I was on bed rest for five weeks during my third pregnancy. I did everything I was supposed to. Even though it felt impossible to parent my 4 and 5-year-old boys from the couch, it became even more challenging when I was admitted to bed rest in hospital. Who wants to do the wrong thing and risk endangering their future baby? Bed rest in some pregnancies is so normalised that there is a widespread belief it must be good for something or doctors wouldn鈥檛 prescribe it. Right?
Wrong. In the US, the Society for Maternal-Fetal Medicine published the first formal guidance against bed rest in 2014, the American College of Obstetricians and Gynecologists. Trying to be an informed patient, I read published studies that didn鈥檛 support what I was being asked to do. But my doctor insisted. Activity restriction has long been viewed by doctors as a 鈥渃an鈥檛 hurt, might help鈥� approach. It remains one of the most commonly prescribed interventions to prevent premature birth and treat the conditions that can lead to premature labour, with high-risk pregnancies around the world every year.
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But data is overturning this age-old practice and doctors need to catch up. have shown that bed rest helps fetuses gestate longer or have better health outcomes. What鈥檚 more, many studies since the 1950s have documented that bed rest can pose considerable harm to those who are pregnant and their families. While 鈥渢aking it easy鈥� or staying in bed may appear innocent, bed rest demands levels of inactivity that can rapidly reduce heart and lung function, initiate muscle and bone loss, and increase the risk of gestational diabetes, blood clots and deadly pulmonary embolisms. It also isolates women from their communities, increases the risk of anxiety and depression, causes family stress and leads to job instability and lost wages.
Despite this, a 2009 paper in the American Journal of Obstetrics and Gynecology reported that 鈥渆ven though the majority believed bed rest was associated with minimal or no benefit鈥�. A 2022 found that 1 in 3 women considered at high risk of preterm birth were placed on activity restriction by their doctor even though the hospital had a policy against it.
When I transferred hospitals and switched providers, I learned there was a different approach. My new doctor said bed rest wasn鈥檛 an evidence-based intervention and liberated me. My pregnancy was complicated, so I still had to stay in the hospital, but at least I could freely shower, go to the bathroom and move throughout the day.
Even though the data doesn鈥檛 indicate that restricting activity prevents preterm birth, patients listen to their doctors. The 2022 study underscored a compliance rate of 100 per cent as 鈥渁 strong reminder of the impact prescribing patterns of physicians can have on patients鈥�. We know research takes a long time to make its way into everyday medical practice, on average 17 years. We also know that pregnant people and their families can鈥檛 wait 鈥� they need evidence-based support right now. There is no evidence to suggest that mothers-to-be can safeguard the health of their future babies through bed rest.
After my experience, I worked with other parents of babies in neonatal intensive care units, as well as doulas, as an advocate and support group facilitator. Even the most informed parents worry about pushing back when their doctor recommends bed rest. Doctors need to do a better job of listening to the data and their patients鈥� legitimate concerns. And, if need be, parents-to-be should be willing to find a new provider who respects the evidence.
Jacqueline Sears is a聽science writer based in聽Richmond, Virginia
