Every year, for various reasons (ranging from premature rupture of membranes to placenta previa to shortened cervixes or carrying multiples), roughly 20% of pregnant women in the US are prescribed bed rest at one point or another.
I was a medical history professor in a former life (this is where my training lies), so I’m used to wading through medical debates old and new (and please know that yes, this PSA will include a brief history lesson — we’ll get to that shortly). But the issue of bed rest during pregnancy is astonishing, in my eye, for still being publicly billed as a “controversy” when in fact the medical literature is abundantly clear on the matter. In short: it’s a classic disconnect between evidence and practice.
**Please note: this article is not intended to offer medical advice (like I said, I’m a historian, not a doctor^^) — and every woman’s pregnancy and situation is unique. Instead, this is a synthesis of the available research and guidance from professional organizations.
If you’re in a hurry and just want the quick synopsis on whether bed rest works as a preventative approach to pregnancy complications, then all you have to know is this:
OK, we’re done…
Just kidding (kind of) — there’s more.
Instead of helping, bed rest often causes negative outcomes, like an increased risk for blood clots, bone loss, muscle deconditioning and atrophy, decreased cardiovascular health, STRESS and a whole host of other nasty psychological effects (I can’t even imagine) — none of which magically vanish after a woman has a baby. Nay, they can continue on for months.
Plus, some studies even show that activity restrictions might have the opposite effect than that intended and may have an increased association with preterm labor (check out the bibliography below for the wealth of sources on all this^^).
And in the midst of a smoldering pandemic, being stuck on bedrest in the hospital is an altogether different breed of misery. I mean, the isolation alone… All the negative effects are exacerbated.
Bed rest during pregnancy is costly, too:
- For women (and their families), when they are forced to give up their livelihood for weeks or months on end — one sober assessment judged that “prescribing bed rest diminishes the role of women in society”;
- For the nation — according to estimates, the annual financial costs of bed rest are somewhere between $2 and $7 billion.
There is no controversy about bed rest during pregnancy — professional medical associations, specialists, researchers, pregnant women themselves… everyone agrees it’s an unproven approach.
“Several reviews have determined that there is no credible evidence to prescribe bed rest in pregnancy for the prevention of preterm labor, and it should not be routinely recommended… There are no studies documenting an improvement in outcomes in women at risk for preterm birth who are placed on activity restriction, including bed rest, and there are multiple studies documenting untoward effects of routine activity activity restriction on the mother and family, including negative psychosocial effects.”~ACOG
Said one expert: in fact bed rest “can be very dangerous.”
AND YET (because old habits die hard)… bed rest is still very frequently prescribed — in 2013, some 95% of OBs reported that they recommended some form of activities restrictions (bed rest being one of them) among their patients. Some FIFTH of pregnant women in the US (we’re talking 800,000 women, every year, friends) are on bed rest at some point, for some period of time, during their pregnancies. Even among Maternal-Fetal Medicine docs — the best experts — the vast majority say they would turn to bed rest to prevent preterm labor.
Notice the disconnect here? Some doctors have called the situation unethical.
Which leads us to the million dollar question: WHY do OBs prescribe bed rest if there’s no evidence to support it?
History, partly. The idea that confined rest itself could be curative was first introduced in a series of lectures in the late 1800s by surgeon and anatomist John Hilton, in London. He literally said rest was the “chief natural therapeutic.” After Hilton’s pronouncement, rest became a more popular way to approach medical issues.
Don’t get us wrong… we don’t have anything against the concept of resting. Resting is great — and our culture’s unrealistic expectations that The Pregnant Working Woman must do it all needs to be thrown out the window.
But rest should be an available choice… not a sentence. (And any woman who’s been on bed rest will tell you what you could probably already guess: bed rest isn’t restful.)
The thing is, there’s a long tradition of considering bed rest as a “cure” for American women. In the 19th and early-20th centuries, doctors often prescribed the famous “rest cure” for women they thought were suffering from things like neurasthenia (an outdated medical diagnosis used to label people — usually women — suffering from “weak nerves” or exhaustion) and “hysteria,” with the idea that they needed to be isolated and buffered from any sort of “over-stimulation” (read: anything intellectually stimulating) to calm their nerves.
Men suffering from similar afflictions, on the other hand, were prescribed the “West Cure”: thus, while women with these problems were told to stay still in bed, men with the same set of problems were told to “get out there” and go have an adventure… Manifest Destiny and all that jazz.
In pregnancy, Americans often talked about a woman’s “lying-in” period or “confinement.” These descriptors, to a certain extent, have literally built the idea of bed rest into our cultural conception of prenatal care.
The Guilt Factor (by Meg)
The first thing that we have to come to terms with when discussing pregnancy is that making babies is risky business. It just is. If you’re someone who is particularly risk-adverse or has an expectation of perfection, believe me: this is a tough pill to swallow!
Yes, you can minimize many risks, but in general — we as a culture are very bad at accepting the fact that bad things happen AND many times, it’s nobody’s fault. Look at all the billboards for personal injury attorneys: we desperately need someone to blame when things go wrong. It’s almost a cultural illness in and of itself.
Roughly 10-15% of pregnancies are lost to miscarriage prior to 20 weeks; 12% of babies are born prematurely (before 37 weeks); and still another 1% are stillborn.
It’s tragic, it’s heart-wrenching… there are no words to describe how it feels to lose a baby or to have a baby born with severe health problems.
The Guilt Factor is such a strong, driving force for pregnant women these days. We desperately want to “do pregnancy right.” But the reality is that most of these pregnancy losses and early births are totally outside of our control.
That’s a really hard fact to come to terms with for both patients and their doctors.
Dr. Anne Drapkin Lyerly, an OB-GYN and professor of bioethics at the University of North Carolina at Chapel Hill, says, “When bed rest is prescribed, the implication is that it is useful and that the immobilization is what is going to prevent whatever dreaded outcome — whether that’s preterm birth or miscarriage or preeclampsia,” Lyerly says. “If it ends up that a baby is born prematurely, or a woman develops preeclampsia, she is going to worry that she didn’t adhere to the recommendation well enough and will blame herself.”
Lyerly says she prescribed strict bed rest to one of her patients early in her career, and the pregnancy ended in miscarriage several hours after the woman took a shower. “There was no amount of argument I could do to make her think it wasn’t her fault,” Lyerly recalls. “Because, after all, we had prescribed bed rest and she had gotten up.”
The fact is that things can go wrong whether or not you are on bed rest.
As Emily Oster recounts in Expecting Better, “In a randomized controlled study of 1,200 women with singleton pregnancies and threatened preterm labor, about 400 of them were put on bed rest and the other 800 were not…. 7.9% of the bed rest group and 8.5% of the control group still had their babies prematurely.” As she describes, the difference was not statistically significant; “bed rest was not effective at preventing preterm birth.”
Part of the problem is that the widely held presumption that bed rest is effective in preventing preterm birth creates an underlying situation of guilt. The thought is always there. That’s part of why this is such an important conversation to have.
Another reason bed rest is still a “thing” is because we, as a culture, feel the urge to “do something” in response to medical issues/problems that arise. As one doctor wrote: “it feels better to prescribe bed rest than to tell a patient, ‘we really don’t have anything to offer you to reduce the chance you will deliver early.’”
“Medical counsel is slow to change,” says Brigid McCue, M.D., an OB/GYN at Beth Israel Deaconess Hospital in Plymouth, Massachusetts. “The need to do something—anything—to try to help is strong.”
Other doctors think bed rest should remain within the obstetric toolkit because it might be a relief or a reassurance for women… though I don’t know a single woman confined to her bed who saw it as a “relief.”
Lastly, “in-hospital” bed rest (vs. bed rest at home) can be a way to ensure women with high-risk pregnancies (i.e., partial or full previas) are simply near to medical care should they experience dangerous bleeding or other symptoms very suddenly and need immediate care or intervention. (According to evidence, though, such a hospital stay need not entail confinement to the bed — and in fact, calling it “bed rest” seems inaccurate, since it’s roughly a different matter altogether.)
If you think about it, bed rest doesn’t really make a whole lot of sense from an evolutionary anthropological perspective: mobility is at the core of human evolution. Our bodies are “adapted to movement.” It seems like more and more evidence keeps coming out that being sedentary in general (heard about “epidemic of sitting?”) is deleterious to human health. And the same goes for pregnancy: activity and exercise is healthful.
In short — formal bed rest has no health benefits during pregnancy and has not been shown to effectively treat or reduce any pregnancy complications. Instead, it’s emotionally/mentally, physically, and financially harmful for women and families.
Rest, on the other hand (the kind where you “take it easy” and practice self-care and give yourself permission to slow down when you need to — that kind of rest), is never a bad thing.
We are NOT telling you to ignore your doctor’s medical advice — but if it were me, and my OB raised the prospect of bed rest during pregnancy, I would have a conversation. ACOG’s own committee opinion and standards for practice urge against bed rest, after all.
Bottom Line: If your doctor prescribes bed rest, and you don’t feel good about it, know that you can feel confident asking about the goals and/or about your options — there is a wealth of literature on the topic (see the bibliography below for a start). Alternatively, if that makes you uncomfortable, you could think about seeking a second opinion.