What You Need to Know About Pregnancy Bed Rest

woman lying on bed holding white cat

For many years the standard recommendation for suspected preterm labor has been bed rest during pregnancy. Whether the woman is having contractions, experiencing vaginal spotting or she is expecting twins, pregnancy bed rest is a common treatment to prevent a host of problems such as miscarriage, preterm labor and low birthweight. However, more evidence now shows that bed rest may not be effective and it may actually cause unwanted side effects for mom and baby.

Pregnancy Bed Rest – Why is it Recommended?

According to some experts, limiting the woman’s physical activity is still often used as a treatment option by the majority of obstetricians. Bed rest is often recommended for a number of pregnancy complications including:

  1. Twins or multiples
  2. High blood pressure
  3. Labor contractions or other sign of preterm labor
  4. An incompetent cervix
  5. Lack of growth in the baby
  6. Following fertility treatments (embryo transfer)

The theory behind bed rest is that movement and mobility can increase uterine contractions, so encouraging the mother to lie down (primarily on her left side) may help to slow down or stop contractions. Also lying on her left side can increase blood flow to the uterus, helping to increase the baby’s weight gain during pregnancy. However, does this theory prove to be true?

Evidence Shows Bed Rest not Effective

Multiple studies over the last few years have shown that pregnancy bed rest does not live up to its reputation to prevent miscarriage or preterm labor. Here is a quick summary of the some of the most recent studies to examine whether bed rest did prevent pregnancy problems:

  • One study in China showed that there was insufficient evidence to suggest bed rest to mothers after having an embryo transfer (in order to increase the chances of the embryo implanting.)
  • A recent systematic review in the Cochrane database found that there was a lack of evidence to support a policy of hospitalization for bed rest for mothers carrying multiples.
  • One review in Ireland including 22 trials showed that there was not enough evidence to show that bed rest is effective in preventing preterm birth.

These studies are not the exception. Medical journals are chock full of research in the last 5 years that consistently show that pregnancy bed rest is not the be-all-end-all when it comes to effectively treating pregnancy problems.

Negative Side-Effects of Pregnancy Bed Rest

As it turns out, bed rest is not only ineffective to prevent labor but has a number of downsides. Studies have shows that bed rest during pregnancyit can cause the following harmful effects for mother and baby:

  1. muscle atrophy
  2. bone loss
  3. weight loss
  4. decreased birthweight in babies from singleton pregnancies
  5. decreased gestational age at birth
  6. psychosocial problems for the mother

According to Judy Maloni, PhD, a nursing professor and researcher from Case Western Reserve University, pregnancy bed rest is problematic and should no longer be recommended as a treatment option for preterm labor. Maloni states that “antepartum bed-rest treatment should be discontinued until evidence of effectiveness is found.”

Tests to Detect Preterm Labor

If the mother is having some signs of going into labor too early, why not find out if there is a risk of preterm labor? One of the most accurate ways to determine if the mother is likely to go into preterm labor is to do a fetal fibronectin test.

The fetal fibronectin test (fFN) is a fairly new test that can be performed as early as 24 weeks of pregnancy in order to identify the presence of a protein that may signal to the mother’s provider that the mother is at a higher risk for preterm labor. If the fFN test result is negative, it can help the mother to avoid unecessary interventions such as bed rest and medications to stop labor.

Why Should You do if Your Doctor Recommends Bed Rest?

Despite the amount of evidence indicating that bed rest is not an effective way to prevent a host of pregnancy problems, surveys show that medical care providers often seem to resort to prescribing it. What can you do if your doctor or midwife recommends bed rest? Here is a list of questions to ask:

  1. Why is bed rest being recommended to me?
  2. Is there research/evidence to indicate that the treatment of bed rest is effective with regard to my current health problem?
  3. If I am having signs of labor (such as contractions, spotting, cervical change) do I have the option of getting a fetal fibronective test? What options will I have if the test is negative?
  4. What type of bed rest is being recommended (modified or strict) and what type of activity level is acceptable?
  5. If I agree to bed rest, at what point in pregnancy will I be able to resume a normal activity level?

While pregnancy bed rest as a treatment for complications is still controversial, there may be situations when it may be helpful. If you have any questions about whether or not bed rest is a good idea for you in your pregnancy, be sure to discuss all of your options with your doctor or midwife.

Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.

References:

  • Maloni, JA., “Lack of evidence for prescription of antepartum bed rest,” Expert Review of Obstetrics and Gynecology.
  • Mayo Clinic – Bed Rest During Pregnancy – Get the Facts.
  • Bigelow, C., “Bed rest in pregnancy.” Mt Sinai Journal of Medicine, New York.
  • Dodd, JM., “Hospitalisation for bed rest for women with a triplet pregnancy; an abandoned randomised controlled trial and meta-analysis,” BMC Pregnancy Childbirth.
  • Li, B., “Bed rest after embryo transfer”, Euro Jnl of Ob, Gyn and Reprod Biology .
  • Crowther, CA., “Hospitalisation and bed rest for multiple pregnancy,” Cochrane Database Systematic Review.
  • Smith, V., “A systematic review and quality assessment of systematic reviews of randomised trials of interventions for preventing and treating preterm birth,” Euro Jnl of Ob, Gyn and Reprod Biology.

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