Value of bed rest for pregnant women questioned

Interested in home birth, hospital birth or Medicare-funded private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448. The value of bed rest has been disputed for many years. When I did my midwifery degree in 2000, We were taught that there was very little value, if anything, in bed rest. It only serves to increase levels of depression and increase the woman's socialisation into the medical model of care via fear. It's not helpful! Gentle activity is safe; nothing too vigorous, and nothing too stressful.

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Margaret Simon spent the last four months of her pregnancy lying in bed on a doctor's orders, hoping to prevent a miscarriage and a preterm birth. As a result, Simon lost her job, struggled to care for her two older children and grew so unfit that she got winded taking showers.

"Everything that made me who I am, being a wife, mother and employee, all got yanked out from under me," said Simon, 34, who had been the family bread-winner and described bed rest as the "darkest, most conflicting" time of her life.

As many as 95 percent of obstetricians report having prescribed bed rest or restricted activity to women with complications that may increase the risk for preterm labor, such as high blood pressure, carrying multiples and vaginal bleeding ...

Yet experts say there's little evidence that immobility leads to better outcomes for those women. And although bed rest is often assumed to be a safe intervention, it can be a physical, emotional and financial nightmare for expectant mothers ...

The American College of Obstetricians and Gynecologists states that "bed rest, hydration and pelvic rest does not appear to improve the rate of preterm birth and should not be routinely recommended." ... pregnant women should not be systematically prescribed bed rest "due to the adverse effects that bed rest could have on women and their families, and the increased cost for the healthcare system."

Most doctors are aware of the scant evidence. Yet they perpetuate the old-fashioned practice, mostly because they have no better options ... [and] it's the way things have always been done. A fear of liability and medical malpractice lawsuits plays a role too.

"There's no evidence-based way to keep someone from delivering prematurely," ...

"The risks of placing a woman on bed rest outweigh the current evidence it improves outcomes," ...

Bed rest isn't the peaceful vacation one might fantasize about. Women on "modified" bed rest may need to rest for an hour, three times a day. Others stay horizontal 24/7, rising only to use the bathroom. They can't ride in a car, have sex, walk up stairs, lift a laundry basket, cook dinner or stand in the shower, let alone take care of children or work. Some women take it so seriously they crawl to the bathroom.

Proponents say bed rest can buy extra time for a pregnancy; the closer a baby is born to term, the better. Lying down, they say, can reduce women's stress, increase blood flow to the uterus, diminish uterine activity and decrease pressure on the cervix.

And then, some say bed rest is just common sense, based on the perception that contractions mean a baby is on the way. Sarah Jacobs, of Brooklyn, N.Y., said that whenever she was up for too long, her contractions increased.

"It was really clear to me that lying down kept the baby inside," said Jacobs, who was on bed rest for six months during her third pregnancy.

But experts say that most preterm births occur in women without risk factors and that contractions are a poor predictor of preterm birth, as they don't always produce the changes in the cervix that lead a baby to be born.

"While women might experience worse contractions with activity or standing, it is important to differentiate contractions from labor," ... "Having (contractions) doesn't always mean you are in labor."

... The longer women are on bed rest, the more severe their symptoms and the longer it takes them to recover ... after you lie around for a while, you begin to ache and your muscles begin to atrophy — starting as soon as 48 hours — so it's easy to injure the muscles in the postpartum," ...

In addition to losing their conditioning, women on bed rest may experience bone loss and have trouble sleeping. Meanwhile, they tend to lose weight, and low maternal weight can affect the fetus and is associated with preterm birth.

"Doctors don't realize the dangers," ...

Perhaps the toughest part of bed rest is psychological. The abrupt and sometimes catastrophic disruption of their life, coupled with the stress that comes with a "high-risk" pregnancy, can leave women feeling isolated, helpless and unusually dependent. It often strains the marriage and is hard on other children in the family. Like astronauts in space, women on bed rest may feel estranged from their familiar routines and may experience sensory deprivation and depression ...

... Ultimately, Simon's 9-pound, 14-ounce baby did not come prematurely; she had to be induced at 39 weeks. As awful as bed rest was, she would do it again "because he's here," she said. "And he's healthy."

Don't you love the language? She "had" to be induced at 39 weeks. What was the indication? Pregnancy? It was Monday? 39 weeks is not a reason to induce a baby!!

Melissa Maimann, Essential Birth Consulting 0400 418 448