How Long Does the Baby Rest Dyring Pregnancy

Iv-yr-old Violet (right) supervises equally her mom Margaret Siebers pours a offset-ever spoonful of honey for one-year-old Frances to try. Siebers spent much of the stop of her pregnancy with Frances confined to bed residue at her abode in Milwaukee. Sara Stathas for NPR hibernate explanation

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Sara Stathas for NPR

The couch is dark chocolate-brown corduroy with lumpy cushions. There are a few telltale smears of food, maybe yogurt or a banana, and some crumbs here and in that location. Information technology'southward a well-loved slice of piece of furniture.

Margaret Siebers plops herself downwardly in the eye and reaches out to baby daughter Frances, who climbs onto her mother'southward lap to breastfeed.

"This is where I spent several months," says Siebers, with a shrug. Her iv-yr-old, Violet, runs around nearby. "I could come up downstairs and sit on the couch."

Siebers was almost halfway through her pregnancy with Frances, when health professionals guiding her intendance told Siebers she should be on bed rest. And the subsequent months, spent bars to a bed and couch in her small abode in Milwaukee, turned her family's life upside downwards.

"My hubby immediately quit his full time job," Siebers says, "and he took care of me. I wouldn't even get my own glasses of water. So I similar to say that 'I was on bed rest, and he was on firm arrest,' because he really couldn't leave either."

Siebers is just ane of thousands of pregnant women who are put on bed rest by their doctors, nurses or midwives each year. The stated reason: Going to bed volition aid foreclose a premature birth, or worse, a miscarriage. But there'south a major problem with this advice — there is no solid, scientific show that bed rest improves outcomes for pregnant women and their babies.

"The lesser line is that at that place'southward never been any proven benefit of bed residual," says Dr. Anne Drapkin Lyerly, an OB-GYN and professor of bioethics at the Academy of Due north Carolina at Chapel Loma. Lyerly and colleagues in 2013 did a review of the scientific enquiry on bed rest as information technology relates to a diversity of atmospheric condition, from early contractions to high blood force per unit area to carrying twins. They found no benefit.

In fact, women put on bed residuum can suffer harm — concrete, psychological and economic. "Information technology doesn't seem like a dangerous intervention in the same way we remember about surgeries or medications," Lyerly says. "But in fact it can exist very dangerous."

Siebers was nearly 22 weeks meaning when she visited a radiologist for a routine ultrasound. It was a standard screening at that betoken in her pregnancy — one that checks the infant's growth, proportions and organs to ensure the fetus is developing properly. The infant was doing great, the dr. told her. The fetal heartbeat was strong and the ultrasound looked perfect. But there was i point of business concern: Siebers' neck was 'shortened,' which tin exist a sign that a adult female is at risk of preterm labor.

"And so that was really scary for us," she says. "We're at this appointment and the doctor'south looking at the baby and saying, 'You've got a beautiful heart.' And I'm thinking, 'Oh great, they've got a cute heart and they might die.' "

Siebers' health care team at that point included a midwife, who was her primary caregiver, an obstetrician consulting on her instance, and the doctors who performed the ultrasound. Because she'd had a miscarriage the year before, the team recommended she undergo a procedure chosen a cerclage to help keep her cervix closed. And they wanted her to stay in bed.

Margaret and Alex Siebers say they struggled brand ends encounter during the weeks Margaret was confined to bed remainder during her pregnancy with Frances, who is now 1 year quondam. Alex had to quit his paid job for a fourth dimension to take care of Margaret and their older daughter, Violet, who is now 4. Sara Stathas for NPR hibernate caption

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Sara Stathas for NPR

Margaret and Alex Siebers say they struggled brand ends meet during the weeks Margaret was confined to bed rest during her pregnancy with Frances, who is at present 1 year sometime. Alex had to quit his paid job for a fourth dimension to accept intendance of Margaret and their older daughter, Violet, who is now 4.

Sara Stathas for NPR

Deb Studey, Siebers' midwife, had cared for her during her previous pregnancy, which had ended in miscarriage at the end of the first trimester. Studey says she believes the bed rest may have helped Siebers carry this 2nd child — Frances — to term.

"I know that being on bed residue was difficult for Margaret. But I likewise knew, on the flip of that, having a 24-calendar week babe in an ICU wasn't going to be an easy effect either. So, in my mind," Studey says,"bed residuum let her get to term."

Studey is aware that the enquiry doesn't bear witness bed balance to exist beneficial. In fact, a 2013 study that specifically addressed the issue of a shortened cervix constitute that women who were prescribed activity restrictions during their pregnancy were actually more likely to give birth early.

"I think studies are always of involvement," Studey says. "I approximate I pay attending simply as as to how things are working for women — and that doesn't always fit a study. I think we're all different."

But Lyerly, the UNC bioethicist, tells NPR bed residual is not a beneficial intervention, and doctors and others who work with pregnant women need to think difficult before prescribing it. And the American College of Obstetricians and Gynecologists cautions confronting information technology, for several medical reasons.

"One of the most dangerous things that can happen when a woman is on bed rest is having a blood clot," Lyerly says. "You can have blood clots in your legs or in your pelvis. And if those clots travel to your lungs, it's life threatening."

She says women besides risk losing muscle tone, becoming weak — just before they're about to go through labor so care for a kid. And lying in bed can weaken bones, and reduce lung capacity. Some women become depressed.

"Women who are pregnant are not merely 'women who are significant,' " Lyerly says. "They are oftentimes mothers of other children. They are senators; CEOs; journalists; professors. They work in restaurants. They have jobs and they need their jobs."

On a mid-November evening, the Siebers family unit is jubilant Frances' first birthday. Margaret and her husband Alex have come dwelling house from piece of work, where Alex had simply injured his finger with a miter saw and was trying to clean and cast the wound. Margaret fabricated popcorn and peeled mandarins for the kids, as iv-twelvemonth-one-time Violet twirled around the firm in a whirlwind of red sparkles, and Frances climbed everything she saw.

Information technology wasn't a scene that lent itself to repose fourth dimension on the couch.

That'southward why, when Margaret Siebers was told to stop moving, to get to bed, Alex Siebers, 33, quit his job to care for the family for several months.

"Information technology felt kind of similar 'knocked out of society' for a while," Alex Siebers remembers, of the fourth dimension his married woman was confined to the burrow. "Our daily routine, our lives and our connections with people — we lost touch. Considering we were, y'all know, trapped in here just trying to get in." Sara Stathas for NPR hide caption

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Sara Stathas for NPR

"It felt kind of like 'knocked out of society' for a while," Alex Siebers remembers, of the fourth dimension his wife was bars to the burrow. "Our daily routine, our lives and our connections with people — we lost touch. Considering we were, you know, trapped in here just trying to make it."

Sara Stathas for NPR

"Her mobility was extremely limited," he says, "and the fact that we live in this house where the bathroom'south upstairs, you know, wasn't helpful."

His wife would go up in the morning, use the bathroom and go downstairs to the brown corduroy couch. She'd write letters, watch Netflix, read books.

"I could get upstairs to use the bathroom," Margaret recalls. "I tried not to go too often, just because I didn't desire to exist up and down the steps too much. I would sit on the porch sometimes. But whenever I moved, I would try to stay where I landed for hours, if I could."

She was able to continue working from bed, 24-hour a week, for her family'south company, Bagtags Inc., which makes lanyards and custom name tags for big events. Only that was hardly enough to make ends come across.

The Siebers went on Medicaid. They also qualified for FoodShare, Wisconsin'southward food stamp program, and WIC, the federal diet plan for women, infants and children. Friends from church got organized to bring the family meals. And their landlord gave them a break on their rent.

Margaret received a pocket-sized inheritance of $1,000, along with a tax render of about $800 that gave her some unexpected money.

"All of those things together helped us to go through," she says, "but barely. If any of those things were missing, I don't really know what nosotros would take done. Peradventure move in with relatives."

And the family unit became isolated, says her husband.

"It felt kind of similar 'knocked out of society' for a while," Alex Siebers says. "Our daily routine, our lives and our connections with people — we lost impact. Because we were, you lot know, trapped in here just trying to make it."

Kelly Jones, an economic science professor at American University in Washington, D.C., and a senior research economist at the Institute for Women'south Policy Research, says prescribing bed rest diminishes the role of women in society.

"If you lot're telling a woman to undertake an activeness that you're non certain is going to be benefiting her, and yet it's keeping her away from her chore, what you're proverb to her is 'Your participation in the economy is not important,' " Jones says.

The practice can also more generally harm the standing of women in the workplace.

"Nosotros know that the gender wage gap really starts when a woman has her showtime child," Jones says. She says that'due south partly because women accept on more household work and child care. "But in that location are as well aspects of that, that come from imitation assumptions, or [from] discrimination in the workplace surrounding childbirth and motherhood."

Sending women to bed reinforces the notion that they are frail or weak, Jones says. And those long-term absences from the workplace tin have lasting furnishings on a woman'south earning power.

Siebers' consulting obstetrician, Sheldon Wasserman, says he'southward seen women and men make huge sacrifices to ensure a successful pregnancy — including people who mortgage their homes to pay for fertility treatments and women who spend months in bed.

"The pursuit of having a kid is one of the most primal desires," he says.

Wasserman is chair of the Wisconsin section of ACOG. He knows what the research on bed rest says, and knows about ACOG's recommendations against it.

"I'thou kind of torn between the art and the science of medicine," he says. "Have I seen over the years patients who were on bed residue who were able to take children when their previous obstetrical history is very poor? Yes, I accept."

It'due south difficult to quantify just how many pregnant women are ordered to bed each yr by their doctors. A widely cited study from 1996 found that about twenty pct of women were prescribed bed balance at that time. A written report two years later found that as many equally 90 percent of maternal-fetal specialists order bed residue for some patients in high risk pregnancies.

The practice dates back to the time of Hippocrates, but became widespread in the late 1800s, when a British anatomist posited that if immobility heals cleaved bones, it likely could heal other ailments. The "rest cure" became standard medical care, co-ordinate to Jacqueline Wolf, a professor of the history of medicine at Ohio University, who has written books nearly the history of pregnancy and childbirth.

Prescribing bed balance for pregnancy persisted in part, she says, because there was a notion that pregnant women were vulnerable to getting upset and hysterical.

"And then, prenatal care brought out [among] obstetricians — almost all of whom were men in the U.S. until the 1970s — a very intense and pervasive paternalism," Wolf says. "If a woman had whatsoever sign of preterm labor or haemorrhage, she was to get complete remainder. No visitors. No conversations. Darkened room — shades drawn. Even earplugs."

The depth of research on the topic has inverse since the 1970s. But bed rest is still widely prescribed. Today, women's magazines, consumer communication web sites and even major medical centers include information about bed rest equally a common practice that anyone may look to face.

When NPR asked listeners if they've been on bed rest in the last twelvemonth, more than 200 women responded in merely iv days.

Some said they'd spent just a few days in bed, or were told merely to 'lighten up' on their physical activity. Others, like Margaret Siebers, were given strict orders to stay in bed.

Siebers says she was aware that the enquiry showed little do good to her staying in bed.

"You better believe I spent a lot of that time lying on my dorsum reading articles well-nigh the effectiveness of it," she says. "So that was that was something that came upwardly a lot."

She asked her doctors if she could travel to her family unit's cabin, and lay on the couch there, simply for a change of scenery. She questioned exactly how much she could practice. Could she cook? Walk her daughter one block to the park? The caregivers didn't ever agree. But in general information technology came down to this: The baby is OK, then don't modify a thing.

That rationale is particularly troublesome to Anne Drapkin Lyerly with UNC, because it tin induce unearned guilt in the mother if something goes wrong with her pregnancy.

"When bed rest is prescribed, the implication is that information technology is useful and that the immobilization is what is going to present prevent whatsoever dreaded issue — whether that's preterm nascency or miscarriage or preeclampsia," Lyerly says. "If it ends up that a baby is born prematurely, or a woman develops preeclampsia, she is going to worry that she didn't adhere to the recommendation well enough and will blame herself."

Lyerly says she prescribed strict bed rest to one of her patients early in her career, and the pregnancy ended in miscarriage several hours after the woman took a shower.

"There was no amount of argument I could do to brand her think it wasn't her fault," Lyerly recalls. "Because, later on all, nosotros had prescribed bed rest and she had gotten up."

When Siebers' pregnancy reached 37 weeks, a time when doctors believe it's safe to give birth, the stitch that doctors had taken to hold her cervix airtight was removed. She was allowed to become up and return to normal action.

It was and so a full three weeks before she went into labor, and gave nativity to Frances.

"And then maybe it worked really well, or maybe it wasn't necessary," Siebers says of her time spent on bed rest. Just afterwards all the family went through, she says, she doubts she'll desire to have another child.

At present, a year after Frances' nativity, both her parents have returned to full-fourth dimension jobs.

Margaret Siebers sings Happy Altogether to Frances on the baby's first birthday. Sara Stathas for NPR hibernate explanation

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Sara Stathas for NPR

Margaret Siebers sings Happy Birthday to Frances on the infant'southward first altogether.

Sara Stathas for NPR

The family gathers effectually a table, with little bowls of ice foam – ane with a single candle for Frances. They sing an extra-long version of Happy Birthday, Margaret Siebers' family unit tradition, and mom blows out the candle equally Frances dips her fingers tentatively into her first water ice cream.

Alex Siebers ponders the whole feel.

"It would be very disheartening to learn later on in life — after there had been much more than study and research done on this — to find out that that hadn't been necessary," he says. "Considering that was a existent hardship for the states. I can't, obviously, aspect the issue to the bed residual completely. But, you know, there she is. You know — there's the baby."

The Siebers family, now relaxed, on the living room couch that express their world for several months when Margaret was on bed remainder. Today both parents have returned to full-fourth dimension paid work. Sara Stathas for NPR hide caption

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Sara Stathas for NPR

The Siebers family unit, now relaxed, on the living room couch that limited their world for several months when Margaret was on bed balance. Today both parents have returned to full-fourth dimension paid work.

Sara Stathas for NPR

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Source: https://www.npr.org/sections/health-shots/2018/11/26/669229437/rethinking-bed-rest-for-pregnancy