One quiet Sunday afternoon, shortly before the birth of my second child, I decided to make a great escape. I was in the midst of my third — and longest — hospital stay then and hadn’t left my tiny room in weeks. I peaked out my lockless door, checked for wandering nurses, crept out of the room and shuffled into the sterile hospital corridors. I could barely remember the last time I’d walked that much.
I made it all the way to the cafeteria, where I ran into a woman I knew. I didn’t recognize her at first; at that point I’d been on bed rest for months. We ordered veggie sushi (no raw fish for us!) and discussed how really very dark the cafeteria was for such a nice hospital. She told me how lucky I was. I didn’t have to work anymore – commuting to and from work was killing her back. She had to wear flats.
I snuck back into my room and buried myself in my hospital bed, pulling the thin blanket and starched sheets over my head. I stayed like that for a long time. I wasn’t moving but my body ached. I was always in bed but never tired. I was receiving long-term disability benefits but wasn’t ill.
"Mama's in the hospital because the baby is coming,” I told my three-year old when she came to visit. “Just like in your books.”
"Sometimes people go to hospitals because they're very very sick," she replied, wrinkling her little brow as she sat in the bed with me, eating orange jello from a plastic cup.
But I wasn’t very, very sick. I was pregnant.
****
Everyone has a pregnancy and birth story. A natural birth gone wrong, an emergency C-section or a shockingly fast deliveries. Mine sounds like a tale from a Victoria novel, something from the days of sanitariums, hysteria and rest cures.
But in fact, bed rest remains one of the most frequently prescribed treatments for pregnant women at risk of preterm brith. It’s estimated that around 20 percent of women will be prescribed bed rest at some point in their pregnancy. Up to 95 percent of obstetricians report that they’ve prescribed the treatment in some form.
Once I started looking, I saw bed rest everywhere. Realty TV star Tori Spelling dished about her two months of bed rest to E! News in 2013: "I was flat on my back. I wasn't allowed to even get up to walk in the halls. My bathroom privileges would be taken away. I wasn't allowed to shower. Everything was stripped from you.” Bachelorette star Ali Fedotowsky fretted that her orders of modified bed rest was preventing her from preparing for her babies arrival. “I’m not doing as well as I would like to be doing,” she told PEOPLE earlier this month.
The practice continues despite a growing body of medical evidence showing that bed rest offers basically no benefits to the mother or the fetus. The treatment has not proved effective in treating preeclampsia, preterm birth, gestational diabetes, low infant birthweight, or a shortened cervix. The American College of Obstetricians and Gynecologists now advises that bed rest "does not appear to improve the rate of preterm birth, and should not be routinely recommended.” The risks, however, have been well documented: Women prescribed bed rest may suffer from bone loss, muscle atrophy and a wide range of post-partum psychological disorders.
Even as they keep prescribing the treatment, most doctors don’t believe it does all that much. A 2009 survey of U.S. members of the Society of Maternal-Fetal Medicine found that 71 percent of doctors would prescribe bed rest for women in preterm labor and 87 percent for premature rupture of membranes (water breaking). But a majority said they believed the treatment was associated with “minimal or no benefit.”
So why do doctors keep sending their pregnant patients to bed? In part, it’s because they don’t have much else to offer. Despite advances in science, pregnancy and many of its complications remain a medical mystery. “Pregnant women may be the most underrepresented group in the entire clinical research process,” declared a 2011 report by the National Institutes of Health’s Office of Research on Women’s Health. There are no randomized controlled trials evaluating exercise prescription in women with a history of preterm birth. The lack of research leaves many of our most heated debates over pregnancy — issues like bed rest, breastfeeding, even a glass of red wine during pregnancy – taking place in a murky mix of medicine, traditional practice and history — a type of maternal science disconnected from actual maternal lives.
***
My restrictions began shortly after my twenty week ultrasound, when my doctor discovered that my placenta was in the wrong place. She compared my condition, known as placenta previa, to having a bag of blood hanging between your legs. Moving could cause the bag to burst — threatening the baby and my uterus. Staying still was my best chance of slowing the bleeding, said my doctors, an ever-expanding team of ob-gyns, perinatologists, neonatologists, nurses, fellows and residents. Or, at least, that was their best guess. Sometimes medicine is the art of diminishing risk, my obstetrician explained during one of her daily visits.
She’d been on bed rest herself, spending her time reading medical journals, writing thank you notes and cross-stitching. After my baby was born, I’d bring a set of mugs with drawings of cross-stitched uteruses to my first post-natal appointment. My doctor was thrilled. She was so over all the sperm-related swag she always gets, she said.
Classic, I thought. The uterus does all the work but it’s the sperm that gets all the glory.
During my fourth invasive ultrasound at the hospital, I asked the high-risk doctor if she thought it might be possible for me to go home. My cervix hadn’t lengthened at all — a sign that the baby wasn’t pushing down. In the hospital, I’d continued spotting but never had another heavy bout of bleeding. She asked me, her voice dripping with medical condescension: “Don’t you want to do everything you possibly can for your baby?”
I snapped back that I didn't much care. I just wanted to leave. I called my husband and informed him that I no longer wanted to have this baby. Couldn’t we just call the whole thing off?
I began to suspect I was going insane.
***
I wasn’t alone: A secret society of home-bound pregnant women lurked all over the Internet, on message boards, members-only discussion groups and across parenting magazines. An active bed rest market is eager to service moms-to-be, offering survival guides, novels featuring bed rest-bound protagonists (usually featuring hard-charging “career women” who realize what’s truly important in life once they’re forced to slow down), children’s books and lists of bed rest essentials. (The Parents magazine list includes a telephone, hairbrush, laptop and lip balm. “Your favorite hand and body lotion is a great way to treat yourself to an in-bed spa!” they advise.)
Every day, every hour, every minute in the womb will make your baby’s life better, websites like keepemcooking.com perkily proclaim, offering tips for “making the best of bed rest.” It was a type of magical thinking: You can control the uncontrollable if you just stay stiller.
“Stay focused on your goal — a healthy baby,” recommends Fit Pregnancy magazine. “If your doc approves, try one (or more!) of these favorite restorative bed rest techniques!
Breathe deep…
Visualize your baby…
Squeeze a ball.”
On message boards, women fretted over the details of their prescriptions. Was a walk to the kitchen too much? How about a quick shower? Is it ok to lie on your back or do you have to stay on your side? Bed rest can mean everything from strict time in bed to simply modifying activities. Some doctors use the term “couch rest” – no lifting, no exercise, no sex and no housework. The rules vary widely, perhaps a reason why so many doctors say they’ve prescribed some form of the treatment.
But mostly, the moms-to-be blamed themselves for their bodies. Contractions were due to carelessness, maybe a quick walk around the room or a decision to pick up a toddler for a hug. After the babies were born, they returned to post encouraging notes, attributing their success to those weeks or months of rest.
The Internet was full of sad stories. Women who were in the hospital for six months. Who lost their jobs. Who snuck in their other children because there was no one to watch them at home. Who went into debt paying the hundred thousand dollars my pregnancy would eventually end up costing my insurance company.
Everyone was depressed. Everyone was anxious. Pages of posts were devoted to debating the merits of various anti-anxiety medications and sleep aides. I rarely slept in the hospital, even when I took the Ambien my doctor prescribed. At three in the morning, I sat up reading studies on my phone.
A 2004 study of 1,266 pregnant women found that 7.9 percent of those on bed rest had premature babies, versus 8.5 percent of the non-bed-rest group – a difference the researchers said was within the margin of error. Another study published nine years later found that women prescribed some form of activity restriction were more likely to deliver early. “It is not biologically implausible that activity restriction could result in an increased risk of preterm birth,” wrote the researchers, citing an association between limits on movement and increased stress and anxiety.
At best, the studies recommended more scientific research. At worst, they called the practice unethical. “There have been no complications of pregnancy for which the literature consistently demonstrates a benefit to antepartum bed rest,” wrote the authors of a 2011 article. A 2013 review of studies on bed rest put it even more bluntly: “Prescribing bed rest is inconsistent with the ethical principles of autonomy, beneficence, and justice.”
The researchers attributed the continued prescription of bed rest to a deep-rooted cultural bias that elevates the fetus above all else in pregnancy. “Evidence frequently is ignored or interpreted selectively in a way that disregards maternal interests,” they write. If there’s a risk to the fetus, immediate prohibitions follow — like limiting caffeine or alcohol. But possible risks to the mothers were more likely to be overlooked.
That is certainly the case with bed rest. Various studies found that the physical effects of bed rest like bone loss, muscle atrophy and cardiovascular deconditioning can persist for months after the baby is born. Women who spend time on bed rest are more at risk of post-partum depression and anxiety.
One study described a “type of sensory deprivation.” “When women spend long, isolated, fright-filled hours in bed, time is perceived as slowing down, in seconds and minutes, rather than hours or days. Women also feel out of control of what is happening with their bodies. Women report feeling imprisoned,” wrote the authors.
***
In ancient Greece, most diseases were blamed on a wandering womb that would travel around the body. A cough or sore throat? That pesky womb must have wandered north. Chest pain? The womb took a wrong turn again. Greek physician Aretaeus of Cappadocia called the uterus “an animal within an animal.”
English physicians in the late 1600s believed a healthy pregnancy depended on the right use of the classical “non-naturals:” air, food and drink, exercise and rest, sleep and waking, fullness and emptiness and passions of the minds.
In early medicine, bed rest was rarely recommended, even for pregnancy. After all, if you went to bed, you might not get up again. That began to change with the publication of John Hilton’s “Rest and Pain” in 1863, an influential book arguing for the benefits of rest on the body. Hilton argued that if rest could help heal broken bones, it could also help heal other organs.
Doctors ran with Hilton’s guidance, prescribing rest at home or in the hospital for indefinite periods of time. Rest became the standard treatment for heart attacks, tuberculosis, mental illness, ulcers and rheumatic fever. The bed could cure all ills, leaving doctors and nurses responsible largely for preventing bedsores and maintaining good hygiene.
Dr. S. Weir Mitchell gained fame for championing what he called “the rest cure” as an answer to the malady of the day: Hysteria, a common medical diagnosis reserved exclusively for women. Sick women were ordered to bed, isolated from friends and family, instructed not the move a muscle or engage in intellectual work of any kind. Writing, reading and sewing were strictly forbidden. Effectively reduced to infants, they were placed on a milk diet with nurses to clean, feed and even turn them over in bed.
Mitchell was so renowned he had his own Christmas calendar. His cure was prescribed to Edith Wharton, Virginia Woolf and scores of female artists and writers. Most of Mitchell’s successful cases ended when the patient married or carried a pregnancy to term, regardless of whatever she might say about her mental state.
Several months of confinement became the norm for pregnant Victorian women. In the 1908 edition of the textbook Obstetrics for Nurses, De Lee recommended that pregnant women be removed from “gossiping neighbors” to “lead a placid, quiet life, avoiding mental as well as physical fatigue and excitement.” Confinement would begin when the pregnancy began to show (modesty!). Several weeks of “lying-in” — remaining strictly in bed — would follow childbirth.
The value of bed rest began to be questioned during World War II, as doctors treating injured soldiers began to notice that patients forced to return to battle earlier recovered faster. Those who remained in bed for longer periods suffered muscle loss and other physical ailments. A few years later, aerospace scientists began to use bed rest as a model to investigate the impacts of weightlessness in space on the body. In multiple studies, the scientists discovered that bed rest produced a wide range of harmful physiological effects, impacting every major organ system. As their research became better known, clinical care for postoperative patients began to change for a range of conditions. Increasingly, doctors moved away from convalescing in bed as a treatment, finding that even short bed confinements unhelpful for many patients.
Medical experts now see mobility as the next major hospital reform — akin to the move from the Victorian-era open wards to private rooms. Some facilities have begun investing in walking tracks and outdoor “healing gardens,” designed to encourage patients to get up and move.
Those changes haven’t yet made it into maternity wards. Some researchers attribute this to a desire by obstetricians to “do something” in the face of limited research. “Unnecessary interventions such as bed rest may make the patient (and sometimes the health care provider) feel that all attempts are being made to “save” the pregnancy,” wrote in 2013.
A 2011 paper by Judith Maloni, a professor at the Bolton School of Nursing at Case Western Reserve University, suggests a few factors that could to spur a change in practice: better explanation of the side effects to patients, ending insurance reimbursement for bed rest care or patient lawsuits. But, she acknowledged, limiting the use of the bed rest may come down to women forcing the changes themselves. “If not, it is likely that women will continue to struggle with the untreated side effects of bed rest during pregnancy and the postpartum, and wonder why they do not recover like other childbearing women,” Maloni concluded.
***
I am part of a generation raised to believe that co-parenting was not just aspirational but achievable. But trapped in that hospital room, I began to have a sinking feeling about the whole enterprise. After the baby came, there would be breastfeeding, another task only I could do. Because I took leave, I'd know the doctor and the babysitters, handle the appointments and the scheduling. A version of the trade-offs I made with my time and health during my pregnancy would be expected to continue once the baby was born. Our assumptions about our pregnancies set the tone for our assumptions about the motherhood that follows.
I have a foreign journalist friend who spent five months on bed rest. During that time, there was a government coup. She’s from a country where this sort of thing happens every couple of years. But still, she missed it. The whole damn coup. Her daughter is now thirteen. At a conference last month, she ran into a senator involved in the coup. She couldn’t talk to him without feeling an overwhelming sense of rage for those lost months.
My baby is over a year old now. Even if I wasn’t her mother, I’d recognize that she is the cutest baby in the world. Her pediatrician can’t believe the strength of her dimpled baby legs. My babysitter calls her the Bolita because she looks like a chubby, smiling ball. She spends much of her time trailing after her big sister. When she sees me enter a room, she laughs.
As for me, mostly I feel lucky. To have good insurance, a supportive family, amazing medical care. I will stay with the doctors who cared for me as long as they’re in practice. As I watch my baby grow — stumbling around my living room as she tries to walk or squawking out her first words — I sometimes feel overwhelmed by my good fortune.
But, like my reporter friend, my time on bed rest stays with me, a nagging memory of those lost months of anxiety and depression, Netflix and hospital food. My pregnancy was complicated and dangerous. Maybe the bed rest helped. Maybe it didn’t. Like so much of pregnancy, it remains a mystery.