Short of being a professional mattress tester, there are probably few times in life when an otherwise able-bodied person would wish to lie in bed for weeks or months on end.
But each year, an estimated 700,000 women with high-risk pregnancies or complications are ordered to bed by their doctors. There, they face a host of physical problems caused by lack of activity, and emotional issues related to boredom and isolation.
Candace Hurley understands those issues all too well, having spent about half of each of her two pregnancies lying down.
"The first time it happened, I was 20 weeks pregnant, so I was only half-way into my pregnancy. I'd had some vague twinges that were not painful, but I didn't know what they were," says Hurley, founder and executive director of Sidelines National Support Network, a resource for women and families who are experiencing complicated pregnancies. "Luckily, I had a very responsive physician, who said 'Nobody knows her body better than an infertility patient -- come on in.' He saved my baby for sure."
When he examined her, he found that her cervix was 80% effaced (thinned out -- a sign of early labor), and she was having contractions that lasted about 100 seconds and were spaced only five minutes apart. She went on bed rest from that moment on and remained in bed for 14 weeks until her water broke. Then she went to the hospital for delivery.
As hard as it was to spend a long stretch stretched out, she'd do it again to give her child every chance, she says.
"I told my doctor at the time, 'You can hang me from my ankles in a hospital -- just do what you can to save this child," she says.
Hurley didn't have to hang by her ankles, but to many women consigned to enforced repose, that might be preferable. Women who write to Sidelines and similar support organizations say they felt lonely, scared, frustrated, and depressed.
"It's very hard on many levels -- physically it's hard to stay in bed. As far as mentally, I always say that it seems to happen to us 'A' types that are the casserole-bringers of the world," Hurley says. "We don't want to stay in bed; we're used to being very active; we're used to helping others, and we don't want other people to have to help us."
She says that in addition to being lonely and isolating, forced bed rest is hardly the pregnancy most women hope for or imagine.
"You see images of pregnant women doing aerobics or running and you can't even run or walk; it's an extremely hard adjustment to have to make," she says.
And So to Bed ...
In addition to pre-term labor, conditions that might prompt an obstetrician to order bed rest include cervical changes such as premature effacement of the cervix, or "incompetent" cervix, in which the cervix dilates prematurely during the second trimester; vaginal bleeding due to conditions such as placenta previa, in which the placenta develops in the lower end of the uterus and sometimes blocks the internal opening; and high blood pressure (including the pregnancy-related forms preeclampsia and eclampsia).
"Only mild forms of high-blood pressure would be treated with bed rest at home; with anything more serious people would be in the hospital," says Jodi Abbott, MD, assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, and an ob-gyn at Beth Israel-Deaconess Medical Center in Boston.
But there also are times when bed rest may beneficial, even when the medical indications are less clear, says another expert in high-risk pregnancies:
"Even if it does not help medically, you have to deal with the psychological health of the woman," says John Elliott, MD, director of maternal and fetal medicine at Good Samaritan Medical Center in Phoenix.
"Sometimes a lot of bed rest is prescribed so that the patient can psychologically deal with the outcome better," he says. "For example, there is absolutely no data, and I firmly believe that bed rest does not help in threatened miscarriage, and yet we will tell a patient to go to bed rest with bathroom privileges when she does have bleeding and cramping in the first trimester. I do it not thinking it's going to help, but if you don't do that -- and she goes on and miscarries -- her psychological adjustment to that loss is terribly hindered, because she feels that she didn't do all she could to prevent [it]."
What's a Mother-to-Be to Do?
The range of activities allowed to a woman on bed rest depends on the reasons for the medical order, Abbott says. Some women are on very strict bed rest and are told to only get up to use the bathroom, and not shower more than once a week.
"Most people who are on bed rest, however, get up and go to the bathroom, might be able to fix themselves something to eat, but if they aren't near the kitchen we tell them to keep a cooler near the bed, or have someone make them a sandwich," she says. "And pretty much, you can only do what you'd be able to do lying down."
Fortunately, many women with the financial resources or support from their employers can work from bed using a portable computer and telephone, for example.
"When people ask a woman with a high-risk pregnancy "what can I do for you," the best thing they can do is get that computer that may be in the basement or in another room set up next to your bed," Hurley says. Women with Internet connections can download information, participate in chat groups, and just keep in touch with the world outside.
But many women don't have access to technology, and for them Sidelines and other groups offer telephone support around the clock. "It's very hard for women on bed rest to stay compliant, but since we link up women [who are currently on bed rest] with women who have already been months in bed, there's nothing that patient can tell us that we haven't already been through," Hurley says.
Sidelines network chapters are staffed by volunteer "buddies" who offer counseling, support, encouragement and sometimes just a friendly ear to other women consigned to mandatory bed rest. In some cases volunteers travel at their own time and expense to be with single mothers during labor and delivery, and one Sideline buddy managed to find Catholic nuns who were willing to donate blood to a pregnant woman who was fearful about the safety of the blood supply.