Sleeping on the side reduces stillbirth

by Claudia Ravaldi

Sleeping on your side from the 28th week of pregnancy reduces the risk of stillbirth.

The British association Tommy’s we have already talked about about the effective campaign on active fetal movements , has recently dealt with another important modifiable risk factor that can make the difference for the health of mothers and children: we are talking about the position in sleep, and in particular the importance of sleeping on your side from the 28th week of pregnancy.

It is known that sleep during pregnancy can be disturbed for various reasons, and it is also clear that as the term of pregnancy approaches, finding a “comfortable” position can be very challenging: in the past years much more weight has been given to quality. sleep and its duration rather than sleep patterns and posture.

The first studies on the “safest” position for sleeping in pregnancy were done on small samples of women in Australia and presented at the stillbirth conferences in 2007 and 2008 (I was present, and I still remember the deep sense of guilt I felt. discovering that the position on the right side is always not recommended, due to the increased compression of the vena cava: it was the only position in which I was able to fall asleep, during Lapo’s pregnancy, and only I know how much I cried, during that congress) .

These studies, pioneering and based on small samples of mothers, were not yet significant, and were asked by the international community to investigate, to avoid creating “false alarms” in pregnant women and not to spread false hopes in women already struck by death. in utero.

The commitment of researchers and clinicians has therefore continued year after year and subsequent studies and insights have confirmed the intuition of Australian colleagues: sleeping on the left side reduces the risk of stillbirth.

The greatest risk of death is linked to the supine position ( NEVER face up ): if we fall asleep face up, we double the risk of stillbirth. (Research tells us that it does not matter if we move and change position during the night: great importance is attached to the position of falling asleep , for the purpose of this increased risk).

The latest, important work, carried out on a significant number of mothers affected by stillbirth and mothers with physiological births, definitively confirmed what was studied ten years ago in Australia: 4 different studies, in 4 different countries, with mothers of different ethnicities have brought similar results, making this risk factor no longer “suspect” but “certain”.

What is the purpose of studying risk factors?

It serves to reduce avoidable stillbirths, which we covered with the special issue of Lancet 2016 .

It is for saving lives .

It serves to inform women of the fact that, even if we cannot get close to zero risk, unfortunately, it is possible to keep under control some variables that are dangerous for the health of the woman and the unborn child.

The sleeping position has become one of these variables, which is worth knowing (it is estimated that 100,000 children could be saved in the world, just by assuming the position on the side to fall asleep: easy, free, important).

Sleep on side is the title of the information and prevention campaign launched by Tommy’s dedicated to the general population and operators. The campaign, in a few months, has reached one hundred thousand views on youtube from all over the world, has been hosted in newspapers, weeklies and months, and has also appeared on the streets and in the subways of large English cities, in multiple languages, to reach all mothers.

Today 1 in 225 pregnancies in England results in stillbirth: this Tommy’s campaign, combined with the previous one on active fetal movements, is aimed at reducing the frequency of stillbirth, and saving all avoidable stillbirths.

I always wonder when it will happen that even the government of our country, which has a stillbirth rate very close to the English one (about 1 in 280), will decide to implement prevention strategies that could lead to this tragic event. a much lower frequency, saving the lives of many children.

While I dream that this will happen here one day, and that the information is accessible to all pregnant women entering the third trimester, let’s see why sleeping on your back from the 28th week of pregnancy is so dangerous: Prof Alexander Heazell, researcher , gynecologist, as well as a special dad like us, studied 291 pregnancies with stillbirth and 735 pregnancies with physiological outcome. He saw, in this great sample of women, what was found in Australia:

in the third trimester of pregnancy, pregnant women who fall asleep on their back are more likely to have intrauterine death.

Why does it happen?

To date there are only a few hypotheses:

in the third trimester, the combined weight of the baby and the pregnant uterus compress the fundamental vessels for maternal and fetal-placental circulation;

another explanation may be that of breathing difficulties during sleep, which worsen if you sleep on your back, and even more so if you are overweight or obese.

In this particular case, then, the sum of the risk factors is particularly alarming.

Knowing these things allows us to initiate the right lifestyle changes and reduce the risk as much as possible.

A must-have note for grieving mothers: if you have lost your baby in utero, reading studies and research afterwards could make you die of guilt.

This is due to the fact that biologically moms and dads want to protect their child more than anything else. And a child who dies in the belly, forces us to realize that even if love is limitless (and it is), life has many. And sometimes he slams them in our faces, from the sharpest side.

When I lost my son, the first thing I was told was that I was healthy, and therefore it was undoubtedly bad luck (lie).

Well: made the necessary investigations in another hospital that has a referral center for women like me, I discovered that I have hyperinsulinism, which leads me to have glycemic fluctuations especially at night, to develop gestational diabetes and to have large children. All of this is a known risk factor, and painstakingly manageable, if you start right before conception with the right moves.

When the diagnosis arrived I was steeped for quite a while in guilt, in the I should have and in the ” what if only “.

I was ashamed of not having “known” to know how to protect.

I was ashamed not to have foreseen. I mean, I wanted to be a superhero and save my son. Like all of us.

When I realized that there was nothing to be ashamed of, because I didn’t do it on purpose not to know, and certainly I didn’t do it on purpose to be hyperinsulinemic, I was able to start looking at the studies, the works, the campaigns of prevention without hearing me court-martialed. But what has been most helpful to me, and still is today, is promoting perinatal health, so that all avoidable deaths become avoided deaths and the world is richer in healthy children and bereaved parents.

This makes me feel good, more than “ifs” and “buts”.

#KickCounts #SleepOnSide #Movementsmatter

The bibliography on which the indications given to English women through the #sleeponside campaign are based and on which this short article is based is this:

Heazell A, Li M, Budd J et al, 2017, Going-to-sleep supine is a modifiable risk factor for late stillbirth – findings from the Midlands and North of England Stillbirth Case-Control Study

Stacey T, Thompson JM, Mitchell EA et al, 2011, Association between maternal sleep practices and risk of late stillbirth: a case-control study. BMJ. 2011 Jun 14; 342: d3403. doi: 10.1136 / bmj.d3403.

Gordon A1, Raynes-Greenow C, Bond D et al, 2015, Sleep position, fetal growth restriction, and late-pregnancy stillbirth: the Sydney stillbirth study. Obstet Gynecol. 2015 Feb; 125 (2): 347-55. doi: 10.1097 / AOG.0000000000000627.

McCowan LME, Thompson JMD, Cronin RS et al, 2017, Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; Findings from the New Zealand multicentre stillbirth case-control study. PLOS One https://doi.org/10.1371/journal.pone.0179396

Here is the video of Tommy’s media campaign.

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