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Peer-reviewedCC BY-NC-NDPregnancy (Hoboken, N.J.)

Barriers and facilitators to deimplementing activity restriction in pregnancy: A qualitative study of prenatal care clinicians

  • Emma Keegan1
  • Lisa D. Levine2,3,4
  • Sunni Mumford2,4,5
  • Rebecca F. Hamm1,2,3,6
  • Nandini Raghuraman7
  • Jhumna Sarkar2
  • Mary Corinne Steele2
  • Peter F. Cronholm3,4,6,8,9,10
  • Beth L. Pineles1,2,3,4,5
10 affiliations
  1. 1Department of Obstetrics and Gynecology Pennsylvania Hospital, University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA
  2. 2Department of Obstetrics and Gynecology University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA
  3. 3Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
  4. 4Center for Clinical Epidemiology and Biostatistics University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA
  5. 5Department of Biostatistics, Epidemiology, and Informatics University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA
  6. 6Penn Implementation Science Center University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA
  7. 7Department of Obstetrics and Gynecology Washington University at St. Louis St. Louis Missouri USA
  8. 8Department of Family Medicine and Community Health University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA
  9. 9Mixed Methods Research Lab (MMRL) University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA
  10. 10Center for Public Health University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA
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Abstract

Introduction: Activity restriction and bedrest are frequently prescribed in pregnancy with the goal of preventing preterm birth, despite evidence that these practices are ineffective and harmful. While these practices persist, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal‐Fetal Medicine (SMFM) guidelines recommend against the routine use of activity restriction. Understanding clinicians’ perspectives related to guideline‐informed activity recommendations is essential to inform deimplementation strategies. This study aims to identify barriers and facilitators of deimplementation of activity restriction in pregnancy from the perspective of prenatal care clinicians, using the Consolidated Framework for Implementation Research 2.0 (CFIR) in a qualitative approach.

Methods: We conducted a qualitative study using semi‐structured individual interviews with prenatal care clinicians (n = 14) at sites within or affiliated with a large urban academic medical center between November 2024 and September 2025. Participants included obstetrician‐gynecologists, a maternal‐fetal medicine physician, a family medicine physician, nurses, a certified nurse midwife, and office staff from both academic and community practice settings. Interviews were coded and analyzed using NVivo software. Emergent themes were mapped to CFIR domains and constructs.

Results: Clinicians universally endorsed the benefits of physical activity in pregnancy but demonstrated significant knowledge gaps regarding current evidence and professional society guidelines. No clinicians recognized the inverse relationship between physical activity and preterm birth. Many followed outdated guidance, citing contraindications to exercise that have been removed from current ACOG recommendations. Key barriers to deimplementation included a perceived lack of evidence, patient anxiety, social media misinformation, cultural expectations around rest during pregnancy, and fear of rare adverse outcomes. Trust in ACOG and SMFM as credible sources and system‐level infrastructure such as consensus meetings and standardized recommendations were described as facilitating decision support.

Conclusion(s): In this exploratory, single‐institution study, deimplementation of activity restriction in pregnancy was less constrained by clinician opposition to physical activity and more by knowledge gaps, patient expectations, and fear of rare adverse outcomes. Strategies that leverage existing clinician trust in professional society guidelines and address condition‐specific uncertainty may facilitate practice change.

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Cite

BibTeXRIS
BibTeX
@article{keegan2026barriers,
  title = {{Barriers and facilitators to deimplementing activity restriction in pregnancy: A qualitative study of prenatal care clinicians}},
  author = {Emma Keegan and Lisa D. Levine and Sunni Mumford and Rebecca F. Hamm and Nandini Raghuraman and Jhumna Sarkar and Mary Corinne Steele and Peter F. Cronholm and Beth L. Pineles},
  journal = {Pregnancy (Hoboken, N.J.)},
  year = {2026},
  month = nov,
  doi = {10.1002/pmf2.70499},
  url = {https://europepmc.org/article/PMC/PMC13724831},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Barriers and facilitators to deimplementing activity restriction in pregnancy: A qualitative study of prenatal care clinicians
AU  - Emma Keegan
AU  - Lisa D. Levine
AU  - Sunni Mumford
AU  - Rebecca F. Hamm
AU  - Nandini Raghuraman
AU  - Jhumna Sarkar
AU  - Mary Corinne Steele
AU  - Peter F. Cronholm
AU  - Beth L. Pineles
PY  - 2026
DA  - 2026/11/01
JO  - Pregnancy (Hoboken, N.J.)
DO  - 10.1002/pmf2.70499
UR  - https://europepmc.org/article/PMC/PMC13724831
AB  - Introduction: Activity restriction and bedrest are frequently prescribed in pregnancy with the goal of preventing preterm birth, despite evidence that these practices are ineffective and harmful. While these practices persist, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal‐Fetal Medicine (SMFM) guidelines recommend against the routine use of activity restriction. Understanding clinicians’ perspectives related to guideline‐informed activity recommendations is essential to inform deimplementation strategies. This study aims to identify barriers and facilitators of deimplementation of activity restriction in pregnancy from the perspective of prenatal care clinicians, using the Consolidated Framework for Implementation Research 2.0 (CFIR) in a qualitative approach.  Methods: We conducted a qualitative study using semi‐structured individual interviews with prenatal care clinicians (n = 14) at sites within or affiliated with a large urban academic medical center between November 2024 and September 2025. Participants included obstetrician‐gynecologists, a maternal‐fetal medicine physician, a family medicine physician, nurses, a certified nurse midwife, and office staff from both academic and community practice settings. Interviews were coded and analyzed using NVivo software. Emergent themes were mapped to CFIR domains and constructs.  Results: Clinicians universally endorsed the benefits of physical activity in pregnancy but demonstrated significant knowledge gaps regarding current evidence and professional society guidelines. No clinicians recognized the inverse relationship between physical activity and preterm birth. Many followed outdated guidance, citing contraindications to exercise that have been removed from current ACOG recommendations. Key barriers to deimplementation included a perceived lack of evidence, patient anxiety, social media misinformation, cultural expectations around rest during pregnancy, and fear of rare adverse outcomes. Trust in ACOG and SMFM as credible sources and system‐level infrastructure such as consensus meetings and standardized recommendations were described as facilitating decision support.  Conclusion(s): In this exploratory, single‐institution study, deimplementation of activity restriction in pregnancy was less constrained by clinician opposition to physical activity and more by knowledge gaps, patient expectations, and fear of rare adverse outcomes. Strategies that leverage existing clinician trust in professional society guidelines and address condition‐specific uncertainty may facilitate practice change.
SN  - 2997-9684
ER  -