Is Complete Bed Rest Best?

October 16th, 2009

Recently someone made the comment that high risk pregnant women should not engage in any sort of physical activity while on prescribed bed rest. I cannot disagree more vehemently! When a pregnant woman is placed on bed rest, not only is she at risk for the usual complications of pregnancy (in addition to the particular risks that landed her on bed rest in the first place!) she then adds an increased risk for deep venous thrombosis (DVT) and embolism, pulmonary complications an muscle atrophy (wasting and loss of strength). This is why I produced Bedrest Fitness, a series of exercises pregnant women can do while on prescribed bed rest.

Numerous research studies have documented that prolonged inactivity is detrimental to health. For this reason, when a person has heart bypass surgery, as soon as they are taken off the ventilator and are breathing on their own, nurses are instructed to get them out of bed and into a chair. This sometimes occurs within in hours of open heart surgery! But the sooner patients sit in an upright position, the sooner they will begin reusing their muscles, taking deep breaths and recovering. The same thing happens for orthopedic patients. Once a hip or knee is replaced, within hours to days, physical therapists begin moving the new joint to aid in healing, range of motion and optimum utilization. Early movemtner lowers the risk of venous blood pooling in the legs , blood clot formation, embolisms (blood clots that dislodge and travel to other areas of the body), pulmonary (lung) collapse, fluid in the lungs and the development of pneumonia. So given these examples (and there are many more such as cancer patients and other surgical patients) doesn’t it seem strange that we tell pregnant women to go sit/lie down for weeks to months at a time???

I am sure that opponents and naysayers will chide me by saying, “Well then YOU take responsibility when a woman loses her baby!” I think that we can all agree that no one wants a pregnant woman to lose her baby (or babies as the the case may be).  But I think that it behooves all of us, especially in this era of health care reform, to re-examine how we manage high risk pregnant women and to really ask ourselves, is complete bed rest really best?

In some cases, bed rest really is the answer. If a woman is actively bleeding from her vagina, experiencing contractions indicative of preterm labor or has severe high blood pressure and is at risk of pre-eclampsia then yes, bed rest is indicated and I think that inpatient hospital care is best in these settings. But once the bleeding stops, the contractions stop and her blood pressure is closer to the normal range is it still necessary to completely restrict a woman’s activities? Is it best to send her home without medical supervision? Is it in her and her baby’s best interest for her to remain immobile and inactive?

Researchers are just beginning to look at how high risk pregnant women are managed and are beginning to realize that perhaps restricted activity and modified bed rest are better options. If a woman is able to be up out of bed but sitting with her feet up she can work from home and engage in family activities. But some people still argue this isn’t enough, especially in the case of the incompetent cervix. They argue that the gravitational pull downward requires that a women stay reclined in bed. Again, this may not be the case.

The September 2009 American Journal of Obstetrics and Gynecology published a study, “Prediction of spontaneous preterm birth in asymptomatic twin pregnancies with the use of combined fetal fibronectin (fFn) test and cervical length”.  Now first let’s qualify their findings by saying that the mothers in this study were in fact having twins but they were not otherwise high risk, i.e. they didn’t have incompetent cervices. The researchers found that in 155 twin pregnancies examined between 22 and 32 weeks gestation,

  • A positive fFN test  or a cervical length of <20mm increased the risk of spontaneous preterm birth at <37,<34,<32, <30 and <28 weeks gestation.
  • The combination of a positive fFN test result and cervical length <20mm had a significantly higher positive predictive value for delivery at all gestational ages than either test alone.
  • A positive fFN test result was a stronger predictor of spontaneous preterm birth than a short cervical length alone.

Although this is one test and on a fairly small, very specific population, we can’t ignore the potential indications. To date many women with multiple pregnancies are placed on bed rest to prolong gestation-regardless if they are having symptoms of preterm labor or other complications. While most mothers of multiples often lower their activity levels later in pregnancy out of necessity, those who wish to remain “restricted” but not “bedridden” may now have a way to determine their risk and potentially avoid bed rest.

Likewise, incompetent cervix is one of the most common reasons women are placed on prescribed bed rest. If a pregnant woman with an incompetent cervix can have a cerclage (sugical stitch placed around the cervix) and if the cervix is not effacing (thinning and shrinking), the fFN test may be used to establish which mothers actually need to be on bed rest because preterm labor is highly probable and which mothers may be able to be on modified bed rest, “house arrest” or simple modified/restricted activity.

Truly more research must be done in this area, but it is exciting to see that people are actually doing work for us high risk mamas.  Maybe one day, we’ll be better able to tell who really needs to be on bed rest and who does not.

Mamas on bed rest, if you want to keep moving, try Bedrest Fitness! It’s simple yet effective at helping maintain muscle strength and mobililty. see a clip at www.mamasonbedrest.com.

One response to “Is Complete Bed Rest Best?”

  1. […] This post was mentioned on Twitter by Shannon Anderson and Sherry Feldberg, LisaGylla. LisaGylla said: Pregnant women: the fFN test may be your get-out-of-bed free card, read more from @mamasonbedrest: http://tinyurl.com/ykklwvr […]

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