Out of one million pregnant women a year classified as "high-risk" or "at-risk," 70 percent will be put on bed rest by their health care provider. And bed rest is prescribed for about 20 percent of all pregnant women. Most often, doctors recommend it for various conditions, like preeclampsia or cervical incompetence, which could lead to premature birth. The rationale being that very minimal activity can take pressure off the cervix, reduce strain on the heart and improve blood flow to the kidneys, increase circulation to the uterus, and minimize the level of stress hormones that can trigger contractions.
But as helpful as that sounds and as excited as some expectant moms are to be prescribed chill-out time, others are skeptical that it's right for them -- and their baby. Especially when they've got a job, a household to run, and a few other kids to take care of. And it's not just moms who are unsure about bed rest; as it turns out, there's definitely a medical case againstbed rest.
"For women at risk of preterm labor, even those with a shortened cervix, there is no evidence that bed rest reduces preterm delivery," explains Katherine Bolt, MD, OB/GYN with Texas Children’s Pavilion for Women. In fact, even the American Congress of Obstetricians and Gynecologists (ACOG) states that bed rest should not routinely be recommended to women with symptoms of preterm labor.
Here, 7 must-know facts about the controversy surrounding bed rest.
- Science shows bed rest is not effective at preventing preterm birth. A 2004 study published in the Cochrane Database of Systematic Reviews found that the same percentage of women at risk for delivering prematurely ended up doing so, whether they were on bed rest or not.
- It's not all that helpful for improving a baby's wellness. Another study, published in Expert Review in Obstetrics & Gynecology, concluded, "Research indicates ... that bed rest treatment is ineffective for increasing gestational age at birth and infant birth weight."
- There's a chance that bed rest could actually hurt mom's health. Not only has an increased risk of blood clots been linked to bed rest, but it also raises a variety of other risks. "Strict bed rest may lead to deconditioning, which is especially undesirable in someone who may need to be ready to push for several hours for a vaginal delivery," says Dr. Bolt. "There's bone loss and negative psychosocial effects, like time away from work. And this isn’t even considering all the benefits that are missed out on by not exercising during pregnancy."
- It's expensive. Research shows families may suffer financially when a mom is put on bed rest, even if they don't work, because they end up having to fork over for someone else to help around the house.
- It might not help with high blood pressure issues. "Although bed rest or even decreased activity may improve blood flow to the uterus and through the placenta to the fetus and reduce exacerbations of high blood pressure, there has been no evidence that bed rest results in any significant improvement in outcomes for the mom or the baby," notes Dr. Bolt. "However, surprisingly, there are no large randomized trials that have evaluated these benefits or risks of bed rest for high blood pressure in pregnancy." In other words, the jury's still out on this one. Not to mention that a woman with high blood pressure could benefit from a less extreme alternative to bed rest: "Simply avoiding stressful situations, whether it be at home or at work, also helps limit unnecessary elevations in blood pressure," explains Dr. Bolt.
- There's a pretty strong consensus among medical professionals that it's not helpful. In 2009, findings published in the American Journal of Obstetrics & Gynecology noted that more than half of practicing obstetricians who were surveyed admitted bed rest has no or minimal benefit.
- Even if you are prescribed bed rest, it might not be the same as the "old school" version. "Due to the lack of evidence for strict bed rest, 'modified bed rest' or 'light activity' are more frequently prescribed," explains Dr. Bolt. Translation: If a woman is really active or has a physically demanding job, she might just need to reduce the amount of working out she's doing or stop working, but continue with her normal daily activities, which could be helpful.
Though it seems like most of the evidence points to avoiding bed rest altogether, "the decision for bed rest should be made between the patient and her provider," recommends Dr. Bolt. "At the end of the day, the benefits would need to outweigh the risks."
How would you feel about being prescribed bed rest?
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