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Bed Rest During Pregnancy

If your doctor has prescribed bed rest for a few days or weeks, you probably have a lot of questions. Although you may welcome a little rest initially, extended bed rest during pregnancy can be quite difficult, especially if you are normally very active. Even if you are not very active, you may find the hours of bed rest more of challenge if you can’t do basic things, like shower or sit up while eating.

Although “therapeutic” bed rest is often prescribed as a means to prevent pregnancy complications, evidence has shown that it provides little to no benefit. In an article published in the June 2013 issue of Obstetrics and Gynecology, the authors propose discontinuing the practice of prescribing bed rest.

The American College of Obstetricians and Gynecology has recommended that bed rest shouldn’t be prescribed routinely; it should only be used in certain circumstances, in high-risk cases. So if your doctor recommends bed rest, he or she must have a good reason. Here you will find all the facts about bed rest during pregnancy, when it may be recommended, and how it can affect the remainder of your pregnancy and delivery.

Why Your Doctor May Recommend Bed Rest During Pregnancy

Your doctor may recommend bed rest, or restricted activity, if you have a condition that puts your pregnancy at high risk for complications. Because of the lack of clear evidence regarding its effectiveness, bed rest should be viewed as only part of the treatment of your condition.

The following conditions are often cited as reasons doctors prescribe bed rest:

  • Gestational hypertension (high blood pressure): For pregnant women with hypertension, the goal of treatment, including bed rest, is to prevent the development of more serious conditions, such as fetal growth restriction and placental abruption. While some studies have found no protective benefits from bed rest in pregnant women with hypertension, others have reported a slight decrease in the risk of developing worsening high blood pressure or delivering prematurely.
  • Vaginal bleeding: If you have bleeding, you should call your doctor immediately because it could be a sign of a miscarriage or ectopic pregnancy, especially if the bleeding occurs during the first three months. However, bleeding may be caused by a number of conditions, many of which pose no risk to the baby or the mother. In such instances, bed rest may be recommended until the vaginal bleeding subsides, because activity, lifting, or exercise may worsen the bleeding.
  • Problems with the placenta, such as placenta previa: Bed rest has often been recommended for placenta previa (a condition in which the placenta partially or completely covers the cervix) but it is not always necessary. If you have placenta previa with heavy bleeding or persistent preterm labor, bed rest may be required. Although many cases of placenta previa resolve before the pregnancy comes to term, the associated complications are serious and can be life-threatening.
  • Cervical insufficiency or incompetent cervix: In women with a weak cervix, or a cervix that is likely to dilate early, pressure from a growing fetus can cause the cervix to open prematurely, leading to pregnancy loss. This loss typically occurs in the second trimester. Placement of a cerclage (a suture or synthetic band) is the standard treatment. Decreased activity for the remainder of the pregnancy is often recommended with transvaginal cerclage.

Other conditions for which bed rest is often recommended but has not been proven to be effective include:

  • Preeclampsia (high blood pressure with high levels of protein in the urine)
  • Contractions or preterm labor
  • Twin or multiple pregnancy
  • Impaired fetal growth

How Will Bed Rest During Pregnancy Affect Me

Although a prescription for bed rest often means that your doctor is concerned about a condition that may prevent you from carrying your baby to full term, the risks should be evaluated in the context of your overall health and well-being.

Strict bed rest may mean monitoring in the hospital: you won’t able to leave your bed for any reason and will require assistance to care for yourself. Bed rest can also mean activity restriction: you may get up to use the bathroom and do other activities in the home, but must also rest in bed for short periods. The length of bed rest can vary. You may be confined to your home for a short period or for the duration of your pregnancy.

Your doctor may instruct you to lie on your side or prop yourself up. It is essential to follow your doctor’s instructions exactly and ask questions if you have any doubt about what activities you can and cannot do.

Possible Benefits of Bed Rest During Pregnancy

Lying in a reclining position increases blood flow to the placenta and decreases the pressure of the baby on the cervix. This is why getting enough sleep during pregnancy is essential for your health and the health of your growing baby. When more than the usual amount of rest is prescribed, it is usually to prevent pregnancy complications.

There are three potential benefits of bed rest:

  • Decreased pressure on the cervix. This may reduce the risk of having a miscarriage, preterm contractions or labor, ruptured membranes, or vaginal bleeding.
  • Increased oxygen and nutrients to the placenta. Improved oxygenation and nutrition can presumably boost the development of a fetus with impaired growth.
  • Improved maternal organ function. Bed rest is thought to help the mother’s organs function more efficiently.

Complications of Bed Rest During Pregnancy

For many women, lying in bed all day for days or weeks may feel more like a punishment than a treatment. Bed rest during pregnancy can cause emotional upset, stress on the family, and financial problems if you are not able to work. Potential health problems while on bed rest include:

  • Joint pain and muscle aches
  • Increased risk of blood clots, especially in the leg veins
  • Decreased bone mass
  • Anxiety and depression
  • Increased risk of preterm birth

After you deliver your baby, getting back to your usual activities may take longer than you might expect. This is because of the lingering effects of muscular and cardiovascular deconditioning.

How to Survive Bed Rest During Pregnancy

Although bed rest can be challenging, it is important to make the best of it. Get organized and establish a daily routine. Be mentally active if not physically active. If you can, prepare for the day as if you were going to work. Have everything you need to connect with the outside world nearby (computer, phone, TV remote) and keep books, pens, tissues, healthy snacks, water, lotion and any other needed items handy. Do what you can to reduce boredom and prevent depression. Try starting a hobby that requires you to spend lengthy periods sitting (such as reading, scrapbooking, or knitting). Arrange for family members and friends to help you do household chores and get you through the short-term inconvenience.

Medical References:

    C. A. McCall, D. A. Grimes, A. D. Lyerly. “‘Therapeutic’ bed rest in pregnancy: unethical and unsupported by data.” (Obstetrics and Gynecology, June 2013) 121(6):1305-1308. doi: 10.1097/AOG.0b013e318293f12f. C. A. Crowther, S. Han. “Hospitalisation and bed rest for multiple pregnancy.” (Cochrane Database Syst Rev, 2010) Jul 7;(7):CD000110. doi: 10.1002/14651858.CD000110.pub2. Cleveland Clinic, “Pregnancy Bed Rest,” January 3 2013, http://my.clevelandclinic.org/healthy_living/pregnancy/hic_pregnancy_bed_rest.aspx Mayo Clinic, “Bed rest during pregnancy: get the facts,” May 21, 2011 http://www.mayoclinic.com/health/pregnancy/PR00107
[Page updated February 2015]