Why bed rest in pregnancy doesn’t work
The use of bed rest or extreme activity restriction is a common first-line treatment for many complications of pregnancy, including: preterm labor, being pregnant with multiples, placenta previa, and preeclampsia or high blood pressure, to name a few. In fact, up to 20 percent of pregnant women will be put on bed rest at some point in their pregnancy. This is a very high number for a treatment that has no evidence behind it and can actually be quite harmful.
Much like it sounds, bed rest is just that: when a pregnant woman’s activity is limited to her bed. Brief breaks may be allowed to get up to the bathroom or to sit in a chair, but on average these women are bedridden for approximately 22 hours a day. This may be done at home or in a hospital setting.
The concept behind bed rest is pretty straightforward: less activity means less pressure on the cervix, so this may keep preterm labor or contractions at bay. In women with high blood pressure or preeclampsia, the hope is that decreased activity will keep a woman’s blood pressure lower and allow more of that blood to get to the placenta to help baby grow. While these assumptions make sense, there is no scientific evidence that they actually play out this way.
Many studies have looked at whether or not bed rest works, and the overwhelming majority have shown that it does not. A Cochrane meta-analysis (a review of multiple high-quality studies) updated in 2010 came to the conclusion that bed rest or extreme activity restriction has no data behind it, and providers should not be recommending it to their patients.
If, for example, you are pregnant and are worried about preterm labor, you might then conclude that even though there is no data behind it, bed rest falls in the category of “better safe than sorry.” However, we know that with bed rest comes many unwanted (and potentially dangerous) side effects: loss of muscle mass and muscle deconditioning, bone resorption and loss, weight loss (with lower infant birth weight), blood clots, longer postpartum recovery, psychiatric issues such as depression and anxiety, job loss, and financial and familial stress.
Therefore, bed rest is a treatment that should not be recommended especially in light of the serious problems it can cause. This can be a hard pill to swallow when a doctor truly believes it works, or a woman who was in preterm labor goes on to deliver at term after being put on bed rest in a previous pregnancy. It can be hard to believe that she might have had the exact same outcome had her activity not been restricted.
As the side effects of bed rest become more well known, the hope is that less providers will continue to recommend it. Since approximately 70–85 percent of American obstetricians currently still recommend this practice, there is still a long way to go in making this change.
Reviewed by Dr. Jen Lincoln, April 2020
Takeaways
- Bed rest or extreme activity restriction is when a pregnant woman’s activity is mostly limited to resting in bed.
- This may be recommended for various pregnancy complications, such as preterm labor or preeclampsia.
- There is no evidence that bed rest works.
- The side effects of bed rest are very real and can be quite serious.
Do you have a link to the Cochrane meta-analysis you spoke about or any of the other studies on bed rest? I’m curious about their test methods and supposed results.
I’ve been on bed rest my entire pregnancy and it’s been horrible. Wish I would’ve known that there is no proof that it works
What should the woman be doing then? Sitting? Walking around? I imagine a woman with pre-eclampsia shouldn’t be exercising. Would sitting be a viable alternative? Or should she be moving around?
They should know it’s OK to do their normal activities within reason – getting out of bed, walking around, showering, etc – basically, we tell women they shouldn’t be bedridden, but shouldn’t be going crazy either! Exercise is not recommended if a woman has preeclampsia (or any other high-risk issues either), but the above would be fine.
Being vertical is always better for gravitational reasons especially when there are medical problems
This can be scary for a pregnant women. I have never heard of bed rest being a bad thing and I don’t understand how so many doctors can still be prescribing it without research to back up the effectiveness of it.
I think most doctors have read about the lack of effectiveness of bed rest, but really feel like their hands are tied when we have nothing better to offer – and one “success” story, and you swear it was the bed rest that saved the day. However, it is really important to think risks vs benefits and the harm you can be causing by recommending something!