Does Bed Rest Prevent Prematurity in Twin Pregnancy?

My twin pregnancy more than 17 years ago was pretty much uneventful. Every doctor’s appointment was met with good news. Blood pressure? Normal. Weight gain? Steady and plentiful. Still, as a precaution, my doctor encouraged me to take my maternity leave a bit early (around Week 30) and “get off my feet.” I wasn’t put on bed rest per se but she did advocate for my lying down on my left side for 30 minutes several times a day. I followed her advice religiously and spent several hours each day for the next two months horizontal. Although I was convinced that my fraternal twins would arrive early as most often do, my doctor had to induce me at Week 39 with my boys tipping the scales at more than six pounds each.

So, were my big bouncy babies due in part to my taking it easy those last few weeks? I’ve always thought so. But recent research indicates probably not. In fact, a new study suggests that bed rest not only doesn’t prevent premature birth but may actually increase its likelihood.

But how could that be?

According to the study published in the journal Obstetrics & Gynecology, researchers looked at a group of women at risk for preterm birth—those with a short cervix, a complication that raises a woman’s chance of premature cervical effacement and dilation (or “thinning”) which could lead to preterm labor. Of the 646 women in the study, nearly 40 percent were placed on some form of bed rest around Week 24 yet of those women, nearly 39 percent still gave birth prematurely compared with only 17 percent of women who didn’t curtail their activity at all! (Remember, all the women in the study were at risk of preterm labor.) Although researchers believe that the study indicates that bed rest doesn’t prevent preterm labor, it isn’t definitive and more studies are called for where participants are randomly assigned to bed rest or not.

black and white photo of pregnant womanBed rest has always been very controversial. (In fact, while writing this post, I found several past studies and articles here and here that also raise concern for the practice.) Critics believe that bed rest is simply not effective. Furthermore, it can cause dangerous side effects including raising a woman’s risk for a blood clot. With inactivity, she can lose important bone and muscle mass as well. If a mother-to-be needs to leave her job earlier than expected, it can also cause financial and emotional stress. So why do doctors recommend it so often especially to moms expecting multiples? Well, there’s really nothing else out there to help women who are at risk of preterm labor.

It’s common for doctors to recommend some form of bed rest ranging from lying down round-the-clock to something less extreme like my part-time respite to moms expecting twins, triplets, quads (or more). Nearly one in five pregnant moms go on bed rest, and you can bet that the bulk of these women are pregnant with multiples. For moms-to-be expecting twins and the like, proponents argue, the benefits are plentiful.

  • Lying down takes the weight and stress of carrying two or more babies off the cervix.

  • Reduced physical activity may reduce the risk of preterm contractions. (Less movement = less contractions.)

  • Resting on your left side increases blood flow and nutrients to the babies.

  • When you’re inactive, you burn fewer calories, fuel that is now channeled directly to your babies ultimately helping them grow bigger.

Makes sense, doesn’t it? But with no scientific evidence to back it up, what should a mom-to-be expecting multiples do? Let common sense prevail. Yes, studies indicate that full-on bed rest may not be the answer to preventing preterm labor and delivery but you can still reap the benefits of taking it easy during your twin pregnancy. Sit or better yet, prop your feet up whenever you can. In other words, don’t stand if you don’t have to! If your doctor does recommend that you go on bed rest, ask questions. Discuss your concerns. Reach a compromise. And worry if you don’t follow her advice to the letter—remember you have science on your side!


6 thoughts on “Does Bed Rest Prevent Prematurity in Twin Pregnancy?

  1. Carrie

    Very Interesting. I have always thought I had seven pound twins at 39 weeks because I did not push myself and really took it easy the last couple months, too. I notice the research article studied those with a short cervix, since there are other causes/risk factors for preterm labor, it’d be interesting to see what effect bed rest had in those cases.

    1. Christina Baglivi Tinglof Post author

      Agreed. I’d also like to see a study focusing on just multiple pregnancies. After all, women carrying multiples typically carry more weight than women carrying singletons.

  2. Nicole

    I was put on bed rest at 26 weeks due to a cervix that was shortening. I did not have to be in bed all the time but was encouraged to be laying down 80% of the time. Sitting I was told still places a lot of pressure on the cervix. I followed doctors orders the best I could having an almost 2 years old and an almost 4 year old home with me and with a lot of help from my parents. My twins were born one day shy of 37 weeks weighing in at 6.3 and 6.11 and as healthy as can be! As for the blood clot issue I was told to keep my feet moving and to stretch calf muscles while laying down. I believe that the bed rest was good for me and the great care of my OB. follow what your doctor recommends they take your health and the health of your baby seriously.

  3. Cazrat

    I spent much of the end of my pregnancy lying down in the lounge or bed. My two boys arrived at 37.5 weeks after a CS due to increased fluid. I went on to have a DVT after the operation. Was it partly caused by lying down too much? Who knows?

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