Mamas on Bedrest: Don’t Get out of Bed!

January 31st, 2011

Sometimes you just know when the s–t is going to hit the fan! Such was the case with this bed rest article published in the Sunday, January 30, 2011 Chicago Tribune, “Value of bed rest for pregnant women questioned.”

I actually thought that I’d be raked over the coals first. I wrote a similar article for Science and Sensibility, the blog for Lamaze International. The article was an editorial review of “Antepartum Bedrest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth” by Judith Maloni, Ph.D. Dr. Maloni is one of the leading researchers in the field of bed rest and this article was a literature review. It covered 69+ research articles on bed rest and found that there is no medical or scientific evidence that bed rest is effective in preventing preterm births.  As you can imagine, those of us who work in the field of bed rest support are aghast.

Support for women on bed rest first began in 1991 with Sidelines, founded by Candace Hurley. Hurley herself had been on bed rest with her pregnancies and knew first hand how difficult a task bed rest can be. She started the Sidelines support network to assist other women who ended up in her situation. To date, Sidelines has supported over 100,000 women through the bed rest experience with their one on one phone support and online resources.

In 1995, Joanie Reisfeld founded Better Bedrest after her own stint on bed rest complete with some financial distress. You remember Better Bedrest, don’t you? Mamas on Bedrest & Beyond sponsored a fundraiser for Better Bedrest just last fall. Better Bedrest provides peer support to pregnant women on prescribed bed rest but may be is best known for the microgrants that it provides mamas in need. It’s an awesome organization as well.

One of my favorite support resources is KeepEmCookin’. Founded by Angela Davids, KeepEmCookin’ is an online forum where women on prescribed bed rest can come and share their stories and get support from one another and from Angela. Angela was on bed rest with both her pregnancies and started KeepEmCookin’ after the birth of her son. She has been running the forum for about 3 years.

But a colleague recently reminded me,

“It’s important to heal (from your own experience) and focus on the work”

(Dr. Mimi Poinsett, @yayayarndiva, Thanks for keeping me focused!)

As much as we may all be shocked at what researchers are saying, it is important for us to all take a deep breath, step back and look at the data critically. Read the articles for yourself,  look at what the data is saying. Much to all of our dismay, bed rest may not be the panacea it is touted to be. Despite many of the experiences of the founders of the aforementioned organizations and for millions of other women, bed rest may not have had anything to do with their pregnancy outcomes.

Currently there is not strong enough evidence that putting a woman on bed rest with activity restriction prolongs a pregnancy. The research to date states that in acute, emergent situations, women should be put on hospital bed rest and the situation stabilized. However, once a woman is stable and the complication has been “adequately managed” then women should be discharged home and supported there, but should not be placed on full bed rest. (Goldenberg, 2002, 2005). Further, researchers advocate considering alternative models as used in other countries which prescribe activity restriction in home and also provides home care programs (housekeeping, childcare, errands/shopping and medical monitoring).

One thing is very clear, the practice of bed rest needs to come under review. It may be time for clinicians, especially those in the United States, which has some of the highest rates of complications, bed rest, maternal and infant morbidity and mortality in the world (WHO, Amnesty International) to rethink how to manage high risk pregnant women.

One very good thing that is coming from all this flurry of interviews, articles and e-mails is that bed rest and high risk pregnancy are front and center in people’s minds-at least for the moment. When I mention that I support high risk pregnant women on bed rest, so many people are not even aware that women with pregnancy complications are even put on bed rest.  Then, they see bed rest as some sort of life of luxury. Nothing could be further from the truth! Bed rest is hard on a mama’s body, it poses risks to the baby (primarily that of being born at low birth weight) it strains mama’s family and can cause significant financial and professional hardship. With these negatives and than an article stating that bed rest is not beneficial, Bed rest Advocates are concerned that women will read the article and simply ignore their bed rest prescriptions.

So let’s just get some things straight. We are not sure if bed rest is efficacious. We know that it causes some harm to a mama’s body, her emotions, disruption to her life and potential harm to the baby. Until there is evidence supporting other treatments, the position of Mamas on Bedrest & Beyond is to continue with the bed rest presciption as your clinician has recommended. Talk candidly with your clinician about your concerns and ask when appropriate: what things can be changed, when your activities can be increased, etc… Finally, utilize all of the support services available-Sidelines, Better Bed Rest, KeepEmCookin’ and of course, Mamas on Bedrest & Beyond.

Want a transformative bed rest experience?  Try Bedrest Coaching. E-mail info@mamasonbedrest.com for a 30 minute Bedrest Breakthrough session and experience the power of coaching for yourself!

References

Maloni, J. “Antepartum Bedrest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth.” Biologicial Research for Nursing, 2010 October. 12, (2) 106-124

Goldenberg, R.L. “The management of preterm labor.” Obstetrics and Gynecology, 2002. volume 100, 1020-1037.

Goldenberg, R.L. “Arrested preterm labor. Do the data support home or hospital care?” Obstetrics and Gynecology, 2005. volume 106, 3-5.

Goldenberg, R.L., Cliver, S.P., Bronstein, J., Cutter, G.R., Andrews, W.W., Mennemmeyer, S.T. “Bed rest in pregnancy.” Obstetrics and Gynecology, 1994. volume 84, 131-136.

Goulet, C., Gevry, H., Gauthier, R.J., Lepage, L., Fraser, W., Afia,M. “A controlled clinical trial of home care management versus hospital care for preterm labor.” International Journal of Nursing Studies, 2001. Volume 38, 259-269.

Goulet, C., Gevry, H., Gauthier, R.J., Lepage, L., Fraser, W., Polomeno, V. “Arandomized clinical trial of care for women with preterm labour: Home management versus hospital management.” Canadian Medical Association Journal, 2001. Volume 164, 985-991.

Helewa, M., Heaman, Dewar, D. Community based antenatal home care programme for the management of preterm premature rupture of membranes.” Journal of the Society of Obstetricians and Gynecologists of Canada, 2000. volume 27, 928-935.

Helewa, M., Heaman, M., Robinson, M.S., Thompson, L. “Community based antenatal home care programme for the management of pre-eclampsia: An Alternative.” Canadian Medical Association Journal, 1993. volume 149, 829-834.

Monincx WM, Birnie E, Zondervan HA, Bleker OP, Bonsel GJ. “Maternal health, antenatal and at 8 weeks after delivery, in home versus in-hospital fetal monitoring in high-risk pregnancies.” European Journal of Obstetrics, Gynecology and Reproductive Biology, 2001. volume 94, 197-204.

Stainton, M.C., Lohan, M., Woodhart, L. “Women’s experiences of being in high risk antenatal care day stay and hospital admission”. Australian Midwifery, 2005. volume 18, 16-20.

6 responses to “Mamas on Bedrest: Don’t Get out of Bed!”

  1. Hi, Darline.
    I wanted to clarify a sentence above about Judith Maloni’s literature review. You wrote: “It covered 69+ research articles on bed rest and found that there is no medical or scientific evidence that bed rest is effective in preventing preterm births.”
    I think it is important to clarify that only 5 of those articles were about the relationship between bed rest and preventing preterm birth. (The remainder had to do with the physical and emotional effects on mother and child, or with comparing home bed rest to hospital bed rest. )
    About those 5 studies that compared bed rest to no bed rest, Maloni wrote that they showed “no group differences in infant outcomes commonly associated in preterm birth.” So if on average there were no differences, I’d still want to be the mom for whom bed rest did make a difference.

    I’d also like to point out that Maloni wrote: “It is possible that [antepartum bed rest] might decrease preterm birth but evidence has not yet been found to support that conclusion. Such evidence may be masked by the complex multi-causal and interrelated factors that contribute to preterm birth.”

    I agree with this wholeheartedly, based on what I see on the online forum I host for women at risk of delivering prematurely. Each woman’s set of circumstances is unique and complicated. We can’t make a blanket statement about the efficacy of bed rest, when it is used to treat so many different conditions of high-risk pregnancy.

    And while bed rest doesn’t always keep a baby from being born prematurely, the outcomes for Baby can still be positive. A positive outcome for one woman on bed rest might be providing her baby a few extra days in the womb to get steroid shots to speed lung development. A positive outcome for another woman may be holding off delivery until 37 weeks or more. Every day in the womb reduces the chance of death and time spent in the NICU.

    I’m very excited about the work you’re doing Darlene! And thank you for mentioning all these organizations fighting for better care for mamas and their babies. Let’s all keep it up!

  2. Darline says:

    Angela,
    You are so right. We don’t want to “through the baby out with the bath water!” (pun intended!) We can’t abandon bed rest until we put a suitable replacement in place. This may be a specific treatment, but I believe it will be an algorithm or process that will guide OB’s in the treatment of high risk pregnant women. Because pregnancy complications have so many layers, we have to address all those layers in order to effectively treat the complications.

    The thing that is clear is that we need something substantial and we need answers. What I hope is that this dialogue will stimulate researchers and clinicians to actually begin putting their research into practice. There is a lot out there, a lot that could be implemented now. I also hope the we women don’t hold so tightly to bed rest that we are resistant to change or unwilling consider that there could be treatments that could be more effective, safer, better, etc…

  3. Exactly! Change is good. We need doctors to use (and patients to request) additional preventions and treatments, such as standard cervical length measurement by ultrasound, increased use of 17P injections in women with previous preterm births, and repeat fFN testing in cases where it is warranted. These are three tools that can be used to assess IF bed rest is a logical next step. I love your idea of a standard algorithm or process!

  4. Darline says:

    Angela,
    Was also thinking, women are put on bed rest for many reasons, not just preterm labor.Maloni, in her literature review and citations included literature about all of these causes.

    I think that we are going to eventually find that bed rest, even if for a short time, in conjunction with other treatment modalities is what is going to become the standard of care. It’s interesting to see how it will all unfold.

  5. ‘women are put on bed rest for many reasons, not just preterm labor”

    This is my thought. I am currently on bedrest for pPROM. I am trying to research more about the effects and benefits, if any, of bedresting for this condition. I’m not having preterm labor (no contractions, dilation, bleeding etc). But most women with pPROM *do* go into labor very early and deliver micro-preemies.

    Much to think about.

  6. Darline says:

    Carrie, you do have much to think about as you are at increased risk of preterm labor as well as infection. However, you are right, there is no documentation (at least that I have found) that notes being on bed rest improves outcomes (i.e. keeps baby in longer). What is your OB suggesting for you? I have seen other women in this situation be put on “house arrest” i.e. told to stay home as much as possible to avoid infection an preterm labor. It really varies from woman to woman. Do keep us posted on what you and your OB decide is the best course for you and if there is anything we can do to help/support you. Good luck and here’s to going to term!!!

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