Don’t Sleep on Your Back

November 3, 2017
At the International Stillbirth Alliance Conference

Researchers are always trying to find out how to prevent stillbirth. As a result, new findings mean we have to change how we think about our losses. I was just at the International Stillbirth Alliance conference and new research has come out that changes my thinking on the death of my boys. Several different researchers, doing very different types of research, all came up with the same conclusion: going to sleep on your back increases the risk of stillbirth. Since then, I have been racking my brain as to whether I may have slept on my back that night. With the passage of time, there’s no way I could possibly remember, although I do remember I slept well.

Managing Guilt?

So how can I cope with new information, with the possibility that it may have been something I did that caused my boys to die? It’s something I’ve really been grappling with. I mean, obviously if I had known the risks, I would never have done it right? Still, part of me thinks that isn’t true.

After all, until it happens to you, you really don’t think stillbirth is something that could happen. Yes, you know the statistics. I certainly did. I knew that twins were riskier, especially monozygotic twins like my boys. But it was always something to put in the back of your mind as something that happens to other people. You know, those ones who take real chances. Those ones who don’t love their babies as much as we do. Knowing statistics and acting on them still requires you to believe that you might be one of the unlucky ones. And we all take chances every day. I know that driving a car is risky, but I still do it. If we always thought we were going to be the unlucky ones, we’d be paralyzed by fear all the time, and that’s no way to live.

Sleeping on your back increases risk

So a bit more about the research: A couple years ago, some researchers in New Zealand wondered if something similar was going on with stillbirth as with SIDS. Was it possible that when a pregnant woman lay on her back, the blood flow was restricted to her placenta, causing her baby to not get enough oxygen? So they did something called a case-control study, a common research type for this kind of thing, where they compare women who’ve had a stillbirth (the cases) to women who haven’t (the controls). What they found was that women who had a stillbirth were far more likely to have slept on their backs the night they lost their baby than women who did not have a stillbirth.

But one study, even a reasonably large case-control study, is not enough proof. Researchers need to be replicate studies in order to be certain, otherwise we could potentially cause more harm. That’s what the three studies presented at ISA hoped to do.

Amulets at the Memorial Service for our babies

New Research

Two of these are also done in New Zealand, from some of the same researchers, and they hoped to show physiologically how this might work. Ten healthy pregnant women were scanned using an MRI. The researchers wanted to know if they could see changes in blood flow depending how the woman was lying down. What they found was that that cardiac output (how efficiently the heart pumps blood) was the same in both positions. But when women were lying on their backs, the blood flow and diameter of the inferior vena cava were reduced. This would affect how blood flows back to the heart from the body.

The second group asked 30 pregnant women to spend the night in a sleep lab. They monitored their breathing and position while sleeping to see if there was a relationship between the quality of their breathing and their position. None of the women met the criteria for sleep apnea. However, the women didn’t breathe in as deeply when they were lying on their backs. Both of these studies show that it might be true that babies are not getting enough oxygen if mom is sleeping on her back.

A third set of researchers, in the UK, interviewed over 1000 women in another case-control study. They were asked about their sleep practices at three points in time. All the women were asked how they slept before and during pregnancy. Women who had a stillbirth were also asked how they slept the night before their baby died. Those who did not were asked how they slept the night before the interview. Women who said they had gone to sleep on their backs the night before were twice as likely to have had a stillbirth.  This study is problematic for the same reasons I can’t remember what position I was in when my sons’ died (guess what – your memory is horrible – it’s human nature!). Taken together with the other three studies, it starts to become clearer that sleeping on your back might not be a good idea when pregnant.

Conclusion?

So, if you’re pregnant again after your loss – don’t sleep on your back!

Worried about whether your own sleep position might have contributed to your baby’s death? I am. But, please remember that you did the best you could. You deserve to forgive yourself. I’m still working on it.

 

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  • Amanda

    Amanda Ross-White is the proud mother of four beautiful children, including her twin boys Nate and Sam, who were stillborn in 2007. She is eternally grateful to watch her rainbow children, daughter Rebecca and son Alex, grow around her. She is also the author of Joy at the End of the Rainbow: A Guide to Pregnancy After a Loss, which won second place in the American Journal of Nursing's Book of the Year Awards (Consumer Health).

    1 Comments

    • Casey

      November 3, 2017 at 7:56 am

      I lost twins at 21 weeks but to incompetent cervix and so they were born and did not survive. Got pregnant again with twins and was on bedrest at 14 weeks and hospital at 20 weeks. I was contracting constantly and on lots of meds. I was laying in tredelenburg (foot of bed raised high) and on my back. At week 28 they noticed a decreased flow to my baby girl. I knew many women who had a stillbirth and a few with twins as it is more common. I knew something was wrong as she moved less and was smaller. I decreased my foot elevation a little and tried to move on my sides. It kept her flow stable but it was low and I was monitored 3x’d a day to see if we should deliver. Laying on my sides was painful as it felt like baby boy was getting pushed down into my cervix that had no length and was holding on by my cerclage. I just knew that laying on my back was decreasing the baby girls flow more and so I had to find a balance. Ended up that the boy did push down so much that I dilated through the cerclage and his bag was budging. Got another round of steroids and then did a c section for their safety at 30 weeks. I wanted to make it further but I honesty don’t think our girl would have survived and we would have lost blood flow.
      I’m so sorry for your loss. I think that sleeping on your back most likely increases the chances of there is a placenta issue but you could not have known. I felt the same way in my first pregnancy. I was working out and active in the second trimester and had no idea my cervix was opening up. I ended up in full blown labor, water breaking, hospital and bedrest for 3 weeks and then getting an infection from the broken membranes and delivering despite fighting it at 22 weeks. I did everything I could in the second pregnancy and still had the same issues and realized that there was Just know what to know.

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