The Bed Rest Controversy
When Wendy Zang started bleeding heavily at 31 weeks, she spent four days in the hospital and the next three weeks on bed rest. Zang went on to deliver a full-term, healthy baby boy and doesn't regret spending one minute cooped up. "I had no doubt it was medically necessary," says Zang, of Sewickley, Pennsylvania. "I was so freaked out by the bleeding episode that I was afraid to do anything."
Sharyn Frankel was assigned hospitalized bed rest after contractions started 30 weeks into her pregnancy. She delivered a healthy boy via c-section just short of 34 weeks. She, too, believes in the value of bed rest: "I think it helped me to make it further in my pregnancy to where it was safe to deliver," says the Millbury, Massachusetts, mom.
But did bed rest really stop their preterm labor? Studies would say no. In fact, the American College of Obstetricians and Gynecologists (ACOG) advises that bed rest "does not appear to improve the rate of preterm birth, and should not be routinely recommended." Active contractions, bleeding, ruptured membranes, and placenta previa are the most common reasons that doctors call for bed rest in as many as one in five of their patients. But the treatment's popularity has not stopped the rate of preterm births from rising, accounting for 11 percent of all pregnancies in 2005, up from 9.7 percent in 1990.
The Bed Rest Controversy
Because ACOG does not have a firm recommendation, doctors have to make the call. Some, like Robin de Regt, MD, medical director of Evergreen Hospital Maternal-Fetal Medicine Program, in Kirkland, Washington, believe bed rest helps. "Patients who are on limited activity contract less, so they feel better," she says. And it can reduce a woman's anxiety about her pregnancy and in some cases stop or slow cervical dilation.
But other physicians, like Laura Riley, MD, medical director of labor and delivery at Massachusetts General Hospital, in Boston, prescribe bed rest reluctantly. "I'm fully honest with patients," she says. "I say, 'Get off your feet, and let's see if that will make any difference [in reducing your symptoms], but I don't really believe that it will.'"
Dr. Riley is well aware of the downsides to bed rest: "You've lost work. You lose all of your muscle tone if you sit around long enough, and you increase your risk of getting a blood clot in your leg or your lung, which can be pretty significant." And that's why she may try to steer her patients toward alternative measures.
Should I Have More Tests?
To determine if bed rest -- or something else -- is best for you and baby, ask your doctor the following questions. Together you can devise a plan.
Simply having contractions does not mean you're in preterm labor. They must be accompanied by cervical change (dilation or effacement). If you're having contractions, ask for an ultrasound to determine whether the cervix has shortened or thinned out. Another valuable test looks for the presence of fetal fibronectin, a protein that helps the fetal sac attach to the uterine lining. While a negative test is "very good at suggesting you're not going to deliver," a positive test is less definitive, says Dr. Riley. Based on the results of these tests, your doctor may lean toward holding off on bed rest.
Are Medications an Option?
Medications called tocolytics can help stop preterm labor. The drug terbutaline relaxes the uterine muscles in women having preterm contractions. Other medications such as magnesium sulfate and calcium channel blockers deprive muscle of the calcium it needs to contract. Yet another treatment, using progesterone, may be prescribed for women with shortened cervixes. One of these medications may work in place of bed rest.
What Are the Risks of Bed Rest?
The prescription is not without drawbacks: being immobile causes muscles to weaken and bones to lose mass, says bed rest researcher Judy Maloni, PhD, of Case Western Reserve University's Bolton School of Nursing, in Cleveland. And women lose weight, or stop gaining, because the body eliminates excess fluids so they don't collect in the chest or head. But bed rest's biggest risk is the aforementioned blood clots that can form in the legs and travel to the lungs, where they can be fatal.
As to bed rest's effect on childbirth, doctors say decreased body conditioning could make you tire more easily, but no studies have been done showing whether that increases the incidence of c-section or other medical interventions. Each woman should discuss these factors with her doctor, and weigh the risks and the benefits.
What Kind of Bed Rest Do You Suggest?
Bed rest means different things in different pregnancies. Hospitalized bed rest is ordered when doctors fear a woman could quickly go from dilation to delivery or have spontaneous, excessive hemorrhaging. At-home bed rest can come with a variety of restrictions; ask your doctor specifically what you are and aren't allowed to do.
Do I Trust My Doctor?
The bottom line is that if you trust your doctor and she recommends bed rest, you should follow the prescription. After all, prematurity poses serious risk to the baby -- respiratory ailments, bleeding in the brain, and problems with the heart, intestines, or eyes, plus an increased risk of mortality. And once preterm labor begins, it can be difficult to stop.
But if your lifestyle simply doesn't allow for bed rest, or you have trouble believing it is really warranted, get a second opinion. "It's hard for doctors to say, 'I don't know,'" says Dr. Riley. "You want to feel as though you can help somebody." (Some doctors may prescribe bed rest just to make you feel better, she says, not because they know it will help.)
Armed with the facts, you can make an informed decision. If you decide bed rest is best, you may find that doing nothing was the hardest -- and yet most important -- thing you've ever done. Stay positive: Before you know it, you'll be counting toes and staring into baby's perfect eyes. And you'll be so tired, you'll wish you could just lie around in bed again.
Surviving Bed Rest
Here's how some women have passed the hours (and days) in bed or on the couch:
- Sherri Clemente, of Flanders, New Jersey, used her laptop in bed to enroll in online graduate classes. She also listened to audiotapes to learn Portuguese, her husband's native language.
- For Sharyn Frankel, of Millbury, Massachusetts, making friends with other women hospitalized for bed rest helped. Consider Internet sites like Sidelines.org, a support network for high-risk pregnancies, as well as message boards such as bedrestbookbuddies at Yahoo! Groups.
- Some women try to tackle that box of unorganized photos or take up long-neglected hobbies, such as knitting.
- Sarah Bilston, of Hartford, Connecticut, used her two experiences with bed rest to write a novel called -- what else? -- Bed Rest (Avon). She also penned a fictitious blog, bedrestdiary.com, based on her novel's character.
When Mommy Is Sidelined
Staying in bed or on the couch all day can be hard enough for the first-time mom. But if you have another child to care for, bed rest becomes a double burden. It won't be easy, but take off your Superwoman cape for a while. That means doing what you can -- and accepting what you can't.
Indianapolis mom Heather Palmer knows this first-hand. Her son, Max, was 3 during her second pregnancy. Helping him understand that Mommy had to stay in bed -- Palmer could only get up to use the bathroom and get meals -- was initially a challenge. "We told Max that Mommy's having a baby and she has to lie in bed or rest on the couch to keep the baby safe and healthy," Palmer says. "Eventually he understood."
Each morning, Palmer's husband brought her what the two of them would need for the day, including games, videos, and books (a favorite: Mommy Has to Stay in Bed, by Annette Rivlin-Gutman [BookSurge Publishing]). Keeping you company is a good responsibility for him (he may also be able to get snacks for you both).
Palmer regretted having to say no to Max's many requests, but she knew that taking care of the baby-to-be, Max's future sibling, was of primary importance. Having helpful family, friends, and neighbors was a godsend, Palmer says. Max had overnight trips with the grandparents and daily playdates.
Stay focused on your goal -- a healthy baby -- and don't be shy about asking for help. The empathy and patience your child is learning now are teaching him how to be a terrific big brother or sister.
Used with permission from American Baby magazine.
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