While bed rest was once a common recommendation for pregnancy complications, experts now say there's little evidence it improves outcomes. Instead, health care practitioners are more likely to recommend modified activity based on your individual needs. 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 is bed rest?
Bed rest — increasingly known as activity restriction — can mean different things to different practitioners, 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% of pregnancies in the United States each year. But whether you'll be asked to actually "put your feet up" really depends on your practitioner and your specific pregnancy.
A growing number of practitioners 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.
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 practitioners 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 women 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, blood thinners, and/or leg compression devices to prevent leg clots.
Get more expert advice and connect with other pregnant moms who have similar concerns in our free What to Expect app.
Why might my doctor prescribe activity restriction during pregnancy?
Certain pregnant women are more likely to wind up on activity restriction, including those with certain chronic conditions. Some pregnancy complications may also prompt your practitioner to recommend reducing your activity, although research has not shown that activity restriction improves outcomes for most of these conditions:
- Preeclampsia: Also known as pregnancy-induced hypertension (high blood pressure), preeclampsia may occur in up to 8% of pregnancies. Because delivery is the only definitive treatment for preeclampsia, the goal of bed rest is simply to prolong the pregnancy long enough to make sure that delivery is safe.
- Preterm labor: Pregnant women who begin having contractions 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: If you're carrying multiples or have a history of cervical insufficiency, your practitioner may monitor your cervical length with transvaginal ultrasound. 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) to help prolong the pregnancy for as long as possible.
- Impaired fetal growth: Also known as fetal growth restriction (FGR), some practitioners may prescribe modified activity levels or even bed rest if you're diagnosed with this condition.
Some practitioners believe activity restriction may reduce pressure on the cervix and lessen physical strain while increasing circulation to your uterus — though evidence supporting these benefits is limited. If your practitioner prescribes some level of activity restriction and you're not sure why, ask. They 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 inactive for long periods of time comes with its share of drawbacks — which is why many practitioners are likely to be cautious about 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
- 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, it may also affect your baby's growth.
Research also suggests prolonged inactivity may increase the risk of depression and anxiety during pregnancy and after birth. 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 I 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 practitioner exactly which activities are allowed (and which aren't), use these tips to minimize some of the side effects.
Physically
Given the reservations many practitioners 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:
- Stay as active as your provider recommends. 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! Drinking enough water is especially important during pregnancy. 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 however you can. And don't forget to check in with your favorite WTE group. You might meet other moms-to-be going a little stir-crazy. "I would encourage you to set up friends to visit you whenever they can," advises What to Expect Community member hailey4589. "Space the visits out so it occupies your time."
- 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. "I think breaking up your day is most important, and having some sort of routine," says Community member entchg, who was on activity restriction for eight weeks with her first baby. "I'd break it up into a morning chore, afternoon chore, and evening chore."
- 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.
- Take an online class. This can be anything from a one-hour workshop to a weeks-long class, depending on your interests and commitment. "I took advantage of the free time last pregnancy by getting taxes done and continuing professional education for my CPA license," says Community mom pwmeritt, who was on hospital bedrest.
- Prepare for baby. Use this time to shop online and gather everything you'll need for your baby. Register for baby gear online, grocery shop, order your crib, or find a doula, lactation consultant and babysitter.
- Stream some shows. Catch up on a favorite series or movie.
- Get crafty. Teach yourself to knit, crochet, scrapbook, or embroider (or have a talented pal come over and teach you!). "I started knitting little hats for them," says Community mom watermelonwatermelon, on hospital bedrest with twins.
- Organize. Upload photos into a digital frame, or transfer your phone contacts 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, 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. "I enrolled in a virtual face yoga daily class, which has been a lifesaver!" says Community mom lillia33.
- 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.
"I'm going stir crazy and it's only been a week," laments Community mom Gradu8in2003.
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 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.
In some cases, your partner may be responsible for most of the household chores, errands, and meals. Intercourse might be taken off the table, too (though 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 they have a support system in place.
"My husband is home dealing with our son and trying to keep track of everything and get things ready as I direct him," says Community mom rbates11. "We're not sure who has the harder job in this situation!"
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.
"I've been doing a ton of outdoor time with my toddlers (2 and 3)," says Community mom ely1119. "I fill up the water table and let them go nuts making mud puddles while I sit and watch on the patio."
"We put a little twin mattress on the floor in the living room and set up a snack station so my 1.5-year-old can grab what he wants, and I can open it for him. He had an adjustment period from me not picking him up or doing much, but me being at his level on the floor helped a lot — to cuddle, play with the toys he brought me, etc."
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. Once your practitioner says it's safe, walking, yoga, and swimming can be good ways to gradually rebuild strength and endurance. Don't worry. With consistent effort on your part and help from your practitioner, family, and friends, you'll get there!
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