The Bed Rest Myth

September 28, 2010 at 10:53 pm

“Bed rest does not appear to improve the rate of preterm birth and should not be routinely recommended.” -American College of Obstetricians and Gynecologists

“The majority of women who are on bed rest don’t need to be, and many experience physical, emotional, and financial complications that are completely unnecessary.” -Mark Taslimi, M.D., professor of maternal-fetal medicine at Stanford University

“Just because something is widely believed doesn’t make it true. Scientifically, bed rest is simply not a valid treatment.” -John Thorp, M.D., a maternal-fetal specialist at the University of North Carolina School of Medicine in Chapel Hill

Disclaimer: Nothing contained in this post should be considered medical advice. If you have concerns or questions, please consult with your healthcare provider.

Several weeks ago, someone I care about was put on bed rest (at seven months pregnant) for some worrisome cramping she had been and continues to be experiencing.  Her situation catapulted preterm labor and bed rest onto my radar screen with big flashing red lights.  I had never really given preterm labor or bed rest much thought because I had never experienced them nor had anyone close to me.  As I started digging into the scientific literature on these subjects, I was totally blown away by what I discovered.  I’ve been researching pregnancy and childbirth topics for over seven years, but, yet again, I’m asking myself, “How did I not know this before?”

Before I dive into those stunning facts, let me first set the scene with the not-so-pretty reality of the bed rest experience.

Bed Rest Challenges

“Rest cure” has been recommended to women as a means of treating a wide variety of physical and emotional ailments since the 1800’s.   Almost a million American women are prescribed bed rest during their pregnancies every year for all types of pregnancy complications.  My heart aches for those hundreds of thousands of women, especially considering all the amazing benefits of remaining active throughout pregnancy.  Bed rest is no vacation.  Bed rest can take an enormous emotional, physical, and financial toll on women and their families.

In her New York Times op/ed piece, “Don’t Take This Lying Down,” Sarah Bilston describes the crippling physical and emotional toll of her experience with bedrest:

Although I was lucky enough to have a supportive family and a husband who could adjust his schedule to work from home, like all women on bed rest I experienced a range of debilitating problems. By the time my bed rest regimen was relaxed in the final week of my pregnancy, I could barely walk. I also experienced intense joint pain from lying on my left side — as directed — 24 hours a day, circulation problems, dizziness, fatigue and the bewildering frustration of a life suspended.

For many women (though fortunately not for me), such feelings of frustration and isolation lead to outright depression, not to mention the burden of lost wages and other financial costs. (Source)

Bed rest depression is real, and unfortunately it is often unrecognized or dismissed by care providers. PregnancyToday reports:

During Amanda Morin’s second pregnancy with bed rest (and bed rest depression), she bottomed out. “I cried all the time, didn’t sleep much and started having dreadful thoughts. . . .'” she says. Her depression, illness and feeling of hopelessness caused her to believe a premature infant would be better than keeping on like she was.

Unfortunately, she wasn’t taken seriously when she requested help. “I talked to my OB/GYN about the severity of my depression and suicidal ideation, but she dismissed it,” says the Bangor, Maine, resident. “I don’t know whether she thought I was being overly dramatic or truly didn’t understand the depth of what I was feeling.” (Shannon McKelden, “Bed Rest Depression: When you’re on bed rest and feeling blue“)

Between the lost income and medical bills, the financial costs of bed rest can also be a substantial and crippling burden. Amie Newman of RH Reality Check discusses this problem in her piece, “Breaking the Bank for Bed Rest.” One of her interviewees, Aviva, was put on bed rest at 22 weeks. Eight weeks later, her water broke, so she spent the next two weeks on hospital bed rest.  Her baby was born eight weeks early. Of that time, she says:

My plan, with my husband, was that I was going to work until the week before the due date so I could be out of work for three months after the baby was born. But immediately that went out the window. . . . That time spent not at work – I couldn’t get any official help. I had three weeks of accrued vacation time and a week of sick leave. I had to get loans from my family. (Source)

The burdens and costs associated with bed rest prompt some women to seek a second opinion when given doctor’s orders to restrict their activity. Just such a scenario proved to be a nightmare for Samantha Burton. At 25 weeks pregnant, her body began threatening miscarriage, but she felt she couldn’t comply with her doctor’s bed rest orders because of her two jobs and young children. She planned to seek a second opinion, but her doctor took matters into his own hands. He obtained a hospital bed rest court order. Yes… a court order. “After three days of hospitalization, she had to undergo an emergency C-section and the fetus was found dead” (Case on Court-Ordered Bed Rest Highlights Reproductive Rights Concerns for Pregnant Women).

Hundreds of thousands of women, approximately one in five pregnant women, endure these perils every year. It’s appalling to me because all these burdens are being suffered for a treatment that has not been proven beneficial.

The Bed Rest Myth

Yes, you heard me right. The benefit of bed rest is largely a wives’ tale. Every year, nearly a million women are submitting or being compelled by court order to bed rest, and science can’t even back it up.

As of September 2003, after reviewing all of the scientific literature on the efficacy of bed rest for preventing preterm singleton births, Cochrane researchers concluded:

Although bed rest in hospital or at home is widely used as the first step of treatment, there is no evidence that this practice could be beneficial. Due to the potential adverse effects that bed rest could have on women and their families, and the increased costs for the healthcare system, clinicians should not routinely advise women to rest in bed to prevent preterm birth. (Sosa C, Althabe F, Belizán JM, Bergel E. Bed rest in singleton pregnancies for preventing preterm birth. Cochrane Database of Systematic Reviews 2004, Issue 1., emphasis added)

Fresh off the presses, a brand new study out of Case Western Reserve University confirms the Cochrane researchers’ findings about preterm birth and bed rest:

Antepartum bed rest/activity restriction (ABR/AR) has been a mainstay of treatment to prevent preterm birth for the past 30 years prescribed for nearly 1 million women in the United States annually, despite a lack of evidence for its effectiveness. In fact, there is increasing evidence that ABR causes several adverse physiologic and psychological side effects among women and their infants. Unfortunately, these findings have had little impact on clinical practice. (Maloni JA. Antepartum bed rest for pregnancy complications: efficacy and safety for preventing preterm birth. Biol Res Nurs. 2010 Oct;12(2):106-24., emphasis added)

As for bed rest’s effectiveness at preventing miscarriage, Cochrane reviewers conclude:

There is not enough information to justify the recommendation of bed rest for women with threatened miscarriage or at high risk of miscarriage. There is currently no evidence to give reassurance that such a policy could not be harmful for women and their families since none of the studies assesses potential side-effects of bed rest (thromboembolic events, maternal stress, depression, costs). Until further evidence is available the policy of bed rest cannot be recommended for routine clinical practice for women with threatened miscarriage or at high risk of miscarriage. (Aleman A, Althabe F, Belizán J, Bergel E. Bed rest during pregnancy for preventing miscarriage. Cochrane Database of Systematic Reviews 2005, Issue 2., emphasis added).

Preterm births are on a troubling rise in the United States.  Preterm labor is not something to be dismissed or minimized.  It can be serious, and the effects of prematurity can be devastating.  But preterm contractions  aren’t, in and of themselves, a recipe for disaster.  80% of women with preterm labor will go on to have full-term births (source).  And the research indicates that those births probably would have gone full-term whether the women were on bed rest or not… except that the women on bed rest would arrive at their births with weakened bodies and possibly broken spirits and bank accounts.

If I had been given bed rest orders a month ago, I probably would have complied without question.  It never would have occurred to me that the benefits of bed rest could be a wives’ tale.  After all, doctors have been prescribing it for decades, and women will do just about anything if they believe it will protect their babies.  Knowing what I know now, I don’t know for sure what I would do, but I certainly wouldn’t comply without question.  I’d definitely consider my options very carefully in consultation with my care providers and husband and seek divine direction.

The intent of this post was not to urge women to disregard their doctor’s or midwife’s orders.  But all of this information was new to me, and I thought it might be new to many of you as well.  It is my hope that raising awareness about this issue might (sooner rather than later) lead to a change in clinical practice.  Talking about this issue may save our daughters and granddaughters from potential unnecessary suffering.

More articles about this subject:

Value of bed rest for pregnant women questioned, By Julie Deardorff, Chicago Tribune

Bed rest questioned, Milwaukee Journal Sentinel

Why I’m resisting bed rest, Katie, Babble’s “Being Pregnant”

Is Bed Rest Bunk? , By Dina Roth Port,