Tagged: Sleep

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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Beyond the baby monitor

baby monitoring

Did I mention that I am currently part of a science experiment?

Sure, there is a sample size of one so I can’t promise a powerful data set coming out that would revolutionize how we think about pregnancy but maybe…

Anyway, as soon as I announced my pregnancy to the world last spring, a fellow postdoc, who is interested in biological rhythms in humans and other furry creatures, immediately jumped at the chance to make me a lab rat.  “Can I wire you up?”, he asked.

My first thought was that I was going to have electrodes attached all over my body for the next six months.  So, of course, I responded “Hell yeah!”

How could I resist?

Luckily, I do not have to wear multiple electrodes on my increasingly uncomfortable body, but I have been wearing an armband with a little data collector attached to it.  It is actually marketed for the much more lucrative fitness and weight loss industry (technically an “on-body monitoring system”) and it monitors aspects of everyday life from steps taken (your standard pedometer) to calories burned (changes in body temperature) to sleep patterns (are you laying still or moving around a lot).

So far, we have only peeked at the output with plans to really get into the data once the womb baby has joined the world. My predictions – my sleep will get progressively crappier (I can see that 3am wake up, toss and turn, and every additional midnight trip to the bathroom), the number of steps I will take will decrease and calories burned will …. well, that one will be interesting (Can we see if I’m actually “eating for two”?)

While I’m quite interested to see what information my friend can actually mine from this data set, I don’t have my hopes up too high.  It feels very limited.

But is there a way to glean even more information from our pregnant bodies?  A way to glean more information about this tiny stranger that we are building and carrying around inside our body for 9+ months? 

Looking around for this kind of technology it appears that there are quite a few things out there for understanding our own bodies… to some degree.  For example, fitness buffs and not-so-buffs looking to get into shape are using things like BodyMedia (what I currently have strapped to my arm), FitBit, and Jawbone UP.  Again, think fitness, these guys are really out for quantifying your physical output and come with handy apps to also keep track of your eating patterns, weight, etc.  They also claim to measure sleep “efficiency” but really they just rely on an accelerometer to say “ooh, movement! fitful sleep!” or “no movement, must be cruisin’ in deep sleep”.  Interesting, but not completely insightful (and maybe not even that accurate!)

In addition, there has been a burst of technology coming out to monitor babies’ bodies as well. Mimo, comes with a cute little “turtle” that attaches to a special electrode equipped onesie and tracks sleep trends and development and can also alert the parents about changes in breathing, sleep position, temperature, and waking patterns. Owlet, is a little foot cuff thing that tracks baby heart rate and oxygen levels.  Sproutling is another wearable for the baby’s ankle that monitors heart rate and breathing along with a base station that measure temperature and humidity in the room. Teddy the Guardian by iDerma is a special teddy bear that will take the kid’s temperature and oxygen saturation.  This one requires the kid to actually grab onto the bear’s paw for a reading.  With a name like Teddy the Guardian, I would actually be a little frightened that the thing might grab back, Poltergeist-style, so I don’t know about this one.

It is hard to escape the fact that we live in a world revolving around technology.  Through our keyboard, we literally have information at our fingertips (although, I must say, I am not impressed with much of the pregnancy “advice” coming up on Google).  Is monitoring our own bodies and our babies’ bodies the next step in the fully informed patient generation?

Is having access to this level of knowledge about your baby empowering or neuroses enabling?

What do we need to know?  What do we want to know?  Where is the line?

What can we learn about pregnancy if devices are available or adapted for pregnant women to track biological rhythms, changes in womb baby’s movement, heart rate, sleep cycles?

What can we learn about babies when more parents opt to go beyond the baby monitor and keep track of biological details of daily and nightly patterns?

Is this a pediatrician’s worst nightmare or previously unattainable dream?

As I prepare to make this transition from pregnant scientist to mommy scientist, I have just a few more questions for those of you who have gone through all of these stages already.  From what is available and what might become available, what is one thing you wish you could have monitored at any point during pregnancy or infancy?  What kept you up at night, checking on the baby (besides the screaming, feeding, changing part)? Would a little bit of tech have brought you peace of mind?  Or made you crazy?

And what the hell is the point of TweetPee?

Please leave comments below!