Mamas on Bedrest: Women need resources, financial and otherwise, to reduce their risk of depressive disorders.

August 22nd, 2011

Daily I hear stories from women who are struggling to maintain their jobs, their homes, their family order and their own sense of self after being placed on bed rest. Data presented by Judith Maloni, PhD and others show that the number of depressive symptoms found in women placed on bed rest are associated with the length of time on bed rest (i.e. the longer women are on bed rest, the more depressive symptoms they tend to exhibit) and that bed rest is a precipitating factor for perinatal depression.

Delving deeper into mood disorders I was alarmed to find that women are disproportionally affected by depressive disorders more than men, and both are dramatically under treated. But what really stuck me is the World Health Organization’s (WHO) explanation for why women are at increased risk. According to WHO,

“Depression, anxiety, psychological distress, sexual violence, domestic violence and escalating rates of substance use affect women to a greater extent than men across different countries and different settings. Pressures created by their multiple roles, gender discrimination and associated factors of poverty, hunger, malnutrition, overwork, domestic violence and sexual abuse, combine to account for women’s poor mental health. There is a positive relationship between the frequency and severity of such social factors and the frequency and severity of mental health problems in women. Severe life events that cause a sense of loss, inferiority, humiliation or entrapment can predict depression.”

Now WHO is speaking about all forms of mental health disorders in all women, not just depression in women on bed rest. But looking at their statement, it is clear why bed rest can be such a difficult situation for a woman emotionally as well as physically.

Those of us who advocate on behalf of women on bed rest know that the loss of independence, the loss of a sense of well being, the potential loss of income which can lead to a loss in home and financial security and the very real potential loss of a child can all lead to depressive disorders. Yet, with all that is going on, depression in women across the board, let alone women on bed rest, remains under diagnosed and under treated. This under recognition and treatment, especially in mamas on bedrest, can lead to significant morbidity and mortality for both mother and baby.  So how can we make changes in this scenario?

According to data presented to WHO by researchers,  there are 3 main factors that are highly protective against the development of mood disorders, especially depression in women. These are:

  • having sufficient autonomy to exercise some control in response to severe events.
  • access to some material resources that allow the possibility of making choices in the face of severe events.
  • psychological support from family, friends, or health providers is powerfully protective.

These are not shocking or highly complex solutions.  Quite the contrary, these points could be easily implemented if we as a culture elevated the needs of women and children in our society.

It’s no secret that I am a staunch advocate for paid maternity leave, especially for women on bed rest. While one could argue that women having uncomplicated pregnancies are not actually “sick” and therefore don’t need to be paid for their time off to deliver, clearly women who are prescribed bed rest have medical issues with their pregnancies that warrant intervention and treatment. Yet, women placed on bed rest are rarely offered any sort of support for making informed choices and retaining any sort of autonomy. They typically lose or face dramatic reduction in material resources at a time when their need for such resources is dramatically increased. And finally, while some women on bed rest may have support of family and friends, many women (myself included) face their high risk pregnancies in relative isolation. It is alarming to me that the same woman could suffer a heart attack or stroke and would not face the same risk of job loss, loss of income, loss of home and security and isolation that a high risk pregnant woman on bed rest faces. We have to change this.

It would not take much for the US systems to reverse their policies and procedures. What it will take is “We the people” standing up and demanding that we place our citizens (women and children in particular) ahead of defense spending, ahead of supporting other nations, ahead of aid to other nations and ahead of corporate taxation and compensation. It can happen. We can make it happen. And the very health of our society and culture demand that we make it happen very soon or face dire consequences.

Judith A. Maloni and Seunghee Park “Postpartum Symptoms After Antepartum Bed Rest” March/April 2005 JOGNN 17. Volume 34 (2) 163-171.

The World Health Organization. Gender and Women’s Health. Gender Disparities and Mental Health: The Facts.

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