Does Bed Rest Work as a Medical Intervention During Pregnancy

The standard of care for premature labor has typically been to place the pregnant woman on bed rest; limiting activity for the remaining weeks of pregnancy. The signs and symptoms of premature labor are varied and may include spotting and early contractions, or maybe she is pregnant with multiple. The cause of the suspected labor is irrelevant – bed rest is the common suggested treatment to prevent miscarriage and/or other complications like lower than normal birth weight, but there is very little proof that bed rest has any effect on the outcome of pregnancy even with complications. There may also besome side effects suffered by the pregnant woman and fetus as a result of bed rest.

Why is Pregnancy Best Rest a Common Treatment?
There are some experts, including many obstetricians, that believe limiting movements and activity is the best option for treatment when pregnancy complications arise.

Resting in bed may be suggested if:

• You are pregnant with multiples.
• You suffer from high blood pressure.
• You are having premature contractions.
• You have an incompetent cervix.
• Fetal growth is below normal.
• You’ve undergone one or more fertility treatments.

The idea is that moving too much can cause contractions to begin or grow stronger if contractions are already occurring. If the pregnant woman lies down, preferably on the left side of the body, contractions may ease off and eventually stop. Removing pressure from the right side of the body may also increase blood flow to the fetus and uterus. More blood could mean an increase in fetal weight. Just becaus experts push these treatments does not mean they are effective. Are these treatments proven?

Bed Rest May Not be as Effective as Experts Think
Over the span of a decade, there have been multiple studies proving that bed rest is not as effective as experts would like to believe. When it comes to pregnancy prevention or cessation of premature labor, bed rest is not a treatment obstetricians can rely upon.

Here are a few summaries of research studies completed on the subject of bed rest.
A Chinese study showed no benefit from bed rest as a means of protecting an implanted embryoafter embryo transfer. A Cochrane database report claims no change in outcome was reported after women pregnantwith multiples were hospitalized for bed rest. An Ireland report that covered 22 individual studies on bed rest as a means of preventing premature delivery proved no benefit from the rest.

There are other studies with the same general outcome. All it takes is a brief search of medical journals across the globe to find medical studies on the ineffectiveness of bed rest for any of a number of pregnancy- or fertility-related conditions and treatments. 

What are the Potential Negative Effects of Bed Rest?
While medical journals tell the story of how bed rest is ineffective as a treatment choice, they do nottend to touch on the potential negative side effects of prolonged bed rest. The possible side effects include:

• Atrophy of the muscles.
• Loss of bone mass.
• Weight loss for mother and fetus.
• Lower than normal birth weight – singlet pregnancy.
• Premature gestational age at delivery.
• Emotional side effects from alienation.

One nursing professor and researcher from Case Western Reserve University, Judy Maloni PhD, claims that bed rest as a means of treatment for pregnancy complications is not the best option. She also believes that doctors should stop prescribing bed rest as a treatment until medical research supports this claim.

Medical Tests to Diagnose Premature Labor
If there are signs of premature labor or other pregnancy complications, there are tests to determine if premature labor is a potential problem. One such test with quite a successful history is the fetalfibronectin test (FFN). The FFN is relatively new, but the results can give doctors a window view into thefuture of then pregnancy. Pregnant women must be at least 24 weeks pregnant to have the test. FFN tests for a protein that may mean early labor could be a problem. If the protein is not found during the test, it does not mean premature labor is out of the question, but it could help the pregnant women avoid bed rest and other invasive treatments that are simply not needed.

What Happens When Your Doctor Suggests Bed Rest?
Despite the lack of evidence supporting bed rest as a means of treatment for pregnancy complications, medical providers still use and support bed rest as a viable prescription. If your medical provider suggests bed rest – ask the following questions.

1. Why am I being asked to go on bed rest?
2. Is there clinical research supporting bed rest as a medical treatment for my condition?
3. If the best rest is suggested as a means of preventing premature labor, am I eligible for the fetalfibronective test?
4. If the fetal fibronective test is negative, what are other treatment options aside from bed rest?
5. What kind of bed rest is being suggested, exactly (strict or modified)?
6. How much activity will be allowed while I’m on bed rest?
7. If I say yes to bed rest, is there an option for returning to normal activity at some point?

The use of bed rest as a medical treatment for pregnancy complications is a controversial topic. There may be situations where bed rest is the best or only option, but there are also situations when bed rest is simply not the right answer.

You can discuss your condition and the possible alternative treatments with your primary care provider.