Being able to get enough sleep is an essential part of your pregnancy, but just when you need it you may find that you struggle to get a good night’s sleep.
There are many reasons why sleep may be disturbed during pregnancy. It begins in early pregnancy with soaring progesterone levels, which zap your energy and can cause you to feel overwhelmed by tiredness.
By the second trimester, these pregnancy hormones should have settled down; however, you still have to deal with other common pregnancy niggles that can affect your sleep. These include backache, leg cramps, heartburn, needing to pee frequently and vivid dreams.
In the later stages of the pregnancy, you may struggle to get an uninterrupted night’s sleep.
(Cure Kids, NZ, 2018)
In order to help you get the rest you need for a safe and healthy pregnancy try the following tips:
1. Avoid fluids at bedtime
Your growing womb puts pressure on your bladder during pregnancy and it is common to need to go to the loo in the middle of the night. To reduce the number of times you wake, drink lots of fluids during the day to stay hydrated, but cut down before going to bed. Also avoid caffeine before bedtime, as this will both keep you awake and increase the urge to pee.
2. Settle your stomach
What you eat and when you eat it can affect your sleep. If you find yourself waking in the night because you are hungry, try having a small meal before bedtime. Suitable options include:
a small bowl of porridge or cereal with low-fat milk
yoghurt with oats sprinkled on top
crackers with peanut butter, cheese or chicken
an apple with a small slice of cheese.
Avoid eating big meals just before bedtime as this may make you more likely to have heartburn and indigestion. Also avoid spicy, acidic (eg, tomato products) or fried foods before bedtime.
3. Get comfortable
As your baby’s birth gets closer, you may find that your bump is too large for you to find a comfortable sleeping position. It’s safest to sleep on your side during the last 3 months of your pregnancy, as this reduces your risk of stillbirth. To make yourself more comfortable, support your bump with a pillow and put a pillow between your knees. This keeps the pressure off the muscles around your hips and pelvis.
If heartburn is a problem, you could try raising the head of your mattress a few centimetres to help keep stomach acids where they should be.
4. Wind down at bedtime
Take some time to relax as it gets close to your bedtime. Your antenatal classes may teach you some relaxation techniques, or you can find many relaxation videos, podcasts and apps online.
If you find yourself worrying at night about your pregnancy or the idea of becoming a mother, write down the things that are on your mind. Talk about them with your partner, a friend or your midwife. This can help you to feel less anxious about your concerns or help you to find practical solutions to them.
5. Exercise
Exercising regularly during pregnancy will help improve your circulation and reduce leg cramps. It can also help you feel less tired. Try to do something active each day. If you were active before your pregnancy, you can continue with the same level of activity. Exercise during pregnancy has not been shown to create any problems for mother or developing child. See if there are any pregnancy yoga or pilates classes in your area.
Avoid vigorous activity for about 4 hours before bed, to give your body a chance to wind down. Read more about exercising during pregnancy.
6. Ask for help and rest when you can
Sleeplessness is very common during pregnancy. It won’t harm your baby, but it can make you feel run down and exhausted. Listen to your body when it tells you to slow down or rest. If you can find time to sleep during the day, do so.
If you find tiredness is really affecting your day-to-day life, try to get help where you can. If you are working, ask your employer about changing your hours or duties. If you already have children, see if family or friends can look after them for a bit so you can catch up on rest.
If lack of sleep continues to bother you, talk to your doctor or midwife.
Why you should sleep on your side during the last trimester
In early pregnancy, going to sleep in any position you feel comfortable in is fine. However, during the last trimester of your pregnancy, you should try to go to sleep on your side, either your left or right. Lying on your back in the last 3 months of pregnancy presses on major blood vessels, which can reduce blood flow to the womb and oxygen supply to the baby, increasing the risk of stillbirth.
It is normal to move about when you sleep, so don’t worry if you wake and find yourself on your back. Simply roll on to your side before going back to sleep.
(Cure Kids & Ministry of Health NZ, 2018)
What is the risk of stillbirth?
Stillbirth in the last 3 months of pregnancy affects about 1 in every 500 babies. However, research has confirmed that going to sleep on your side halves your risk of stillbirth compared with sleeping on your back. It’s estimated that if all pregnant women go to sleep on their side from 28 weeks of pregnancy, there could be a 10% decrease in late stillbirth nationally.
Approximately every 3 in 1,000 women are affected by late stillbirth, resulting in approximately 160 New Zealand babies' deaths annually.
Studies have shown that lying on the back in the third trimester increases the risk of stillbirth.
Health professionals are encouraged to discuss sleeping on the side with all pregnant women from 28 weeks of pregnancy.
Going to sleep on the side (either left or right side is fine) from 28 weeks of pregnancy halves the risk of stillbirth compared with going to sleep on the back.
Facts and figures
Late stillbirth (death occurring on or after 28 weeks' gestation) affects approximately 3 in every 1000 women, resulting in deaths of approximately 160 New Zealand babies annually.
According to published studies (two from New Zealand, one from Australia and one from the United Kingdom), there is an increased risk of stillbirth in women who go to sleep lying on their backs in the third trimester of pregnancy.
This is a modifiable risk factor for late stillbirth, thus it is important to discuss the issue with all pregnant women.
Physiology
In the supine position (when a mother lies on her back) in late pregnancy, the uterus compresses the inferior vena cava, reducing more than 80% of the blood flow in the inferior vena cava. The pregnant uterus also compresses the aorta partially, reducing approximately 30% of blood flow in the aorta.
The mother's circulatory system compensates for this reduction in IVC flow by:
increasing blood flow back to the heart through collateral veins below the obstruction
increasing heart rate.
Nevertheless, this does not fully maintain optimum blood flow.
The physiological response to the supine maternal position in late pregnancy includes:
approximately 24% reduction in venous return to the heart
reduced cardiac output on average by 16%, which is likely to reduce uterine and placental blood flow leading to reduced oxygen delivery to the fetus.
The foetal response
In response to the supine maternal position, the foetus spends more time in a quiet behavioural state (non-reactive fetal heart pattern) and rarely exhibits a very active behavioural state. This suggests that the healthy foetus responds acutely to the reduced blood flow by conserving oxygen consumption.
While the healthy foetus can compensate adequately for periods of reduced placental perfusion, it is speculated that an at risk of vulnerable foetus is likely to become acidotic and decompensate when a mother lies on her back.
Sleep-disordered breathing
Sleep-disordered breathing increases in pregnancy, can be associated with maternal hypoxic episodes and is more common when lying on the back. Sleep-disordered breathing has been associated with pregnancy complications including foetal growth restriction, hypertensive disorders and gestational diabetes, which are all associated with increased stillbirth risk. Sleep-disordered breathing while lying on the back could therefore add to the adverse effects of reduced blood flow.
Goodfellow Gem: Going-to-sleep on the side in late pregnancy (≥28 weeks) reduces the risk of stillbirth
A meta-analysis on maternal going-to-sleep position and late stillbirth has been published, incorporating all available international data.This showed that supine going-to-sleep position is independently associated with late stillbirth in the general pregnant population. This is regardless of mother’s body size, baby size, smoking, recreational drug use, pre-existing hypertension or diabetes, fetal movements, or gestation. There was no difference in risk with right side going-to-sleep position compared to left.
If all pregnant women in their third trimester slept on their side, this could potentially reduce late stillbirth by approximately 6%.
It's important this health message is conveyed to women in late pregnancy. Whooping cough vaccination / invitation letter in second / third trimester is one potential opportunity for this.
Professor Lesley McCowan discusses the impact of maternal sleep position on late stillbirth risk and how the public health message of side sleeping is best in late pregnancy.
