Don't Take This Lying Down
By SARAH BILSTON
Published: March 24, 2006
IN 1877, Dr. Silas Weir Mitchell, describing what he called his "rest cure" for hysterical women, wrote, "I do not permit the patient to sit up or to sew or write or read. The only action allowed is that needed to clean the teeth." At the end of six weeks to two months of such treatment, he expected that women would be good as new.
A few years later, Charlotte Perkins Gilman was prescribed Mitchell's rest cure for postpartum depression, and her fictionalized account of its effects in "The Yellow Wallpaper" depicts a woman descending slowly but surely into insanity. As someone who was prescribed bed rest two years ago when I was pregnant with my daughter, I know that Gilman, not Mitchell, gets closer to the truth.
Over a century later women are still prescribed the equivalent of the rest cure for obstetrical complications, but now it is recommended before birth. It is a standard means of treating just about any pregnancy-related problem in the United States. Women at risk of preterm labor, women with too much or too little amniotic fluid, women with placenta previa (where the placenta implants on or near the cervix), women with pregnancy-induced hypertension, women whose fetuses are judged to be growing poorly, women with multiple fetuses and women with chronic health problems are all likely to find themselves on bed rest. Indeed, doctors prescribe it for about one in five of all pregnant women, or around 750,000 women a year.
When I was placed on bed rest, it was because of low amniotic fluid levels. Frankly, I would have stood on my head if there was a chance it would save my daughter's life. While lying prone at least sounded comparatively benign, I soon realized, as Gilman did 120 years before me, that it was anything but.
Small actions like teeth-brushing became for me, as for Mitchell's patients, the high point of my day. The change from an active, fulfilling professional life to one of complete immobility left me weakened and depleted just when my strength was most needed for the rigors of birth and motherhood.
Although I was lucky enough to have a supportive family and a husband who could adjust his schedule to work from home, like all women on bed rest I experienced a range of debilitating problems. By the time my bed rest regimen was relaxed in the final week of my pregnancy, I could barely walk. I also experienced intense joint pain from lying on my left side — as directed — 24 hours a day, circulation problems, dizziness, fatigue and the bewildering frustration of a life suspended.
For many women (though fortunately not for me), such feelings of frustration and isolation lead to outright depression, not to mention the burden of lost wages and other financial costs.
And yet there is substantial doubt within the medical profession about the efficacy of bed rest. My own doctors, who were undoubtedly acting in good faith, openly admitted that they were not sure bed rest would increase my amniotic fluid levels. I carried my daughter to term, although no one could tell me if bed rest really helped or not.
In fact, doctors in other countries are far less likely to prescribe it. For example, obstetricians in Australia typically monitor pregnancy complications through daily testing at a clinic or, for more serious cases, at prenatal units in hospitals where regular movement is encouraged. Yet 92 percent of American obstetricians prescribe bed rest in some form, according to Judith Maloni, a professor at the Bolton School of Nursing at Case Western Reserve University and one of the few researchers of the phenomenon.
Dr. Maloni's investigations reveal that obstetricians in the United States tend to discount both the side effects of bed rest and to believe in its value in the face of evidence to the contrary. (Although bed rest continues to be prescribed almost routinely by some doctors for mothers of multiples at 24 to 28 weeks gestation, a study in 2000 conducted by a professor of obstetrics and gynecology at the University of Adelaide in Australia linked hospitalized bed rest to higher rates of preterm delivery in mothers of twins.) Dr. Maloni hypothesizes that fear of lawsuits may also play a part in its widespread prescription. Bed rest convinces patients and doctors alike that everything possible is being done to sustain a difficult pregnancy. And it is, after all, cheap to prescribe.
Charlotte Perkins Gilman finally took herself off Mitchell's rest cure. "Using the remnants of intelligence that remained, and helped by a wise friend," she remarked, in 1913, "I cast the noted specialist's advice to the winds and went to work again — work, the normal life of every human being; work, in which is joy and growth and service."
Few of us today are likely to follow Gilman's example. For most women, it's one thing to dally with their own health, but quite another to risk their child's. Women on bed rest feel they have little choice but to follow the advice they are given by their doctors. They may wonder if the prescription is founded on much more than superstition, dubious assumptions and unexamined tradition, but their doctors have experience and expertise and they do not.
Still, the lack of research on bed rest's value for the long shopping list of complications for which it is prescribed, and the lack of recognition of its consequences, is simply astounding. For example, I have yet to hear of a woman on bed rest being offered rehabilitative treatment; I certainly was not. The profession needs to recognize the profound psychological and physical costs of this modern rest cure, and to thoroughly research its putative benefits, before yet another generation of women finds itself staring blankly at the wall- paper.
Sarah Bilston, a professor of English at Trinity College, is the author of the forthcoming "Bed Rest," a novel.