— When Michelle Massucci went into preterm labor with twins
almost four months before her due date, she followed her
doctor’s orders for strict bed rest.
weeks in the hospital, she was allowed out of bed only to
shower and go to the bathroom, and some days not even to do
that. For another four weeks at home, she laid on her living
room couch day and night, needing family help even to get
herself a sandwich.
funny — people say to me, ‘I wouldn’t have been able to
do it,’" she said.
be completely honest with you, you wouldn’t think of doing
anything other than that because the health of your babies is
in your hands."
date, Massucci of Ross, Pa., credits bed rest with helping to
keep her pregnant as long as she was — delivering twins
Justin and Madelyn at 35 weeks gestation (for twins 37 weeks
is considered full-term delivery).
many years, that was indeed the prevailing wisdom.
— just seven years after Massucci’s twins were born —
strict bed rest is becoming a thing of the past.
editorial that ran last summer in the journal Obstetrics and
Gynecology used the phrase "unethical and
unsupported" about therapeutic bed rest.
all interventions that make some sense are scientifically
valid, and this is one of them," said Dr. Ronald Thomas,
division director for maternal-fetal medicine at the West Penn
Allegheny Health System.
said bed rest has been a tempting solution to all manner of
problems in pregnancy because it seems logical that sharply
reduced activity would put less stress on the body, making an
early birth less likely to occur.
have used it for all sorts of things — history of preterm
birth, contractions in the current pregnancy, multiple
gestation," he said. "You name it, someone has
suggested it as a possibility."
recent studies have found is that not only is there no
evidence that bed rest helps any of those conditions, but that
strict bed rest can do both physical and economic harm, said
Dr. Hyagriv Simhan, chief of maternal fetal medicine at Magee-Womens
Hospital of the University of Pittsburgh Medical Center.
of blood clots increases, he said, and women can quickly have
atrophied muscles and bone demineralization that can increase
the risk of osteoporosis, the brittle-bone disease. In
addition, women who are prevented from working can experience
when Massucci came home from her six weeks on hospitalized bed
rest, her muscles had atrophied to the point where she
struggled just to lift her leg to step up onto the curb
outside her house. "To be honest, I was in pretty bad
physical condition," she said. "I definitely was in
a state where my muscle tone was long gone."
cautioned that there is a difference between strict bed rest,
when patients are told that they should only move around for
very short periods, and modifying strenuous activity. It is
advisable for pregnant women to take it easy, he said, meaning
that strenuous activities can and should be reduced during
all know the exceptions — people in phenomenal shape — but
for the average patient there’s always some modification of
activity," he said. "You don’t want to say to a
patient go to bed rest and literally don’t get out of bed,
but on the flip side, if you do a job where you carry
100-pound bags of feed back and forth, or climb up and down
steps with heavy loads, you need to modify activity."
away from prescribing bed rest has come gradually, as studies
have stacked up showing its lack of effectiveness.
wheels of medical care sometimes turn slowly," said
Simhan. "Fifteen years ago, there were fewer data on the
topic, because it has this intuitive appeal. In the last five
to 10 years, I was much less aggressive with bed rest.
Beginning five years ago, we hardly do it."
bed rest is now something that patients sometimes request
themselves, said Simhan. In extreme cases, he’s seen women
rent a wheelchair and have their husbands push them around —
just because they feel that bed rest intuitively should help
them, and it helps them take charge of a scary situation.
can lessen contractions, said Simhan, but while contractions
often accompany preterm labor, they are not necessarily the
cause of it. Rather, doctors now think of contractions as more
of a symptom than anything else.
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rest out of the picture, women can feel helpless during
preterm labor because of a lack of effective long-term medical
interventions. "In the world of prematurity prevention,
we’ve made a ton of strides, but once a woman has had
preterm labor we do not have any effective prevention
strategies," said Simhan. "Prematurity is the
biggest problem in obstetrics but there’s more that we don’t
know than we do know."
said, there are medical conditions where bed rest is
warranted. If a woman is hospitalized for high blood pressure
during pregnancy she is told to restrict movement, as activity
raises blood pressure. If her blood pressure rises too high,
doctors have to deliver the baby.
when Massucci went into preterm labor with her twins, doctors
told her there wasn’t much scientific proof that bed rest
was effective. But looking back on the experience, she feels
as if bed rest worked for her.
felt that limiting my movement did help calm the babies inside
of me," she said. "But I don’t know the