When is bed rest recommended during pregnancy?

Tammy had a miscarriage with her first pregnancy. She has just confirmed her second pregnancy. Her parents and her husband want her to quit her job and stay in bed for the first three months to avoid a miscarriage in this pregnancy. However, Tammy's obstetrician has reassured her that she can be as active as she wants and does not need bed rest.

Tamilselvi is carrying twins. Her friends are confusing her — they tell her that she needs to have bed rest to prevent going into premature labour. Does she really need to do that?

When is bed rest recommended during pregnancy?

Bed rest is sometimes prescribed in pregnancy for some women. It is important to know if you really need the rest, what it means and what its side effects are.

Your obstetrician may ask you to be at bed rest when you are having certain complications.

* Vaginal bleeding any time during pregnancy: If there is vaginal bleeding in pregnancy, the obstetrician might be ask you to be at bed rest for a few days till the bleeding stops.

* High blood pressure and/or low weight baby: If you develop blood pressure in pregnancy or the baby is smaller than usual (IUGR), your obstetrician may recommend a certain amount of bed rest. Bed rest during pregnancy increases blood flow to the placenta and can slightly increase a baby's birth weight. You will be asked to lie on your side for an hour or two after each meal and also to try and sleep on your sides at night.

* Contractions or other signs or symptoms of premature labour: Some women may develop mild contractions or leak fluid and the obstetrician may suspect this as a sign of labour starting prematurely. In this case, you may be asked to stay at bed rest for a few days till the contractions/ fluid leakage subsides. You will then be asked to gradually increase your activity.

What does bed rest mean?

Women are under the impression that if they are asked to be at bed rest they should not move at all! Some women will not even get up to go to the bathroom. Except for certain emergencies happening just before the birth of the baby, there is really no reason to be exclusively confined to bed. And in any case, if it is that kind of emergency, you will be in the hospital!

Bed rest during pregnancy simply means decreasing your activity level for a period of time. You can sit and read books, watch TV and gradually graduate to moving about the house. Your obstetrician may ask you to avoid lifting heavy objects and doing heavy housework.

When is bed rest not needed in pregnancy?

* When a woman has had one or two miscarriages earlier, she (and everybody around her) thinks that she should be at complete bed rest in pregnancy to prevent another miscarriage. This is a completely false assumption.

The Cochrane Database (which summarises and interprets the results of medical research) categorically states that ‘there is insufficient evidence to support a policy of bed rest in order to prevent miscarriage.'

In other words, if the heart beat of the fetus is seen on an ultrasound scan, bed rest is not required, except for a few days if bleeding is present.

* Women who are carrying twins do not require bed rest either. They can carry on normal activity and they may continue working if they have a job. Closer to the due date, your obstetrician may recommend slowing down, to prevent premature labour.

There is no situation in a pregnancy where a woman has to be at complete bed rest for weeks or months at a stretch.

What are the harmful effects of complete bed rest?

Complete bed rest is quite a punishment for young women who are used to being active. Not using muscles can cause joint pain and muscle aches. Prolonged bed rest can actually weaken leg muscles and can cause them to thin out. Bed rest also can increase the risk of blood clots, especially in the veins of the legs.

Boredom and anxiety can cause mood swings. If you have another child, he might feel frightened and confused, seeing you confined to bed. For a family that normally depends on two incomes, loss of your job can be a financial stress.

Bed rest without decreasing dietary intake can lead to the piling on of unwanted kilos, which in itself can lead to complications.

The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.

www.passport2health.in

Keywords: pregnancy

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MetroplusJune 28, 2012