Claire Mazzia, MSc & Kelsey McLaughlin, PhD
Bed rest is sometimes recommended for pregnant women who are at high-risk of preterm birth and other pregnancy complications. However, recent research suggests that bed rest may not minimize health risks during pregnancy.
Keep reading to learn more about bed rest!
What is bed rest?
Bed rest during pregnancy is an intervention that can be recommended by medical professionals for a pregnant woman to limit her movement. Activity restriction and bed rest are two terms that are often used interchangeably to describe medically prescribed decreases in mobility as neither have standard definitions, however, bed rest refers to very restricted physical activity.
Bed rest emerged in the 1800s as a treatment for various diseases. Prior to the 1800s, people who were sick rarely stayed in bed, as it was necessary for most to work and it was considered shameful to rest. During the 19th and 20th century, doctors wrote about the benefits of rest to promote healing, and bed rest became frequently used in medical practice. However, it was noted that some patients who were under bed rest for long periods of time experienced unwanted side effects due to immobility.
Bed rest is sometimes recommended by doctors for women who are at increased risk of delivering their baby preterm (before 37 weeks of gestation) and other complications, such as vaginal bleeding, short cervical length, preterm premature rupture of membranes (PPROM) and hypertensive disorders of pregnancy.
Bed rest recommendations
The Society of Maternal Fetal Medicine (SMFM) does not recommend bed rest be prescribed for patients with fetal growth restriction, preterm premature rupture of membranes or high blood pressure during pregnancy.
Interestingly, the American College of Obstetricians and Gynecologists (ACOG) and the Society of Obstetricians and Gynecologists (SOGC) do not have guidelines for bed rest. These societies state that there is not enough evidence to support eliminating bed rest as a treatment option, however, the ACOG states that minimizing activity is preferred to bed rest.
How common is bed rest?
A survey of Canadian healthcare professionals showed that the majority of obstetricians (65%), family practitioners (70%) and midwives (52%) who took part in the survey recommended bed rest at home for pregnant women at risk of preterm birth. Bed rest in hospital was less commonly recommended for high-risk pregnant women.
However, 2/3 of these professionals felt that bed rest was fair-to-poor for the prevention of preterm birth.
Is bed rest beneficial?
Recent studies have determined that bed rest:
Does not prevent hypertensive disorders of pregnancy, gestational diabetes, miscarriage, Cesarean delivery, fetal death and admission of the infant to the neonatal ICU
Is associated with lower infant birthweight and earlier gestational age at delivery in women with preterm premature rupture of membrane (PPROM)
Is associated with increased risk of very preterm birth (less than 32 weeks of gestation) in developed countries such as Canada
Bed rest is also associated with additional physical adverse effects, including loss of muscle tone, constipation, increased risk of blood clots, increased risk of infection and insomnia or fatigue
Psychological impacts of bed rest
Bed rest is associated with:
Increased stress, particularly related to familial responsibilities
Loss of income
Why is bed rest still considered as a treatment option by some doctors, considering the evidence against the potential value of bed rest?
A recent commentary in the Journal of Obstetrics and Gynaecology Canada addresses this question. The authors suggests the following: if there is a pregnant patient at risk of an adverse outcome during a pregnancy, it may feel better to do something (even if it may not help or even make things worse) than to do nothing.
There are also many cases where bed rest was prescribed and the pregnant patient had a healthy baby, a positive outcome which the patient and her physicians may falsely be due to a reduction in activity when she would have had a healthy pregnancy anyway. Anecdotal evidence can be misleading and is not a reliable method to determine whether interventions are effective.
Bed rest is sometimes recommended for the prevention of preterm birth, and other pregnancy complications. However, recent research suggests that bed rest does not minimize health risks during pregnancy, with some research showing that bed rest may have negative effects on maternal physical and mental health.
Every woman and every pregnancy is unique. Pregnant women should speak to their healthcare provider to ensure maternal and fetal safety. This article is meant to provide readers with current information and opinions. All medical and treatment decisions should be discussed with your healthcare provider.