Bed rest sounds rather dreamy—watching hours of reality TV, noshing on popcorn, and reading novels. And while your feet are up, your baby-to-be gets a chance at more growth, thanks to a potentially longer stay in the womb. This theory has been in place for many years, with an estimated 18 percent of all pregnant women in the U.S. (about 720,000) put to bed annually at a cost of more than $1.6 billion, according to David Grimes, M.D., a clinical professor of obstetrics and gynecology at the University of North Carolina School of Medicine at Chapel Hill.
But according to the American College of Obstetricians and Gynecologists (ACOG), bed rest—while frequently prescribed—is only rarely indicated, and in most cases, allowing ambulation should be considered. In fact, many doctors are hopeful that the best rest will fall out of favor for good, although it still continues today. "Medical counsel is slow to change," notes Brigid McCue, M.D., an ob-gyn at Beth Israel Deaconess Hospital Plymouth in Massachussets. When physicians are worried about a patient, the therapeutic imperative often drives the practice, Dr. Grimes adds. "The need to do something—anything—to try to help is strong.”
If you're pregnant, here's what you should know about bed rest, past and present:
What is bed rest?
The definition of bed rest varies, says Dr. Grimes, but the strict version typically means you stay put, in bed, and can only get up to use the bathroom. "When women are hospitalized with this recommendation, they're told to rest mostly on their left side to improve circulation and blood flow to the fetus," says Dr. McCue. Time out of bed is very limited—only to shower but not sit for any length of time. A modified version at home allows for showering and meals at a table, but bans work, caring for older kids, cooking, and cleaning.
Why it's recommended
Certain conditions tend to receive this directive with the hope that slowed movement will ease worrisome symptoms (high blood pressure, contractions). The most common pregnancy complications for which resting in bed is recommended include preterm labor, prevention of preeclampsia, multiple gestation, hypertensive disorders, intrauterine growth restriction, antepartum bleeding, and placenta previa (when the placenta partially or fully covers the opening in the cervix). "Originally there seemed to be an association between excess activity and complications such as preterm labor and miscarriage," explains Dr. McCue. Physicians assumed that reduced activity would be good, but this has never actually been proven to be the case. In contrast, the medical harms of bed rest are clear. For example, placing a pregnant woman at bedrest dramatically increases her risk of blood clots in her legs, which can travel to her lungs causing a pulmonary embolism.
While bed rest or activity restriction are often recommended to moms-to-be for a variety of pregnancy conditions, according to ACOG the practice hasn't been shown to improve birth outcomes. In contrast, there are several negative affects connected with extended time in bed, including an increased risk of blood clots in the legs (which can travel to a mom-to-be’s lungs and cause a pulmonary embolism), bone demineralization, cardiovascular deconditioning, and muscle atrophy. "Resting in bed is also a significant stressor for the patient and her family and costs money in child care and lost wages," says Dr. McCue.
So while the first day or so of couch time may be relaxing, the following days and weeks can be difficult for expectant mothers. "It's awful to be struck in bed worried and bored, having to ask others to do everything for you, separated from your family (if you are in the hospital) and not able to work or care for your other children," says Dr. McCue. Prescribing this kind of rest also suggests that the patient has some measure of control over her pregnancy complication, leaving her to feel guilty if she can't fully comply, especially if the guidelines are vague.
Rather than send women to bed to wait out their pregnancies, some doctors are now directing moms-to-be to listen to their bodies. "I'll sometimes counsel a patient who has elevated blood pressure or bleeding to 'be active but don't overdo,' says Dr. McCue. While this recommendation is no more evidence-based than bed rest, she admits, the advice means that women should skip their workouts, work from home when possible and let someone else run errands and do the grocery shopping. Taking it easy and resting when needed is easier advice to give—and follow.