Expert Interview: All About Bed Rest

*Dr. Siobhan Dolan is an Associate Professor, Clinical Obstetrics & Gynecology and Women’s Health, at the Albert Einstein College of Medicine/Montefiore Medical Center in New York City. She is also on the faculty of the Human Genetics Program at Sarah Lawrence College in Bronxville, NY, where she teaches public health genetics and genomics. She was formerly Associate Medical Director for the March of Dimes Foundation in White Plains, New York. Dr. Dolan is board certified in both obstetrics & gynecology and clinical genetics, and also holds a master’s degree in public health. Dr. Dolan graduated magna cum laude with honors from Brown University and received her medical degree from Harvard Medical School. She did her clinical training in Obstetrics and Gynecology at the New York Hospital-Cornell Medical Center and at Yale-New Haven Hospital, then completed clinical training in human genetics at the Albert Einstein College of Medicine. Dr. Dolan received a master’s degree in public health from the Epidemiology Division of the Mailman School of Public Health of Columbia University. She has co-authored publications genetics, genomics, obstetrics and public health, and has presented numerous abstracts at scientific and professional meetings. She maintains her clinical practice in the Bronx where she provides prenatal care to women through a group prenatal care model called Centering Pregnancy.

What are some circumstances that could land an expectant mother on bed rest?

The goal of bed rest is to allow pregnancy to continue in a healthy way and for as long as possible.
Best rest often is prescribed to address a complication during pregnancy. However, there is no clear consensus of its benefits and there is conflicting research evidence about its effectiveness.
There are several reasons or pregnancy complications that may cause a doctor to prescribe best rest, including spotting or vaginal bleeding, high blood pressure, early contractions or other signs of preterm labor.

Bed rest also may be prescribed to take pressure off an incompetent or effacing cervix. An incompetent cervix or cervical insufficiency is when the cervix, which at the base of the uterus, opens too early, leading to preterm birth. Medical experts do not always know why incompetent cervix occurs.

There are different degrees of best rest. Some women are put on bed rest at home, some are in the hospital. Some are on partial bed rest, meaning they can get up and fix a meal, take a shower, and stay off their feet the rest of the time. Others are on strict bed rest and must remain horizontal, perhaps hooked to monitors, at all times.

What are the main differences between bed rest and hospital bed rest?

The decision to put a woman on bed rest in a hospital versus home bed rest often is based on what the consequences of delivery might be, as well as the severity of the condition.
For example — if a woman has seriously high blood pressure and needs close blood pressure monitoring, medications to control blood pressure, and fetal monitoring — she would be likely put on bed rest in the hospital, versus she could be on home bed rest if she were farther along in the pregnancy and the blood pressure was not as high.

Another example would be bleeding disorders like placenta previa where a woman can bleed very precipitously and severely — thus she would be put on bedrest in the hospital.

What should a mom expect when she is placed on hospital bed rest?

If a woman is on bed rest in a hospital, she should expect that her and her baby’s health will be closely monitored.

Whether she is on best rest at home or in a hospital, a woman should expect to lose muscle tone and become short of breath as a result of her restricted activity. She also is at increased risk of developing blood clots because of the lack of movement and for that reason her doctor may recommend she do some stretching and other relaxed movements.

A woman on best rest may become bored, depressed, anxious or isolated.

What can family and friends do for a mother who is on either regular or hospital bed rest?

Call and offer to visit. Offer to run errands, help with meals and care for older children.

What tips do you have for expectant mothers who are on bed rest?

Don’t feel guilty. This is what you need to do to help give your baby a chance at a healthy start in life.

Talk to professional counselors, spiritual advisors or others who have been in the same situation.
Stay Occupied. Catch up on things you’ve wanted do. Pay bills, read, for yourself or to your children, sew, play games, keep a journal or use a computer to pass the time. This may be the time to start a new hobby. To minimize movement, keeps what you needs nearby, such as medications, food and beverages, a telephone, reading materials, the computer, a radio or TV.
Some women may be able to work from home. Others can’t and the family finances may change. Check if you qualify for medical leave.

Realize that family roles and responsibilities will change. Childcare, meal preparation and other household tasks may need to be handled differently.

*Susan Pease Banitt, LCSW is a psychotherapist and author living in Portland, Oregon. When she’s not busy raising her twins, she’s working on her new book The Trauma Toolbox: Healing From the Inside Out. You can find Susan on Twitter, Facebook and www.InsightOutHealing.com.

When were you put on bedrest?

I was put on bedrest at 23 weeks.

Were you on hospital bedrest or were you allowed to stay home?

Mostly I was home, but I did go in for a mag sulfate wash over Thanksgiving weekend.

What tips do you have for Moms on bedrest?

• Follow your intuition about what is good for you.
• Get help! Say yes to all reasonable offers.
• See if there is a support group in your area, like Sidelines or through the hospital social worker
• Connect with other Mom’s of multiples online (if you can use your hands, I got carpal tunnel syndrome in both wrists and couldn’t hold a remote even)
• Know that there is controversy about bedrest; push your doctor for as much activity as possible.
• Watch uplifting or humorous television. Observe how what you watch can affect contractions.
• Lay on your left side more than the right (better for heartburn).
• Do some weightlifting from the couch to keep muscles from atrophy.
• Hydrate!
• Plan your day ahead so you have a minimum of getting up. For example my hb used to leave snacks by my sofa and premade meals in the fridge.
• Enjoy the rest and peace and quiet, you sure won’t have it after the babies are born!

What do you wish you knew before you were put on bedrest?
I wish I’d known what a toll bedrest was going to take on my body through fat gain and muscle atrophy.

I wish I’d known to get physical therapy after bedrest.

I wish I hadn’t drunk Gatorade that the nurse recommended. It messed up my blood sugar and caused weight gain.

I wish I had known that lots of research has shown that bedrest is controversial and some doctors don’t recommend it at all. (but every case is different)

I wish I had known THAT IT IS ALL WORTH IT. My kids were healthier than I was when they were born, and they did not spend one day in an incubator.