Bed rest. On the face of it, it sounds so relaxing, almost like a vacation. Lie in bed or on the couch ... read or watch television ... take a little break from "real" life. But these are two words that no pregnant woman wants to hear -- whether the doctor's order comes at 16, 26, or 36 weeks of pregnancy.
The need for bed rest is surprisingly common during pregnancy. Roughly one in five women spends part of her term in bed as a treatment for a host of pregnancy-related issues.
Women who are in danger of delivering too early, for example, may be confined to bed. Those who have certain medical conditions, like preeclampsia, a short or weak cervix, premature rupture of membranes, risk of miscarriage or chronic heart disease, are often required to stay in bed (or on a sofa) for days, weeks, or even months, during pregnancy. In some cases, women are admitted to a hospital and stay in a bed where they can be monitored 24 hours a day.
Lying down, according to the American Congress of Obstetricians and Gynecologists (ACOG), lowers stress on mom's heart, kidneys, and other organs and reduces the pressure of the baby on the cervix, which in turn decreases the risk of premature contractions. Rest also increases blood flow to the placenta, so baby gets more nutrients and oxygen.
Interestingly, though, most studies show that bed rest does not decrease the incidence of preterm delivery, although it may help in the case of triplets. For this reason, ACOG concludes that bed rest is ineffective in preventing premature delivery. In addition, a review by the Cochrane Collaboration, which evaluates the evidence for particular treatments, found there was not enough research to know whether bed rest was effective in preventing miscarriage.
Indeed, bedrest seems to be declining in popularity. A study of more than 600 women with a short cervix, known to be a risk factor for preterm labor, found that bedrest did not reduce the chances of entering labor before 37 weeks, according to a study in the June 2013 issue of the Journal of Obstetrics and Gynecology (Premature birth now includes babies born at 38 weeks).
In addition, the women who were on doctor-prescribed bedrest were more likely to have a premature birth than those who stayed on their feet. Two editorials in the same issue of the journal called for an end to the practice in all but the most extreme cases.
How long should bed rest be?
Some women are advised to lie down for a few hours each day; others must stay in bed and aren't even allowed to get up to shower. If your doctor has ordered bed rest for you, make sure you understand why and know how much activity you're allowed. Here are some questions to ask:
- Do I need to stay in bed all day? Know your specific parameters. Ask your physician exactly what she means by bed rest. Do you need to lie in a certain position, i.e., on one side or the other, propped up, or with your feet up?
- Are there any activities I can safely do on my feet? Again, you must ask your physician for specifics. You may be able to get up to shower and use the bathroom, or your physician may prefer that you have sponge baths and use a bedpan. You may be able to stand long enough to cook one meal a day, but you might have to rely on friends, family, and local takeout for meals. If you have older children, you may need to make arrangements for their care. If you work, perhaps you will be permitted to do some work from home, but your physician may prefer that you just rest quietly.
- Can I exercise? Ask your physician if you can safely do any exercises to keep your blood flowing and your muscles loose. He might say that Kegel exercise (muscle exercises that tighten the pelvic area), deep breathing exercises, pelvic tilts, neck circles, and even leg lifts are safe to do from your bed or couch. If you can't do these kinds of exercise, ask your doctor what you can do to keep your blood circulating and avoid bedsores, backaches, and blood clots from lying in one spot all the time.
What can I do while I'm confined to bed rest?
No matter how long you have to stay in bed, these tips will help you get through this time as easily as possible.
- Accept all offers of help. This is no time to prove how independent you are. When neighbors, friends, family, or your spouse offer to cook, clean, and care for you, don't feel guilty about saying yes.
- Eat a sensible and healthy diet. Unless your physician has given you specific instructions to increase your calories, don't think of bed rest as a free pass to gluttony! Continue to eat nutritiously and drink plenty of water. Extra pounds can be bad for your health and that of your baby and can make it harder for you to get back in shape after the birth. Keep a basket of nutritious snacks next to your bed or couch -- things like whole-grain crackers, fruit, and cereal bars are ideal.
- Make your surroundings more comfortable. Ask a close friend or a partner to set up a room where you will be comfortable for the duration of your bed rest. You want to keep things like a television remote control, telephone, books, magazines, paper, and pen, and maybe even a laptop computer within easy reach. Ideally, you should be resting on the same level of the house as your bathroom to avoid having to use the stairs.
- Pamper yourself. Fill a basket with your favorite hand cream, nail polish, a hairbrush, makeup, etc., so you can indulge in some pampering when you're bored. Maybe your partner or a friend can give you a foot massage -- or you could hire someone to come to the house and give you a facial or pedicure as a special treat when your spirits need a lift.
- Line up some interesting things to occupy your time. Ask your partner to buy you some favorite magazines or a couple of paperback books. Consider signing up for a movie delivery service such as Netflix, or ordering a movie channel for your television. You may even be motivated to organize photo albums or other paperwork, which you should be able to do while lying down. If you knit or do needlework, this is a great time to catch up on those projects you've been putting off.
- Create a schedule. Even though you won't be leaving the house, it may help you get through each day if you have a schedule, just as you do when you're not homebound.
- Daydream about your baby. No matter how difficult bed rest is, remember that you're doing the best thing for your growing baby. Keep a journal about your pregnancy or write notes that you can put in your baby's scrapbook.
- Find support. For more information about making the most of bed rest, visit www.sidelines.org, a support group for women facing bed rest. Talking with other women who have gone through the same experience can be comforting -- and they may have some suggestions for passing the time that you haven't thought of.
Finally, don't forget why you're confined to bed in the first place. Relax as much as possible and try not to get stressed about all the things you can't do. Remember that by staying in bed, you're doing something important -- taking the best possible care of yourself and your baby.
American Pregnancy Association. Bed Rest During Pregnancy. Updated October 2008. http://www.americanpregnancy.org/pregnancycomplications/bedrest.html
Robert Johnson, M.D., editor-in-chief. Mayo Clinic Complete Book of Pregnancy and Baby's First Year. William Morrow and Company, Inc. New York. Why Bed Rest, p. 248-256.
Bed Rest During Pregnancy for Preventing Miscarriage, The Cochrane Database of Systematic Review, Issue 4, 2005.
Hospitalization and Bed Rest for Multiple Pregnancy. The Cochrane Database of Systematic Review. October 2005.
The American College of Obstetricians and Gynecologists. Planning for Pregnancy, Birth and Beyond. Second revised edition. Signet. New York. p. 156-157.
Goldenberg RL, et al. Bed rest in pregnancy. Obstetrics and Gynecology. 84(1):131-6.