Bed rest is often prescribed during pregnancy when there are complications or concerns about the health of the mother or baby. Determining how long bed rest should last depends on the individual circumstances and reasons it was recommended in the first place.
What is bed rest?
Bed rest refers to limiting physical activity and staying in bed for most of the day. It can range from complete bed rest where the mother can only get up to use the bathroom to partial bed rest where some walking and activity is allowed. The goal of bed rest is to take stress off the body and promote an optimal environment for the baby to grow and develop.
Why is bed rest prescribed during pregnancy?
There are several reasons a doctor may recommend bed rest during pregnancy including:
- Preterm labor threats or history of preterm birth
- Pregnancy-induced hypertension (PIH) or preeclampsia
- Placental problems like placenta previa or placental abruption
- Incompetent cervix or cervical insufficiency
- Multiple pregnancy (twins, triplets, etc)
- Intrauterine growth restriction (IUGR)
- Gestational diabetes
- Reduced amniotic fluid
- Fetal distress
The goal of bed rest in these situations is to reduce complications and help the mother carry the pregnancy closer to full term.
How strict should bed rest be?
The strictness of bed rest will depend on the severity of the condition and specific risks. Recommendations may include:
- Complete bed rest – The mother can only get up for bathroom purposes and remains lying down at all other times.
- Strict bed rest – The mother stays in bed but can sit up for meals or showering.
- Modified bed rest – The mother can get up for limited periods each day but spends most of the time reclining or lying down.
- Ambulatory bed rest – The mother is encouraged to rest and limit activity but can still move around more freely.
More severe complications like preterm labor, incompetent cervix or placenta previa often warrant strict complete bed rest. Other conditions like IUGR or hypertension may only require modified bed rest. The doctor will make recommendations based on the individual situation.
How long does bed rest usually last?
There are no definitive guidelines on exactly how long bed rest should last. Some general recommendations are:
- Preterm labor before 34 weeks – Complete bed rest until delivery or 34 weeks.
- Preeclampsia before 34 weeks – Complete bed rest until delivery or 34 weeks.
- Placental complications – Strict bed rest until delivery.
- Cervical insufficiency – Complete bed rest from diagnosis until viable gestational age.
- IUGR – Modified bed rest for remainder of pregnancy.
- Gestational diabetes – Modified bed rest if needed for glucose control.
However, the duration of bed rest is ultimately determined on a case by case basis. The healthcare provider will monitor both mother and baby closely and decide when activity can be increased or resumed. Some factors that determine duration include:
- Gestational age at diagnosis and delivery goals
- Severity of the condition
- Response to treatment
- Results of tests like cervical length measurements, biophysical profiles, amniotic fluid levels, etc.
- Presence of other complications
- Overall health and risk factors of the mother
How is the effectiveness of bed rest monitored?
While on bed rest, the mother and baby will undergo regular tests and monitoring to assess their status. This helps determine if the bed rest is having the desired effect. Some methods include:
- Contraction monitoring – For preterm labor to see if contractions have decreased.
- Cervical checks – To evaluate any cervical changes with dilation, effacement, or cervical length.
- Ultrasounds – To visualize baby’s growth and amniotic fluid levels.
- Kick counts – To check on baby’s movement and activity.
- Biophysical profile – Combination of ultrasound and fetal movement scoring.
- Blood and urine tests – For issues like preeclampsia and gestational diabetes.
Results from this monitoring will help the doctor determine if the bed rest restrictions can be eased, extended, or if delivery should be considered.
Are there any risks to prolonged bed rest?
While bed rest has its benefits, remaining inactive for long periods does come with some potential risks including:
- Loss of muscle tone and strength
- Bone density loss
- Joint stiffness
- Increased risk of blood clots
- Skin breakdown
- Mood changes like depression or anxiety
To minimize these risks, some activity may be allowed even in strict bed rest. This can include periodic stretching, range of motion exercises, or short supervised walks around the room or house. Supportive measures like compression stockings, medication, and counseling may also help manage extended bed rest.
What can be done while on bed rest?
Bed rest can be challenging both physically and emotionally. Here are some tips for making it more manageable:
- Set up a comfortable resting area with pillows, blankets, entertainment, and conveniences within reach.
- Stay hydrated and eat a healthy diet.
- Alternate positions between lying on your side, propped up, and reclined.
- Perform light range of motion exercises.
- Practice relaxation techniques like meditation or yoga.
- Stay connected with loved ones through social media, phone calls, visits.
- Take up hobbies like reading books, audiobooks, drawing.
- If approved, go for short supervised walks.
- Get counselling or join a support group if struggling emotionally.
Having a good support system is also key. Loved ones can help with meals, house chores, running errands, transportation to appointments and providing mental health support.
When can normal activity be resumed?
Returning to normal activity should be a gradual process, not done all at once. Guidelines include:
- Discuss with your healthcare provider when you can start being more active.
- Begin with short, supervised walks around the house building up distance and duration slowly.
- Gradually increase standing and sitting but still rest frequently.
- Slowly resume household tasks but avoid heavy lifting, straining or long periods on your feet.
- Build back strength and endurance with light exercise.
- Continue monitoring kick counts and contractions.
- By 37-40 weeks, most activity restrictions can be lifted as delivery approaches.
Increases in activity should be done slowly and only with your healthcare provider’s approval. Let them know if you have any concerning symptoms like contractions, bleeding or decreased fetal movement.
Conclusion
Determining the ideal duration of bed rest in pregnancy depends on the individual’s health, risks and response to treatment. While there are general guidelines based on the condition, regular monitoring and assessments should guide whether strict bed rest can be relaxed or needs to remain in place. With some adaptations and support, bed rest can be managed safely and help support the best outcome for mom and baby.