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Taking to bed Prenatal Care

Taking to bed

Recently more experts are moving away from bed rest recommendations—here’s why and what to do if your doctor prescribes it.

Jessica Hanley was 19 weeks pregnant and feeling great when she went in for a routine ultrasound. “I had no reason to think I would be in the hospital that afternoon and not leave for a week,” recalls the San Diego hairstylist.

The ultrasound showed that her cervix had shortened to “practically nothing” and had begun to funnel. Following an emergency cerclage to stitch her cervix closed, Hanley
was put on bed rest.

Rest might not be best
Since the 1800s, bed rest has been recommended to help women with pregnancy complications carry to term. Complications could mean anything from multiple babies or fetal growth problems to vaginal bleeding or signs of preterm labor. In Hanley’s case, it was an incompetent cervix.

Each year, roughly 20 percent of mothers are put on bed rest at some point during their pregnancy. Hanley, who was put on strict bed rest, was permitted to shower every other day (“They tried to have me maximize my bathroom/shower [time] to five minutes,” she says) and leave the house only for doctor’s visits. In other cases, a mom may be asked to rest for anywhere from one to eight hours a day while avoiding household chores and heavy lifting.

Interestingly, there is no evidence that bed rest is beneficial in preventing preterm birth. In fact, one 2013 study of women with a short cervix found that women prescribed activity restriction were much more likely to deliver early than those who were not.

While the jury is still out on whether bed rest actually works, evidence shows that it might cause harm. The main concern is blood clots. “Pregnancy increases your risk of having blood clots, and then not moving increases your risk even more,” says Linda Szymanski, medical director of labor and delivery at Johns Hopkins Hospital in Baltimore.

Other possible complications include depression, bone loss, weight gain and trouble sleeping. “We also worry about muscle deterioration from just lying around and not being active, which also can be a problem after the baby is born,” says Audrey Merriam, an OB/GYN in Delaware who specializes in maternal-fetal medicine.

In addition to medical concerns, bed rest can take a toll on other aspects of life as well. In cases where both parents are working, the loss of income once the mom-to-be goes on bed rest can result in a tremendous amount of pressure. Partners get loaded down with additional responsibilities, which can cause anxiety and stress, and children often don’t understand why mommy can’t hold them or play.

Alternate route
Neither Merriam nor Szymanski recommend bed rest to their patients, though they may prescribe reduced activity. For instance, “If a woman is a heavy exerciser and has a risk for preterm birth, we might ask that she cut back on the amount of exercise she does,” says Merriam.

If your doctor does prescribe bed rest, talk to her about it. Find out what kind of bed rest she’s recommending and why. You can also mention the lack of evidence to support bed rest. Share any concerns you may have and discuss possible alternatives. It could be that the perceived benefits of bed rest in your situation outweigh the possible risks. Ultimately, if you’re not satisfied with her responses, get a second opinion.

After 17 weeks on bed rest and an additional four weeks following her cerclage removal, Hanley gave birth to a healthy baby boy. Two years later, she and her husband have decided to add a second little one to their family. “That’s another long, hard thing to think about,” she confesses. “It took a while for me to actually go, ‘OK, I think I’m ready now.’” She hopes that, “by some miracle,” this time she won’t have to go on bed rest.