Coping With Bed Rest.

From the WebMD Archives

July 6, 2001 -- For some moms-to-be, pregnancy just doesn't seem to faze them. They continue their day-to-day activities uninterrupted. They work full-time until the day they deliver. Some even maintain vigorous exercise routines. Still, other expectant moms need to stop work and limit their activities during their pregnancy.

But exactly who should? For what reasons? And, most important of all, does it help mother and/or child? A new study in a recent issue of American College of Obstetrics and Gynecology addresses these questions.

"We thought it was important to look at how commonly [stop-work recommendations] come up during pregnancy," study author Linda Frazier, MD, MPH, tells WebMD. Frazier, who has worked in occupational medicine, is an associate professor in the department of preventive medicine at the University of Kansas School of Medicine, in Wichita.

Using pregnancy data gathered for 1996-1997, Frazier and her colleagues reviewed all employment information and birth results. Of more than 1,600 women who worked at least 10 hours each week, more than 27% had been advised by a doctor or nurse to stop working.

The number surprised Frazier and her colleagues. "We thought it would be about 5%," she says. "And that is for a very significant work restriction. The numbers who have a smaller ... work restriction -- like no heavy lifting, shorter shifts, day shifts, and no handling toxic chemicals -- is probably greater."

Women most likely to be prescribed bed rest had been hospitalized during an earlier pregnancy and had delivered a premature baby previously, reports Frazier. Almost 60% of those told to stop working had high blood pressure, vaginal bleeding, or were at risk for premature labor. The other 40% were given that advice because of stress, swelling, or fatigue.

The good news? Of those told to stop working before or at the seventh month of pregnancy, almost 92% delivered a full-term infant. On the other hand, twice as many expectant moms instructed to stop working delivered a small baby, weighing roughly less than five pounds, compared to moms who stayed at work.

This, says Frazier, suggests that women advised to stop working already were at higher risk for pregnancy complications. But another explanation, suggests Atlanta obstetrician Michael Randell, MD, is that the women prescribed bed rest actually stayed busier at home.


"We always have to be concerned about the patient that we put on bed-rest or take out of work because we never know what their home life is like," he tells WebMD. "They could now be stuck chasing around three children, which may be more strenuous than what their day activity was at work." Randell, in private practice and on staff at Atlanta's Northside Hospital, was not involved in the study.

"The second thing we looked at was the last month of pregnancy that a woman worked," says Frazier. "It turned out that 50% stopped in the seventh month or before." That is significant because the Family and Medical Leave Act only covers 12 weeks of unpaid leave in connection with the birth of a child.

"This might be of interest to policy makers," says Frazier, adding that many women aren't even covered under the FMLA act. "What happens to those women and their jobs? We need to study how it really happens in corporate America."

So what is the bottom line?

"Most women are healthy and sail through their pregnancies; there's no reason why pregnancy should be exclusion from employment," she says. "But there is a significant minority of women who appear to have some kind of pregnancy complication and, as a society, we need to think about what supports are in place to promote healthy pregnancy outcomes."

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