Is Bed Rest Necessary in Pregnancy?

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Some negative effects of maintaining bed rest during pregnancy include deep vein thrombosis, decreased bone mass, an overall decrease in conditioning, and an increase in the development of mood disord
Some negative effects of maintaining bed rest during pregnancy include deep vein thrombosis, decreased bone mass, an overall decrease in conditioning, and an increase in the development of mood disord

Over the years, clinicians have advised bed rest for pregnant patients who present with a variety of conditions. Although many providers still believe that bed rest is a reliable precaution for women at increased risk for preterm delivery, experts now routinely warn against bed rest in most situations. 

According to the Mayo Clinic,1 even when a patient's condition warrants bed rest, it should be done with as much moderation as possible, with activity-restriction levels varying in order to keep pregnant patients as active as possible. This might include limiting or avoiding certain activities such as strenuous exercise, lifting, and other intense activities.

Pelvic rest is different from bed rest and describes the avoidance of certain activities for patients with conditions such as placenta previa. Pelvic rest may include avoiding actions that place pressure on the pelvis or pelvic muscles, such as intercourse, douching, or using tampons.

According to information from the Mayo Clinic website, some of the negative effects of overprescribed bed rest include deep vein thrombosis, decreased bone mass, overall decrease in conditioning, and increased occurrence of depression and anxiety disorders.  

Information from the Mayo Clinic also outlines some helpful tips for pregnant patients facing recommendations of increased bed rest and decreased activities. Such patients are advised to press for clear explanations from their clinician about why bed rest is necessary, whether pelvic rest would serve as an alternative to bed rest, what modifications are suggested and what activities are appropriate, and specific recommendations about which sexual activities should be limited and which are unrestricted.

When restrictions on activities are necessary, the Mayo Clinic website also offers these tips for patients to deal with such restrictions when truly indicated:

  • Get organized. Make sure everything you need throughout the day is within reach.
  • Beat boredom. Email, text, or write letters. Organize photos, or start a scrapbook. Shop for baby goods online. Read your way through the bestseller list. Learn relaxation techniques for labor.
  • Stay limber. If your healthcare provider approves, walk, stretch, or do gentle exercises.
  • Accept help. When friends and loved ones ask what they can do, be prepared with a list of tasks — mowing the lawn, putting away the groceries, building the crib, cleaning the bathroom, taking the kids to the park, or keeping you company.
  • Help your older children adjust. Do your best to provide as much stability for the older children as you can. This includes hiring a regular babysitter in the morning, coordinating with a favorite aunt to pick them up from school, or scheduling weekend visits with grandparents. Read books, color, or watch movies together.
  • Seek support. To maintain a positive attitude, connect with other moms-to-be who are on bed rest or those who have been through it. Check for support groups online. If you're having trouble coping, ask your healthcare provider or mental health provider for additional help.
  • Expect emotional challenges. Share your fears, hopes, and concerns with your partner. Let each other vent. If intercourse is not permitted, look for other ways to maintain intimacy.

It is important for physician assistants and nurse practitioners to be aware of the shift away from the overuse of bed rest and the need to provide detailed information for patients when it is thought to be indicated. As the American College of Gynecologists and Obstetricians notes, cautioning against bed rest and promoting safe activities is ideal.2

References

  1. Mayo Clinic Staff. Bed rest during pregnancy: get the facts. Mayo Clinic website. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20048007. Published March 31, 2017. Accessed December 17, 2018.
  2. Did you know? Cautioning against bed rest and why. American College of Gynecologists and Obstetricians website. https://www.acog.org/About-ACOG/ACOG-Departments/Patient-Safety-and-Quality-Improvement/Did-You-Know-Video-Series/Preterm-Birth-Patients/Cautioning-Against-Bed-Rest-and-Why. Accessed December 17, 2018. 
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