Prenatal Bed Rest: Indications, Research and Management

Nearly one in five women in the United States is put on bed rest during pregnancy. Bed rest is when a doctor or midwife tells a patient to spend much or all of her time in bed based on certain pregnancy complications. Complications that often result in prescribed bed rest include twins, pre-term labor, a weak cervix, intrauterine growth restriction, placenta previa, gestational hypertension, gestational diabetes, vaginal bleeding, too little amniotic fluid, or a history of miscarriage, stillbirth, or premature birth.

Best rest has been prescribed for pregnancy complications for decades, based on the idea that it works, is safe, and has no serious side effects. However, we have since learned that it is questionable how effective bed rest is, and that it does have many risks. Such risks include muscle weakness, cardiovascular deconditioning, blood clots, fatigue, drop in blood pressure when standing up, backache, bone loss, changes in metabolism, muscle aches, joint pain, difficulty walking and with stairs, difficulty concentrating, dizziness, shortness of breath, insomnia, weight loss, maternal stress, depression, anxiety, child care problems, tenseness, financial difficulties, mood changes, boredom, sense of confinement, and loss of control.

These side effects might be worth risking if bed rest worked to counter the complications it is prescribed t do, but does it? There is currently no research to suggest that it does anything for treating placenta previa, preterm rupture of membranes, and other obstetric diagnosis. However, there is evidence saying that bed rest is ineffective for each of these diagnosis: low birth weight, miscarriage, preterm birth, fetal/infant death, suspected impaired fetal growth, and hypertension.

One study showed that bed rest for preventing preterm birth among twins actually put them at higher risk for preterm birth, and did not help to stop intrauterine growth restriction.

According to Pregnancy Magazine (July 2006), bed rest may be helpful for those who have preeclampsia, those who are remote from term, and those with a mild and slowly progressing disease. But according to Gail and Tom Brewer, MD, author of "What Every Pregnant Woman Should Know", some research shows bed rest may not even be helpful for preeclampsia.

An alternative to bed rest may be for women to help prevent complications by mixing adequate rest with exercise, relaxation and visualization. One midwife recommended hypertensive women have one vigorous exercise a day that raised the heart rate and brings her to a sweat, and that she then remain in a more relaxed state, putting the feet up at least for 10 minutes every hour.

If however, you have an indication for bed rest and your treatment options are limited, you and your doctor may decide that bed rest is appropriate for you. If this is the case, ask what level of activity is appropriate: are you supposed to be in bed 24/7, just for periodic rests, or something in between? Then talk with your family, friends, and employer to work out a plan that accommodates your new restriction. If you must be in bed much or all of the time, it may be helpful to receive counseling, and to seek advise from a physical or occupational therapist.

For ideas on how to cope while on bed rest, see the following for good ideas:

Resources

"The Whole Pregnancy Handbook" by Joel Evans, MD, OBGYN

"Nutrition for a Healthy Pregnancy" by Elizabeth Somer, MA, RD

"Heart and Hands" by Elizabeth Davis

http://fpb.cwru.edu/Bedrest/faq/bedrestworks.shtmwww.americanpregnancy.org/pregnancycomplications/bedrest.html , "The Whole Pregnancy Handbook" by Joel Evans, MD, OBGYN p353-6, and "Nutrition for a Healthy Pregnancy" by Elizabeth Somer, MA, RD p225.www.americanpregnancy.org/pregnancycomplications/bedrest.html