Mamas on Bedrest, are you ready for change?

January 31st, 2011

This is an addendum to my previous post, “Mamas on Bedrest: Don’t Get out of Bed!”, a response to an article on bed rest published in the January 30th Chicago Tribune.

I have been watching the chatter back and forth on The Chicago Tribune website, on twitter and on facebook. While I am smiling at all this recognition of bed rest, I am a bit surprised at some of the venom coming out in the comments. Ladies, (I’ve not seen any responses from men/dads) I think we all need to step back, take a deep breath and then consider what needs to happen next.

What I am most concerned about is how tightly we are holding onto bed rest. I don’t know if it’s because bed rest is connected to child bearing,  something so visceral and intimate for a woman but I want to remind us all that bed rest is simply a treatment, a tool, to help us during pregnancy.  Some of the responses I’ve read have elevated bed rest to  a spiritual endeavor. Its as if women are wearing their bed rest experiences like badges of honor. Many women are stating, “Bed rest saved my baby.” To that comment I wince. We have no scientific evidence that bed rest cures or treats anything. As Judith  Maloni Ph.D aptly put in her publication,

“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.”

It is likely that a combination of bed rest, medical treatment,  support (and support is critical!) and factors that we don’t yet understand contribute to high risk pregnant women successfully giving birth to healthy babies.  But what about the women who go on bed rest and don’t deliver healthy babies or even live babies? What then?

I want to put this out there for everyone’s consideration. Back in the middle ages, physicians used leeches to “bleed out” infection/poison from sick people. If  you were ill today and went to your doctor and he/she recommended bleeding with leeches as your treatment,  you’d consider them crazy as you sprinted out of their office. We don’t do that anymore because somewhere along the way a physician or researcher either realized the practice didn’t work or, more likely, found something that was more effective.

Likewise, from the 1940’s to the early 1970’s Diethylstilbestrol (DES), a synthetic estrogen, was given to women of child bearing age with the mistaken belief that it would prevent pregnancy complications and miscarriage. We now know that DES not only does not prevent pregnancy complications and miscarriage, but it also damages the reproductive organs of the babies in utero. I have friends whose moms took DES. One has no uterus. One had a bicornate uterus (a skinny uterus with two separate sides, not able to hold a pregnancy). I have a male friend who is infertile (makes no sperm) and the origin was traced back to his DES exposure in utero. DES was a product approved by the US Food and Drug Administration in the 1940’s and was finally ordered off the market in 1975. As new evidence became available, we had to change our thinking and our treatment methods.

Wouldn’t it be nice if the same could be said of high risk pregnancy? The Sidelines Support Network was founded in 1991. Better Bedrest was established in 1995. The work that these organizations have done for high risk pregnant women is nothing less than phenomenal, supporting thousands of high risk pregnant women in 20 years. But it is also a sin and a shame that we can’t say that much else has changed in the care of high risk pregnant women in the 20 years since these organizations were established. In what other medical discipline has there been such slow progress? Not heart surgery. Many bypasses are now being done via incisions in a person’s left side and using arteries from breast and upper arm muscles as opposed to the bone cracking open chest surgeries formerly performed as standard.  Breast cancer no longer requires the mandatory, disfiguring radical mastectomy but is often treated with lumpectomy, (much less disfiguring and tissue sparing surgery) chemotherapy and precisely focused radiation. Prostate surgeries today are more frequently performed via minimally invasive DaVinci Robotic surgery than open abdominal surgery. And what about Diabetes? Today many patients receive insulin via minipumps which provide pulses of the medication enabling more evenly sustained blood sugar levels as opposed to half a dozen or sometimes more individual shots daily.  Even birth control pills have been radically redesigned and the dosages and release of hormones manipulated such that some only need be taken quarterly or once a year. I could go on with the advances in arthroscopic orthopedic surgeries and Automatic Implanted Cardiac Defibrillators (AICD’s) (which are now so small and compact they fit virtually unnoticed in the small depression below one’s collar bone) and other medical advances but you get the picture. Despite all these amazing medical and technological advances in other medical disciplines, high risk pregnant women are still being treated with bed rest,  with no new treatment options proposed or offered in more than twenty years,  no improvements in outcomes and no reduction in maternal and infant morbidity and mortality. Isn’t it time for a change?

Bed rest has been shown to have some fairly major negative consequences and yet no one can definitively say that it is helpful. I believe that the truth about bed rest in pregnancy is yet to be elucidated. Until then, I humbly request everyone who is on bed rest, who supports women on bed rest, or who endured bed rest for one or many children:

  • Let’s at least be open to the fact that bed rest may not be what we think that it is; it may be better than we believe, it may be more harmful than any of us could have ever expected.
  • Let’s be open to the fact that there are likely treatments out there-some sitting idly on a shelf or currently being developed-that may be much better than what we are using now to manage high risk pregnant women.
  • Let’s not hold so tightly to our own experiences and to our own work (those of us who support high risk pregnant women) that we resist changes and advances.

Finally, I hope that we can find alternatives to bed rest and that we can vastly improve the way we manage high risk pregnant women. I say this selfishly because I have a beautiful 8 year old daughter and I am concerned about how much of my physiology is in her (i.e. will she experience the same or similar problems I had trying to have children).  I certainly hope that in 20 or so years if/when she is having children, if she does have complications, we have something more to offer her than the same inconclusive bed rest prescription that was offered to her mother 28 years earlier.

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