Last month the American Congress of Obstetricians and Gynecologists (ACOG) released a list of “Five More Things Physicians and Patients Should Question” when it comes to OBGYN procedures. It’s an addition to their Choose Wisely campaign which started with “Five Things Physicians and Patients Should Question.” In all, there are now ten recommendations ACOG makes for physicians and patients to question.
Four of the ten recommendations specifically address pregnant women, and one of them caught my eye for a number of reasons. Julia West at Mothering addressed it as such:
This research shows many side-effects of bed rest during pregnancy including: “muscle atrophy, bone loss, maternal weight loss and decreased infant birthweight in singleton gestations, and psychosocial problems including depression, anxiety, stress, family disruption and financial burden.” ACOG states plainly that “information to date does not show an improvement in birth outcome with the use of bed rest or activity restriction.”
I just wish you could have seen the look on my face as I read that paragraph the first time. And the second. And the third. And then when I clicked over to read the research. Jaw-dropping doesn’t begin to describe it.
I’m not your typical pregnant patient. I have chronic unilateral hydronephrosis; the ureter out of my right kidney isn’t big enough and a growing uterus pinches it off, causing a host of problems. I experienced two surgeries during my first pregnancy as they tried to insert a stent which they eventually removed because it only made things worse.
They placed me on Level III bed rest at 18 weeks gestation. Financial burden? Anxiety? Stress? Depression? Oh yeah. I ended up placing my baby for adoption because I couldn’t see past the crisis mode that I was in at the time. You can also tick off “maternal weight loss,” too. I gained a total of 19 pounds. I wasn’t proud of it; I looked sick because I was sick.
I was also alone for almost all of that time. I spent hours in my apartment, staring at the ceiling of my bedroom, or when I dared, the ceiling in the living room. The isolation only exacerbated the depression and anxiety. It was a dark, scary, and very lonely time.
I expected, with better health care and a planned pregnancy, my subsequent pregnancies wouldn’t be quite so isolating and debilitating. I was wrong, of course. Level III bed rest came later on than it did during my first pregnancy—28 and 32 weeks—but I still found myself stuck on the couch or in bed. Living in a new state with no real friends yet, I didn’t really have any visitors other than my beloved mother-in-law. My husband worked 24 hour shifts, leaving me alone with our toddler during my third pregnancy. Parenting from the couch isn’t easy, let me tell you.
Was I depressed during these episodes of bed rest? You betcha, though I worked hard at hiding it. These were pregnancies I was supposed to be happy about; these were the babies the adoption agency told me I would someday have, when I was “ready” for “my own” children. I plastered a smile on my face and made jokes about how losing 11 pounds during pregnancy meant that my figure would bounce back so much more quickly. (Of note, it did not.)
I also stressed about the financial burden my bed rest placed on our growing family. While my husband’s job as a firefighter provided well for us, I felt an overwhelming need to provide something since I couldn’t during my first pregnancy.
My anxiety continued to sky-rocket. While I was actively seeing a therapist when I got pregnant with our second son, I couldn’t visit her once placed on bed rest, and from that point on, things were kind of touch and go when it came to intrusive thoughts, fear, depression, and panic attacks.
Part of me understands that I was a special case, that bed rest kept the constant contractions from turning into progressive contractions and pre-term labor. I was lucky and carried all three babies to 38 weeks. But this new news out of ACOG makes me wonder if they would have done something differently with my case(s) over a decade ago. If I had been allowed to keep working with my daughter, would I have parented? If I had been able to continue attending therapy during the final trimester of my pregnancy with our youngest, would my relapse of postpartum depression and anxiety have been caught sooner?
I don’t know. But I do hope these new recommendations will help expectant moms avoid unnecessary stays in bed and that it helps them avoid antenatal and, perhaps, postpartum depression and anxiety. Placing moms in isolating situations doesn’t seem conducive to positive mental health.
Were you on bed rest? How did it affect your mental health?