Lessons Learned From Bedrest
At First Shift Justice, the legal services we provide and the other work we do - policy advocacy, outreach, and education - complement each other to address health disparities faced by low-wage workers in the workplace. As the Medical Legal Advocate, I work to bridge the gap between the law and health. As I communicate with medical providers, It is also part of my job to identify and address needs and gaps in workplace policy that make it difficult for them to serve their patients. . Recently, in my work, engaging with medical providers about D.C. paid family leave policy, I became aware of a disconnect in the understanding of bed rest as a treatment option, and I decided to take a deeper dive into the practice.
During one of my meetings with a group of obstetrics and gynecology (OBGYN) providers, I mentioned “bed rest” as an example of a treatment that would qualify their patients to take leave from work and receive prenatal benefits through D.C.'s paid family leave program. One of the doctors immediately interjected that they would rarely prescribe bed rest for their pregnant patients. This puzzled my colleagues and me because “bed rest” is specifically mentioned in the paid family leave statute as a basis for benefits eligibility.
After some research and a follow-up meeting with the medical provider, I found that bed rest used to be common practice years and years ago. Still, many studies have suggested that bed rest does not benefit pregnant patients and could increase their health risks. According to the Mayo Clinic, there is no evidence that bed rest positively contributes to the health of the birthing parent, or the baby. In fact, bed rest could threaten a patient’s health by increasing the risk of blood clots, bone demineralization, reduced lung capacity, and muscle loss. Furthermore, patients forced out of work to go on bed rest risk becoming depressed or stressed due to worries surrounding job loss, finances, and child care. All of these risks can have a negative impact on a person preparing for labor.
Why is this information important? Presently, the D.C. code specifically references bed rest but does not expand on its definition and practice. The lack of precise language presents a tricky problem: medical providers do sometimes recommend that pregnant patients limit physical activities such as walking and climbing stairs. Sometimes, these limitations might require patients to take time off from work, but they do not meet the specificities of bedrest in its medical definition and practice. If a medical provider provides documentation that a patient should take some time off to “rest” by limiting activity before birth, but the words “bed rest” are not included in that documentation, the government could deny paid leave benefits.
The issue of bedrest exemplifies the critical importance of ensuring that all stakeholders have an opportunity to contribute to the policy dialogue. First Shift works with medical providers, to engage their perspectives and to suggest to policymakers improvements to the law that better serve low-wage workers, an essential component of our policy work. Our clients' economic security and health depend on our collaboration and partnership with the medical community.
Author: Kally Xu, Medical Legal Advocate
If you are interested in reaching out to Kally regarding medical provider training for your organization, you can email her at Kxu@FirstShift.org or by calling 202-644-9043.
