Bed Rest Concerns
Questions to Ask About Bed Rest
By Shannon McKelden
During pregnancy, bed rest may be prescribed for many reasons, including preeclampsia, cervical
shortening/weakness, premature rupture of membranes, placenta previa and, most commonly, preterm
labor. However, the definition of "bed rest" isn't always clear.
"There are different degrees of bed rest," says Shari Criso, certified nurse midwife and owner of The Birth
Boutique in New Jersey (www.birthboutique.com). "It is important for a woman to get clarification and fully
understand why she is being prescribed bed rest, what are the specific limitations and what are the risks
to her and her baby if she is noncompliant."
General Questions
Dr. Seema Venkatachalam, OB/GYN at Northwestern Specialists for Women in Chicago, provides a list of
basic questions every woman should ask when told to go on bed rest:

Why am I being put on bed rest?

How long do you think this will be necessary?

Why do we think this will help me?

Can I be on bed rest at home versus at the hospital?

Does it matter whether my baby is head down versus breech? "In many cases, if the head is
down, a little more leeway is given in terms of activity if the membranes are ruptured since there
is less likelihood of cord prolapse," says Dr. Venkatachalam.

Finally, perhaps the most important question: What does bed rest mean?
"This may have different answers depending not only on the reason it's being prescribed, but even what
the provider's interpretation of bed rest is," says Dr. Venkatachalam.
Mobility Questions
Bed rest doesn't necessarily mean resting in bed 24/7. "For the most literal definition [of bed rest], it can
mean no more than one to two hours out of bed, allowing a woman only to shower and go to the
bathroom," says Dr. Venkatachalam. "This usually is only prescribed if a woman requires hospitalization.
In most cases, if a woman is put on 'bed rest' at home, it means 'modified bed rest.' It means that a
woman should no longer go to work, can move around the home a bit and do no more than light work at
home. Most of the time, she should either be resting in bed or on the sofa."
But even the specifics of modified bed rest must be clarified. Can you go up and down stairs? If so, how
often? Are you allowed to sit up in a chair or work at a desk, or must you lie down? Does lying down
mean flat on your back, on either side, or on a specific side? (Lying on your left side, for instance, eases
pressure on the vena cava, which may be important.)
If light housework is allowed, what constitutes "light?" "Light household chores might be OK, but if the
tasks involve heavy lifting of laundry or multiple trips up and down stairs, it's probably not a good idea,"
says Dr. Benito Alvarez, OB/GYN at Women's Health Institute, Cleveland Clinic. Clarify exactly what is
allowed with your doctor.
While on hospital bed rest, Kelly Damron of Phoenix, Ariz., asked if she could exercise. This is important,
as women on bed rest are prone to blood clots, muscle wasting and deconditioning. "It took a few days,
but I received permission to exercise in bed," she says. "The exercises were simple, but it was helpful to
keep my body moving even though I was bedridden."
"A woman should ask if she is allowed to at least walk and, if so, how much, to try to maintain some
cardiovascular conditioning," says Dr. Venkatachalam.
Getting Specific
There are so many things moms might not think of when it comes to specifics about bed rest. Can you
drive, or do you need someone to drive you? "Ask if you can sit up or have to lie down in the back seat
while driving to your doctor's appointments," says Natalie Caine, a mom from Los Angeles, Calif. "I had to
lie down. I also had to lie down if I was going to attend a birthing class."
Ask about resources available for help. You may find your insurance covers a home health nurse if you
are on strict bed rest. It may also cover renting a hospital bed to make bed rest more comfortable.
Diet may be modified also to prevent constipation, heartburn or other issues related to decreased activity.
Ask your doctor what might be helpful.
Making Sure It's Clear
When discussing bed rest with your doctor, it's very important to be specific about what is expected of
you. In this case, what your doctor doesn't know about your lifestyle can hurt you – or, more important,
your baby.
When Maureen Doolan Boyle was pregnant with triplets, her doctor told her she needed to take it easy
and not do as much as she normally did in her everyday life. "So I did," says Boyle. "I ran only 3 miles a
day instead of 5."
When, at her next visit, she mentioned this to her doctor, he "freaked." "He thought that I was home
eating bon-bons," says Boyle. "I am an exceptionally active person who had a 2-year-old. Bon-bons were
not a part of my life." When he confirmed that he really meant bed rest, Boyle complied.
Now, as the executive director of MOST (Mothers of Supertwins), Inc. (www.mostonline.org), Boyle
regularly works with mothers with high-risk pregnancies, who are expecting triplets or more. "Doctors and
patients need to somehow get on the same page and understand that 'taking it easy' and 'bed rest' might
mean totally different things to different people," Boyle says.
Dr. Alvarez has seen this in his practice. "If a woman has a specific activity she is unsure about, she
should ask," he says. "When I place a patient on bed rest, I usually inquire about their extracurricular
activities. Some have told me skydiving, bowling, etc. On occasion, patients have seemed surprised when
I restrict these because it hadn't crossed their minds."
MOST provides their families with a list of questions to help their doctors become familiar with their
lifestyle. "If you live in a four-story walkup, your doctor needs to know that," says Boyle. "If you have a
long commute to work (with walking involved) and your doctor has you on partial bed rest allowing you to
still work – he needs to know that, too."
Boyle also reminds moms that what is fine to do one week, at your next visit may no longer be
permissible. "You need to bring your checklist with you and review it every week with your doctor," says
Boyle.
One topic women may be uncomfortable talking about with their doctor is sex. "I have spoken with
expectant moms who have said that they are on bed rest and only get up to go to the bathroom, shower
once or twice a week and possibly one meal a day, but they are having sex three or more times a week,"
says Boyle. "When your doctor puts you on bed rest does this mean no more sex? What specifically are
you not allowed to do? A patient (and her partner) needs to have a frank discussion with their doctors
about this."
Whatever your physician's definition of bed rest, it's in your best interest to comply. "Some of the risks if a
woman chooses not to comply with bed rest include preterm delivery, seizures and even maternal or fetal
death in extreme cases," says Criso.
In the end, those few months of inconvenience can help you give your child a better chance at a healthy
life.