Bed Rest: The Rest of the Story

In the 20 years since I completed a high-risk pregnancy, articles like Kathleen Phelan's "Forget the Rest" [Dec.10] have appeared presenting inaccurate and harmful information.

The term "bed rest" is a misnomer, as it is not a dictum that one must stay in bed, nor is it restful. Lateral recumbent positioning (LRP) -- the positioning of a woman to change her center of gravity -- is prescribed as part of a complete treatment program of restricted activities for specific high-risk complications.

The skill in maintaining LRP for days or weeks is to see it as an issue of management, not illness. Simply setting up what one needs within arm's reach of the couch or bed on which one is positioned can minimize the temptation to take "just a few minutes" to get up.

The real problems for a woman prescribed LRP are that of cooking, cleaning, clothing and caring for her other children. How many women will say to their doctors that they are adhering to LRP and then confide to the nurses that they are doing laundry and housecleaning and running after their toddlers? When health care for high-risk pregnancies addresses the home care services that are needed for these women and their families, LRP will not be the travail described in the article and real data will finally be possible to generate.

Deborah A. Kraut

Bethesda

Many women diagnosed with preterm labor are also given medications. One of the more common medications, terbutyline, (also known by the trade name Breathine) is approved by the Food and Drug Administration for asthma, not preterm labor. Although these medications have been shown to delay labor by 48 hours, continuation of the drugs beyond that time is not effective. The maternal side effects for this drug include tachycardia, tremors, arrhythmia and pulmonary edema.

I have not seen any studies that have determined what effect this medication has on the fetus. There is a real lack of controlled studies, and individuals find themselves relying on anecdotal evidence. Web sites devoted to at-risk pregnancies are filled with stories of women suffering on these medications for months, when it is not likely that this has benefited them or their child and may in fact have caused more problems.

Laura Medhurst

Alexandria

Mammograms: No Price Gouging

With respect to "Hospital's Former Patients Continue to Pay a Price" [The System, Dec. 10], consumers should be informed that the Mammography Quality Standards Act, regulated by the Food and Drug Administration's Center for Devices and Radiological Health, specifically addresses the patient's right to obtain her mammograms from a medical provider. The facility may charge a fee for this service, but the fee must not be more than the cost of providing the service to the patient.

Patients should question Excel as to the true cost of providing these records. If other providers believe the $55 fee is excessive, then perhaps it is. For additional information, consumers may visit www.fda.gov/cdrh/mammography/mmwebbro/mambrochure.html, or call 800-838-7715.

Penny Reynolds-Boyce

Rockville

Mixed Reviews for the Sleep Lady

Will there be no end? Will it never stop? Now we have "the sleep lady" ["Hush, Parents, Don't Cry," Dec. 10]? Are we as parents in this culture so deviated from our instincts and common sense that we must keep having one more self-proclaimed expert tell us how to make our kids sleep? Because let's face it: The problem isn't that our kids won't sleep (that would be biologically impossible), but that our kids won't sleep where and when we want them to! The need for sleep is biological, but the ability to sleep is learned? What? Just in humans, then? Do other mammals take these courses? Does "the sleep lady" service the other animal populations?

Elysia Whisler

Manassas

Thank you, thank you, thank you! The article could not have arrived at a more perfect time. For about eight weeks, my husband and I have been at a loss how to get our 21-month-old (formerly "perfect" sleeper) son to go back to his crib once he woke up in the middle of the night. The Ferber technique did not work, as he would shake the bars all night given the opportunity, leaving all of us with no sleep. That left us with the option of bringing him to our bed, where again none of us slept well as he kicked and slept horizontally taking up the whole bed! We had recently reached the point where he would not even initially go to sleep in his crib. After reading your article, we took the author's suggestion and put the crib mattress on the floor and turned it into a "special, big boy bed." Things are already improving!

Noelle Hawley

Annandale