US doctors say bed rest should be outlawed as a treatment during pregnancy

Old remedy ... Mounting research shows the century-old prescription of bed rest does not improve outcomes in pregnancy. Picture: Thinkstock Source: Supplied

WHILE doctors continue to prescribe bed rest as a treatment for complications in pregnancy there is mounting evidence it may be doing more harm than good.

Recently the American Society of High-Risk Obstetricians issued a new guideline recommending against the routine use of bed rest in pregnancy. The Society of Maternal-Fetal Medicine guideline said bed rest has not been proven to benefit any pregnancy condition. “We have to stop,” said Dr Anthony Sciscione, the director of the Christiana Care Health System in Delaware and co-author of the guideline.
Bed rest is often recommended for potential complications, such as preterm contractions, dilated cervix from preterm labour, a short cervix, premature rupture of the amniotic sac, elevated blood pressure,
pre-eclampsia, inadequate growth of the baby, placenta complications, risk of miscarriage and pregnancies of multiples. Also referred to as “modified bed rest” or “activity restriction,” bed rest varies in definition, and how and when it is used among practitioners. It can range from resting for a few hours a day to not even being allowed to stand up to shower.
“It’s like obstetric heroin,” Dr Sciscione said, “We don’t want to tell anyone we use it, but we all do.”
When Lindsey Lafferty was 22 weeks pregnant with triplets, her body showed signs that it was preparing for delivery, so her doctor prescribed bed rest.
For most of the past eight weeks, seven of which have been in the hospital, Lafferty has lain in bed, only getting up to use the bathroom, shower or go on a short wheelchair ride.
She misses being home with her husband and 3-year-old son. But she’s thankful she’s made it past 30 weeks, she said. “I think if I was not on bed rest, the babies would’ve already been here.”

Keep active ... Exercise is increasingly being encouraged during pregnancy. Picture: Thinkstock Source: News Limited

Researchers started to question the use of bed rest in the 1980s, and researchers concluded as early as 1994 that doctors should sharply reduce ordering bed rest. Ten years later, nursing professor Judith Maloni called for the use of bed rest to be discontinued until evidence supported its use.
While bed rest might have been first used under the assumption that it didn’t hurt to try, studies show several harmful side effects.
After just a few days of immobility, muscle and bone loss begins. Blood volume decreases, and every major organ system is affected. Blood pressure tends to rise. Women are at an increased risk of weight loss because of these changes and are more likely to have low birth weight babies.
Recovery from birth is also more difficult. In one of Maloni’s studies, she found that 71 per cent of women struggled going up and down stairs, 71 per cent needed assistance sitting, and 14 per cent needed help walking. Researchers fear this could lead to a downward spiral of inactivity across a woman’s lifetime.
Bed rest may increase the risk of developing blood clots in the legs. The clots can move to the lungs, a leading cause of maternal death, and increase the risk of gestational diabetes.
Some studies even show that active women have a significantly lower risk of preterm birth, Maloni reported in her 2011 review. Regular leisure physical activity also appeared to protect against low birthweight babies, gestational diabetes and pre-eclampsia — perhaps because exercise improves blood flow and reduces oxidative stress and inflammation.
Women on bed rest are at increased risk of anxiety and depression, which is also associated with poor birth outcomes, studies show. Patients report feeling isolated, scared and out of control. Other family members are stressed, and a majority faced financial difficulties because of loss of income.
Bed rest, however, is so prevalent that many pregnant women come to expect it or even self-prescribe it, Dr Sciscione said, especially when pregnant with twins. Mothers send him letters calling him crazy, he said, because they believe bed rest saved their babies. Because the practice is so ingrained, Dr Sciscione is not hopeful the new guideline will have much impact.
“Until there is a large study that looks at this,” he said, “they are not going to stop.”