美国国家公共电台 NPR Rethinking Bed Rest For Pregnancy

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RACHEL MARTIN, HOST:

Doctors send thousands of pregnant women to bed each year, some for just a few days, some for months. The idea is that laying still may help women with complicated pregnancies¹ carry their babies to term. But the practice is questionable² at best. In fact the American College of Obstetricians and Gynecologists generally advises against putting women on bed rest. NPR's Alison Kodjak recently spent time with a woman whose life was upended when she was sent to bed.

ALISON KODJAK, BYLINE³: The scene in Margaret Siebers' house at the end of the workday is pretty chaotic⁴.

(SOUNDBITE OF BABY CRYING)

KODJAK: Her husband, Alex, is tending to a wound on his finger that he got at work that day.

ALEX SIEBERS: I was using miter saw, and it crushed my finger.

KODJAK: Margaret stands in the kitchen popping corn.

(SOUNDBITE OF CORN POPPING)

A SIEBERS: It's a special treat because tonight is their daughter Frances' first birthday.

MARGARET SIEBERS AND ALEX SIEBERS: (Singing) Happy birthday to you.

KODJAK: Frances toddles⁵ through the kitchen. And her older sister, Violet, twirls around in red sparkles.

VIOLET SIEBERS: I want to be in the...

KODJAK: It's a typical scene for a busy family, not one that lends itself to rest. But rest is what Margaret was ordered to do last year by the doctors and midwife who were caring for her during her pregnancy⁶.

MARGARET SIEBERS: So I could come downstairs and sit on the couch and hang out on the couch.

KODJAK: This couch right here?

M SIEBERS: Yeah. This is where I spent several months.

KODJAK: Margaret was 22 weeks pregnant and getting a routine ultrasound. The baby was fine, but there was a potential problem - her cervix was shortened, a sign that she might go into labor⁷ too soon.

M SIEBERS: That was really scary for us. It was, like - we were at this appointment. And the doctor's looking at the baby and saying, they've got a beautiful heart. And I'm thinking, oh, great. They've got a beautiful heart. And they might die.

KODJAK: A year earlier, Margaret had a miscarriage⁸ when she was about 14 weeks pregnant.

M SIEBERS: So it was, you know, just - it was really scary to think that we might lose another baby.

KODJAK: Her midwife and doctor recommended the procedure called a cerclage, where they stitch up her cervix in hopes of keeping it closed. And they told her to go to bed and stay there. It was hard financially.

M SIEBERS: My husband immediately quit his full-time⁹ job. And he took care of me. He brought me - like, I wouldn't even get my own glasses of water.

KODJAK: And it was hard emotionally.

M SIEBERS: I like to say that I was on bed rest, and he was on house arrest because he really couldn't leave, either.

A SIEBERS: Her mobility¹⁰ was extremely limited. And the fact that we live in this house where the bathroom's upstairs, you know, wasn't helpful.

KODJAK: The whole experience was isolating¹¹.

A SIEBERS: We felt kind of, like, knocked out of society for a while, you know, out of, like, our daily routine in our lives and connections with people we lost touch with because we were, you know, trapped in here, just trying to make it.

KODJAK: Margaret worked from home part time for her family's company. But the loss of Alex's paycheck was tough.

M SIEBERS: So we qualified¹² for Medicaid, which we were on. We qualified for food share, which we were on. We qualified for WIC.

KODJAK: Friends from church brought them food. Their landlord gave them a break on the rent. Margaret received a small inheritance, about a thousand dollars. And they got an $800 tax return.

M SIEBERS: All of those things together helped us to get through - but barely.

KODJAK: And all of that upheaval¹³ may have been unnecessary, says Anne Drapkin Lyerly, an OB-GYN and professor of bioethics at the University of North Carolina.

ANNE DRAPKIN LYERLY: The bottom line is that there's never been any proven benefit of bed rest.

KODJAK: In 2013, Lyerly and her colleagues did a review of the scientific research. They found that bed rest didn't reduce premature¹⁴ births, miscarriages¹⁵ or low-birth-weight babies. It didn't help women who had high blood pressure. It didn't help women pregnant with twins carry them longer. And it didn't cut the risk of placenta previa, a condition where the placenta covers the cervix. In fact, Lyerly says, bed rest can cause harm.

LYERLY: The thought has been how could it be bad to have a woman stay in bed for a bit? It doesn't seem like a dangerous intervention¹⁶ in the same way we think about surgeries or medications. But, in fact, it is and can be very dangerous.

KODJAK: Lying in bed can cause blood clots¹⁷, which are potentially fatal. It can also weaken a woman's muscles and bones or reduce their lung capacity. Some become depressed¹⁸. And the economic hardship can be dramatic. Kelly Jones is an economics professor at American University and a senior researcher at the Institute for Women's Policy Research.

KELLY JONES: If you're telling a woman to undertake an activity that you're not certain is going to be benefiting her and yet it's keeping her away from her job, what you're saying to her is your participation¹⁹ in the economy is not important.

KODJAK: Margaret's midwife, Deb Studey, who cared for her during her previous pregnancy that ended in miscarriage, says the temporary hardship pales in comparison to what could've happened had something gone wrong.

DEB STUDEY: And I know that being on bed rest was hard for Margaret. But I also know, on the flip²⁰ of that, having a 24-week baby in ICU wasn't going to be an easy outcome either. So in my mind, bed rest let her get to term.

KODJAK: Studey is well aware of the research showing that bed rest doesn't improve outcomes. But, she says...

STUDEY: I pay attention to how things are working for women. And that doesn't always fit a study. I think we're all different.

KODJAK: Lyerly, the bioethicist, says one of the problems in prescribing bed rest is that women can end up blaming themselves when something goes wrong.

LYERLY: The implication is that it is useful and that the immobilization is what is going to prevent whatever dreaded²¹ outcome. So I think this false sense of agency that is imposed around bed rest is highly dangerous.

KODJAK: Margaret Siebers actually read the research on bed rest while she was stuck on her couch. Still, she stayed there just to be safe. When she was 37 weeks pregnant, her doctor removed the cerclage. She was allowed to get up and returned to normal activity. It was a full three weeks before she went into labor and gave birth to Frances.

M SIEBERS: So maybe it worked really well. Or - maybe it worked really well. Maybe it wasn't necessary. It was a strange time.

KODJAK: Alison Kodjak, NPR News, Milwaukee.