Why bed Rest in Pregnancy Doesn’t Work

The use of bed rest or extreme activity restriction is a common first-line treatment for many complications of pregnancy, including preterm labor, being pregnant with multiples, placenta previa, and preeclampsia or high blood pressure, to name a few. In fact, up to 20 percent of pregnant women will be put on bed rest at some point in their pregnancy. This is a very high number for a treatment that has no evidence behind it and can actually be quite harmful.

Much like it sounds, bed rest is just that: when a pregnant woman’s activity is limited to her bed. Brief breaks may be allowed to get up to the bathroom or to sit in a chair, but on average these women are bedridden for approximately 22 hours a day. This may be done at home or in a hospital setting.

The concept behind bed rest is pretty straightforward: less activity means less pressure on the cervix, so this may keep preterm labor or contractions at bay. In women with high blood pressure or preeclampsia, the hope is that decreased activity will keep a woman’s blood pressure lower and allow more of that blood to get to the placenta to help the baby grow. While these assumptions make sense, there is no scientific evidence that they actually play out this way.

Many studies have looked at whether or not bed rest works, and the overwhelming majority have shown that it does not. A Cochrane meta-analysis (a review of multiple high-quality studies) updated in 2010 came to the conclusion that bed rest or extreme activity restriction has no data behind it, and providers should not be recommending it to their patients.

If, for example, you are pregnant and are worried about preterm labor, you might then conclude that even though there is no data behind it, bed rest falls in the category of “better safe than sorry.” However, we know that with bed rest comes many unwanted (and potentially dangerous) side effects: loss of muscle mass and muscle deconditioning, bone resorption and loss, weight loss (with lower infant birth weight), blood clots, longer postpartum recovery, psychiatric issues such as depression and anxiety, job loss, and financial and familial stress.

Therefore, bed rest is a treatment that should not be recommended especially in light of the serious problems it can cause. This can be a hard pill to swallow when a doctor truly believes it works, or a woman who was in preterm labor goes on to deliver at term after being put on bed rest in a previous pregnancy. It can be hard to believe that she might have had the exact same outcome had her activity not been restricted.

As the side effects of bed rest become more well known, the hope is that fewer providers will continue to recommend it. Since approximately 70–85 percent of American obstetricians currently still recommend this practice, there is still a long way to go in making this change.

Sources:

• Sosa C, Althabe F, Belizán JM, Bergel E
• Bed rest in singleton pregnancies for preventing preterm birth
• Cochrane Database of Systematic Reviews 2004, Issue 1
• Art
• No.: CD003581
• DOI: 10.1002/14651858.CD003581.pub2
  J
• Maloni
• Lack of evidence for the prescription of antepartum bed rest
• Expert Rev Obstet Gynecol
• Jul 1, 2011; 6(4): 385–393.

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