Bed Rest and Your Pregnancy
Bed rest is used in nearly 20% of all pregnancies to prevent or treat a wide variety of conditions: early bleeding, early labor, and elevated blood pressure. A 1994 publication in the Journal of the American College of Obstetricians and Gynecologists identified almost no published literature to support the effectiveness of bed rest in ANY pregnancy condition. Most commonly, bed rest is used to prevent early miscarriage, early labor, and complications from elevated blood pressure.
Because blood pressure has been demonstrated higher in women NOT on bedrest, there is at least some logic to the use of bed rest in pregnancy for actual high blood pressure. However, there is little evidence that bed rest improves maternal or baby well being in preeclampsia. There is benefit to intensive in-hospital monitoring followed by appropriate medical intervention, in highest risk preeclampsia pregnancies, but it is not clear that the “bed rest” part has anything to do with better outcomes.
Virtually every obstetric textbook recommends the use of bed rest for women at risk for preterm delivery, although there is almost no data to support it. For twins, no study has shown a significant benefit in relation to preterm delivery, low birth weight, low Apgar score, or admission to the special care nursery.
Several medical complications and other potential side effects have been associated with bed rest in non-pregnant adults. Bed rest has been associated with increased risk of blood clots in the legs, muscle atrophy and bone thinning. Bed rest is also associated with lower cardiac output.
One might wonder how and why an intervention such as bed rest became so widely used with so little demonstrated proof of effectiveness. The answer is not clear, but it is suspected that bed rest is used frequently because it is perceived as inexpensive and non-invasive, and it seems that it should work. Furthermore, because most pregnancies end in the delivery of a normal fetus, and because bed rest is used frequently, there may well be an apparent association between bed rest and good outcomes.
Let’s Consider “Chair-Rest” Instead
While it does seem to make sense that certain complications of pregnancy be managed with decreased activity, lying in bed for days or weeks for the last part of pregnancy is NEVER indicated, as we’ve established that bedrest is Dangerous. The happy medium, better than bedrest, is “CHAIR-REST.” Here is a list of activities which are okay for a pregnant patient on “chair-rest:”
- ALL regular personal hygiene issues (bath, shower, etc…).
- Sitting: couch, table, chair, wheel chair, toilet.
- NO prolonged standing, like cooking, loading the dishwasher, or doing laundry.
- NO sexual intercourse.
- NO housework.
- NO shopping (no walking around to shop… you can use a wheelchair)
- Driving to weekly DOCTOR appointments is OK.
- BED IS ONLY FOR SLEEPING. THIS IS NOT BEDREST.
- WHEEL CHAIR RIDES: wheel chair “rental” can be arranged, easily.
adapted from: Robert L. Goldenberg, MD, Suzanne P. Cliver, Janet Bronstein, PhD, Gary R. Cutter, PhD, William W. Andrews, PhD, MD, and Stephen T. Mennemeyer, PhD. Obstet Gynecol 1994;84:131-6.