Sometimes when you are pregnant, you may develop a complication and your obstetric provider may recommend that you go on bed rest. Common reasons why you might be prescribed bed rest include, but are not limited to, preterm contractions before 37 weeks, a prematurely dilated or shortened cervix, preterm premature rupture of membranes (which is when the water bag breaks before 37 weeks’ gestation and before labor pains start), elevated blood pressure, pre-eclampsia, poor fetal growth, placenta previa (where the placenta covers the opening of the cervix), risk of miscarriage, and multiple gestations (for example, twin or triplet pregnancies).
Most women admitted to the hospital for complications of pregnancy are subjected to some degree of bed rest, with the ability to use the bathroom and bathe. However, it is unclear if there are any medical benefits to bed rest and in fact some studies suggest there may be more harm.
Dates back to Hippocrates
Approximately 18 percent of pregnant women each year in the United States will be placed on bed rest at some point during their pregnancies. In a 2009 survey, as many as 70 percent of providers would recommend bed rest for preterm labor and almost 90 percent would recommend it for preterm, premature rupture of the membranes. Interestingly, most specialists who make this recommendation reported that they expected little to no benefit from the intervention.
The origin of obstetric providers recommending bed rest for the treatment of certain medical conditions dates back to the time of Hippocrates. However, it was in the latter half of the 19th century when the frequency of bed rest use increased after a series of lectures were given by Dr. John Hilton, the president of the Royal College of Surgeons. Dr. Hilton taught that multiple medical problems could be cured with the prudent use of bed rest. Although originally aimed at orthopedic disorders, this principle was applied in multiple fields with little question of its benefit for nearly 100 years.
Bed rest as part of routine pregnancy care, especially in the postpartum period, has been practiced for hundreds of years. This is reflected in the use of terms such as “lying-in” and the term “date of confinement.” Lying in is an old childbirth practice involving women resting in bed for a period after giving birth and is associated with the social event of having a baby. Women received congratulatory visits from friends and family during the period and are among many traditional customs from around the world. Your due date has been referred to as the estimated date of confinement (EDC) in the past. Confinement is a traditional and now outdated term referring to the period of pregnancy whereby a woman would be confined to bed in an effort to reduce risk of premature delivery. The proper terminology for describing your due date is the estimated date of delivery (EDD).
Downsides to bed rest
Extended periods of activity restriction can result in muscle and bone loss. This is true for pregnant and nonpregnant women and is called “deconditioning.” These changes can occur after only a few days of immobility. Pregnancy is associated with an increased risk of developing blood clots in the legs (deep venous thrombosis, or DVT) and movement of clots to the lungs (pulmonary embolism, or PE).
Some studies have described an additional increased risk of DVT and PE among pregnant women placed on bed rest compared to pregnant women who were not placed on bed rest. There appears to be an increased risk of blood clots in patients placed on activity restriction. This fact led to changes in the use of bed rest for treatment during or after uncomplicated pregnancy dissipated.
However, bed rest remains one of the most commonly prescribed treatments to improve reproductive outcomes in complicated pregnancies, despite a lack of evidence that it improves any obstetric or neonatal outcomes.
Along with the potential negative maternal physical effects associated with activity restriction, there is also an increased risk of maternal anxiety and depression, adverse psychological effects on the family, loss of income and lower birth weights. Bed rest has a considerable emotional and social effect on the patient, her partner and her family.
Moreover, the negative financial effect of activity restriction can be profound when one calculates the lost income and productivity. It is estimated that the typical annual cost of bed rest in 1993 was over $1 billion with conservative estimates but could be as high as $5 billion to $6 billion. Adjusted to 2013 dollars, the cost ranges from nearly $2 billion to $7 billion per year.
The American College of Obstetricians and Gynecologists states that bed rest has not been shown to be effective for the prevention of preterm birth and should not be routinely recommended, and the Society for Maternal-Fetal Medicine recommends against the routine use of activity restriction or bed rest during pregnancy for any indication.
Although Hippocrates taught the value of rest in the treatment of disease, he also indoctrinated his pupils to “First, do no harm.” Bed rest should be carefully considered by your provider as to whether the risk–benefit ratio justifies prescribing it.