preterm labor

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: Can routine cervical measuring and treatment with progesterone as indicated reduce and/or eventually eliminate bed rest?

January 6th, 2015

Hello Mamas and Happy New Year!!!

Right before we all took a much anticipated holiday break, The Society for Maternal-Fetal Medicine (SMFM) added their voice to those of  The American Congress of Obstetricians and Gynecologists (ACOG), The American College of Nurse Midwives (ACNM), The March of Dimes, Medicaid and The Perinatal Research Branch of the Eunice Kennedy Shriver Institute to recommend that preterm birth risk screening include cervical length measurements and for those women at increased risk, treatment with progesterone injections.

Why is this important? Well, if you visit our Facebook page, you will notice that a large number of the mamas in our community are on bed rest for cervical insufficiency or incompetent cervix. Cervical insufficiency is one of the leading causes of preterm labor in the US and one of the leading causes of infant mortality (infant death). The United States ranks 55th globally in infant mortality, with 26,000 infants dying annually before their first birthdays. This is a horrendous and utterly embarrassing statistic given that the US is one of the richest countries in the world with some of the most advanced health care, yet we can’t seem to save our babies. What is worse, infant mortality in the United States for African American babies is twice that of Caucasian babies, so deaths among little black infants is disproportionately high in the US.

But despite all this doom and gloom, the upside is that all of these medical societies have looked at the data as well as at available treatments and they have all come to the same conclusion: If there is more screening for preterm labor in pregnant women-measurement of the cervix and in those women at risk, the initiation of progesterone injections-the rates of preterm labor can be reduced 40-50% in mamas having just one baby and no prior history of preterm birth. And if every pregnant woman is screened for shortened cervix and those at risk identified and started on progesterone shots, medical costs associated with preterm labor, premature birth and subsequent medical and developmental support could be reduced by $750 million annually. Given that preterm labor and prematurity currently costs the US in excess of $26.2 billion annually, this is substantial savings. All of the medical societies are also in agreement that if a woman is noted to have a shortened cervix and is less than 24 weeks gestation, she should have a cerclage (a surgical stitich placed to hold the cervix closed) placed.

Preterm labor and prematurity are major issues in Maternal and Infant health and the leading cause of infant death before one year in the United States. If by simply screening and measuring cervical length early on with ultrasound and providing treatment with progesterone and cerclage can reduce preterm labor and prematurity and save the lives of babies, then we should be adopting these recommendations.

The elephant in the room for us here is will these practices negate the need for prescribed bed rest? That subject was not addressed in these recommendations, however, many of these same professional medical societies are recommending that bed rest not be routinely prescribed due to the negative effects that is has on Mamas’ bodies. So it will be very interesting to see how these recommendations are implemented and their effect on the overall preterm labor and prematurity rates. My guess is that if rates start dropping, we my in fact see a reduction in the bed rest prescription. Now wouldn’t that be exciting???

Mamas, share this information with your health care providers and see what they have to say. If you’ve been screened for a shortened cervix and started on progesterone, let us know in the comments section below. We would love to share the journey with you (join our Facebook Community!!)! And if you are prescribed the progesterone and/or cerclage without bedrest, do let us know how you fare and when you deliver your baby.

Reference

Society for Maternal-Fetal Medicine Joins with Other Organizations to Brief Congress on Need for Medical Protocols that will Save the Lives of Infants in the US by Reducing Preterm Birth. (Press Release December 17, 2014, Washington, D.C. Society for Maternal-Fetal Medicine. www.smfm.org

Mamas on Bedrest: This is how it’s done! An Interview with “Former” Mama on Bedrest Karen Gates

December 15th, 2014

Good Monday Morning Mamas!

Today we have a treat! While trolling the posts on our community, I came across a post by this very knowledgeable “Former Bedrest Mama”, Karen Gates. Her post was so full of good information, tips and triumph that I just HAD to speak with her! Being the gracious mama that she is, she agreed and here she shares her story of being on bedest for Placenta Previa with her second son. Listen to how Karen was able to intuit and support the needs of her husband, to receive help from friends and family and to overall Thrive while on bed rest!  It’s an interview you won’t want to miss-especially if you are on bed rest during the holidays!