The Truth about Bed Rest

iStock_000014892681XSmall-300x199“A business trip?” I was incredulous.

“I’ll make sure to sit the entire time,” my patient assured me with great seriousness.

“I guess, if you have to.” I admit it: there was a hint of disapproval in my voice.

My patient’s cervix was 2.5cm at 20 weeks of gestation. I had prescribed progesterone, and modified bed rest – which meant she was supposed to absolutely limit her activities, proscribe lifting weight of any significance, and spend most of her time reclining or lying down.

Now, after four weeks of bed rest, her cervix was unchanged. My emotional response was to be concerned: bed rest was working – why would this patient risk catastrophe by taking a business trip.

“Well,” I said, a bit disdainfully. “They know how to measure cervical length in New York if anything happens.

The truth is that my indignation was unjustified.

There is no credible medical evidence that bed rest prevents preterm delivery in any group of patients – those with preterm labor, cervical shortening, or vaginal bleeding.

Evidence is entirely lacking for the oft-prescribed practice of imposing bed rest for patients with hypertension, fetal growth restriction, or pre-eclampsia.

The Lords of Obstetrics, who hand down the holy “ACOG Practice Bulletins” from on high even proclaim, “Although bed rest and hydration have been recommended to women with symptoms of preterm labor to prevent preterm delivery, these measures have not been shown to be effective for the prevention of preterm birth and should not be routinely recommended. Furthermore, the potential harm, including venous thromboembolism, bone demineralization, and deconditioning, and the negative effects, such as loss of employment, should not be underestimated.” (ACOG Practice Bulletin #127, June 2012.)

Why is it that most obstetricians I know still recommend bed rest, when peer-reviewed literature and the American College of Obstetricians and Gynecologists suggest the practice doesn’t work and might even be dangerous? Here are some possible explanations:

  • Bed rest seems logical: the reclining posture theoretically reduces the force of gravity on the cervix – another theory entirely lacking evidence.
  • It feels better to prescribe bed rest than to tell a patient, “we really don’t have anything to offer you to reduce the chance that you will deliver early.”
  • Women on bed rest are doing something, which feels a whole lot better than doing nothing.
  • If bed rest isn’t recommended, and the patient delivers prematurely, they and their doctor will always wonder whether bed rest would have changed the outcome.

To gain insight into this slightly nutty phenomenon, I asked my friend Angela Davids, the patron saint of women on bed rest, and curator of her website,, to offer her thoughts.

“Based on what I see on the online forum I host for women at risk of delivering prematurely, each woman’s set of circumstances is unique and complicated,” she wrote me in an impassioned email. She poo-pooed my skepticism. “Regarding the frequent statement, ‘We have no proof that bed rest works,’ I say we have no proof that it doesn’t work. How would you create such a study? I doubt there ever will be a controlled study that proves the effectiveness of bed rest, because it would be nearly impossible to find volunteers for a control group.”

Fortunately, research published in the past decade has finally given obstetricians and their patients a treatment for preterm delivery: progesterone injections for women who delivered their last child prematurely, and vaginal progesterone for women with a short cervix.

What do I recommend:

  • Patients who are worried about preterm labor, short cervix, or vaginal bleeding should consult their midwife or physician.
  • I work hard to identify patients who would benefit from progesterone and get them on that medication when appropriate.
  • I believe it is reasonable for women at high risk for preterm delivery to limit strenuous activities or exercises.
  • I have never had a patient suffer long term consequences of bed rest, and since I’ve never met a mother who delivered prematurely who didn’t – irrationally – blame herself, I prescribe activity reduction because it’s something my patients can do.
  • If bed rest is going to interfere with a patient’s need to earn a living, hold down a job, or take care of her family, I support her decision to remain active (and I cite the evidence that bed rest doesn’t help).
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