Lori Gray was 27 weeks into her pregnancy and working full time as an elementary school teacher when she received the bad news. During a routine prenatal check, her doctor informed her that her levels of amniotic fluid were high and placed her on strict bed rest.
Gray hated the idea of leaving work, but her concern for the baby was paramount. On doctor's orders, she immediately settled into a daily routine of near complete inactivity.
"The only thing I did for three weeks was walk to the bathroom and the refrigerator," she recalls. "My mother-in-law flew into town and did everything for my husband and me."
Each year in the United States, bed rest is prescribed for hundreds of thousands of pregnant women considered to be at increased risk for preterm delivery. The use of bed rest is based on two important assumptions: that it is effective in prolonging pregnancy and that it is harmless. Both assumptions are largely unsubstantiated.
"The scientific evidence in support of bed rest is weak," says Dr. Thomas Goodwin, director of maternal fetal medicine at USC's Keck School of Medicine. "It's not science with a capital S."
The reason that bed rest is almost universally recommended for women who go into preterm labor is that physical activity is directly related to uterine activity.
"When you're more active, you have more uterine contractions," Goodwin says. But bed rest doesn't appear to produce the expected results. Guidelines released in 2003 by the American College of Obstetricians and Gynecologists acknowledge that it does not improve rates of preterm birth in these women and caution against its routine use in the treatment of preterm labor.
Bed rest is also commonly prescribed to prevent the development of preterm labor in women who are considered "at-risk." Many doctors routinely place patients carrying more than one baby on bed rest during the last few weeks of pregnancy. They also widely use it to treat women thought to have an incompetent or weakened cervix, women suffering from pregnancy-related high blood pressure and women whose babies aren't growing as well as expected. Abnormal levels of amniotic fluid -- whether too high or too low -- can also trigger a prescription for bed rest, as in Gray's case. And so can abnormalities in the placement or attachment of the placenta.
Whether or not bed rest is actually effective in any of these situations is largely unknown because, unfortunately, the studies simply haven't been done.
