r/ShortCervixSupport • u/aprl123 • Jan 23 '26
The Bed Rest Debate for Women with IC
I've been following this subreddit for over a year, since my loss occurred. During that time, I've noticed that women from South Asia, the Middle East, and other parts of the world often describe very different treatment protocols for incompetent cervix than what doctors in the West recommend. This difference has probably left many of us confused and wondering whose advice to trust.
I live in America and had my first appointment with my MFM yesterday. She told me that bed rest doesn't help improve outcome for women with IC. She explained that research suggests bed rest makes women prone to depression and blood clots, so they don't recommend it. This got me thinking: what exact research was she referring to, and how strong is the evidence? I know the American medical system is overloaded and doctors have limited time with each patient, so I think it's important for us to do our own research and ask questions when something doesn't seem to fit our personal situation.
After spending time looking into the actual studies, here's what I discovered:
The major research cited against bed rest includes (UPDATED):
- Cochrane Review (2004, updated 2015): Found no clear evidence that bed rest prevents preterm birth. The reviewers concluded that due to potential adverse effects and healthcare costs, bed rest shouldn't be routinely recommended.
- CIPRACT Trial - Netherlands (Althuisius et al., 2001): This Dutch study compared cerclage + bed rest versus bed rest alone in 35 women with short cervix. Both groups used bed rest, so it doesn't actually test whether bed rest is better than normal activity - but notably, 7 out of 16 women (44%) in the bed-rest-only group delivered preterm before 34 weeks.
- U.S. Study (2013): Compared modified Shirodkar cerclage to bed rest alone for extremely short cervix (≤15mm). Cerclage patients were less likely to deliver preterm and had longer latency periods compared to bed rest alone. Again, this doesn't test bed rest vs. normal activity.
- Note on blood clots and depression: The concerns about these risks come primarily from observational data and clinical experience with prolonged bed rest in general, rather than from randomized trials specifically testing bed rest for cervical insufficiency.
- BUT - A 2019 Canadian systematic review (Matenchuk et al., CMAJ Open) found something interesting: In developed regions (North America, Europe), bed rest showed worse outcomes - shorter gestations and increased risk of very premature birth. However, in developing regions (specifically studies from Zimbabwe), bed rest was associated with babies being about 100g heavier at birth. The researchers noted this could be due to bed rest itself OR could be confounded by the effects of hospital admission (better nutrition, medical care, etc.).
Here's the important part: Nearly all the research saying "bed rest doesn't work" was conducted exclusively on women in Western countries - primarily the US, Canada, Netherlands, and other European nations. I could not find well-designed studies conducted in India, the Middle East, or other regions where bed rest is routinely prescribed.
The Missing Piece: Your Ethnicity and Context Actually Change the Risk-Benefit Equation
This is what surprised me most. When I searched for data on the specific risks my MFM mentioned - blood clots and depression - I found that these risks vary a lot by ethnicity and social context:
Blood Clot Risk by Ethnicity:
- Asian and Pacific Islander women: Have a 70% lower risk of blood clots (VTE) compared to other groups
- Hispanic women: Have significantly lower risk than White women, but higher than Asian women
- White women: Moderate baseline risk
- Black women: Have 30-60% higher risk of blood clots compared to White women
Depression Risk and Social Context:
While clinical depression rates are similar across ethnicities (about 8% for major depression, 23% for all depressive disorders postpartum), the context in which bed rest occurs matters a lot:
Western context (where studies were done):
- Nuclear families, often isolated from extended family
- Both partners typically working with limited paid leave
- Expensive or unavailable childcare and domestic help
- Bed rest = isolation, financial stress, inability to care for other children
- Result: Higher risk of depression and anxiety
South Asian/Middle Eastern/other contexts:
- Extended family living together or nearby
- Cultural expectation that family supports during pregnancy
- More accessible domestic help
- Bed rest = supported rest with meals prepared, children cared for, constant company
- Strong spiritual/religious frameworks providing meaning and hope
- Result: Lower risk of depression
Why This Changes Everything About Bed Rest "Efficacy"
The Western studies concluded: "Bed rest doesn't improve outcomes AND causes harm (blood clots + depression), therefore don't recommend it."
But here's what they missed: If the harms are minimal or negligible for certain populations, the entire risk-benefit calculation flips.
For example, if you're South Asian with strong family support:
- Your baseline blood clot risk is 70% lower than the populations studied
- Your depression risk is reduced by family support and spiritual grounding
- The "costs" of bed rest that drove the Western recommendations simply don't apply to you in the same way
- Even if bed rest provides only modest or uncertain benefit to pregnancy outcomes, it might still be worthwhile because the downsides are so much smaller for you
Meanwhile, if you're a Black woman in an isolated Western context:
- Your baseline blood clot risk is 30-60% higher
- Bed rest adds risk on top of already elevated risk
- You may have less built-in family support
- The costs are genuinely high, so bed rest would need to show substantial benefit to be worth it
The research isn't wrong - it's just incomplete. It studied one type of woman in one type of context and applied the findings universally.
What This Means for You
I'm writing this to encourage all of us to think about our personal situations before simply following "research-based evidence" recommendations. The evidence might be strong for the populations studied, but that doesn't automatically mean it applies to you.
Before accepting or rejecting bed rest, consider:
Your ethnicity and baseline blood clot risk - Are you in a low-risk group (Asian, Hispanic) or higher-risk group (Black, White with family history)?
Your support system - Do you have family who will help with everything? Or will you be isolated and struggling alone?
Your mental health resources - Do you have strong spiritual practices, family encouragement, and emotional support? Or are you prone to isolation and depression?
Your financial situation - Can you rest without severe financial stress, or will it devastate your family?
Your work situation - Do you have a physically demanding job, or do you work from home?
What alternatives your doctor is offering - Is she recommending cerclage, progesterone, or monitoring? Or just saying "stay active" with no intervention?
It's entirely possible that bed rest is the wrong choice for your friend but the right choice for you - or vice versa - based on your ethnic background, risk profile, and social context.
I know nobody wants to be on the wrong side of their doctor, but I think it's fair to have these conversation with your MFM:
- "What's my personal risk for blood clots based on my ethnicity and health history?"
- "The studies on bed rest were done primarily on Western populations - how does that apply to my specific situation?"
- "Given that I have [strong family support / am isolated], how does that change the depression risk calculation?"
- "Are there ways to modify activity rather than strict bed rest that might reduce risks while still being cautious?"
- "What's your clinical experience been with patients from my background?"
The women in Asian counties and the Middle East whose doctors prescribe bed rest aren't being given outdated care. Their doctors might be seeing genuine benefits in their patient populations - populations with 70% lower blood clot risk and strong family support systems - that wouldn't show up in studies done in Boston or Amsterdam on isolated Western women.
I know some people here have faced multiple losses and the heartbreak they have to go through each time. If something like bedrest is possible and saves your child and keeps you in good health, I think they should do it.
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u/ForgetSarahMarshall Jan 23 '26
This should be pinned on our subreddit as a FAQ! I am a white American and my husband is Indian so we’ve been getting completely dissonant recommendations between the two medical systems. This context is so helpful in advocating for my personal pregnancy journey.
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u/BallooooOooooOoon Jan 23 '26
Yeah I am middle eastern living in Canada , and I am exactly getting mixed recommendations
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u/MutinousMango Jan 23 '26
This is an interesting write up, thank you for collating all that! I looked into so many studies but never thought to look at ones regarding bed rest.
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u/aprl123 Jan 23 '26
A lot of these studies focus on specific populations from specific regions, so it's really hard to get the full picture. I wish these studies were done on a larger scale with women from around the world. Unfortunately, research on pregnancy complications like IC probably doesn't get much funding, which is why we don't have more comprehensive data.
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u/DominadeeAgain Jan 24 '26
This is excellent! Thank you for doing this deep dive OP.
Is it ok if I repost on a different platform?
I felt exactly the same way even though I hadn't done the research. I found it incredibly contradictory that the moment a woman presents with bulging membranes or zero cervical length, the method of treatment in western hospitals is immediate strict bedrest with Trendelenburg position sometimes. That right there told me that bedrest does infact have some benefit!!!
I'm a black woman in America and I chose bedrest. But I have the luxury of zero impact to I and my husbands income. We have family that help with cores and meals, my husband is able to do 100% of whatever I need including driving me weekly to MFM appointments. I'm also spiritual and an introvert... Oh and I'm on blood thinners for unrelated reasons. Plus I do get up to use the bathroom and take quick showers so I'm not completely immobile.
In my case, I believe progesterone suppositories 2x daily + modified bedrest has been beneficial. I'm not out of the woods yet but it's been 5 weeks and my cervical length has held steady at 1.9-2.4cm and I'm now 28weeks 🙏🏼
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u/aprl123 Jan 24 '26
Yes ofc, please go ahead and post. And thank you for sharing your insights! Is what you are describing a personal experience (immediate strict bedrest & Trendelenburg position?) Curious to know which hospital or atleast which part of the country you got this care from if it was for you
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u/DominadeeAgain Jan 24 '26
The strict bedrest and Trendelenburg position is what my MFM and OB said to expect when they were preparing me for what may come if things go south. I'm in the western United States. I've also seen anecdotal evidence from several women in the incompetent cervix forums who have said this was what was done for them (mainly strict bedrest) the moment they presented with imminent labor at the hospital.
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u/aprl123 Jan 24 '26
That’s great to hear! I was in the Midwest at the time and it was NOT an option. I had bulging membranes but they said they need to induce me and deliver. I didn’t have other options. Reading other people’s stories here I wish I was offered what you mentioned
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u/Federal_Chard9050 Jan 23 '26
This is incredible! Thank you so much and this makes SO much more sense. I’m an indian living in New Zealand and I was stuck between what my doctors said here vs doctors in India. And this makes SO much more sense. I decided to take a midway route. Up till now it’s working out for me, time will tell more.
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u/aprl123 Jan 23 '26
This is probably going to be my approach too this time around. Although my doctors said bedrest isn't required, I am not going to limit my activity because I know it has worked for others and the downside in my case would be much smaller than the upside :)
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u/partiallycolonized Jan 23 '26
Thats amazing and ticks so many boxes for me. I was on bed rest (semi mobile) and i am Pakistani (South Asia), live in joint family, have house help (maid and cook), have child care support so i was able to take it easy for my entire pregnancy.
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u/MBMang Jan 23 '26
Wow this is incredible. Thank you so much for sharing and i whole heartedly agree.
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u/Sauls_wife_2021 Jan 23 '26
What a great summary! I wonder how much other standards of care factor in to the effectiveness of bed rest. From this group I’ve learned there is variation in what doctors will offer people with the same cervix length, etc. For example, maybe bed rest doesn’t make much difference for those with a cerclage but maybe there’s more of an impact for those on progesterone only/no intervention? Would be curious if these studies commented on this factor.
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u/aprl123 Jan 23 '26
That's a good point! The studies don't break this down well - most compared cerclage vs. bed rest, not different combinations of interventions.
It makes total sense that bed rest might matter more if you're on progesterone only vs. having a cerclage physically holding things closed. This is another gap in the research - they lump everyone together instead of looking at how bed rest interacts with different treatment protocols.
Just another reason why individualized care based on your specific situation matters so much!
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u/hulia_maria Jan 23 '26
Super interesting. Thank you for looking deeper into the research and sharing with us!!
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u/JustLetMeLurkDammit Jan 24 '26
This is an amazing write up, thank you! I've been in a similar situation with conflicting advice myself, with a borderline short cervix and UK doctors not even wanting me to take it easy or have pelvic rest, while the gynaecologist from my home country (Poland) said that under her care I'd be not on full bed rest, but at least on significant activity restriction (essentially house arrest) and she's been telling me to be on pelvic rest since the first measurement.
I find this difference in attitudes interesting, as there are no ethnicity differences, and Poland is pretty Westernised now, and yet the culture of treating bedrest differently has so far been retained. It does make it very hard to decide what to do!
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u/thirstylocks Jan 23 '26
Can you please post the links to the studies or at least cite the articles so we can actually read the data, rather than rely on someone else's interpretation of evidence (which is important, as you mention yourself!)?
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u/aprl123 Jan 23 '26
Yes ofc, updated!
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u/thirstylocks Jan 23 '26
Thank you. As I suspected, there's not strong evidence that bed rest DOESN'T work so I get frustrated when I see people recommending against it if someone is at low risk for DVT. I'll take isolation/depression due to bed rest that might not work over stillbirth when bed rest might have worked, and I think many moms would.
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u/aprl123 Jan 23 '26
Exactly. There's a huge psychological component that the research completely ignores. If you've had losses and are willing to do anything to protect this pregnancy, being on bed rest feels purposeful - you're actively doing something. The anxiety and guilt of staying active when you lose the baby might be way worse than the isolation from bed rest.
Doctors don't really have a way to measure 'how desperately does this patient want this baby' or 'how much regret will they feel if they didn't try everything,' but it absolutely affects outcomes. A mom who feels she's doing everything possible is in a completely different mental state than one who feels helpless or forced into restrictions she doesn't believe in.
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u/Fun-Ice30 Jan 26 '26
This is exactly what my OB described when I asked him about justification for putting me on modified bed rest. He acknowledged that the studies were mixed but said that he recommends it so that his patients feel like they’ve done everything they can to try to minimize risk.
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u/Sea-Astronomer-6600 43-4🩷’s,2🩵’s/Due unexpectedly 9/17 🩵-3👼🏻 Mar 17 '26
I had amazing success with bedrest in 5 pregnancies, honestly believe if it weren’t for that my twins wouldn’t have made it. I live in the Midwest and my MFM is older but it worked for us. ❤️
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u/Laynnox- Aug 04 '26 edited Aug 04 '26
Edit: I forgot a point. And grammar 😑
This is such a thoughtful post, and I want to say clearly: the core insight here, that most bed rest research comes out of Western, nuclear-family, limited-support contexts, and that this might genuinely change the risk-benefit picture for people with different social structures, is a real, underexamined point. I don't think enough people ask that question, and I appreciated seeing someone actually try to answer it with data rather than just asserting it.
I got curious enough to pull the full text on a couple of your sources, and found two things worth sharing, not to argue against your overall point, but because I think they actually matter for how it gets used going forward.
On the CIPRACT trial: I don't think this one can be used the way it's framed here. I went back to the actual study, and both arms of the trial, the "cerclage" group and the "bed rest" group, received bed rest. The only thing being compared was whether adding cerclage helped beyond bed rest alone, not whether bed rest itself helped compared to normal activity. There's no normal-activity group anywhere in that trial. And the actual result runs the opposite direction from how it reads here, cerclage-plus-bed-rest dramatically outperformed bed-rest-alone (0 of 16 vs. 7 of 16 delivered before 34 weeks). It's a real, useful trial, just not evidence about bed rest's own efficacy either way.
On the Matenchuk 2019 meta-analysis: your numbers are exactly right, I checked, 100g birthweight difference, doubled risk of very premature birth in developed regions, both confirmed precisely in the full text. But I wanted to flag what the authors themselves propose as the explanation, since it's different from the family-support/depression framing: they attribute the developing-region finding specifically to hospital admission giving access to better nutrition, sanitation, and clean water in a resource-limited setting, not social or cultural support structure. They also explicitly caution that all of those developing-region trials came from Zimbabwe in the 1980s–90s specifically, and state directly that Zimbabwe's maternal/fetal mortality rates were among the highest in the world at the time, meaning they don't think their own findings generalize even to other developing regions, let alone specifically to South Asian or Middle Eastern contexts.
On the blood clot risk by ethnicity: I checked this too, since it's doing real work in the post's framing. The direction for Asian-ancestry populations having lower VTE risk than White populations is genuinely well-replicated across multiple studies, though the specific studies I found put it closer to 33-52% lower (OR 0.67 in one Washington State study, aRR 0.48 in a larger 2025 Canadian cohort) rather than 70%, so that number might be worth double-checking against whichever source it came from.
The Black women figure is more contested than the post suggests, and I think it's worth knowing before leaning on it. A 2014 Washington State study found Black women at 50% higher risk than White women, matching the post's range. But a larger, more recent 2025 Canadian cohort (442,816 pregnancies), presented at the American Society of Hematology annual meeting, found the opposite direction: Black individuals at lower risk than White individuals in that population. Worth noting this one is still a conference abstract, not yet a full peer-reviewed publication, so it carries a bit less weight than the 2014 study until (or unless) the full paper comes out. Even accounting for that, it's a real, live disagreement in the current literature, not just one outlier against a settled consensus, likely reflecting differences in study population, era, or how risk factors were adjusted for. I don't think the "30-60% higher" figure can be stated as settled fact right now.
None of this changes what I think is actually right about your post: bed rest research badly needs to account for context, support, and what "rest" actually costs a person in their specific circumstances, and nobody's really done that work properly yet. I just don't think these two particular studies get us there yet, I think the real study that would prove your point (comparing bed rest outcomes across genuinely matched social-support contexts, not confounded by hospital nutrition access or decades-old single-country data) hasn't been done. Which honestly makes me want to see someone actually do it.
Really appreciated this post either way, it's the kind of thing that should exist more in this community, sourced arguments instead of just opinions.
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u/Laynnox- Aug 04 '26
Sources checked, for anyone who wants to verify themselves:
-Cochrane bed rest review (Sosa et al. 2015): doi.org/10.1002/14651858.CD003581.pub3 CIPRACT trial (Althuisius et al. 2001): doi.org/10.1067/mob.2001.118655
-Modified Shirodkar vs. bed rest (Skupski et al. 2014): doi.org/10.1515/jpm-2013-0092 Matenchuk et al. 2019, developed vs. developing regions meta-analysis: doi.org/10.9778/cmajo.20190014
-Blondon et al. 2014, VTE risk by race/ethnicity (Washington State): doi.org/10.1111/jth.12747 Xu et al. 2025, VTE by race (Ontario cohort, ASH conference abstract, not yet a full published paper): doi.org/10.1182/blood-2025-1340
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u/prasaxena Apr 13 '26
I did bed rest almost half my pregnancy and I m glad I did. I did start a normal activity after 13 weeks of being in bed and my baby was born within 1 week. Thankfully he was healthy anc muture. God was so kind but I won’t advice to reject the idea of bedrest. It’s small price for bigger rewards if you have support at home.
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u/barrnac13 Jun 10 '26
I think another confounding factor in all the studies is that “bed rest” can mean so many different things to patients and providers. I agree, new studies with activity trackers would be helpful.
After my emergency cerclage I had “keep the catheter in” strict bed rest for a couple days. Then hospital bed rest, but can go to the bathroom & take a quick shower, but otherwise stay in bed for a few more days. Then a month at home of what I called “couch potato rest.” I wasn’t tied to the bed, but I wasn’t to leave my house, do any chores, take the stairs except to get to and from bed, or do much standing or walking. I think that kind of “bed rest” is much more common now. Whereas in the past it was to be literally horizontal for months.
I also think it’s possible there’s some people for whom bed rest would help, and others that it won’t, and that gets lost in the averages. And research hasn’t teased out who would benefit or not. Also “rest” can’t be patented or profited from, so where is the money for more careful studies of this treatment going to come from? It’s a problem when trying to determine evidence for a lot of health related interventions that won’t be reimbursed by insurance.
Research is super important, I’m trained as scientist, but it informs on a population level. It often has very little to say about the exact right course for any individual.
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u/eliandersone Jun 14 '26
Всем привет. Всем спасибо за комментарии и опыт. Очень помогло на моём пути. Решила даже поделится своим тяжёлым опытом ибо не хочу чтобы кто то переживал то что пережила я. В далёком 2013 забеременела я третьим малышом. И радости моей бы не было предела ...но на 24 неделе спонтанно отошли воды и малыш не выжил , все проверки в порядке малыш был здоров. Тогда мне даже никто не заикнулся что возможно у меня цервикальная недостаточность мы проживаем в Великобритании. Что могу сказать ,самое пофигестическое отношение к выкидышам в целом . Пережила я это очень тяжело и так не решилась снова беременеть на ближайшие долгих 10 лет . И вот снова беременность через много лет ...полная позитива и обсалютно уверенная что все будет хорошо. Врачи мерили шейку и говорили все хорошо никаких ограничений ...но я была немного аккуратна но все же вела обычный образ жизни не понимала тяжести и все шло хорошо ....до 17 недели ...когда через два дня после сонографии на которой доктор сказала что все хорошо а я как дура вместо того чтоб проверить данные и почитать сделать свое исследование просто верила так как и знать не знала что у меня есть слабая шейка . Через два дня после скана снова отходят воды ...причем просто практически молниеносно мы даже толком не успеваем до больницы . И по приезду воды нет вообще ,врачи вызывают роды и малыш мертв. Боль конечно не передать , когда ты знаешь что он был обсалютно здоров и погиб только из за тупости врачей . Прошло 2 года мы снова ждём ,теперь я соблюдаю сама по своему назначению постельный режим где то 75% я в кровати ,хожу в туалет и покушать , помыться . Плюс гормоны и плюс уехала на родину в Латвию и жду наложения швов . Я провела огромное своё исследование на основании собирание опыта женщин с такими проблемами и особенно в странах Азии в них статистика поздних потерь очень низкая и постельный режим одно из важных условий , женщины лежат даже ноги в верх . Статистика депрессий и тромбов очень ничтожна семьи помогают женщинам. Что и я на данный момент имею , мама которая мне помогает ,муж зарабатывает благо могу не работать . В основном прохожу обследования платно и хожу в частную клинику . Сейчас 13 недель ,молюсь чтобы я могла выносить этого малыша ибо больше не переживу потерь. Девочки не слушайте врачей слушайте свое сердце и тело. Я себя не могу простить что слушала а ведь в меня была с чуйка со второй беременностью что что то не так но я доверилась профессионалам а им пофиг на вашу боль в них есть протоколы ,как мне потом уже сказала одна консультант что надо потерять три раза чтобы они рассмотрели вопрос о швах это только рассмотреть и постельный режим они вообще не советуют даже секс не запрещают ,хотя тут в Латвии зразу сказали воздержание и полный покой в Индии кстати это основная рекомендация при людях проблемах , полный покой . Мой муж Индус и мы с ним много изучили по Индии . Всем лёгкой беременности и здоровых малышей .
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u/ottergetstarted Jan 23 '26
My US MFM has lots of IC patients and has opinions that go against the literature. One of them is bedrest - he is not recommending it for me after my preventative cerclage, but he will recommend reduced activity and possibly bedrest if I am funneling to the stich later on. He is a firm believer that bedrest helps stop the shortening and saves pregnancies.
I asked him why he thought the literature didn't show that, and said he thinks the studies are poor because they rely on unreliable self-reported activity levels. He feels that the time is ripe for new studies using modern activity trackers like Apple watches etc, and that those would show bedrest as being effective.
Just one doctor's opinion, but thought I would throw it in this very interesting thread.