by Jeri Alper, RN, MSN

We have all had days where the idea of staying in bed under the covers seemed extremely appealing. Unfortunately, for many pregnant women, bed rest during pregnancy is not a luxury, but a medical mandate.

Although bed rest is controversial because the benefits have not been clearly documented in the scientific literature, as many as 20 percent of all pregnant women are confined to a week or more in bed. Preterm labor is the most common condition for which bed rest is prescribed. The rationale for bed rest is that decreasing your activity may help keep your cervix closed, prolong your pregnancy, and increase the likelihood of a healthy baby. Other medical indications are:

• Unexplained bleeding, where bed rest may help to reduce the bleeding.
• High blood pressure, in which rest may actually reduce your blood pressure.

Even though no proof exists, many medical providers believe bed rest is worth the "effort" because it is not harmful. In my opinion, bed rest is not an intervention without side effects. However, armed with knowledge, support, and determination, it is one you can endure.

Bed rest does not mean the same thing for every woman. Variabilities are dependent on each woman, her medical complications, and her healthcare provider. Bed rest may mean 24 hours a day in bed (strict bed rest). Other women may be allowed to get up only to use the bathroom (bed rest with bathroom privileges). For others, limited activity may be prescribed (rest periods in bed with shower privileges, car rides to the doctor, and the ability to make lunch, for example). It is extremely important that you clarify with your healthcare provider your exact activity level. Some specific questions to ask are:

• Can I sit up?
• How long will I be on bed rest?
• Can I use the bathroom or take a shower?
• Can I drive at all or be a passenger?
• Am I able to do any household chores? Which ones?
• Can I eat my meals at the table or at the couch?
• What level of sexual activity is safe?
• Can I work at home?

For a more detailed checklist, contact Sidelines National Support Network (see Resource Organizations at the end of this article).

Bed rest seems like a wonderful concept until it is an edict from which you cannot stray. The novelty of lounging in your PJs with a romance novel fades quickly, and the realities of confinement and isolation begin to set in. Although it sounds like an oxymoron, bed rest can make you exhausted. Inactivity causes you to tire more easily and more often. In addition, you may feel sore and achy from remaining in the same position for an extended period of time. Realize that while you are on bed rest, your emotions will run the gamut from shock to anger and from fear to hopefulness. Although all of these feelings are normal, they can be overwhelming. You may find it helpful to speak with a therapist who specializes in high-risk pregnancies or contact a support group.