Too Early to Bed?

Side effects of bed rest may outweigh the benefits.

I felt so trapped today! Everyone I know is either out and about or could be if they wanted. I have started to feel so angry and resentful. — Jen Douglas, in her journal, May 4, 1997

Jen Douglas was 20 weeks pregnant with her second child when she was diagnosed with a placental abnormality that threatened her fetus’s life. She was restricted to her home for five weeks, then to the hospital, where she stayed in bed for 21/2 months. But did she have to? While Douglas credits bed rest with potentially saving her pregnancy (Carling Fiona was delivered five weeks early by Cesarean section), it came at a price. “I lost so much time with my other child,” Douglas says, “time I can never get back.” Each year, some 700,000 pregnant American women — nearly one in five — are sent to bed for conditions ranging from preterm labor to bleeding problems to high blood pressure. But bed rest has yet to be proven effective for many of the conditions for which it’s most commonly prescribed. In some cases, there’s no doubt it can be a lifesaver. “If there’s bleeding from a hematoma in the first trimester, bed rest may help prevent miscarriage,” says Kenneth Kaplan, M.D., clinical assistant professor of obstetrics and gynecology at New York University Medical Center in Manhattan. “In a situation like placenta previa, where the placenta is blocking the cervix and causing bleeding, being more active may increase blood loss. And in preeclampsia or chronic hypertension, bed rest helps keep blood pressure down.” But some doctors believe bed rest is overprescribed and often unnecessary. “Physicians don’t agree with each other about it,” says Judith Maloni, Ph.D., of the University of Wisconsin School of Nursing in Madison, who headed up a recent study of the practice. “Depending on her doctor, a pregnant woman may or may not be prescribed bed rest, or she may be prescribed less restrictive bed rest than another doctor might order.” In addition, notes Maloni, the doctors she surveyed seemed generally unaware of the potential physical side effects, including muscle weakness or atrophy, as well as loss of weight and calcium from bones. Mental and emotional repercussions include depression, feelings of isolation and strains on the family, financial and otherwise. While Maloni cites studies of twin pregnancies that showed no improvement in outcomes for women who stayed in bed, studies have yet to be done to prove bed rest’s benefit or lack of it for preterm labor, premature rupture of membranes, placenta previa or incompetent cervix. “It is not known if bed-rest-induced changes in muscle and bone are totally reversible, either,” she says. Kaplan, however, believes any side effects are minor and transitory. “These are generally young women, and after a short time, they’re back to normal,” he says. So what should you do if you’re prescribed bed rest? “Seek a second opinion,” says Maloni. “And ask your doctor if he or she is aware of the side effects.” Also ask your doctor or a physical therapist trained to work with high-risk pregnancies which, if any, exercise you can safely do. (For some doctor-approved moves, see “Making the Best of Rest,”) At least until more is known, most pregnant women believe they’re better off safe than sorry. Says one new mother, “If I hadn’t listened to my doctor and something had happened, I would have felt horrible.”