LOUIS, Mo. ó When Lindsey Lafferty was 22 weeks pregnant
with triplets, her body showed signs that it was preparing for
delivery, so her doctor prescribed one of the most common
interventions used to prevent preterm birth: bed rest.
of the past eight weeks, seven of which have been in the
hospital, Lafferty has lain in bed, only getting up to use the
bathroom, shower or go on a short wheelchair ride. She
eventually got to sit upright in a chair for 30 minutes a day,
and recently got the OK to walk down the hallway of the
antepartum unit at Mercy Hospital St. Louis.
was exhausting," said Lafferty, 31, of OíFallon, Mo.
worried about being strong enough to take care of three
newborns. She misses being home with her husband and
3-year-old son. But sheís thankful sheís made it past 30
weeks, she said. "I think if I was not on bed rest, the
babies wouldíve already been here."
scientific evidence, however, paints a different picture.
Mounting research shows the century-old prescription of bed
rest does not improve outcomes and, worse, is causing more
harm than good.
the nationís society of high-risk obstetricians issued a new
guideline recommending against the routine use of bed rest in
pregnancy. The Society of Maternal-Fetal Medicine guideline
said bed rest has not been proven to benefit any pregnancy
have to stop," said Dr. Anthony Sciscione, the director
of the Christiana Care Health System in Delaware and co-author
of the guideline.
is often recommended for potential complications, such as
preterm contractions, dilated cervix from preterm labor, a
short cervix, premature rupture of the amniotic sac, elevated
blood pressure, pre-eclampsia, inadequate growth of the baby,
placenta complications, risk of miscarriage and pregnancies of
referred to as "modified bed rest" or "activity
restriction," bed rest varies in definition, and how and
when it is used among practitioners. It can range from resting
for a few hours a day to not even being allowed to stand up to
started to question the use of bed rest in the 1980s, and
researchers concluded as early as 1994 that doctors should
sharply reduce ordering bed rest. Ten years later, nursing
professor Judith Maloni called for the use of bed rest to be
discontinued until evidence supported its use. More than a
half dozen comprehensive reviews of studies have been done,
each concluding that bed rest has not been shown to achieve
the research, the use of bed rest has changed little over the
years. About one in five women are placed on bed rest during
their pregnancy ó or about 1 million women a year. Surveys
show nearly all obstetricians report prescribing it, while at
the same time, they admit expecting little benefit from the
like obstetric heroin," Sciscione said, "We donít
want to tell anyone we use it, but we all do."
said he suspects thatís because medicine lacks good
interventions for preterm birth, the leading cause of infant
morality and morbidity, and doctors have a hard time doing
like the Linus and his blanket. They just canít rid of
it," he said. "Patients want it, and we want to give
it to them, but this is just a bad thing to give them."
guideline, researchers hope, will accomplish what study after
study hasnít ó send a clear, unified message that bed rest
feel like we so really needed to put out a statement to put
practitioners up to speed, but also itís important to
educate the public as well," said Dr. Alison Cahill,
chief of the maternal-fetal division at Washington University
School of Medicine. "Itís hard to believe itís true
that something weíve been doing for a long time is not good,
but that really is the case with bed rest."
large hospitals have had antepartum units, caring for
high-risk pregnant women like Lafferty, for decades. The
director of maternal-fetal medicine at Mercy Hospital St.
Louis, Dr. James Bartelsmeyer, said his staff discussed the
new guideline at their weekly meeting. He said they agreed the
key word in the guideline was "routine," and it
should be reserved for rare cases.
donít believe that routine use of bed rest is appropriate,
but patient care needs to be individualized,"
Bartelsmeyer said. "In some cases, it is appropriate to
use activity restriction."
bed rest has not been proved to benefit any condition, more
stringent studies could prove otherwise, he said. "I
think we all would like more data in these areas, but it is
who cares for patients at Barnes-Jewish Hospital, said the
antepartum unit is no longer used to make sure women are
adhering to bed rest. Patients in the unit have conditions
that require close monitoring and frequent tests or need
immediate access to intensive care for their babies. Except in
extremely rare cases of severe heart disease, patients are
encouraged to stay as active as possible, she said. "Bed
rest is not something we prescribe any more," she said.
"It simply doesnít work."
bed rest might have been first used under the assumption that
it didnít hurt to try, studies show several harmful side
just a few days of immobility, muscle and bone loss begins.
Blood volume decreases, and every major organ system is
affected. Blood pressure tends to rise. Women are at an
increased risk of weight loss because of these changes and are
more likely to have low birth weight babies.
from birth is also more difficult. In one of Maloniís
studies, she found that 71 percent of women struggled going up
and down stairs, 71 percent needed assistance sitting, and 14
percent needed help walking. Researchers fear this could lead
to a downward spiral of inactivity across a womanís
may increase the risk of developing blood clots in the legs.
The clots can move to the lungs, a leading cause of maternal
death, and increase the risk of gestational diabetes.
studies even show that active women have a significantly lower
risk of preterm birth, Maloni reported in her 2011 review.
Regular leisure physical activity also appeared to protect
against low birthweight babies, gestational diabetes and pre-eclampsia
ó perhaps because exercise improves blood flow and reduces
oxidative stress and inflammation.
bed rest are at increased risk of anxiety and depression,
which is also associated with poor birth outcomes, studies
show. Patients report feeling isolated, scared and out of
control. Other family members are stressed, and a majority
faced financial difficulties because of loss of income.
hospital antepartum units offer counseling and have activities
such as crafts and pedicures, bed rest is most commonly
prescribed to women at home.
having gone through bed rest herself, Elizabeth Lowder started
Sage Tree Therapy a few years ago to help women struggling
emotionally from being on bed rest. She commonly sees women
confined at home because of a thinning cervix, high blood
pressure or placenta problems.
a lot of guilt and shame," Lowder said, "that they
didnít do something right, that they canít play with their
kids, keep up with cleaning the house, or check emails related
rest, however, is so prevalent that many pregnant women come
to expect it or even self-prescribe it, Sciscione said,
especially when pregnant with twins. Mothers send him letters
calling him crazy, he said, because they believe bed rest
saved their babies.
the practice is so ingrained, Sciscione is not hopeful the new
guideline will have much impact.
there is a large study that looks at this," he said,
"they are not going to stop."
is applying for a federal grant to study 1,700 women at high
risk of preterm birth. Half would go on bed rest, while the
other half would continue normal activities. All would be
outfitted with a device that accurately measures their
I think we are going to find," he said, "is that it
doesnít do anything except cause problems for moms, and thatís