Best Sleeping Positions During Pregnancy for Comfort and Health

Pregnancy is a time of significant change, and getting enough restful sleep is crucial for both the mother and the developing baby. As the pregnancy progresses, finding a comfortable sleeping position can become increasingly challenging. However, choosing the right sleeping position is essential for maintaining optimal blood flow, reducing discomfort, and supporting overall health during this special time.

Why Sleeping Position Matters During Pregnancy

As the uterus grows, particularly after the first trimester, it can put pressure on major blood vessels, most notably the inferior vena cava (IVC), which is the main vein returning blood from the lower body to the heart [8]. Incorrect sleeping positions, such as lying flat on the back, can compress the IVC, leading to a condition called Supine Hypotensive Syndrome. This compression can reduce blood flow to the mother, and in turn, the fetus [1]. Adopting the right sleeping position helps maintain optimal blood flow, reduces the risk of complications associated with vena cava compression, and ensures a more comfortable pregnancy [8].

Best Sleeping Position for Pregnant Women

The most recommended sleeping position for pregnant women, particularly from the mid-second trimester onward, is on their side [1]. Sleeping on the left side (SOS) is traditionally preferred, as it is anatomically believed to minimize compression of the IVC, which is positioned on the right side of the spine.

Below is a guide to help pregnant women find the best sleeping positions for maximum comfort and safety:

Sleeping on Your Left Side (SOS)

Sleeping on the left side is considered the optimal position for pregnant women. It is theorized to improve blood circulation to the uterus and fetus, ensuring optimal nutrient and oxygen supply [1]. This position also supports better kidney function, which helps reduce peripheral swelling in the legs and ankles [1].

Tone and Balance of Discussion: It is important to know that women naturally change positions while sleeping [6]. The goal is to start the night on the left side. If you wake up on your back or right side, simply shift back to your side without unnecessary worry, as brief position changes are normal and typically safe [7].

Using Support Pillows

Support pillows are key to enhancing comfort and compliance while side sleeping. Placing a pillow between your knees helps align the hips and spine, effectively easing lower back and pelvic pressure [4]. A pillow under your growing abdomen provides much-needed support for the uterus, while one placed behind your back offers extra stability and prevents rolling onto the back.

Other Sleeping Positions and Their Effects

Sleeping on Your Right Side

Sleeping on your right side during pregnancy is safe and preferable to sleeping on your back [1]. While some older theories suggested it might put slight pressure on the liver, there is no consistent evidence that it poses a major risk. Alternating between the left and right side can help relieve hip pressure [6].

Sleeping on Your Back (Supine Position)

After the first trimester, and especially in the late second and third trimesters, sleeping flat on your back is strongly discouraged [1, 8]. This position compresses the major blood vessels, reducing blood flow to both the mother and the baby [8]. It can also cause symptoms like back pain, shortness of breath, and lightheadedness [1]. Studies link the supine position in late pregnancy to an increased risk of reduced birth weight and stillbirth [8].

Sleeping on Your Stomach (Prone Position)

Stomach sleeping is fine early on, but becomes uncomfortable and impractical as your belly grows. Expectant mothers should transition to side sleeping well before the second trimester begins.

Ways to Make Side Sleeping Work

First Trimester (Weeks 1-12)

• No particular sleeping position is mandatory during the first 3 months of pregnancy.
• You may sleep in any comfortable position, but starting the habit of side sleeping can make the transition easier later on.

Second Trimester (Weeks 13-27)

• Side sleeping becomes more important. Sleeping on your left side with knees bent is highly recommended to promote better blood flow to the uterus and fetus [1].
• To support your body: Place a pillow between your knees and put a pillow under your belly [4].

Third Trimester (Weeks 28-40)

Maintaining the side sleeping position is crucial due to the size of the uterus [8].

Continue to use pillows between the knees and under your belly.

If you experience shortness of breath or heartburn, slightly elevate your torso (semi-reclined side position) [3, 8].

Move slowly when changing positions to avoid round ligament pain.

Common Sleep Challenges During Pregnancy and How to Address Them

1. Heartburn and Acid Reflux

Heartburn is common due to the relaxation of the lower esophageal sphincter and uterine pressure on the stomach [3].

• To manage: Try sleeping with your torso elevated by propping up your upper body with pillows or a wedge [3, 9].
• Tip: Avoid heavy or spicy meals close to bedtime.

2. Back Pain

Back pain is often caused by the increased weight and the hormonal loosening of pelvic ligaments [4].

• To manage: Sleep on your side with a pillow between your knees to maintain neutral spinal alignment [4]. A pillow under your abdomen can also ease discomfort.

3. Shortness of Breath

Shortness of breath may occur in the later stages of pregnancy due to the uterus compressing the diaphragm and lungs [8].

• To manage: Sleep on an inclined surface (semi-reclined side position) by propping up your torso with pillows. This can support lung expansion and reduce pressure on the diaphragm [8].

Tips for Better Sleep During Pregnancy

• Sleep on Your Side: Go to sleep on your side; the left side is considered optimal [1].
• Utilize Pillows: Place a pillow between your knees and another under your belly for essential support [4].
• Make Slow Movements: When shifting sides, move slowly to avoid discomfort.
• Elevate Your Torso: Prop up your upper body if you experience heartburn or shortness of breath [3, 9].
• Establish a Routine: Maintain a consistent sleep schedule and create a relaxing bedtime environment.

When to Consult a Doctor

If you experience any persistent or severe discomfort, such as worsening back pain, frequent or extreme shortness of breath, dizziness, or heart palpitations upon waking from any position, it is crucial to consult your Obstetrician-Gynecologist (OB-GYN). Your healthcare provider can offer personalized advice and ensure the health and safety of both you and your baby.

Conclusion

Sleeping comfortably and safely during pregnancy is essential for both maternal and fetal health. The most recommended sleeping position is on the side, preferably the left side, from the second trimester onward, with proper pillow support, as it promotes optimal blood flow and comfort [1]. By following these evidence-based guidelines and consulting your doctor when necessary, you can ensure a more restful and healthy pregnancy journey.

Frequently Asked Questions (FAQs)

What sleeping positions should pregnant women avoid?

Pregnant women should strictly avoid sleeping on their back (supine), especially after the first trimester, as this position can compress major blood vessels, reducing blood flow to the baby [7].

Is it safe to sleep on the right side during pregnancy?

Yes, sleeping on the right side is generally safe and a good alternative to the left side, particularly for alternating positions to relieve hip pressure [6].

When should pregnant women stop lying on their stomachs?

Pregnant women should stop lying on their stomachs by the second trimester, as the growing abdomen makes this position both uncomfortable and impractical.

Does the baby’s location depend on the mother’s sleeping position?

No, the baby’s location does not depend on the mother’s sleep position; the baby moves freely within the uterus.

Why might pregnant women struggle to sleep on their side?

Pregnant women may struggle to sleep on their side due to hip pain, back pain, or general discomfort; using supportive pillows is the best strategy to overcome this challenge [6].

What is the best sleeping position for pregnant women?

The best sleeping position in pregnancy is on their side, preferably the left side, with knees bent and the use of pillows for essential support [1, 4].

Disclaimer

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider, such as your Obstetrician-Gynecologist (OB-GYN), before beginning any new wellness practice, especially if you have an existing medical condition or are on medication.

References

[1] National Guideline Alliance (UK). (2021). Maternal sleep position during pregnancy: Antenatal care: Evidence review W. In Antenatal Care (pp. 57–78). National Institute for Health and Care Excellence (NICE). https://www.ncbi.nlm.nih.gov/books/NBK573947/

[2] Kember, A. J., Zia, H., Elangainesan, P., Hsieh, M., Adijeh, R., Li, I., Ritchie, L., Akbarian, S., Taati, B., Hobson, S. R., & Dolatabadi, E. (2024). Transitioning sleeping position detection in late pregnancy using computer vision from controlled to real-world settings: an observational study. Scientific Reports, 14(1). https://doi.org/10.1038/s41598-024-68472-x

[3] Law, R., Maltepe, C., Bozzo, P., & Einarson, A. (2010). Treatment of heartburn and acid reflux associated with nausea and vomiting during pregnancy. Canadian Family Physician, 56(2), e33–e36. https://pmc.ncbi.nlm.nih.gov/articles/PMC2821234/

[4] Katonis, P., Kampouroglou, A., Aggelopoulos, A., Kakavelakis, K., Lykoudis, S., Makrigiannakis, A., & Alpantaki, A. (2011). Pregnancy-related low back pain. Hippokratia, 15(3), 205–210. https://pmc.ncbi.nlm.nih.gov/articles/PMC3306025/

[5] O’Brien, L. M., & Warland, J. (2014). Typical sleep positions in pregnant women. Early Human Development, 90(6), 315–317. https://doi.org/10.1016/j.earlhumdev.2014.03.001

[6] Warland, J., Footner, S., Beaufoy, G., Stocker, J. F., Agostini, A., & Dorrian, J. (2022). Giving sleep position advice in pregnancy: Will we make women anxious? Australian and New Zealand Journal of Obstetrics and Gynaecology, 62(4), 536–541. https://doi.org/10.1111/ajo.13507

[7] Anderson, N. H., Gordon, A., Li, M., Cronin, R. S., Thompson, J. M. D., Raynes-Greenow, C. H., Heazell, A. E. P., Stacey, T., Culling, V. M., Wilson, J., Askie, L. M., Mitchell, E. A., & McCowan, L. M. E. (2019). Association of Supine Going-to-Sleep Position in Late Pregnancy With Reduced Birth Weight. JAMA Network Open, 2(10), e1912614. https://doi.org/10.1001/jamanetworkopen.2019.12614

[8] American College of Obstetricians and Gynecologists (ACOG). (2020). Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstetrics & Gynecology, 135(4), e178-e188. https://doi.org/10.1097/AOG.0000000000003772