Pelvic Rest: Dos, Don’ts & What It Really Means

While it’s not quite the bed rest-level bummer of yore, being put on pelvic rest is a bit of a downer. If your health care provider has mentioned that pelvic rest may be in your future, you’re probably wondering what pelvic rest is, what it really means to be on pelvic rest, how long it lasts, and exactly what you can — and can’t — do on pelvic rest. We asked two experts to share their insights. Here, Dr. Kiarra King, board-certified obstetrician-gynecologist, and Rebecca Slape, a pelvic floor therapist, explain everything you need to know about what pelvic rest really means, and what to expect if you are told you need it.

What does it mean to be on pelvic rest?

Pelvic rest is a term that “can mean a couple different things depending on why you’re on pelvic rest,” says Slape. People can even be placed on pelvic rest outside of pregnancy. But, many of us encounter the term during pregnancy. If you’re pregnant and have been placed on pelvic rest, it means that “a patient is not to place anything in the vagina,” King explains. “This would include tampons, fingers, penises or intimate products.”

Though reasons for being on pelvic rest vary, the purpose of pelvic rest is generally the same for every pregnant person who is on it: “To minimize complications and poor outcomes,” as King explains plainly. Pelvic rest is sort of like a modern day equivalent of bed rest, Slape explains, saying that actual bed rest generally has fallen out of favor. “Unless you are like really severely ill or in a very dangerous situation, we don’t put people on bed rest anymore because their overall health really can deteriorate,” says Slape. With pelvic rest, she explains, the focus is on protecting the more delicate cervical tissues so “we don’t want patients to do anything that could disrupt the mucosal plug or strip the membranes.”

While both King and Slape urge pregnant people to follow their doctor or health care provider’s recommendations, the evidence for benefits of pelvic rest still has some strides to make. “The evidence for pelvic rest specifically is a bit muddy, as most studies do not tease it out against other activity limitations,” Slape says. “My advice would be to follow doctor's orders when it comes to pelvic rest, and if given general activity restrictions to just be careful to avoid valsalva (always good advice) and listen to your body.”

Reasons why a person might be on pelvic rest

There are many reasons a doctor or health care provider might prescribe pelvic rest during pregnancy, and they include the following:

You’re pregnant with multiples

If you’re pregnant with twins or triplets, you’re much more likely to end up on pelvic rest because you’re at higher risk for preterm delivery. People carrying multiples are “often put on pelvic rest near the end,” says Slape. But, she adds, depending on just how many babies you are carrying, pelvic rest may happen even sooner.

You have a short cervix

Pregnant people with a short cervix are more likely to have complications, Slape explains, so they often end up on pelvic rest at some point during pregnancy. Some people have a naturally short cervix, and sometimes the cervix may be shorter or “incompetent” (a ‘terrible term!’ adds Slape) because you’ve had a loop electrosurgical excision procedure (LEEP) procedure to remove cancerous cells from the cervix at some point before becoming pregnant. The good news is that having a short cervix “doesn't become an issue until a little bit later in the pregnancy,” Slape says. Typically a person with a short cervix may be told that they need to do pelvic rest around the halfway point, perhaps following a 20-week ultrasound. Why? Well, as you get further into pregnancy, the growing fetus, amniotic fluid and the placenta begin to put a lot of pressure on your cervix. Plus, the cervix is gradually widening. So, naturally, Slape says, “there is a lot of pressure being put on that thinning membrane. If it is shorter to begin with, there's just less tissue there available to widen.”

Placenta Previa

Pelvic rest for placenta previa is perhaps the most strict of all the scenarios. With placenta previa, it's pretty absolute that you cannot place anything in the vagina, and and sexual activity that could lead to orgasm — including masturbation — is completely off-limits. “The fear is that rhythmic muscular movements that often accompany an orgasm could stimulate the uterus to cramp or have a contraction similar to labor, which could put a lot of downward force on the fetus and placenta, which is in a dangerous position,” Slape explains.

You have experienced preterm labor

If you’ve experienced some preterm labor, and your health care provider would like you to get further along before you deliver, Slape explains that they may ask you to try going on pelvic rest to extend the pregnancy as long as possible. Occasionally, they may prescribe full-on bed rest — but usually only for 24-48 hours, in a way that is “targeted and short term” — if you are experiencing contractions.

What can you not do on pelvic rest?

Both King and Slape agree that — no matter who is on pelvic rest and why — the number one thing rule of pelvic rest is nothing can go in the vagina. “That includes any toys, fingers, penis, vaginal trainer devices. estrogen cream, yeast infection cream — nothing at all goes into the vagina,” Slape says.

While it will vary a bit person-to-person depending on the reason you are on pelvic rest, you generally cannot:

• Have sexual stimulation of any kind
• Place anything in your vagina at all

For the most part, it also means that you can’t have sexual stimulation of any kind. Sometimes, it may also include not lifting anything over 20 pounds, Slape adds. She also encourages people to educate themselves about valsalva maneuvers. Valsalva maneuvers involve “downward pressure against a closed glottis, and is something that people will often do to void their bowels, especially if they're constipated,” Slape explains, and Slape says it really should be avoided if you’re on pelvic rest as it places strain on the exact areas that pelvic rest is trying to, well, rest.

What can you do on pelvic rest? How to be intimate when you’re on pelvic rest

While it may feel like a lot of things are off limits if you’re on pelvic rest — and, well, they are — it may be helpful to focus on all of the things that you can do. Though pelvic rest is a descendant of bed rest, it is much more permissive (thank goodness!). Yes, you can definitely go on walks while you’re on pelvic rest. In fact, mellow or gentle exercise is generally encouraged for most people as it can lower blood pressure and help you stay healthy both physically and mentally while you travel through your pregnancy.

“When you're on pelvic rest, we don't want to do anything that could lead to an orgasm, because of the risk for uterine contraction with orgasm, so framing intimacy in a different way would be really helpful,” Slape says. She suggests connecting physically and intimately in other sensual ways by literally engaging the senses, with intention, together.

Ideas to try might include:

• Trying new foods together
• Giving each other relaxing massages
• Partner yoga
• Going on long walks together
• Slow dancing
• Trying meditation or breath work together

How long is a person typically on pelvic rest during pregnancy?

This is the million dollar question, and the answer is going to vary for everyone. “It really all depends on the individual’s condition or diagnosis,” King explains. If you’ve been diagnosed with placenta previa, you’ll probably stay on pelvic rest throughout your pregnancy. Meanwhile, King says that someone who had “threatened preterm labor at 30 weeks would likely only be on pelvic rest until around 36-37 weeks.” It will just depend, and will likely be an ongoing conversation with your OB or health care provider.

Signs it’s time to call the doctor

If you are on pelvic rest, your health care provider has probably told you about the warning signs to watch for. You should check in with your doctor if your blood pressure goes above the threshold you’ve been told to watch for, Slape suggests, and if you notice any bleeding or spotting. Contractions warrant a call, “even if they're intermittent,” she says, as your doctor may want you to reduce your activity to see if they’ll stop.

If you’re on pelvic rest, hang in there — “this isn’t forever,” Slape reminds — and don’t hesitate to check in with your health care provider frequently with questions. They should be monitoring you very closely, as you both wait for your baby’s arrival.

Studies cited:

Greenwood, L. (2022). Journal of Ultrasound in Medicine. Impact of Pelvic Rest Recommendations on Follow-Up and Resolution of Placenta Previa and Low-Lying Placenta https://onlinelibrary.wiley.com/doi/abs/10.1002/jum.16220

Saccone, G., Cuomo, L. (2023) Activity restriction for women with arrested preterm labor: a randomized controlled trial. American Journal of Obstetrics & Gynecology MFM https://www.sciencedirect.com/science/article/abs/pii/S2589933323000964

Experts:

Dr. Kiarra King, board-certified obstetrician-gynecologist

Rebecca Slape, PT, DPT, pelvic floor therapist and owner of Rose City Pelvic Health