Pluristem doing stem cell research as a way to cure PreEclampsia. It is encouraging to see the March of Dimes pouring funds into research to investigate and treat preterm labor and preterm births. And who knows? Perhaps the March of Dimes Research is onto something noting that low maternal blood levels of vitamin D are associated with preterm labor and preterm birth.

Do not be dismayed, Mamas. There is research going on and more and more mama and babies are surviving pregnancy complications every day. While bed rest is still a major part of high risk pregnancy treatment here in the United States, it is nice to see that new treatments are on the horizon.  For me, when I was having my children (namely my daughter), I was offered bed rest as a treatment. I most certainly hope that when my now 12 year old daughter is having her children, if she has complications as I did while pregnant with her, there will be more effective, evidences based and non debilitating treatments available for her and her baby than there were for me while I struggled to carry her.

Want to know more about the origins of bed rest, it’s role in obstetrics and what’s on the horizon as treatment for high risk pregnancies? Subscribe to our blog (the little orange button on the upper right hand corner of this webpage) and also check out our extensive archives. There is a plethora of information for mamas and those who love and are caring for them in our post. For mamas wanting more tips on how to survive bed rest, Download our ebook guide, “From Mamas to Mamas: The Essential Guide to Surviving Bedrest” Available exclusively on Amazon.com.