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There's been much greater awareness in recent years of the recommendation to go to sleep on your side in the third trimester, which is fantastic! But #SideToSleep is only part of the story - quality sleep is also critical to your and your baby's health during pregnancy.

Pregnancy is not typically known to be conducive to restful sleep (midnight bathroom breaks generally aren't!) and research has shown that poor sleep health (especially sleep disordered breathing such as obstructive sleep apnea) is associated with adverse pregnancy outcomes.

So what's a tired mama to do? Do your best to get some much-deserved rest and try to fall asleep on your side later in pregnancy. And if it's any consolation, at least one study has found that restless sleep in late pregnancy seems to be protective against stillbirth!

Does Back Sleep Cause Stillbirth?

Let's be clear: nothing a mother can do during pregnancy (short of gross negligence!) causes stillbirth - and that includes sleeping on your back. Researchers use the triple risk model to explain that stillbirth is generally the result of a "perfect storm" of factors:

1. Maternal factors (high or low blood pressure, smoking, etc.)

2. Fetal and placental factors (umbilical cord abnormalities, placental insufficiency, etc.), and

3. Environmental stressor (such as reduced blood flow during sleep)

While each of these factors alone may not cause significant harm to a baby, when combined, there's a possibility of interplay between the factors that could magnify the risks.

The challenge is that we don't always *know* when some of these vulnerabilities (cord issues, for example) are present. And so, by sleeping on your side when possible, you are eliminating at least one potential factor, thereby dropping your risks of stillbirth from 1 in 170 to even better odds.

Evidence & FAQs About Side Sleep in Pregnancy

The data has shown in five separate international research trials that there is a link between stillbirth (being 2-8 times more likely, depending on the study) and going to sleep on your back in the third trimester (after 28 weeks of pregnancy).

So what are the recommendations? From about 28-30 weeks onward, you should try to fall asleep on your side (either side is fine!). If you wake up on your back, do not worry - research has shown that you likely spent the deepest and longest part of your sleep on your side, and rolling to your back is probably what woke you up. Just roll over onto your side and go back to bed, sleepyhead!

And what if you can't get comfortable on your side? The goal is to get the weight of your tummy off your back, so as long as your hips are tilted (~30° off the bed), that should do it. Some people find that sleep positioners or wedges help. But don't stress over it - as always, listen to your body and remember that this is only *one* preventative measure you can take out of many.

Tommy's in the UK & Australia's Still Aware both offer excellent in-depth answers to many frequently asked questions about safe sleep position in pregnancy - check those out to learn more!

Woman Sleeping
Maternal Sleep Quality & Pregnancy Outcomes

Sleep position is just one aspect of safe sleep in pregnancy - sleep quality, on the other hand, contributes to a whole host of maternal and fetal health factors! For example, issues like sleep disordered breathing and lack of sleep during pregnancy have been linked to:

The good news is that sleep disordered breathing in pregnancy is easily treatable. Though further study is needed, continuous positive airway pressure (CPAP) treatment appears to offer promising results in improving maternal/fetal health and pregnancy outcomes.

Pregnancy is exhausting, but if you are feeling exceptionally tired - or your partner is complaining of your snoring! - talk to your healthcare provider about whether you should be screened for sleep issues.

Young Mother Expecting
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