Bed rest — increasingly known as activity restriction — can mean different things to different doctors, from just getting off your feet every couple hours to a hospital stay. It’s estimated that activity restriction is still being prescribed in about 20 percent of pregnancies in the U.S. each year. But whether you’ll be asked to actually “put your feet up” really boils down to your practitioner’s preference.
A growing number of physicians are moving away from the concept of strict bed rest, instead using it only as a last resort. In fact, the American College of Obstetricians and Gynecologists (ACOG)[1] and the Society for Maternal-Fetal Medicine (SMFM) do not recommend traditional bed rest,[2] stating that there is no evidence that it actually helps prevent or treat pregnancy complications.
But that doesn’t mean that your practitioner won’t ask you to refrain from some of your usual activities to protect both you and your baby. Here’s what you can expect from activity restriction, including how to stay mentally and physically healthy when you’re spending less time on your feet.
What are the different types of pregnancy bed rest?
In the past, bed rest was categorized as one of the following: scheduled resting, modified bed rest, strict bed rest and hospital bed rest. But doctors today are moving away from these distinctions, instead recommending one of the following two categories depending on the severity of the pregnancy complication:[3]
- Reduced activity at home/work: Some practitioners may ask you to shorten your workday in your third trimester, schedule regular times to rest and restrict activities such as exercise, stair-climbing and walking or standing for extended lengths of time. But in general, reduced activity outside the hospital means you’re still up and walking around, doing some work, easy errands and light chores.
- Reduced activity at the hospital: Some pregnant people require constant monitoring, which means hospital admission. And just by nature of being in the hospital, you’ll be spending a lot more time in bed. However, given the concerns about prolonged inactivity, doctors often take steps to ensure moms-to-be remain healthy by prescribing light physical therapy during patients’ stays, blood thinners and/or leg compression devices to prevent leg clots and physical therapy with prolonged hospitalizations.
Why your doctor might prescribe activity restriction during pregnancy
Certain pregnant people are more likely to wind up on activity restriction, including those with certain chronic conditions. There are also certain pregnancy conditions that may prompt your doctor to reduce your activity, however, there is little medical evidence to suggest efficacy:
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- Preeclampsia: Also known as pregnancy-induced hypertension (high blood pressure), preeclampsia may occur in up to 8 percent of pregnancies. Since the "cure" begins with delivery, the goal of bed rest is simply to prolong the pregnancy long enough to make sure that delivery is safe.
- Preterm labor: Moms-to-be who begin to contract regularly before week 37 of pregnancy or show other signs of early labor can expect to be placed on bed rest. The goal generally is to try to delay delivery by at least 48 hours so that steroids that speed the baby’s lung development can be administered. Sometimes preterm labor stops — and the mother ends up giving birth at term.
- Cervical changes: Your practitioner will monitor the length of your cervix during regular checkups with a transvaginal ultrasound (the wand inserted into your vagina) routinely if you are carrying multiples or have a history of incompetent cervix. If your cervix shortens early, you may need a cervical cerclage, which essentially stitches your cervix closed, and activity restriction is typically prescribed.
- Multiple babies: Mothers carrying multiples may be placed on activity restriction simply because their pregnancies tend to be more challenging. If you end up in the hospital, you may even be positioned at a slight angle (feet higher than head) so that gravity can help keep your babies growing in your womb for as long as possible.
- Impaired fetal growth: Also known as fetal growth restriction (FGR) some physicians may prescribe modified activity levels or even bed rest if you're diagnosed with this condition.
Doctors who prescribe activity restriction say it can reduce some pressure on your cervix and strain on your heart while increasing circulation to your uterus. If your doctor prescribes some level of activity restriction and you’re not sure why, ask. She should be able to explain to you what the benefits are along with whether or not they outweigh the risks.
Does pregnancy bed rest have any disadvantages?
Being off your feet for a long period of time comes with its share of drawbacks — which is why many doctors are more likely to be cautious of doling out bed rest. Prolonged inactivity can lead to hip and back pain, muscle atrophy (which can make it harder to bounce back once you deliver), skin irritation, bone loss and even blood clots in the legs.
Bed rest may also aggravate many of the normal symptoms of pregnancy, such as heartburn, constipation and leg swelling, as well as increase your risk for gestational diabetes, since your body isn’t breaking down glucose at its usual rate.
In addition, research has established a link between decreased appetite (which can happen with activity restriction), maternal weight loss and low birth-weight infants. In other words, if you don’t have an appetite and therefore aren’t getting enough to eat, there’s a good chance your baby isn’t either.
Medical experts have also warned that prolonged inactivity can lead to depression — and that the depression sometimes hangs around after the baby arrives. Be aware of the signs: unshakable feelings of sadness, loss of appetite and major mood swings. Any pregnant woman may experience each of these symptoms at various times, but speak to your practitioner if these symptoms feel hard to manage.
How can you stay healthy during pregnancy activity restriction?
Bed rest, unfortunately, is no pajama party. Once reality sets in and you realize that you can’t do some of the things you’re used to doing, any appeal is lost pretty quickly. After you find out from your doctor exactly which activities are allowed (and which aren’t), use these tips to minimize some of the side effects.
Physically
Given the reservations many doctors have about prolonged bed rest now, it’s unlikely that you’ll find yourself completely bedridden — and you may be surprised at the things you can still do when you’re being asked to do less. A few suggestions:
- Move what you can. Your practitioner may allow — if not encourage — you to do some low-impact exercise (walks, light weights for your upper body, resistance bands for your lower body) to keep strong enough for delivery, recovery and caring for your newborn.
- Stretch what you can. As much as you can under your practitioner’s guidance, stretch your legs and ankles to help prevent blood clots and keep your muscles strong.
- Monitor what you eat. Be sure you’re following a healthy pregnancy diet. To keep heartburn at bay, try to eat many small meals during the day instead of three big ones. Dried fruit (which is also chock-full of vitamins) will help keep you regular.
- Stay hydrated! You’re eating and drinking for two. And while it’s easy to remember to drink water when you’re being active, it’s easy to forget to drink water when you’re not. Getting enough fluids helps minimize swelling and constipation, especially when you’re moving less.
- Stay comfortable. If you are confined to bed for most of the day, maximize blood flow to your uterus by lying on your side, not your back, and change sides every hour or so to lessen body aches and prevent skin irritations. Put a pillow under your head, a body pillow under your belly and between your knees and perhaps a pillow behind you, if that helps you to balance. Sitting up slightly in bed (especially after eating) helps prevent heartburn.
Mentally
Living with limitations can drive you a bit nuts, especially if you’re normally a very active person. Sometimes keeping yourself busy can provide a welcome distraction. A few suggestions:
- Reach out. Stay connected with your friends and family by phone, e-mail and social media. And don’t forget to check in with your favorite WTE group. You might meet other moms-to-be going a little stir-crazy.
- Structure the day. Try to establish a routine — even if the highlight is a short walk around the block and a soak in the tub.
- Work from home. If your doctor wants you to stick close to the house, ask your boss if you can work remotely. Speak to both your practitioner and your supervisor to be sure everyone is on the same page about what your capabilities and your limits are.
- Prepare for baby. Use this time to shop online and gather everything you’ll need for your baby. Register for your layette online, grocery shop, order your crib, or find a doula, lactation consultant and babysitter.
- Stream some shows. Two words: binge watch.
- Get crafty. Teach yourself to knit, crochet, scrapbook or quilt (or have a talented pal come over and teach you!).
- Organize. Upload photos into a digital frame, or transfer your smartphone address book onto your laptop. You’ll be so happy when you can print out those address labels instead of hand-writing them when it’s time to send out birth announcements (and thank-you notes and holiday cards and party invitations).
- Primp and polish. As long as your doctor’s cool with it, head to a nearby salon for a little pampering, or treat yourself to a DIY facial or pedicure at home.
- Start a journal. Now’s a wonderful time to begin recording your thoughts or writing a few letters to your baby, which preserves pregnancy moments you can share with your child years later.
- Seek support. Bed rest in pregnancy can be very emotionally challenging on moms-to-be, and has been associated with feelings of powerlessness and a sense of a lack of control. If you're struggling with feelings such as these, seek help from a mental health specialist for support.
Remember that you’re simply starting the parenting process a little earlier than most, doing what may be best for your child — even if it’s not terribly fun for you. Every day you take it easy is one potentially more day your baby (or babies) grows inside you, giving him or her (or them) the best chance at being born healthy and strong.
How does pregnancy bed rest affect your family?
Depending on how much your activity is restricted, you may need to make some changes around your home:
- Your partner: Depending on what your doc okays, your partner may be responsible for most of the household chores, errands and meals. Intercourse might be taken off the table, too (although there are other ways to share intimacy and fun), so try to be gentle and patient with each other. Encourage your partner to go out with friends occasionally. And try to make sure that he or she has a support system in place.
- Your children: If you already have children — especially little ones (who just want to be picked up and carted around) — activity restriction can be an added challenge. You’ll probably be looking at less tickle-fights and twirls and more tea parties, books and board games. If at all possible, have someone else take your toddler for a run around outside every day, since burning off some of that energy may facilitate quieter playtime with you.
How does pregnancy bed rest affect you after you give birth?
Keep your expectations realistic after delivery. Cut yourself some postpartum slack, factoring in all your body has been through. Depending on the level of activity restriction, you may not have the same aerobic capacity or muscular strength that you had before.
So give yourself a chance to recover, and plan on building back up to your former fitness level slowly. Walking, yoga and swimming are good activities to do to get back into the game. With consistent effort on your part and help from your practitioner, family and friends, don’t worry. You’ll get there!
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