When Labor Starts Too Early: Does Bed Rest Help Prevent Preterm Labor?

I am 27 weeks pregnant and restricted to bed rest due to dilation and a previous miscarriage at 25 weeks for massive infection. Is bed rest helpful?


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

While it is difficult to advise you without a complete history, I can give you some guidelines about the management of preterm labor.

First of all, bed rest has not been shown to affect the health of mothers and babies who are at risk for -- or who have experienced -- preterm labor. This has been confirmed again in a review article in the November 2002 issue of Obstetrics & Gynecology, which concluded that there is little evidence that bed rest, home uterine-activity monitoring, hydration and sedation work. These are common treatments to help prevent or stop preterm labor in the U.S.

Randomized controlled studies have not proven many approaches to be clearly effective in preventing preterm labor. The message has been around for a while and seems not to have gotten to the front lines of obstetrical practice. Indeed,

Oral administration of medications to prevent uterine contractions (tocolytics) have not been proven to be of significant benefit in the prevention of preterm labor, but it is used with some success once premature contractions have begun, especially if the cervix is less than three centimetersm dilated.

I would guess from your history that perhaps your early delivery could have been due to a systemic infection -- either caused by premature rupture of membranes or an invasive infection such as beta strep. Infection alone is one of the causes of preterm labor, and if you have been treated with antibiotics during this pregnancy (which you have been), this cause may not recur. Certain vaginal infections and or sexually transmitted diseases such as bacterial vaginosis, trichomonas, gonorrhea and chlamydia have been implicated in preterm labor; every woman should be checked for these.

Corticosteroids (Cortisone is one of these drugs) are administered in the case of preterm labor in order to mature the fetal lungs to prevent respiratory distress syndrome and intraventricular (brain) hemorrhage in the very small infant. In the U.S., we give Betamethasone (12 mg by injection) and repeat it in 24 hours. Optimal benefits begin 24 hours after initiation of therapy and last seven days, which is why you are receiving weekly doses. The risk-benefit ratio of taking this drug is in your favor; no serious side effects have been shown to occur in babies or mothers.

You did not mention whether or not you are having contractions or did have any. If you are already three centimeters dilated at 27 weeks, I'm assuming that the contractions have ceased or that your cervix dilated without labor.

The American College of Obstetrics and Gynecology publication on preterm labor states: "Reduced activity or bed rest in the late second and early third trimesters is commonly recommended to prevent preterm births. Randomized studies do not demonstrate that it results in a prolongation of gestation. Furthermore, there is very little agreement as to what actually constitutes reduced activity. Although sexual abstinence or stress-reduction programs are often recommended, no clear consensus exists regarding the efficacy of these measures."

Frequent cervical exams are usually done to monitor early dilatation and effacement (thinning) but the exams themselves tend to stimulate contractions. Some centers are recommending serial ultrasound monitoring of cervical width and length.

So little is really known about how to prevent preterm labor or even why it happens. Individual clinicians often go on what has worked for them in the past.

Inactivity has its own risks. I hope you are still doing some in-bed exercises -- simple leg lifts and arm lifts (holding soup cans for weights) are beneficial in preventing depletion of calcium stores. Abdominal tone can be preserved by just lifting your head off the bed while exhaling. And pelvic rocking can be done in any position.

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