When in pregnancy should you stop sleeping on your back

When you’re pregnant, sleep can become a problem. Here are some tips to help you get as much sleep as possible so you are as rested and ready as you can be for your baby’s arrival.

When you’re pregnant, your sleep isn’t as deep and refreshing as usual, and you’ll wake more often throughout the night. You need more than usual – as much as you can get.

But getting more sleep isn't always easy, especially if you have work, other children or other responsibilities.

If you can, get to bed earlier than usual and have a daytime nap. It can also help to:

• rest as much as you can during the day
• go for a walk in the late afternoon or early evening
• avoid tea and coffee before bedtime
• relax before bed by taking a bath, reading, listening to music, watching TV or having a backrub

Sleep during the 1st trimester

The main issue in the first trimester is tiredness. See above for some helpful suggestions.

You might also need to pass urine more often, which will disturb your sleep. Going to the toilet more often is normal, but if it hurts to pass urine, talk to your doctor.

Sleep during the 2nd trimester

The second trimester brings new challenges.

Many women get a blocked nose and feel stuffed up due to hormonal changes. Saline nasal sprays can help.

Leg cramps can also disrupt your sleep. It’s not really understood why leg cramps happen, but there are a number of things you can do to ease them, such as stretching your calf muscles, being active during the day and drinking plenty of fluids.

Some women have more dreams than they would normally, or unusual dreams, or nightmares. Sometimes it can be related to stress, or it could be inconsistent sleep. Try to stick to a regular schedule and maybe try different sleep positions or use a pregnancy pillow. If you are having dreams that are disturbing you, it can help to talk to your partner or a friend, or consider talking to a counsellor.

Some start to snore for the first time in their lives. Sleeping on your side and keeping your head slightly elevated can help. Maintaining a healthy diet and not putting on too much weight can also help.

Sleep during the 3rd trimester

It’s important from 28 weeks till your baby is born that you sleep on your side. Whether you are taking a quick nap on the couch or going to bed at night, sleeping on your side is best.

Lying on your back puts pressure on major blood vessels. This can reduce the flow of blood to your womb, and restrict your baby’s oxygen supply. Research has shown that sleeping on your side can reduce the risk of stillbirth by half.

You can make it more comfortable, and easier to stay on your side, by bending your knees then putting a pillow between them. You can also put a pillow under your belly for support.

If you wake and find you’ve been asleep on your back, turn onto your side. If it happens a lot, put a pillow behind your back so rolling over onto your back is more difficult.

Some women find it comfortable to sleep with their head quite high, either with pillows for support or by raising the head of the bed a little. This can reduce heartburn and snoring.

You might find your back aches more at night. If you can, try to avoid heavy lifting, housework and long periods of standing. And as mentioned before, rest during the day with your legs up, if you can.

The frequency of your need to pass urine at night might increase even further. The baby might be pressing on your bladder, and the hormones that go with the later stages of pregnancy can relax your pelvic floor. Pelvic floor exercises will help you manage any 'leaks' and also avoid continence problems in years to come.

Sleep aids

A pregnancy pillow might help you get comfortable – they come in many different shapes and sizes and you should be able to find one that suits.

Generally, pregnant women are advised not to take any sleeping tablets, although your obstetrician or midwife might advise you otherwise.

Services and support

Whether you are experiencing common pregnancy problems or more serious sleep disorders, anxiety or depression, you can get support from a range of professionals and services, including:

• your midwife or obstetrician
• your GP
• Beyond Blue on 1300 22 4636

You can also call Pregnancy, Birth and Baby on 1800 882 436 for advice and support.

As your belly grows, sleeping on your back may not be good for you. It puts the weight of your uterus on your spine and back muscles. In the second and third trimesters, lying on your back may compress a major blood vessel that takes blood to your uterus, making you feel dizzy and possibly reducing blood flow to your fetus.

Sleeping on your side during your second and third trimesters may be best. Keep one or both knees bent. It may help to place a pillow between your knees and another under your belly. You also can try a full-length body pillow for support.

Published: January 2021

Last reviewed: January 2021

Topics

Pregnancy During Pregnancy Health and Safety During Pregnancy Sleep

Copyright 2022 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

Pregnancy can be exhausting. Plus, you need sleep now more than ever. But finding a comfortable position can be a challenge, especially when you are plagued with concerns over which positions are safe and which should be avoided.

If you are a back sleeper, you may have heard that sleeping on your back is a pregnancy no-no. Naturally, you may be concerned, especially if you wake to find that you have spent most of the night on your back.

Turns out, back sleeping is fine during the first and second trimesters. But during the third trimester, it increases your risk of having a stillbirth and other problems, so it is best to choose another position.

"Sleeping on your back during pregnancy should be avoided in the third trimester to avoid compression of the vein that returns blood to the heart," says Kim Langdon, MD, an Ohio-based OB/GYN with more than 20 years of experience.

Previous studies indicated that sleeping on your back during pregnancy puts you at risk of preeclampsia and your baby at risk of low birth weight, reduced fetal growth, and stillbirth. However, the latest research says that sleep position is not an issue during the first 28 weeks of pregnancy.

When the baby, placenta, and uterine fluid grow heavier, sleep position becomes an important consideration. As you get closer to the third trimester, this weight may compress important blood vessels, leading to problems like low birth weight, preeclampsia, reduced fetal growth, and stillbirth.

The weight of the contents of your uterus is what determines when back sleeping becomes unsafe. This may vary from person to person, so you should always talk with your healthcare provider to understand exactly when and whether back sleeping is safe for you and your specific pregnancy.

Around 28 weeks gestation, choose a sleeping position other than supine. But if you do wake up on your back, just resettle yourself on your side or stomach.

Every pregnancy is different. Be sure to consult with a healthcare provider about your circumstances if you have any questions about sleeping on your back while pregnant

Back sleeping during the first 28 weeks of pregnancy will not likely impact your baby. After about 28 weeks, sleeping on your back may increase the baby's risk of being born at low birth weight due to reduced fetal growth, or stillbirth.

Lying on your back during pregnancy becomes problematic when your uterus becomes heavier, around 28 weeks. The contents of your uterus, which includes your baby, the placenta, and amniotic fluid, make up about a third of your pregnancy weight gain.

When you lie in the supine position, the weight of your uterus falls upon a vein called the inferior vena cava. The inferior vena cava returns blood from the abdomen to the heart. Compressing this vein may lead to low birth weight, preeclampsia, reduced fetal growth, and stillbirth.

There are a few risks to be aware of when it comes to sleeping on your back later on in pregnancy. Here are some of the risks associated with sleeping in a supine position.

Too much pressure on the vena cava may increase your risk of developing preeclampsia, high blood pressure during pregnancy. With preeclampsia, you may experience headaches or abdominal pain, and your baby is at risk of preterm delivery or stillbirth.

Sleeping on your back past 30 weeks gestation can compress the inferior vena cava, potentially restricting blood flow, leading to reduced fetal growth. Reduced fetal growth also may result in low birth weight, which is defined as less than 5 pounds, 8 ounces. Babies born at low birth weight face increased risks, including breathing problems and jaundice.

Studies found a threefold increase in stillbirth risk when pregnant people slept on their back after 28 weeks gestation. Back sleeping increases the risk of fetal growth restriction and fetal stress, both of which contribute to the risk of stillbirth. If comorbidities are present, these factors further increase the risk of stillbirth.

If you prefer to sleep in the supine position, it is fine to resume doing so after you give birth. When you deliver your baby and placenta, the vast majority of the weight in your uterus exits your body. Then, you no longer have the issue of compressing the vena cava to worry about. And once your baby is dozing in a bassinet, your sleeping position will not affect their development.

Back sleeping is no longer safe after 28 weeks gestation, but there are a few other comfortable positions for you to safely doze in.

Sleeping on your stomach does not put pressure on any major blood vessels and is considered safe for your baby. Using a donut pillow like a Boppy may help you rest comfortably in this position.

If you sleep best on your back, sleeping almost on your back but not quite might be your most comfortable option towards the third trimester.

"A good position for sleeping while pregnant is what the medical community calls the lateral decubitus position," notes Alan Lindemann, MD, an obstetrician and maternal mortality expert and co-author of “Modern Medicine: What You’re Dying to Know,” a consumer action guide about how to navigate the United States healthcare system. "This position is halfway between flat on your back and totally on your side."

Pillows and bolsters may help you get into this position and stay in it while you sleep. When reclining in the lateral decubitus position, you can be on either side.

"The important point is to not be fully on your side or fully on your back," explains Dr. Lindemann.

After 28 weeks gestation, sleeping on your right side may have similar risks to sleeping on your back because this position can compress the aorta, a major artery. Sleeping on your left side is a safe alternative.

Sleeping on your back during pregnancy is safe during the first two trimesters. During the third trimester, it is best to avoid back sleeping because it has been associated with some risks to both you and your baby.

If you wake to find yourself sleeping on your back, simply reposition yourself. You also can place a pregnancy pillow behind your back to keep you from rolling into that position. Talk to a healthcare provider if you have any questions or concerns about sleep positions during pregnancy.