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

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 Many followed outdated guidance, citing contraindications to exercise that have been removed from current ACOG recommendations.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.