Doctors Lounge - Gynecology Answers
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Forum Name: Obstetrics
|cwladis - Tue Apr 01, 2008 5:25 am|
My husband and I want to begin a family soon, but my job only provides a limited amount of paid sick/disability leave; several of our friends who have recently been pregnant were required to be on bed rest for a long period of time (several months or more), and before I become pregnant, I want to know what the statistical odds are that I might be confined to bed rest for an extended period of time during the pregnancy.
What is the probability of a pregnant woman being prescribed extended (more than say, a few weeks or a month) bedrest during her pregnancy? And is there a maximum amount of time that a woman might be on bed rest (i.e. what is the earliest point in the pregnancy that bedrest might be prescribed)?
|Debbie Miller, RN - Tue Apr 01, 2008 5:59 pm|
This is an interesting question because it is impossible to know if you could be one of the few women who might require bedrest in pregnancy. Fortunately the vast majority of women are able to work right up until they go into labor at the appropriate time. You are wise to think about these things. Some employers offer short-term disability that can help a woman in this situation.
There is also much controversy surrounding the order of bedrest. In many situations where it has previously been prescribed it has mostly been discredited as something with little or no effect on the outcome of the pregnancy. There are exceptions.
Times where bedrest is helpful is in the case of a uterine tear or placenta previa with bleeding, when the mother develops serious high blood pressure and sometimes when there is an incompetent cervix. Other times (threatened miscarriage,
There is no data that bedrest can help in threatened miscarriage, and yet patients are told to go to bed rest with bathroom privileges when they have bleeding and cramping in the first trimester. It likely will not help but if the woman miscarries she feels that she did all she could to prevent it from happening so some providers feel there is psychological benefit.
This should be balanced with the harm that can be done with bedrest. Women on bedrest face a host of physical problems caused by lack of activity, including muscle atrophy and blood clot risk as well as emotional issues related to boredom and isolation. Then of course there is the financial disaster it sometimes causes - leading to further stress. There is even some thought that the stress means increased cortisol levels which may adversely affect the baby or induce preterm labor.
If your job is not physically demanding, you are likely to do just as well going to work, except in those cases listed above. Nobody can predict if you will develop high blood pressure, placenta previa or premature cervical changes that threaten a too-early birth. There are risk factors that might mean you are at increased risk, but even then, there is no way to predict such a thing. Mothers who are obese or who smoke carry a greater risk for hypertenstion. If you were born prematurely, you have a greater risk of delivering a preterm infant.
In most cases bedrest involves a few weeks at most. If it is in early pregnancy, you are likely to miscarry or find that everything is fine within a few days so even if you went to bed it would not be for a prolonged time. If it is for hypertension, this would likely not occur until the last trimester and if it is severe it can be a few weeks. If it gets dangerously high, the baby is delivered even if it is premature. Placental bleeding can occur at any time. If it is early, it will likely heal over and you can go back to normal activities. If it is late, it could involve a few weeks until delivery. Most women are probably on bedrest no more than two months. A mother pregnant with multiples will also be at greater risk for bedrest to avoid preterm labor but many mothers deliver at term, working right up until their 36th or 37th week (or even beyond).
I know of women who had bedrest prescribed who explained their work situation to the doctor who then agreed they were probably at no greater risk by going to work. There is nothing that can be done to prevent an early, first-trimester miscarriage so the negative effects of being on bedrest would likely outweigh any psychological benefit that may theoretically exist by going to bed. If you understand that nothing you could have done differently would have changed the outcome, you emotional health should be fine.
Now, I'm not suggesting you throw caution to the wind and ride rollercoasters, go scuba diving or wakeboarding. There are risky behaviors that can negatively affect your pregnancy. Remember the vast majority of pregnant women never need to be on bedrest, but I can't quote you the odds. It's really senseless anyway since if it happens to you it really doesn't matter if you're one in a thousand.
Good luck with your plans.
|cwladis - Sun Apr 06, 2008 10:41 am|
Thanks for taking the time to write such a comprehensive and thoughtful answer! I really appreciate your taking the time to go through the various causes in such detail and to explain the likely timing of each. It is also really helpful to hear your advise about handling potential prescriptions of bedrest that may be unnecessary - I feel much more confident making medical decisions when I feel reasonably well-informed. Thanks again for volunteering your time to answer my questions!
|Debbie Miller, RN - Sun Apr 06, 2008 8:24 pm|
You are welcome. Good luck.
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