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Few words are more discouraging to a pregnant woman than "bedrest." But being confined to your bed at home or, worse, at a hospital to try to ward off preterm labor or control high blood pressure is surprisingly common.
"Up to about 1 in 5 women will have some degree of bedrest during their pregnancy, mandated by their doctor," says maternal-fetal medicine specialist Chad Klauser, an assistant clinical professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai in Manhattan. "And that's probably excessive."
Bedrest, sometimes referred to as activity restriction, is getting a bad rap, for good reasons: In addition to being unpleasant for moms-to-be, recent research shows that the practice not only doesn't help, but it can actually worsen women's health and pregnancy outcomes.
Why bedrest doesn't help
In the June 2013 issue of Obstetrics and Gynecology, a study of women with a short cervix (a risk factor for preterm labor) found that bedrest didn't reduce the likelihood of going into labor before 37 weeks. The women on mandated bedrest were actually more likely to give birth prematurely than those who stayed active.
In the same issue, two editorials called for an end to the practice.
"The use of bedrest isn't supported by the data on the array of conditions it tends to be prescribed for, including threatened miscarriage, high blood pressure and preeclampsia, preterm birth, impaired fetal growth, or multiples," says obstetrician Anne Drapkin Lyerly, author of A Good Birth: Finding the Positive and Profound in Your Childbirth Experience, and associate director of the UNC Center for Bioethics in Chapel Hill, North Carolina.
Lyerly, coauthor of an editorial against bedrest, combed through rigorous reviews of studies on bedrest. "In all of these cases, strict bedrest has not been shown to improve outcomes," she says. In addition, bedrest can be bad for women's physical and mental health.
"It's associated with a risk of venous thrombosis (blood clots, usually in your legs) and bone demineralization. And as anyone who has been on bedrest can tell you, it can lead to depression, anxiety, family tension, and loss of wages," Lyerly says.
So why has bedrest been a go-to "cure" prescribed to women at risk for preterm labor or high blood pressure, or those carrying multiples? Ob-gyn and maternal-fetal medicine specialist Michael Katz says although the data supporting bedrest has been "flimsy at best," doctors continue to recommend it in order to give patients some actionable advice.
"When [doctors] have very little to offer, they always add bedrest," says Katz, chief of obstetrics at California Pacific Medical Center in San Francisco. "This doesn't make it effective. It just makes it a common practice."
"I think most doctors know there is no benefit to it," agrees Klauser. He doesn't advise strict bedrest except in some unusual, extreme cases. Instead, he and his colleagues have patients stick to moderate physical activity while going about their normal life. If a patient is at significant risk of preterm labor, he might suggest reducing the level of activity.
"We have always been mindful of the risks of bedrest. We try to avoid it in almost all circumstances," he says.
What if your doctor recommends bedrest?
Klauser sees value in some uses of bedrest, including when a pregnant woman has developed preeclampsia or has advanced preterm cervical dilation (3 to 4 centimeters).
But Lyerly would like to see a controlled clinical trial evaluating whether bedrest is ever worthwhile. "We need the evidence if doctors are going to continue to prescribe it," she says.
Until there's official consensus, women still face the possibility that they'll be ordered to bed at some point in their pregnancy. If this happens to you, Katz suggests asking your provider what's meant by bedrest and to explain exactly what it entails and how it will impact your life. Discussing this can help to balance your needs with your provider's concerns.
"For a woman who feels that bedrest would be a major disruption of her life, she needs to discuss with her doctor how strongly he feels about it," says Katz. "Maybe he'll say, 'I don't want you to travel to the West Coast for your job, but I don't mind if you work from home.' You can mitigate disruption and mitigate stress."
Kate Rope is a freelance writer and editor and coauthor of The Complete Guide to Medications During Pregnancy and Breastfeeding.
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Visit the Society for Maternal-Fetal Medicine's website for more information.