Sleeping and Sleep on the Back During Pregnancy

It’s a bad idea to force yourself to sleep in a certain position. You should sleep in the position that’s most comfortable for you. There is no proof that you will harm the fetus if your most comfortable position is sleeping on your back, nor is there scientific evidence that sleeping on your side will improve pregnancy outcome. Whichever you feel more comfortable with, it’s OK to either sleep on your side or on your back,

The American College of Obstetricians and Gynecologists, the professional organization of all Obstetricians and Gynecologists does not have a firm recommendation for the sleeping position of pregnant women. Specifically, there is no recommendation that pregnant women must sleep on their back to improve pregnancy outcome. In a chapter on difficulties of sleeping at night, ACOG suggests that women with sleeping problems should consider sleeping on their side …“with a pillow under the abdomen and another between the legs”, but that suggestion applies to women with sleeping problems, not a precaution to improve pregnancy outcome.

Most pregnant women receive unsolicited advice all the time about  what to do and what not to do. Some of the advice may be correct and of sound background, and some may just be plain common sense that you should follow. Unfortunately a lot of this advice is not based on sufficient scientific information but on incomplete knowledge and sometimes even on myths. Advising pregnant women that they must sleep on their side is one of those not-so-sound recommendations.

The  advice of sleeping on the back has probably it’s origin from a condition called ‘supine hypotension syndrome’ which is experienced by some women occasionally during pregnancy. The ‘supine hypotension syndrome’ usually occurs in the last trimester of pregnancy, though it can also happen earlier in pregnancy or post-partum. It is characterized by a feeling of dizziness and nausea in a woman lying on her back, occasionally forcing her to change position from the back to the side. In very rare exceptions, more likely on the operating room table and under anesthesia is it possible for the pregnant woman to lose consciousness.

The supine hypotension syndrome is also known as ‘vena cava syndrome’ because it is likely caused by the pressure of the enlarged uterus and the fetus on a large blood vessel, the inferior vena cava, which flows behind the uterus and through the liver towards the heart. This compression of the vein in turn  can lead to less blood flowing back to the heart, and eventual decrease in blood pressure (hypotension).

Compression of this big vein can occur when the woman lies directly on her back, but it can also be observed in other positions such as in the pelvic tilt or sitting positions. The low blood pressure usually improves when you move from your back to your side. Because anesthesia may worsen the condition, pregnant women on the operating table are usually placed for precaution slightly tilted on their side with a wedge under their back.

Pregnant women have already a lot of worries on their mind and they often find it hard to sleep anyway. Forcing a pregnant woman to be conscious about her position won’t make her sleeping easier. Consciously trying to control your sleeping position may make your sleep even worse and prevents you from getting your good night’s sleep.

If you do have problems sleeping during pregnancy here some recommendations for a good night’s sleep:

• Find a position that’s comfortable for you. This  could be on your side or your back  Don’t force yourself into one position.
• Use pillows to ease the weight of the uterus, specifically in the last part of the pregnancy.
• Take a warm bath or shower at bedtime.
• Try not to rest or sleep too much during daytime.
• Exercise regularly, but not in the late afternoon or evening
• Don’t eat a heavy or spicy meal before bedtime. Eat 3-4 hours before going to bed. You may want to eat a small snack if you are hungry at bedtime.
• Don’t drink too much in the afternoon and empty your bladder shortly before you go to sleep
• Sleep at a comfortable temperature.
• Your mother was right: Having a cup of hot milk at bedtime eases your sleep and provides you with much needed calcium.
• And if all of this doesn’t work, try the ultimate sleep and relaxation technique: An orgasm at bedtime.