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Bed Rest May Not Help and It May Actually be Harmful

"Does bed rest for preeclampsia improve neonatal outcomes?"

Journal of Family Practice, Nov, 2007 by Maria Linda Cabrera, Todd McDiarmid, Leslie Mackler

"Evidence-based answer

No. Strict bed rest in the hospital for pregnant women with preeclampsia does not appear to lower rates of perinatal mortality, neonatal mortality, or neonatal morbidity, including preterm birth, endotracheal intubations, or neonatal intensive care unit (NICU) admissions (strength of recommendation: B, based on 2 randomized controlled trials [RCF] and extrapolations from 2 RCTs of pregnant patients with nonproteinuric hypertension)."

See here for more about the report, "Does bed rest for preeclampsia improve neonatal outcomes?"

The following is reprinted from Right from the Start, by Gail Sforza Brewer (Krebs) and Janice Presser Greene, 1981.

"Bed Rest", p.50

Bed rest is the current "in" treatment [as of 1981] for everything from multiple pregnancy to high blood pressure, despite its deleterious effects on anyone, not just pregnant women, put to bed for prolonged periods of time. A classic review article, "The Hazards of Immobility," published in the April 1967 issue of the American Journal of Nursing, discusses the effects of bed rest on cardiovascular function, respiratory function, gastrointestinal function, motor function, urinary function, metabolic equilibrium, and psychosocial equilibrium. Awareness of just a few of the drastic alterations in body processes brought about by bed rest should make anyone for whom it is casually prescribed think twice about following the doctor's or midwife's order:

  • reduced metabolic rate;
  • tissue atrophy;
  • protein catabolism and negative nitrogen balance;
  • bone demineralization;
  • fluid and electrolyte imbalance;
  • formation of urinary tract stones;
  • formation of blood clots;
  • increased sweating and excess fluid loss;
  • psychologic and physiologic stress reactions, including a rise in blood pressure due to anxiety (worry over one's condition, rather than getting the "rest" one supposedly needs);
  • reduction in hormone production;
  • increased need to urinate at first, then urinary retention;
  • decreased motivation to participate in social encounters (talking, taking meals, pastimes);
  • depression/anger/aggression/apathy;
  • exaggerated emotional responses;
  • decreased perceptual abilities;
  • loss of sociocultural and economic status;
  • loss of appetite resulting in malnutrition;
  • constipation and complete bowel obstruction;
  • muscle spasm;
  • increase in systemic infection due to malnutrition;
  • fall in serum proteins due to malnutrition;
  • upon arising, weakness, dizziness, falling in a faint due to a falling off in the body's ability to equalize the blood supply (this can happen in as little as a week on absolute bed rest and, where the rest has been imposed for three weeks, the ability of the body to respond effectively to the upright posture is not regained for five weeks or more);
  • increased work load on the heart;
  • decreased respiratory movement and decrease of the movement of normal secretions, leading to bronchitis, tracheitis, or pneumonia;
  • diminished exchange of oxygen and carbon dioxide, resulting in respiratory acidosis and reduction in oxygen supply to the unborn baby--just what the doctor did not mean to order!
  • A reprint of the article, appropriate for sharing with medical professionals, is available from: American Journal of Nursing Company, Educational Services Division, 10 Columbus Circle, New York, NY 10019.

    Note from Joy: This contact information is from 1981, so you could check online to see if it has been changed.

    Right from the Start, by Gail Sforza Brewer and Janice Presser Greene available here

    Some women who've had pre-eclampsia believe that if they'd not had anti-hypertensive drugs and bedrest and a low-salt diet, they would have developed strokes, and seizures, and worse.

    The truth is that Dr. Brewer was able to successfully treat women with pre-eclampsia without the use of anti-hypertensive drugs or bed rest or low-salt diets. This was his intervention program:

    1) The mothers with pre-eclampsia "were placed on a high-protein (120 grams per day) diet."

    2) "The mothers were placed on regular, rather than salt-restricted diets. A salt shaker appeared on the tray at each meal and the mother was instructed to salt her food to taste."

    3) "The women were encouraged to stay out of bed as much as possible, even to do the chores on the ward if they were willing, rather than being ordered to the customary bedrest."

    4) "Diuretics and drugs to lower blood pressures were not used."

    5) "Following the work of Poth, on the most effective way to suppress bacterial flora in the bowel, patients received oral antibiotics to reduce the detoxication load on their damaged livers."

    6) "Tom personally discussed the program with each mother to obtain her permission and cooperation, then made a conscientious effort to see that each followed her diet well."

    Any research study which claims to try to duplicate Tom's results and does not follow the above steps is flawed and unreliable.

    It is also true that while he was the chief OB/GYN resident at Jackson Memorial Hospital Dr. Brewer was successful in treating 13 out of 14 mothers "acutely ill with MTLP" (pre-eclampsia) with serum albumin, although they had initially been treated with diuretics. The 14th mother "had a normal serum albumin concentration and minimal edema" and "she delivered soon after admission...In none of these patients was the infusion of albumin associated with a significant rise in blood pressure, increase in pulse rate, nor with any increase in the severity of symptoms of the disease."

    Later research conducted by Dr. Stella Cloeren and Dr. Peggy Howard, done independently of each other, confirmed Dr. Brewer's findings. In Dr. Howard's "Albumin concentrate can be used for pre-eclampsia," of OB/GYN News, Oct. 1, 1974, "All of the toxemic women given 50 grams of serum albumin daily gave birth to babies in good health. Infusions of serum albumin improved renal function, increased estriol excretion, prevented eclamptic convulsions, and resulted in a reduction in perinatal mortality to one-fourth the rate of the 'controls' and eradication of abruptio placentae."

    See here for most of the quotes used in this paragraph

    See this source (p. 15-16) for the rest of the quotes from this paragraph

    In fact, in a 2004 interview for Townsend Letter, Dr. Brewer described the further damage that can be caused by anti-hypertensive drugs, to mothers' livers and kidneys already ravaged by the pre-eclampsia process...

    Brewer: "Low blood volume, which is the inevitable result of dehydration and the use of diuretics, contributes directly to eclampsia, premature birth, and low birth weight. (23,35,36,38) And now there's a whole group of hypertension drugs that have come out in the last 10 to 15 years. These drugs just ravage women. They cause direct damage to all of the cells in the mother's body, particularly to the liver, a little to the kidneys, and then to the placenta and fetus."

    See here for more of this 2004 interview with Dr. Brewer in Townsend Letter

    See here for a timeline of the Brewer Diet history and development

    Anne Frye recommends having the mother eat a high protein item every waking hour. She also suggests, "Initially recommend an increase to 150 to 200 grams of protein daily (250 to 350 grams or more with multiple gestations), with 3,000 to 4,000 calories and 500 mg of choline daily...If the woman has a history of liver disorders, recommend less protein (120-150 grams for a single fetus); her liver may be overwhelmed otherwise, and monitor her lab work closely for changes...Once liver enzymes and blood proteins have normalized, the hemoglobin has dropped appropriately, the fetus is an appropriate size for dates and secondary symptoms have subsided, the woman can cut back to 100 grams of protein daily (150 grams with multiples)."

    See here for more information on the best ways to treat pre-eclampsia

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