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    Coping With Bed Rest

    What do you do when your doctor orders total bed rest, and it's still weeks or months from labor day? It can be a lonely and scary time, but there are ways to help cope with the situation.

    And So to Bed ...

    In addition to pre-term labor, conditions that might prompt an obstetrician to order bed rest include cervical changes such as premature effacement of the cervix, or "incompetent" cervix, in which the cervix dilates prematurely during the second trimester; vaginal bleeding due to conditions such as placenta previa, in which the placenta develops in the lower end of the uterus and sometimes blocks the internal opening; and high blood pressure (including the pregnancy-related forms preeclampsia and eclampsia).

    "Only mild forms of high-blood pressure would be treated with bed rest at home; with anything more serious people would be in the hospital," says Jodi Abbott, MD, assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, and an ob-gyn at Beth Israel-Deaconess Medical Center in Boston.

    But there also are times when bed rest may beneficial, even when the medical indications are less clear, says another expert in high-risk pregnancies:

    "Even if it does not help medically, you have to deal with the psychological health of the woman," says John Elliott, MD, director of maternal and fetal medicine at Good Samaritan Medical Center in Phoenix.

    "Sometimes a lot of bed rest is prescribed so that the patient can psychologically deal with the outcome better," he says. "For example, there is absolutely no data, and I firmly believe that bed rest does not help in threatened miscarriage, and yet we will tell a patient to go to bed rest with bathroom privileges when she does have bleeding and cramping in the first trimester. I do it not thinking it's going to help, but if you don't do that -- and she goes on and miscarries -- her psychological adjustment to that loss is terribly hindered, because she feels that she didn't do all she could to prevent [it]."

    What's a Mother-to-Be to Do?

    The range of activities allowed to a woman on bed rest depends on the reasons for the medical order, Abbott says. Some women are on very strict bed rest and are told to only get up to use the bathroom, and not shower more than once a week.

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