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Bedrest and What it Really Means

By Louis Keith, M.D
From The Triplet Connection Newsletter


For years some doctors and many concerned lay individuals have advised that bed rest has a beneficial effect on the outcome of multiple pregnancies. This advice has not been uniformly accepted, however, primarily because the studies which have examined twin mothers in a prospective randomized manner have failed to show a clear-cut affect from bed rest.

Happily, some investigators have continued their work in this area. Among them, are Dr. K.T.M. Schneider and his colleague, Dr. Renata Hutch. These individuals have been studying the effect of quiet standing for almost a decade. By quiet standing, they mean the kind of activity that so many women are typically involved in, such as clerks, bank tellers, nurses, teachers, housewives, etc. (in other words, quiet standing refers to low-exertion activities which would keep a woman on her feet).

Drs. Schneider and Hutch observed changes in women who were on their feet for prolonged periods that were comparable to the well known “inferior vena cava syndrome.” Any woman who has given birth or who has been pregnant through the third trimester knows that lying flat on one’s back produces weird effects. The woman may become short of breath, may be dizzy and/or feel faint. Relief is simple: turn on the left side.

Drs. Schneider and Hutch noted that when pregnant women stand for prolonged periods of time, the uterus exerts constant pressure on the vena cava. The net result is the same as if the uterus were lying on the vena cava when the woman is flat on her back. The difference, however, is that when the woman is standing the body has only one compensatory mechanism, and that is to initiate uterine contractions! By initiating a contraction of the uterus, the pressure on the vena cava is relieved and a normal, rather than an abnormal physiologic situation continues. This happens because gravity pushes the uterus downward between the bony pelvis in the front of the abdomen and the vena cava, which lies behind the uterus in front of the bony spinal column.

In other words, contractions are triggered by the woman being in the standing position for a prolonged time. Needless to say, with the added pressure produced by twins, triplets and more, this phenomenon is dramatically increased; bed rest and the reduction of physical activity becomes a matter of grave concern.

So there you have it, ladies! Don’t expect your doctors to believe this research any more than they believe other research that explains some of the beneficial aspects of the care of multiple pregnancies. Don’t worry about your doctors, because you won’t be able to change them. Just think about yourself and your babies and what is best for you and for them. If you do, you will recognize that prolonged standing is a risk for preterm contractions, and you will do something about it. When pregnant with triplets or more, bed rest should be a priority. As your multiple gestation pregnancy advances, engaging in activities which require you to be on your feet could quickly spell disaster.

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