Friday, January 25, 2013

Obstetric Lie #80 - "You Need To Be On Bed Rest"

Is this really the healthiest place to spend your pregnancy?

The obstetric lie is that bed rest during pregnancy is helpful and lifesaving.

The truth is much uglier.

Bedrest during pregnancy doesn't always improve outcome, and in fact can be dangerous.  Yet bed rest is still a treatment assigned to pregnant women to reduce complications.

If your care provider recommends bed rest start asking questions. It might also be useful to know why he/she is not aware of current research regarding concerns over the safety and efficacy of bed rest in the pregnant woman.

For example many practitioners are still recommending bed rest to pregnant women to prevent preterm labor.  However a Cochrane review about bed rest for preterm labor found that,
"Although bed rest is widely used as the first step of treatment, there is no evidence either supporting or refuting its use at home or in hospital to prevent preterm birth. Due to the potential adverse effects that bed rest could have on women and their families, and the increased costs for the healthcare system, routine advice of bed rest for preventing preterm birth should not be given to pregnant women."  (Emphasis added.)
The review (which you can read in full here) found that there was little difference between women assigned to bed rest or not in prevention of preterm labor.

Another abstract  re-iterates the point-
"Antepartum bed rest/activity restriction (ABR/AR) has been a mainstay of treatment to prevent preterm birth for the past 30 years prescribed for nearly 1 million women in the United States annually, despite a lack of evidence for its effectiveness. In fact, there is increasing evidence that ABR causes several adverse physiologic and psychological side effects among women and their infants. Unfortunately, these findings have had little impact on clinical practice."
**Note- it really sucks that regular people can't read the entire article of so many things.  What is up with limiting knowledge like that?**

Another reason women are put on bed rest during pregnancy is for hypertension.  However, the results on the effectiveness of bed rest in reducing this complication are also not clear.
 "At present, there is insufficient evidence to provide clear guidance for clinical practice. Therefore, bed rest should not be recommended routinely for hypertension in pregnancy, especially since more women appear to prefer unrestricted activity, if the choice were given."  (Read the full abstract here.)

The Cochrane review also mentions "potential adverse effects that bed rest could have on women and their families".  What are these adverse side effects caused by bed rest?

An article in the Lancet (1999) found that bed rest worsened many conditions including labor and proteinuric hypertension (also known as pre-eclampsia) during pregnancy.  So the negative side effects of bed rest?  They include:
  • "Loss of muscle function, muscle atrophy, sore muscles
  • Bone loss
  • Maternal weight loss, lower fetal weight
  • Fatigue, sleep cycle changes, boredom
  • Both antepartum and postpartum depression, mood changes
  • Nasal congestion, reflux, indigestion, back and muscle aches "
From (Science Daily)

In addition to causing these problems, bed rest also can lead to thrombosis.  Thrombosis is, "Deep vein thrombosis (DVT) is a condition in which a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs."  There are many things that can increase the risk of thrombosis including sitting or lying for long periods of time, prolonged bed rest, pregnancy, and surgery."

Just think about that for a moment....

If we take a woman who is pregnant (already at increased risk for thrombosis) then tell her to lay around for months at a time (bed rest) and then of course perform a c-section on her because she is high risk (increased risk again) then I wonder how much we are increasing the likelihood of her death due to deep vein thrombosis?

Food for thought.

The primary complication of a deep vein thrombosis is pulmonary embolism which can cause death. 

And don't forget, "It's more dangerous to give birth in the United States than in 49 other countries." (Amnesty International)

Now I am not saying that bed rest equals death.

What I am saying is that even some of the most commonly accepted "truths" surrounding obstetrics such as the accepted practice of bed rest, are not actually truths.  Bed rest for pregnant women has not been proven scientifically to decrease the very complications it is used for.

If your care provider recommends this- or anything regarding your care- ask questions.  Do your own research.  Get a second opinion from another trained health care provider.  Take charge of your health and your pregnancy and your baby.  It is scary to take responsibility for your own health and that of your children.  But it is also part of your job as a mother. 

And remember, even some of the most accepted "truths" of obstetrics are nothing more than routine, tradition, and even rumor.

Question everything.

6 comments:

Mummy Trainer said...

Thank you so much for this awesome blog. It is so important for women to know that bedrest isn't always what is required to prevent further complications.

Malina said...

Thank you so much for this. I was prescribed bed rest for 3 of my 5 pregnancies (twice for preterm labor and once for pre-e.) I didn't feel like it was helpful at all for my condition, plus it was making me horribly depressed so I stopped doing it. I would take it easy and rest if I felt poorly, but it was so much better than staying in bed all the time. Following my own instincts and refusing to follow doctors orders cause a lot of friction in my marriage and with my family because they thought I was endangering my babies. It is good to see more evidence showing that this practice causes more harm than good.

Jeanna Stay said...

Interesting, thanks for the research links. I would be interested, if you ever think about it, to hear about some conditions where bedrest is still considered useful (I imagine there probably are some? maybe "incompetent cervix"?) (and as a side note, what a horrible name to give a medical condition--nothing says "you suck" like telling you your cervix is "incompetent"). I'd also be curious for your research about twin pregnancies and bedrest/other complications/etc. No particular need, just curiosity.

JoyBelle said...

NEVER really thought about it! I've never been on bedrest though but this brings valid points. Learn something new everyday!

Elizabeth Fox said...

This is such an important issue, and I'm so glad many of us are covering it. I have a series on bed rest:

Evidence Regarding Pregnancy Bed Rest

Risks of Bed Rest

The Medical Injustice of Pregnancy Bed Rest

I would love your thoughts.

Kat Brennan said...

Wow, there are a lot of things on here that I totally believed before. My best friend is 3 months pregnant so I've been helping her through the process. After reading this, there are definitely a few questions I want to ask her doctor. Thank you for posting your incites! I'm sure you're blog is immensely helpful for all the future moms reading this! http://www.desertroseobgynaz.com/services.html

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