Pregnancy is a very busy time in a woman’s life. Moms-to-be have to attend doctor’s appointments and plan baby showers in addition to their everyday work and routine. Even on a purely biological level, an expectant mother’s body is very active in its work to support a growing baby.
With so much work to do, a doctor’s order for bed rest might sound like a much-needed relief at first, but the reality is often different. Bed rest can make an already difficult situation more challenging. Activity is important to physical and mental health, and suddenly being confined to a bed can become both an emotional and logistical nightmare. Some moms might even have to quit their jobs in order to remain in bed, or call in-laws to care for their other children. Bed rest, like other forms of extended inactivity, can also aggravate or even create other medical complications.
Although some circumstances do require a decrease in activity, bed rest itself is overrated as a therapeutic intervention in pregnancy.
Why is bed rest usually prescribed?
Bed rest is frequently the initial therapy prescribed for a variety of complications. These include first trimester bleeding, preterm labor, and high blood pressure in pregnancy. This reliance on bed rest has remained constant for over one hundred years of obstetrics.
While bed rest is commonly prescribed for these situations, there are no good, randomized controlled clinical trials that support the use of bed rest to actually prevent these obstetrical complications.
We do know that bed rest decreases Braxton-Hicks contractions and can temporize peaks in blood pressure, but is far from a long-term therapy or cure.
Why is bed rest often unnecessary?
The inactivity provided by bed rest doesn’t seem to significantly alter the outcome that it is meant to prevent. Even with bed rest, 1 in 8 (12%) of babies in the US are born prematurely. Logically, if bed rest were fully effective in prevention, then the preterm birth rate would drop to zero, which it hasn’t.
Bed rest is also often prescribed for the 8 – 10% of first time moms who develop pre-eclampsia, a high blood pressure condition unique to pregnancy. However, bed rest can’t prevent the capillary vasospasm associated with pre-eclampsia, or the immune system reaction to the “foreign” proteins and DNA that the baby represents to the mother’s body. As discussed in a previous post, pre-eclampsia is a breakdown in the maternal “immune tolerance” to the portion of the baby that is “foreign” to the mom. Paternal DNA and proteins are the presumed source for the immune response that leads to pre-eclampsia, none of which can be altered with bed rest.
While bed rest is also prescribed to prevent miscarriage, its effectiveness is hard to prove. If simple inactivity can prevent miscarriage, that would imply that activity causes miscarriage. Again, the statistics seem to contradict this theory, as even marathon-running moms have healthy, full-term pregnancies. If activity caused miscarriage, then these very active moms might have closer to a 100% miscarriage rate.
What are the medical complications of bed rest?
While the benefits of bed rest to these conditions may be uncertain, the potential complications of bed rest itself are more clear. Bed rest leads to a loss of muscle mass and can also increase the risk of blood clots in the lung or legs due to extended inactivity. Deep vein thrombosis and pulmonary embolus are both health and potentially life-threatening complications associated with pregnancy, in general, and are more frequent with inactivity or stasis.
Although bed rest is greatly overrated and overprescribed, reduced activity during pregnancy may be recommended for some patients. While it’s important to be be aware of the potential risks of bed rest, only your doctor knows the individual treatment requirements for your pregnancy.
Always speak with your healthcare provider if you have any questions or concerns. No pregnancy is perfect, but I hope your pregnancy is the very best it can be.
Be safe, be well and have fun!
David L. Berry, M.D.
Founder and Staff Physician
Austin Perinatal Associates