Doctors' doubts
Why do physicians rely on a treatment that has shown no benefits? Primarily because there is no surefire way to prevent preterm birth. "If preterm birth is going to happen, it's going to happen -- but the hardest thing in the world is to tell a patient 'I don't know how to help you,'" says John Thorp, M.D., a maternal-fetal specialist at the University of North Carolina School of Medicine in Chapel Hill who helped draft the ACOG statement. "Doctors prescribe bed rest to patients because they feel like at least they're doing something."
There's also an inherent belief within the medical community that bed rest buys extra time. It's a prescription that dates back centuries and has stuck through the years, largely due to anecdotal evidence that it works and the thought that it can reduce maternal stress, increase blood flow to the uterus, and decrease pressure on the cervix.
Liability and fear of medical malpractice play a role too. "Obstetrics is a field often subject to inertia -- doctors have to be conservative because we're dealing with two patients and there's that much more risk," explains Charles Lockwood, M.D., chairman of the department of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine in New Haven, Connecticut.
And then, some physicians say bed rest is just common sense. "Many expectant mothers overexert themselves -- juggling jobs, families, and social lives," says Suzanne Trupin, M.D., clinical professor of obstetrics and gynecology at the University of Illinois College of Medicine at Urbana-Champaign. "Limited bed rest -- for a few hours a day -- forces them to slow down." The benefits of bed rest, however, are all unproven theories, says Dr. Thorp. "Just because something is widely believed doesn't make it true," he explains. "Scientifically, bed rest is simply not a valid treatment."
