still birth

Indications for Bed Rest

September 22nd, 2009

Each year some 700,000 (about one in five) pregnant women will be prescribed bed rest, either modified activity or complete inactivity and confinement to bed. While bed rest has been a part of obstetrics for years, there is still controversy as to whether or not bed rest actually helps or is effective against any of the conditions for which it is prescribed.

Bed rest is commonly prescribed for women who:

  • Have a multiple gestation; twins, triplets or higher order multiples
  • Have an “incompetent cervix”; a cervix that begins to open prior to 37 weeks pregnancy endangering the life of the fetus and/or mother
  • Preterm labor or a history of preterm labor; labor that begins before 37 weeks gestation
  • History of prior miscarriage, still birth (death in utero) or premature birth (prior to 37 weeks gestation)
  • intrauterine growth restriction/retardation (impaired growth)
  • Placenta Previa; The placenta presenting first at the cervical opening
  • Gestational Hypertension; with or without Pre-Eclampsia(toxemia)
  • Gestational Diabetes
  • Vaginal bleeding
  • Too little amniotic fluid (oligoamnios)

While all of these conditions certainly put mama and baby at risk, to date there is no solid evidence that prescribed bed rest is effective at stopping or improving any of these conditions. In fact, studies to date show that prolonged bed rest and inactivity actually cause a worse overall physical condition to pregnant women-even those considered “high risk”. Women on prescribed bed rest may develop muscle weakness, cardiovascular deconditioning, blood clots, fatigue, drops in blood pressure when standing up, backache, bone loss, changes in metabolism, muscle aches, joint pain, difficulty walking (particularly stairs), difficulty concentrating, dizziness, shortness of breath, insomnia, and weight loss.

What has always struck me is the lack of attention to the emotional and psychological effects that prescribed bed rest has on pregnant women. When I have raised this concern to obstetricians their response typically is many of the psychosocial stressors can be dealt with once mother and baby are physically safe.  However, studies have shown that maternal stress and anxiety prenatally can result in significant depression (perhaps leading to post partum depression) as well as mood changes a sense of confinement and loss of control. These psychological stressors can have significant impact on the course of the pregnancy and the health of both mother and baby. Additionally prescribed bed rest affects a pregnant woman’s entire family an can lead to child care problems, strained relationships and financial difficulties.

The next several blog posts will examine the common conditions for which bed rest is prescribed and the “proposed” benefit of bed rest on the condition. We’ll also look at what some research is revealing about bed rest in these situations and how many clinicians are rethinking how and when they prescribe bed rest for their patients.