Bed Rest: The Prescription That Did Everything Except Work
We prescribed it for preterm labor, preeclampsia, and growth restriction. It helped with none of them.
“Rest will help the baby.”
It sounds like the most benign prescription in medicine. Go home. Put your feet up. Stay in bed. Your doctor is telling you to do less. How could that possibly be harmful?
For decades, obstetricians prescribed bed rest for nearly every complication of pregnancy. Preterm labor. Preeclampsia. Intrauterine growth restriction. Multiple gestations. Placenta previa without active bleeding. Short cervix. The rationale seemed intuitive: rest would reduce uterine activity, lower blood pressure, and improve placental blood flow.
The rationale was never tested before it became standard practice.
When it was finally subjected to rigorous evaluation, the results were consistent across every indication: bed rest did not work. Cochrane systematic reviews found no benefit for preterm labor, preeclampsia, or growth restriction. Not “uncertain benefit.” Not “possible benefit in selected cases.” No benefit.
But the evidence of harm was substantial. Women on bed rest developed deep vein thrombosis, pulmonary embolism, bone loss, muscle atrophy, deconditioning, depression, and anxiety. Many lost income, insurance, and their sense of identity. Some lost their jobs.
The Society for Maternal-Fetal Medicine formally recommended against activity restriction for prevention of preterm birth in 2016. That was roughly three decades after the first negative trials.
For 30 years, we prescribed a treatment that didn’t work, caused harm, and devastated the lives of the women we were trying to help. We prescribed it because it felt right.
🎯 Free Subscriber Bottom Line: Bed rest was prescribed routinely for preterm labor, preeclampsia, growth restriction, and multiple gestations. Cochrane reviews found no benefit for any indication. The harms were significant: thromboembolic disease, bone loss, muscle wasting, depression, and financial devastation. SMFM didn’t formally recommend against it until 2016. Some providers still prescribe it today.
Below, paid subscribers get: - The indication-by-indication evidence analysis with Cochrane findings - The parallel failure of maintenance tocolytics (oral terbutaline, ritodrine, magnesium sulfate) - The documented harms of bed rest with absolute risk numbers - Why the prescription persisted for 30 years after negative evidence - What to say to patients instead of “go on bed rest” - A complete comparison table: indication, evidence of benefit, evidence of harm, year evidence was available, year guideline changed
