Best Sleeping Position During Pregnancy: A Guide for Expectant Mother

Introduction:

Getting good sleep is essential for our overall health and well-being, taking up about a third of our lives. When our sleep quality is poor, it can impact the other two-thirds of our existence. There is growing evidence that issues like sleep-disordered breathing, insomnia (sleeplessness), and simply not getting enough restful sleep can negatively affect pregnancy outcomes.

More than half of the major risk factors for stillbirth (loss of a baby during or just before delivery), like gestational diabetes (raised blood sugar levels seen during pregnancy), maternal hypertension (elevated blood pressure), and fetal growth restriction are linked to sleep disruptions in pregnant women. Recent studies also indicate that how a mother sleeps can be a risk factor for stillbirth.

What Is the Best Sleeping Position in the First and Second Trimesters?

During the first two trimesters, sleeping position is not much of a concern as the size of a woman's uterus and the weight of the womb, including the fetus, placenta, and amniotic fluid, are not that much compared to the third trimester.

So it is also essential to educate which sleeping positions are not linked with poor pregnancy-related outcomes to reduce unnecessary sleep pattern limitations, worry, and anxiety among pregnant women, especially first-time pregnant women who might feel more anxious about the pregnancy.

In one such study, the researchers concluded that various sleeping positions during early and mid-pregnancy do not appear to impact the risk of complications throughout pregnancy and childbirth. This finding may help reassure many pregnant women, especially those who face difficulties sleeping on their left side and those who have difficulty controlling their position while asleep.

Hence, pregnant women can choose their preferred sleeping position during their early and mid-pregnancy without worrying about the negative impact on their baby in the womb.

What Is the Best Sleeping Position in the Third Trimester?

Sleeping on the left side is the best position during late pregnancy. It has long been widely acknowledged that sleeping posture can profoundly impact maternal hemodynamics (cardiovascular function, including arterial pressure and cardiac output).

Studies have reported that in awake pregnant women, there is an apparent reduction in ejection fraction (a measure of the percentage of blood going out the heart every time it squeezes) and cardiac output (the amount of blood that the heart pumps in one minute) in the supine position (lying on the back) compared to the left lateral position.

These changes can reduce the uteroplacental blood flow toward the fetus since the uterus's weight presses on the inferior vena cava (a large blood vessel of the human body). Failure to prevent this compression can cause maternal supine hypotensive syndrome. It may adversely impact the blood flow of the umbilical artery and gas exchange between the mother and fetus, which can consequently result in fetal heart rate decelerations (temporary but a typical decrease in the fetus's heart rate) and fetal growth restriction.

For over 60 years, it has become a standard of care to position a laboring pregnant woman in the left lateral tilt lying down to displace the weight of the uterus from the inferior vena cava for improvement in maternal hemodynamics. Despite this widely spread knowledge, little attention is paid to the maternal sleep position during late pregnancy. Given the known impacts of inferior vena cava compression, the possibility of a supine sleeping position increasing the risk of stillbirth is evident.

What Are the Sleep Positions to Avoid During Pregnancy?

Many recent studies conducted in different countries on pregnant women of different ethnic origins also showed that supine sleep is independently linked to stillbirth. One of them found that the adverse effect of sleeping in the supine position on stillbirth was mediated through low birth weight. Moreover, these studies also suggested that if sleeping in a supine position plays a causal role in stillbirth, altering the sleeping position of pregnant women can decrease the occurrence of stillbirth by approximately 25 percent. However, one study recently demonstrated that of most pregnant women, roughly 80 percent spend some time in a supine sleeping posture, with the average time being around one-quarter of the night; therefore, supine sleep may represent a maternal stressor in case of unexplained late stillbirth.

How to Find a Comfortable Position for Sleep During Pregnancy?

Several potential ways to reduce supine sleep and thus prevent the weight of the uterus from pressing on the important vessels include wedges of mattresses or pillows or other interventions.

Below are the ways to make side sleeping work:

• The Tennis Ball Technique: It involves sewing a patch with a tennis ball on the back of a night dress or a T-shirt, which can prevent pregnant women from sleeping on their backs. If they move their back, the ball will result in pressure, waking the pregnant woman and encouraging them to move to their sides. It prevents supine position effectively, but compliance could be much higher. Some novel devices could also alert a pregnant woman during sleep, and they can then change their sleeping position.

• A Lightweight Backpack: It can also effectively prevent sleeping in a supine position if a pregnant woman places a baseball or a softball into it. When a pregnant woman tries to move their back during sleep, the discomfort from the ball causes them to shift over to their sides. This inexpensive method can make a difference for some pregnant women who struggle to stay in their lateral position throughout the night.

• Wedge Pillows: You can put one pillow under your belly and one pillow behind your back. This will keep you from rolling and help you stay in the left-lying position throughout the night.

• Tilted Position: If you can not get used to the left-lying sleeping position, you can use pillows to hold your upper body at an angle (preferably a 45-degree angle). This way, you prevent the compression of your inferior vena cava as you are not flat on your back.

What Are the Tips to Sleep Better During Pregnancy?

If you are dealing with pregnancy insomnia, there are some simple changes you can make to your sleep routine that do not involve sleep aids.

• Sleep on Your Left Side: This position helps improve blood flow and takes pressure off your liver. You might find adding a mattress topper more comfortable and using pillows for support under your lower back, between your legs, or under your belly.

• Keep Your Bedroom Dark and Quiet: Use a dim nightlight instead of bright lights for late-night bathroom trips. This can help you drift back to sleep.

• Set a Bedtime Routine: Try to sleep and wake up simultaneously every day. A relaxing practice before bed can signal your body that it is time for sleep.

• Eat and Drink Mindfully: Avoid heavy meals and excessive liquids before bed, and steer clear of caffeine in the afternoon. If you are feeling nauseous, a light snack might help.

• Manage Leg Cramps: If leg cramps wake you up, talk to your doctor about possible treatments to reduce their frequency.

• Exercise Early in a Day: Regular exercise can improve sleep. However, to help your body relax, try to finish your exercise a few hours before going to bed.

• Take Naps Wisely: Napping can help compensate for lost sleep, but keep naps early in the day so they do not interfere with nighttime rest.

• Consider Cognitive Behavioral Therapy: This therapy focuses on adjusting sleep habits and thoughts to improve sleep without medication.

• Reach Out for Support: Feeling overwhelmed during pregnancy is normal. Do not hesitate to talk to friends, family, or your healthcare provider for support.

Conclusion:

Overall, extensive evidence suggests an increased risk of stillbirth during late pregnancy, particularly after 28 weeks, and highlights that babies born smaller for their gestational age are also associated with sleeping in the supine position rather than on the left side; therefore, there is sufficient proof to advises pregnant women to avoid sleeping in a prone position, especially after the 28-week mark. However, the evidence does not support an increased risk of stillbirth linked with sleeping on the right side, regardless of the timing, when compared to sleeping on the left side. A pregnant woman can best control her sleeping position through conscious awareness and using pillows or other props to maintain the left lateral position while sleeping.