A Restless Rest| June 13, 2018
Pregnancy. A glowing, miraculous time. Except it doesn’t seem that way when you’re lying on your back. How women on bed rest make it through
My husband had to constantly remind me that I was doing the most important job of all. But it was so, so hard to remember that
affa didn’t think her third pregnancy would be different from her two previous uncomplicated, full-term pregnancies. But at her 20-week ultrasound, the technician furrowed his brows at the screen: Yaffa had excess amniotic fluid, a risk for preterm labor.
Immediately flagged as high-risk, Yaffa began seeing her obstetrician twice a week. Her OB sent the expectant mother for more extensive testing and blood work; everything turned up negative.
But at 32 weeks, Yaffa began vomiting blood. She was commanded to go straight to the hospital, where they monitored her closely for several days, and was finally discharged on one condition: complete bed rest. What did that mean? Her doctor summed it up succinctly: “Lying horizontally 24/7, except when you need the bathroom.”
She stayed in that position for the next four weeks.
Approximately one in five pregnant women in the US are ordered to go on some form of bed rest for varying reasons: multiple gestation, threatened preterm labor, premature contractions, threatened miscarriages or a previous history of recurrent miscarriages, and maternal conditions such as bleeding, hypertension, or heart problems during pregnancy. Other conditions generally requiring bed rest are internal changes that signal early delivery and intrauterine growth retardation, in which “the baby does not grow well inside the uterus,” explains Dr. Hava-Yael Schreiber, senior physician at Bikur Cholim Hospital’s labor ward in Yerushalayim.
How is bed rest supposed to help? “It depends on the condition for which we’re recommending it, but most of the time it’s a matter of pure gravity,” explains Dr. Jessica Jacob, an obstetrician-gynecologist in New York who has been servicing women in private practice since 1987, and who has delivered the babies of more than 15,000 women.
“Increased activity — too much moving around in general — can cause preterm contractions, which can cause preterm births, especially in someone with a weak cervix. If bed rest is prescribed to enhance fetal growth, then the horizontal positioning on one’s side enhances blood flow to the placenta and maximizes growth.”
Thankfully, not every woman on bed rest is as restricted as Yaffa. There are several degrees of bed rest. “How high is the risk of preterm labor? That’s what determines the level of bed rest for the mother,” says Dr. Jacob.
The mildest type means taking it easy — just resting. This is what Dr. Schreiber advises for women who experience first-trimester bleeding: “Avoid running around or exerting yourself, but you don’t need to lie in bed the whole time.”
“I tell moms, don’t host for Shabbos, don’t entertain, don’t exercise,” adds Dr. Jacob. “You can go to work and resume activities of daily living, but don’t go shopping on the way home.”
Absolute bed rest, however, restricts all activity. Yaffa was placed on such bed rest for four weeks. Her last two weeks were downgraded to mild bed rest.
Mindy, though, was an extreme case. Her condition was so severe that even she recognized her need to be on absolute bed rest — which turned into a four-month ordeal, starting in her third month. “I was so weak each time I got out of bed that I just wanted to sleep the whole day,” says Mindy.
Despite the prevalence of bed rest, it doesn’t always prevent premature birth. A 2013 study in Obstetrics & Gynecology examined a large group of high-risk pregnant women. In the group of mothers who went on bed rest, 37 percent gave birth prematurely. In the second group — mothers who didn’t restrict any activity — only 17 percent did.
“The medical community at large isn’t a fan of bed rest,” says Dr. Jacob. “Although there was one study last year showing a reduction in maternal activity in general enhances fetal growth, most evidence-based studies don’t find a significant difference in outcome for the baby when the mother goes on absolute bed rest. So several years ago, the medical community began discouraging it, due to the many physical, psychological, familial, and financial disadvantages. It’s become pass?.
“Still, while statistics don’t recognize bed rest, many doctors — like myself! — ‘break the rules,’ and think bed rest is excellent for several reasons. Over the years, I’ve seen that women who go on bed rest tend to be able to keep a pregnancy longer and have heavier, healthier babies. Of course, though, this is based on my personal observation alone and is purely anecdotal,” she counters.
Dr. Schreiber does not personally encourage bed rest for each risk condition all the time, since bed rest can cause a host of complications — the main one being increased risk of blood clots. “Since immobility causes blood stagnation, if the clot reaches the lungs — called a pulmonary embolism — it could be life-threatening,” she warns.
They must move their legs as much as possible while lying down in bed, adds Dr. Schreiber. “This is also why, on long-haul flights, pregnant women are advised to shake their legs — to reduce the risk of blood clots,” she adds.
“Nobody recommends absolute-absolute bed rest except in extreme situations for fear of blood clots,” says Dr. Jacob. “And those who must go on absolute bed rest must consider blood thinners.” Other complications include muscle atrophy and predisposition to acceleration of osteoporosis.
Neither Dr. Schreiber nor Dr. Jacob prescribes bed rest for those with a history of recurrent miscarriages. “In our grandmothers’ times, when a woman bled in pregnancy, she went to bed and prayed,” says Dr. Schreiber. “Now, she still should pray, but I’d want to find out what’s wrong. Is it thrombophilia? Take Clexane injections. Is it low progesterone? Take progesterone supplements. Or is it a genetic issue, or a defective pregnancy?”
On the other hand, she prescribes bed rest for a mother with hypertension or cardiovascular issues. “Lying down is supposed to improve blood flow and fetal growth, so bed rest is definitely recommended in that case. And since pregnancy adds serious load on the heart, obviously heart conditions in the mother do require real rest.”
When a woman is undergoing premature contractions, Dr. Schreiber also places her on bed rest — in the hospital. “After giving the mother contraction-suppressing drugs like tocolytics and progesterone, we want to gain a few days to ensure the injection for maturation of the baby’s lungs goes into effect. So we always place the mother on bed rest for at least 48 hours, while observing her, because in her case, preterm labor may be likely,” she explains. “Reducing prematurity is difficult, and nothing has been shown to be really effective, but even for the baby to gain a few extra days in the womb, it’s worth the bed rest!”
Not Breakfast in Bed
Pregnancy is no picnic. And for those needing bed rest, physical symptoms are usually even worse.
Daniella, a mother of four, had to be placed on bed rest twice — once with her first, and again with her fourth. She became pregnant with her first baby after undergoing fertility treatment three years into her marriage.
“We were so excited that this baby was coming. The first time I threw up, we had a celebration — it was real!”
When she continued to throw up, however, to the point of collapsing from weakness, her doctor officially prescribed bed rest.
This lasted three months. “It was very, very difficult and boring — there was a limit to how many books or magazines I could read and I totally lost focus on the fact that there was a baby at the end of this. I just wanted it to be over.”
At the time, Daniella wasn’t working, and this was her first child, so she was able to put her life on hold. But for working moms or those with children in the house, bed rest becomes even more challenging.
At 29 weeks pregnant, Tiferet was put on absolute bed rest at the hospital to avoid early delivery. She ended up there for five weeks, while her husband and two young children moved in with her generous sister.
Not seeing her kids every day was very difficult. “I really wanted them to visit,” Tiferet shares, “but a hospital is not a place for kids. I got updates all the time from my sister on how they were, and I paid for babysitting and cleaning help for her to offset some of the work.”
But say Mommy is stuck in bed at home — that’s more pleasant for her, but comes with its own problems. “The hardest part was seeing what my kids needed and knowing that I couldn’t get up from the sofa as I’d almost definitely collapse and faint,” remembers Daniella. “I got a tiny glimpse of how it must feel for elderly people who are dependent on others to do simple tasks like walk or go to the restroom. I once heard my kids upstairs and thought I could manage going to them, but after five or six steps I realized I’d faint and had to lie on the steps till someone could come help me.”
So who ends up doing all the cleaning and cooking and everything Mommy usually does? Enter Mr. Mom.
“Most of the household work fell on my husband — making supper, dropping off and picking up the kids from gan, making Shabbos, cleaning up,” says Yaffa. “It wasn’t easy for him, but he’s generally a very hands-on, very supportive type of guy, even before this experience. I wouldn’t have been able to manage without him.”
Mindy’s husband stepped in as well — working so hard to run the house that he developed mono after the birth. “He did basically everything. It was intense,” Mindy reports. “But it would have been much worse for me if the house were falling apart while I was in bed, not able to do anything about it.”
Mindy’s sister and sister-in-law also assisted with the kids. “It was a brachah that my kids were relatively young, and they weren’t so aware of what was going on. My husband took them to playgroup and gan in the morning and did bedtime at night. We hired a girl to play with them for the two hours before bedtime. It was hard for me, not being with my kids the whole day…. I was always worried about my daughter, a baby at the time, because I could converse with my two-and-a-half-year-old but not her.”
“In addition to the husband helping out, I sometimes ask women to have their mothers come over to cook and hang out with them,” says Dr. Jacob.
And when no family is around? Daniella and her husband, who were living far from family at the time, hired a young woman to watch their one-year-old in her apartment every day from 8 a.m. until the afternoon, while their older children were still in school.
“The babysitter, who was still in shanah rishonah, picked up my child even before she ate breakfast with her own husband, and it would be the three of them in their kitchen, eating together! I remember feeling so jealous that this newly married girl was spending more time with my baby than I was.”
Getting Emotional Help
In addition to physical hurdles, bed rest takes an emotional toll on the mother-to-be.
Yaffa’s first few days on bed rest were relaxing, but eventually she became frustrated with not being able to do anything. “It’s not like I was feeling sick and didn’t feel up to working. I wanted to but couldn’t! You’re there in the house, watching everyone bustling around you… it’s really difficult emotionally.”
Studies show that many women on bed rest suffer psychologically, both before and after the baby is born. “I found myself losing my identity,” says Daniella. “I can’t be a mother, I can’t be a wife, I can’t be a teacher… who am I, then? My husband had to constantly remind me that I was doing the most important job of all. But it was so, so hard to remember that.
“What really ate me up, though, was that I was finding it so hard to be grateful to Hashem that I was pregnant! We had been through so much to get there, and here I was, complaining, feeling awful all the time, when I should have been overjoyed.”
“Going on bed rest comes with its own set of emotional challenges,” asserts Mrs. Rachel Kaufman, client coordinator at NITZA, a support network for maternal health in Yerushalayim, founded to help women and mothers cope with the emotional and mental challenges associated with pregnancy and motherhood.
“Even if she knows there’s a good reason for it, it’s a big deal to ask a woman to lie in bed all day! She suddenly can’t do anything, which can be very taxing on her and can cause depressive thoughts to surface.
“That’s why it’s important to focus on preventing this depression in the first place, and why it’s so important to keep the mind as active as possible while on bed rest. This means talking to your kids, reading, davening, talking on the phone to friends — anything that gives you fulfillment from bed. Even if you can’t do anything physically, your mind is still working, so take advantage!”
Yaffa took this advice to heart when she was in the hospital on bed rest. A computer programmer who thrived on activity and stimulation, Yaffa spent those few days working on her laptop. “The nurses got a kick out of watching me teach my students via video-conference!”
Mrs. Kaufman also advises women to view the situation as positively as possible. “Since you can’t fight the situation, try to find peace with it.”
While listening to shiurim and reading, Mindy also took the opportunity while she was on bed rest for four months to arrange her personal recipes on her laptop and organize all her photos and files. “You know those things you always wanted to do when you had spare time? I did those, from my bed.”
Still, boredom may ensue, and with it, feelings of depression or anxiety. Particularly in these cases, it’s important to seek counseling to work through one’s emotions.
Bashie Reiss, LCSW, is a therapist for Yad Rachel in Lakewood, New Jersey, a community-based organization dedicated to helping pregnant women suffering from or at risk for perinatal mood disorders. A specialist in perinatal depression and anxiety, Bashie shares several approaches to effectively manage anxiety in uncertain times like bed rest. “As in any difficult experience, it’s not the situation per se that causes us anxiety; it is our reaction and response to the situation. To more effectively manage anxiety during bed rest, we can choose to balance and reframe our thoughts, stay focused on the present, and relinquish control to the One who has control.”
For Daniella and her husband, this advice went a long way into helping them manage. “We were struggling to stay positive,” she admits. “Our therapist taught us it was okay to feel that the situation was really difficult. It didn’t mean we were ungrateful for the brachos we had. That helped us accept the situation.”
The therapist also made the couple realize the value of household assistance. “Although we had initially felt paying for babysitting or cleaning help was a waste of our hard-earned savings, the therapist made us realize that there was no better use than investing in the emotional well-being of our family.”
Another piece of advice that helped Daniella was an idea her sister-in-law heard from popular parenting educator Rebbetzin Sima Spetner. Rebbetzin Spetner told her that she was there for her children just by being there — not by what she does with them, but simply by sitting on the couch. “I kept remembering that when I felt guilty for not playing with them or being able to bake or cook with them or do projects with them. I just tried to be present as much as possible.”
It’s vital to acknowledge how difficult of a nisayon bed rest is, urges Rebbetzin Michal Cohen, LCSW, who advises women in her community in her role as therapist and rebbetzin of Congregation Adas Yeshurun in Chicago for more than 30 years.
“We women are such go-getters, running all over the place, all the time. To have to sit still for months on end is a huge challenge for anybody, but much more so for a woman who has so many things pulling at her. So bed rest is a major, major nisayon.
“However, we know that everything we go through is something Hashem wants us to go through. So like every other nisayon in life, we have to figure out what we can possibly do to get through it as easily as possible, without going crazy in the process and without always feeling awful 24/7.”
In addition to finding healthy outlets (not just shiurim!) to entertain yourself in bed, Rebbetzin Cohen also advises women to stay in the present. “Take it minute by minute and try to get through today, just today. Don’t think about the fact that you’ll have to stay like this for months. Anxiety occurs when we think about tomorrow.”
Also, she adds, don’t be judgmental about how women pass time while on bed rest. “Do what you need to do to make it through, and don’t compare yourself to your friends or other women.”
Support from friends and family seems to allay the negative effects of bed rest. “Although it was hard, I don’t view those five weeks as a negative experience because I had company 24/7,” muses Tiferet. “I was in a good place, Baruch Hashem. My friends, family, sisters, and even acquaintances I hadn’t spoken to in ages phoned or came to visit. In five weeks, I was almost never bored!”
Several friends were particularly caring, Tiferet notes. “One always came over to play board games with me, bring snacks… One night she told me to get a babysitter and made a three-course meal for me and my husband to enjoy in the hospital, complete with fancy paper goods!”
Mindy agrees. “I’ll always remember the little things friends did for me, like the time a friend popped over on Chanukah with a sufganiyah and iced coffee…. It wasn’t the pastry that uplifted me; it was the fact that she was thinking of me while she was out and about. It was the most thoughtful gesture.”
And though Shabbos was particularly difficult in the hospital, social support helped Tiferet deal with it. “Most ladies in the high-risk pregnancy ward had their husbands with them on Shabbos; often, the husband stayed nearby and came to spend the meals with his wife. But I wanted my husband to be with the kids, so I spent that first Shabbos alone. Hearing this, my single friend decided to spend subsequent Shabbosim with me, camped out on a chair. I don’t know how much she slept, but we had a great time together and it made the whole experience so much nicer.”
Conversely, a weak support system can make the experience very different. “In the beginning, when I didn’t feel as terrible, I wish friends would have visited more,” says Mindy. “They wanted to give me ‘space’ and felt that I should be left alone, but they don’t realize you already have so much time and space for yourself and you would appreciate their company.”
In Due Time
After six weeks on bed rest, Yaffa reached 38 weeks and got the green light from her doctor to resume normal activity. One week before her due date, Yaffa gave birth to a healthy baby girl.
Not every woman on bed rest makes it that close to her due date. When Tiferet was on bed rest in the hospital, a social worker brought her to the NICU to prepare her for if/when her baby was born premature.
Mindy, however, wasn’t primed for that possibility. “I was so focused on surviving bed rest that it didn’t hit me that I would have a preemie baby until the very end,” says Mindy, who had been on bed rest for four months. Around 27 weeks, she was hospitalized for bleeding. “I looked so pale that when my doctor came to visit me, he walked back out, thinking he had entered the wrong room!” she recalls. She gave birth a short time later.
Her son was in the NICU for the first two months of his life. “Unfortunately, I probably didn’t bond with this baby as well as I did with my others, just because there were lots of technical complications.
“After my baby was born, all these friends came to me and gushed, ‘My baby was also a preemie and he’s totally fine now, don’t worry, he’s so smart, so alert, everything developed beautifully.’ But you know what?” she pauses. “It’s not always fine. My son has significant developmental delays now, and nobody warned me about that.”
However, as with many challenges, survival often brings strength. “When you have a year or more of craziness, and then it slows, you stop to reflect at the end,” says Mindy. “The ordeal definitely helped us grow a lot as a family, and we became a much stronger unit at the end. In a way, I wouldn’t give up the struggle we went through, despite all the discomfort — the long-term positive growth was priceless.”
In Tiferet’s fifth week on bed rest in the hospital, she started having back pain. The nurse called a doctor — and they realized she was in an advanced stage of labor. “Everything went quickly from there. I had an emergency C-section. My baby was born small, and he went straight to the NICU, but baruch Hashem he’s alive and growing now.”
“My roommate,” she continues, “had been in the ward on bed rest too. Her baby wasn’t growing — he was only 400 grams. And the doctors at some point warned her gently that the baby might not survive. Hearing the doctor telling her that, behind the curtain — then watching her daven, day in and day out, crying every day — it was so emotional for me. Baruch Hashem, her baby was born a while later — born small, but growing and thriving now. It was such a miracle.
“It made me value the gift of life so much.”
(Originally featured in Family First, Issue 596)
All statements are true; however, names and some details of interviewees have been changed to protect personal privacy.
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