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Tuesday, June 18, 2013

Resting Is Not Restful. Resting is Not Restorative. and Resting is Relegated To the Past?

Bed rest has long been recommended for a variety of maladies and beyond the obvious need for nightly sleep, there is apparently no proof that it works as a cure, particularly in pregnancy. Bed rest was not found to be restful;  and now bed rest has been proved to cause potential risks such as blood clots, compromise to our immune system, bone thinning, and poor cardiac fitness, and it has now been suggested that it should be abandoned as a recommendation. The Journal Obstetrics and Gynecology has published an article by Drs. McCall, Grimes and Lyerly from UNC College of Medicine that has taken a critical look at the practice of recommending bed rest and found the evidence to support it through research lacking. Not only that, rather than a treatment that can save medical costs, they calculated that the societal costs of bed rest are 1.6 billion dollars a year. The authors do not address potentially dangerous cases, like placenta previas where the cervix is covered with a placenta that could bleed if contractions occur. First, before they establish if the treatment could work, the authors encountered the problem of defining bed rest. Inevitably it becomes more of a 'soft' house arrest, with getting up to retrieve the remote, bathing, trips to the fridge, and even hanging on one's couch far from the actual bed all allowed when recommending 'bed rest.' In other studies 'napping' seemed to suffice for the resting. Trying to improve blood pressure, prevent hypertension, or prevent preterm birth with rest failed miserably in all studies attempting to define a role for bed rest. The authors essentially ask for proper informed consent for all women being put on bed rest in pregnancy, and imply that this should only be done in research settings. Change is hard, yet I bet most moms would jump out of the bed they are confined to if they got the chance.

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