Bed rest during pregnancy: Is it really necessary?

Each year, doctors put thousands of pregnant women on strict bed rest, in which they stay at home in bed or in a chair for most of the day, except for trips to the bathroom. During this time, women are told not to do housework or lift heavy objects. Pregnant women typically are recommended bed rest when they experience:

• Bleeding early in pregnancy, or to prevent miscarriage.
• Premature rupture of membranes, or when the water breaks early. After 24 weeks of gestation, bed rest typically will take place in a hospital.
• Preterm contractions or a shortened cervix, particularly for women who are pregnant with twins or other multiples.
• High blood pressure, to reduce the risk of needing an early delivery.

But are these good reasons for such severe restrictions on activity? It turns out probably not. There is no credible scientific evidence to suggest that bed rest makes a difference in pregnancy outcomes in these situations. Worse yet, it might even lead to other problems for pregnant women and their loved ones.

Downsides of bed rest during pregnancy

Let’s look at why bed rest might cause complications.

Increased risk of blood clots

Pregnancy already increases a woman’s risk for developing clots because the growing uterus puts pressure on veins in the pelvis and the major vein that returns blood from the legs. This blocks blood from returning from the veins in the legs, which is one reason varicose veins can arise during pregnancy. Lack of movement from bed rest further decreases the return of blood. And, during pregnancy, an increase in blood factors that help clots develop also increases the risk of serious clotting. Because clots can become life-threatening if they travel to the lungs, it is important to consider the increased risk of clotting that comes with bed rest.

Related reading: What all women should know about blood clots

Loss of bone strength and muscle

Lack of muscle use leads to a loss of muscle strength at a rate of about 12 percent each week. After three to five weeks of bed rest, nearly 50 percent of normal strength is lost. This occurs because muscle fibers atrophy when they aren’t used. Moreover, bone also becomes stronger through exercise and weakens during times of immobilization. Losing bone or muscle mass can be troubling for women, and restoring it will require strength exercises or plenty of walking and running.

Depression and additional stress on partners

Being on bed rest, particularly in the hospital away from family and friends, can cause patients to experience depression. Bed rest creates additional stress on a pregnant woman’s partner, who might have to pick up more household and childcare duties. Avoiding bed rest allows a woman to stay at work and with her family. 

I am particularly concerned about women feeling guilty if they don’t have a good outcome after being placed on bed rest. I talk to women who are on strict bed rest and know how hard it is to limit activity this much. Women often have questions about exactly how much they can and can’t do. But if they don’t have a good outcome, women can blame themselves for it, wondering if they were somehow responsible, having not followed their doctor’s recommendations to the letter.

In Dallas, we are fortunate to have a resource for women who must be on bed rest – Mommies in Need – that helps provide child care to families when a woman can’t avoid being in the hospital. The application process is simple and can go a long way in assisting families during these times.

Why do doctors prescribe bed rest in the first place?

Even with these implications, some doctors still recommend bed rest during pregnancy – typically because there aren’t any other treatments to offer patients. Doctors usually want to feel like they are doing something, and patients want to feel assured that their doctors are taking action to keep them safe during pregnancy. However, in this case, both doctors and patients must realize that bed rest might lead to more harm than good.

If your doctor prescribes bed rest, I encourage you to have a discussion about why he or she thinks it will be of benefit – and about what the potential risks are.

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