|Prescribed Bed Rest--Harmful or Helpful?
by Darline Turner-Lee
Every year in America approximately 700,000 pregnant women are prescribed bed rest by their obstetricians. The reasons for prescribed bed rest vary, but the prescription is often due to:
- High blood pressure that occurs with preeclampsia (increased protein levels in the urine and extremity swelling) and eclampsia (dangerously high levels of urine protein and generalized (all over) swelling)
- Cervical changes such as incompetent cervix (won't stay closed) and cervical effacement (thinning)
- Vaginal bleeding
- Preterm labor (onset of labor before 37 weeks of pregnancy)
- Multiple Pregnancy (twins or more)
- History of pregnancy loss, stillbirth, or premature birth (delivery prior to 37 weeks)
- Poor fetal development
- Gestational diabetes
- Placenta complications such as placental abruption (tearing from the uterine wall), placenta previa (placenta presenting first at the cervical opening), and placenta accreta (an abnormally strong attachment of the placenta to the uterine wall)
The rationale behind prescribed bed rest is to keep the mother calm and to allow her body to normalize so that the baby can continue to grow and progress to full term. Women with conditions such as vaginal bleeding or cervical changes are prescribed bed rest to keep them from engaging in too much physical activity which could increase vaginal bleeding or put pressure on the cervix and cause preterm labor. Lying down reduces the pressure of the fetus on the cervix decreasing stretching and pressure on the cervix. Laying in certain positions increases blood flow to the placenta, increasing oxygen and nutrients to the baby. Doctors believe that women with high blood pressure give their organs a rest when on bed rest, allowing their organs to function more efficiently because the women themselves are not moving about.
While prescribed bed rest is the standard of care in obstetrics for high risk pregnancies, there is no scientific basis for its use. There are few if any well conducted scientific studies done on pregnant women with the above mentioned conditions that show placing women on restricted activity or bed rest positively affects the outcome of their pregnancies. Restricted activity or full bed rest is what physicians currently have to work with and will be used until other proven effective methods are discovered. However, prescribed bed rest can have adverse complications.
- Increased discomfort. If you are on strict bed rest, you must remain in bed in the specified position your doctor recommends. Over time you can develop pain and stiffness along your shoulders, spine and in your hips. In extreme cases, skin chaffing and even sores can develop. Discuss with your obstetrician how often to change positions and what positions are safe for you.
- Increased Anxiety and/or Depression. Women with high blood pressure are often prescribed bed rest to reduce stress and lower blood pressure, but bed rest can have the opposite effect as a result. Some women who are prescribed bed rest develop clinical depression believing that they somehow caused harm to their babies or are the reason that the pregnancy is proceeding with difficulty. While maternal influences may contribute to complications when women engage in very vigorous activities or have very physical jobs, the vast majority of women with high risk pregnancies are in no way responsible for the pregnancy complications. Some complications (and subsequent miscarriages) are due to genetic abnormalities. Others are due to previously unknown physiologic conditions. Still other complications simply occur without any rhyme or reason. In susceptible women, placing them on restricted activity and the isolation of prescribed bed rest can heighten the guilt and sad feelings that can quickly turn into a clinical depression. Family, friends and obstetricians need to be alert to the signs and symptoms of depression and get pregnant women on prescribed bed rest help immediately should symptoms develop. To learn about the signs and symptoms of depression, visit The National Institute of Mental Health's Depression FAQ.
- Deep Venous Thrombosis (blood clots). Pregnant women are at increased risk of deep venous thrombosis (blood clots forming in the legs) because of the increased estrogen levels and because the growing uterus can press down on major blood vessels restricting blood flow. Pregnant women on prescribed bed rest are at even greater risk for DVT due to their decreased activity level, poorer circulation and because the uterus is more likely to rest on a major blood vessel and restrict blood flow. Meher et al reported in The Cochrane Library (issue 4, 2005) that "insufficient evidence exists that bed rest, either at home or in the hospital, improves outcomes for women with high blood pressure and may in fact lead to other adverse problems such as blood clots".
High risk pregnancy is tricky because while everyone wants what is best for mother and baby, it's currently unclear just what is best. To date no one has been able to show that prescribed bed rest is of any benefit to pregnant women, yet no one is willing to tell women with high risk symptoms to carry on with their normal activities. NASA researchers reported data from studies on women in space showing that women on bed rest who engage in no exercise are at risk of losing as much as one quarter of their muscle mass and losing up to one half of their overall strength (News Release November 15, 2007). They conclude that "Short but intense sessions of exercise may help women on bed rest stay strong and recuperate more quickly".
There is mounting evidence that women who remain active during their pregnancies fare better than their sedentary counterparts. Unfortunately there is no data that gives obstetricians clear guidelines about what is safe and beneficial in high risk pregnancies. Clearly more research is needed.
So if you are on prescribed bed rest, what should you do? Speak with your obstetrician and know why he or she is prescribing bed rest. Knowledge is power and the more you know, the better prepared you can be to take care of yourself and of your baby. If you have more questions about prescribed bed rest-whether or not it is best for you-or if you want more information about your condition consider consulting with a perinatologist. As with all medical conditions, a second opinion often sheds new light on a situation and provides solutions where previously there were none.
Talk with your obstetrician about safe ways you can move while on prescribed bed rest. Prolonged sitting or lying puts pregnant women at risk for deep venous thrombosis, increases overall discomfort and significantly reducing overall strength and muscle mass. Ask for a referral to a physical therapist or an exercise trainer knowledgeable about pregnancy and bed rest to learn exercises you can to do to avoid these negative effects.
Bed rest is a tough prescription to follow. It is everyone's goal to have a healthy mom and healthy baby at the end of each pregnancy. Despite the mounting evidence that bed rest may not be the best prescription for high risk pregnancy and that short bouts of exercise are greatly beneficial, there still remains little information about what is safe in high risk pregnancy. Share this information with your obstetrician and perinatologist and work with them to devise a plan that will help you and your baby remain healthy and happy before, during and after your pregnancy.
Meher S, Abalos E, Carroli G. Bed rest with or without hospitalization for hypertension during pregnancy. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003514. DOI: 10.1002/14651858.CD003514.pub2.
Alexandros Sotiriadis, M.D., Stefania Papatheodorou, M.D., and George Makrydimas, M.D. Threatened Miscarriage: Evaluation and Management. British Medical Journal, 2004 July 17; 329(7458): 152-155.
The Cleveland Clinic Birthing Services and Department of Obstetrics and Gynecology, Pregnancy: Preeclampsia and Eclampsia Edited November 1, 2005 by Tracy Shuman, M.D for WebMD.
National Aeronautics and Space Administration-News Release, November 15, 2007 NASA-Funded Study Finds Exercise Could Help Women on Bed Rest
About the Author:
Darline Turner-Lee B.S, M.H.S, PA-C is a physician assistant, ACSM exercise specialist and certified perinatal fitness instructor. As the founder and principle of Next Step Fitness, Inc., she strives to raise awareness about the myriad of healthcare options available, conventional as well as alternative, and to encourage women to be more proactive in their personal healthcare. She is a frequent speaker to professional and civic groups and a published health care columnist. She has written an e-book called "Planning for Pregnancy", and has recently produced Bedrest Fitness, a DVD exercise program for pregnant women on prescribed bed rest. For more information, visit www.nextstepfitness.com.
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