Surviving Pregnancy Bed Rest
By Alice Y. Chang, M.D.
Brigham and Women's Hospital
I used to envy women on pregnancy bed rest. It sounded like a perfect opportunity to catch up on work, read books and magazines, and watch movies. Then it happened to me. During my six weeks of forced immobility, I quickly discovered that bed rest is no holiday.
In about one out of 500 pregnancies, a woman will need bed rest. Common reasons for bed rest include: preterm or early labor, vaginal bleeding and an incompetent cervix (where the opening to the uterus widens early), and multiple-birth pregnancies, now more common because of in vitro fertilization (IVF).
While many obstetricians prescribe bed rest for these conditions, there are few studies proving that bed rest is successful in all of these cases. The best evidence is available for an incompetent cervix. By resting and staying horizontal, a woman can take the pressure off an incompetent cervix and prevent premature labor and delivery.
Why then do so many obstetricians prescribe bed rest? With few other treatments to offer, putting a mother on the sidelines gives her the best chance of carrying the baby to full term. It makes sense that by resting and keeping the uterus horizontal, you can help to decrease contractions and give the sources of bleeding a chance to heal. Even in the case of a preterm delivery, bed rest may buy the baby a little more time in the uterus rather than in the neonatal intensive care unit. More important, bed rest helps a woman feel she is able to help her baby during a high-risk pregnancy.
Not All Sweet Dreams
If a friend or family member is on bed rest, be sure to consider the following:
How You Can Help
Resting often causes restlessness. Bed rest gives a woman countless hours to think about everything that might happen before the delivery. Instead of enjoying a normal pregnancy, a future mother must consider that the pregnancy is likely to be anything but routine.
Lying horizontally hampers work.
Bed rest often requires a woman to strictly lie on her side or back. My imagined "holiday" quickly turned into trials and tribulations due to the limits of what I could do lying down. I found it difficult to do even routine activities such as reading, eating, writing or using a laptop without being able to sit up.
Asking for help is never easy. If bed rest is necessary, women who work outside the home have to tell their employers about the pregnancy, if they don't already know, and request additional time off from work. Women who work inside the home must recruit help from their partners or husbands, family and friends or hire extra help to take care of daily activities, from car pools to cooking. Having to rely on others completely can leave a woman feeling helpless, guilty, angry and/or depressed.
There are many small and big ways that friends can help a woman during bed rest:
The Bottom Line
- Stay in touch. You can make a real difference to someone with a simple phone call or a short visit. Personal contact may help your friend feel less isolated and help to make her time stuck in bed go by faster.
- Offer to run errands. If you are on your way to the market, post office or dry cleaner, double-up your duty to help your friend. Call and ask if you can drop off or pick up anything for her. If your children go to school or after-school activities together, offer to take over carpool responsibilities. So your friend doesn't feel guilty, tell her how she can pay you back in the future.
- Set up a bed-rest survival station. To help her remain active and able, set up an easy-to-access tray for books and/or a laptop. (Set up the tray on a slant.) Providing Internet access will allow her to surf useful sites such as www.sidelines.org, where she can find information, partner up with an e-mail or phone buddy, and participate in a chat. She also can shop online for services and for the baby. In addition, bring in a bedside cooler or small table with snacks, drinks, lotions, tissue, pens, pencils, paper, scissors and other useful supplies.
- Encourage your friend to get clear instructions from her doctor. Depending on her situation, she may be able to have a few minutes or even hours out of the bed. Make sure she asks about, or help her to find out, whether she can go to the bathroom, take a shower, make a meal or sit upright in bed or a chair.
- Prepare your friend for life after bed rest. After your friend comes off bed rest or delivers her baby, she will still need your support as she slowly resumes normal activities. You might want to work with her to set up a gradual schedule for getting back into her normal life — from work to errands. In addition, she may need emotional support, as she can expect to feel wary about her new upright status and whether she will experience any new problems or complications.
My bed rest experience opened my eyes to what I should do and say as a physician — and as a friend — to help women prepare for this prescription. The next time you hear about a friend on bed rest or if you face this yourself, you will also be armed with the knowledge about what you can say and do to help.
Alice Y. Chang, M.D., is an instructor in medicine at Harvard Medical School, and on the faculty of the Department of General Medicine at Brigham and Women's Hospital. Her clinical interests and experience are in the fields of primary care, women's health, hospital-based medicine, and patient education.