No sleeping on your back! Wait, what?!

Of all the “no no’s” thrown at your growing pregnant body, the one that I found ridiculously frustrating was the “No sleeping on your back” rule.

Sleep is a precious precious commodity when carting around a huge pregnant belly. Why would you dictate how I sleep with this thing?!

The reasoning for the sleep position policing stems from the idea that back sleeping can choke off your baby’s oxygen supply.

Here is the “logic”:

Your uterus is heavy. So heavy, in fact, that it puts weight on the vena cava, the vein that runs blood back to your heart. A compressed vena cava means decreased blood back to the heart and therefore, decreased blood coming out from the heart. Less oxygenated blood for you, less oxygenated blood for the baby. Not good.

I really wanted to call bullshit on this one during my last pregnancy (yet dutifully buoyed myself on my side with pillows each night). I mean, if oxygenated blood is getting cut off, it would affect how that blood gets to the brain and you would feel dizzy. Right? So, isn’t that a simple test to see if your heavy uterus cuts off your blood supply? Lay down, feel woozy, heavy uterus!

Drs Farine and Seaward at the University of Toronto seem to agree with me.

“Women should be told that a small minority of pregnant women feel faint when lying flat” – Dan Farine, MD, FRCSC, P. Gareth Seaward, MD, FRCSC

Of course, my experimental nature was cut short when a friend sent me this article.

Medical student, Allan Kember is fighting stillbirth with a belt that prevents pregnant moms from sleeping on their backs.

Stillbirth!? Back sleeping!? Holy shit. Maybe this deserves a second look.

I called up Allan.

Allan’s research stemmed from studies like this one and this one. Most inspiring though was a study coming out of Ghana in which the authors showed that a quarter of stillbirths might be prevented by changing mom’s sleep position. Allan wanted to answer the call for a simple, inexpensive solution to solve stillbirth in the developing world. His thought process: encourage expecting moms to not sleep on their back, save a few babies.

Cool.

Of course, I had to bug him about the whole vena cava scenario. He admitted that this might not be the full picture.

Another culprit? Gestational sleep apnea (sleep disordered breathing).

Here’s the problem though: we really do not understand gestational sleep apnea well enough to point a finger quite yet and we have no idea how sleep apnea might affect a growing baby. Oxygen flow disturbances? Stress responses? Mom snoring too loudly?

Ok, probably not the last one.

At the end of the day, it seems that stillbirth may follow a similar rule as what has recently been shown in SIDS research. It isn’t any one thing that causes it. It’s the perfect storm of complications that can result in stillbirth.

The triple risk:

(1) maternal risk factors, (2) fetal risk factors (low growth rate, placental insufficiency), and (3) a stressor (such as back sleeping).

Don’t tick off all three boxes, you’re in the clear. At risk already? Do whatever you need to do to prevent that third tick and you’re in the clear.

SIDS research has figured out a way to prevent that third tick in as many babies as possible, regardless of preexisting vulnerabilities – the giant, border crossing “Back to Sleep” campaign where parents are reminded to never put a baby to sleep on her tummy. The result? A decrease in SIDS with an increase in flat heads. But flat heads are fine if it means babies keep breathing into adulthood.

Of the 4 possible sleep positions, pregnant women end up on their backs over 25% of the time, with over 80% of women hitting this position some time during the night. It’s normal. It’s common. It’s an epidemic?

Researchers in the UK are now trying to determine if a national campaign, similar to the SIDS “Back to Sleep”, should be launched to tell moms not to sleep on their backs.

This is where I draw the line.

Going to sleep with a homework assignment (“do not sleep on your back!), is enough to keep us pregnant moms up worrying about what all the damage we can do to our unborn child while we toss and turn. One study showed exactly this – asking women to make sure they slept on their left sides results in decreased overall sleep time.

When quality sleep is so freaking important during pregnancy and so freaking difficult to achieve, why mess with it more?

Here’s another gem of a quote from Drs. Farine and Seaward:

“If lying prone had been detrimental to a normal pregnancy, the species would long ago have ceased to exist” – Dan Farine, MD, FRCSC, P. Gareth Seaward, MD, FRCSC

Back to the stillbirth thing. Maybe the first thing to tackle is figuring out how to define which women and babies are at risk and come up with solutions for this small subset. Maybe it’s a CPAP to treat sleep apnea, maybe it’s a belt with balls to encourage side sleeping, maybe it’s a mound of body pillows.

For now, it’s time for me and my big, heavy, vein crushing uterus to hit the hay.

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4 comments

  1. Yoke Fong

    Love reading your blog! The “no sleeping on your back” has certainly bugged me since I’m a back sleeper and will naturally roll onto my back at night. 9 years ago when I was pregnant with my first kid, there was no such ‘rule’ and indeed, I slept more badly for the more recent pregnancy. And congratulations!

  2. kristinlaureningram

    I’m an L&D nurse. First off let me thank you profusely for this page. Pregnancy and delivery these days is so full of BS. I agree with this post but must say, when you are full term and especially when you’re in labor, this is true. But until your baby and gravid uterus are big enough to cut off your great vessels, just get some rest however you need to! You will start to feel lightheaded before the baby does (so to speak), and you’ll know to get off your back. In labor when we see not so good things happening on the strip, one of us will look at the other and say “hey room 5 is on her back,” so someone can go ask her to tilt to one side or the other. It’s that pronounced. But these are term, heavy, full uteruses. Uteri…?

    • thepregnantscientist

      Thank you, Kristin! This is such an important perspective.
      Yes, you are absolutely right, a giant full-term uterus is not something to underestimate! And you would know better than most!
      I do find it interesting that they tell you this SO early on in pregnancy and don’t really relay the “you will start to feel lightheaded before the baby does” aspect of it.

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