Best rest is a time-honored tradition in obstetrics. According to a recent study in Obstetrics and Gynecology (a reliable and prestigious journal in my specialty) one in five women are put to bed for a week or more during their pregnancies. I have known of women who were put at bed rest for seven months of their pregnancy.

Bed rest is commonly recommend for bleeding in early pregnancy. Common sense seems to say, if a pregnancy is having trouble establishing itself maybe not shaking it up may help it to recover. Unfortunately, this study demonstrated no decrease in miscarriages with bed rest.

Two-thirds of miscarriages have some chromosomal abnormality. Miscarriages are very likely programmed into a pregnancy from the very onset, and there is little that can be done to prevent a pregnancy loss that is going to happen. This is why I feel confident telling my patients not to harbor guilt for a miscarriage. There was nothing that she did that caused it, nor could she have done anything to prevent it.

Premature labor is another reason women are put at rest during pregnancy. This study found no evidence that this was beneficial in singleton pregnancies, although it may be helpful in prolonging the pregnancies of twins, triplets, etc.

For women with elevated blood pressure in pregnancy, bed rest is frequently used to manage blood pressure without medications in an attempt to prolong the time until delivery is necessary. This study found bed rest may be helpful in only some forms of pregnancy-related hypertension.

This study found that bed rest is very disruptive to a woman’s life, and was estimated to cost one billion dollars in home and hospital costs, lost wages and lost productivity. Bed rest also may not be without risk because blood clots tend to form in the veins of pregnant women who are immobile more easily than those who are up and about. Loss of bone mass and muscle tone also occur.

Strict bed rest is also very hard to accomplish; and a poor outcome in a woman put at rest may cause guilt even though a few lapses in her bed rest had nothing to do with what occurred.

The author of this paper, Dr. Robert Goldenberg, recommended further study into the benefits of bed rest. He advised that its recommendation to many women be reduced until proof of benefit is found. This will be hard to do. As a physician caring for a patient with a problem, one wants to be able to offer something. As a patient with a problem to be able to do something proactive can offer hope; and sometimes hope is the best, and also the only, medicine currently available for the problem.


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