Advice on sleep position and foetal movement links to stillbirth
Links between sleep position and foetal movement prior to stillbirth
In high income countries stillbirth affects between 1.7 to 8.8 per 1,000 births after 28 weeks gestation (Flenady et al 2016). Globally the annual rate of reduction is 2% but there is wide variation. Three studies on stillbirth have been reviewed here to inform practice.
Implications for practice
- Pregnant women should be advised to monitor foetal activity and report any unusual movement to a healthcare professional.
- Healthcare professionals should advise pregnant women on their going-to-sleep position and its association with an increased risk of late stillbirth.
- Healthcare professionals need to deliver transparent and perceptive communication when supporting parents who have experienced stillbirth.
Association between maternal sleep practices and late stillbirth – findings from a stillbirth case-control study
This prospective case-control study investigated whether the position of going to sleep when pregnant was associated with an increased risk of late stillbirth.
Participants were recruited from 11 maternity units in the UK. Interviews were conducted with 291 women who had a stillborn baby after 28 weeks gestation within 1-6 weeks of the birth, and compared with 733 healthy controls with ongoing live pregnancies of a similar gestation which was randomly allocated. Information was collected on pre-pregnancy going-to-sleep positions, and on sleep duration, nocturnal toileting and daytime napping in the four weeks prior to the stillbirth. Going-to-sleep positions were categorised as left side, supine, right side, tummy, variable side, propped up, or unknown.
Multi-variable analysis revealed that women with late stillbirth were 2.3 times more likely to report a supine going-to-sleep position than the controls and sleeping for less than 5.5 hours the night before the stillbirth. They were also more likely to report getting up to the toilet once or less and taking a daily nap.
The study confirmed that going to sleep in a supine position during pregnancy is associated with late stillbirth. This was not affected by the duration of pregnancy after 28 weeks, the size of the baby or the mother’s weight.
Heazell A, Li M, Budd J et al (2018) BJOG. 125, 2, 254-262. 10.1111/1471-0528.
Stillbirth is associated with perceived alterations in fetal activity – findings from an international case control study
Any significant change in the usual pattern of foetal movement increases the risk of stillbirth. This international internet-based case-control study investigated women’s experiences of foetal movements and their relationship to stillbirth.
Participants were recruited through online advertising, social media and word of mouth. The 153 cases had a single stillborn baby after 28 weeks gestation less than 30 days before participating in the study. The 480 controls were still pregnant after 28 weeks or had had a live birth less than 30 days before participation.
An online questionnaire survey included demographic and pregnancy characteristics, maternal report of foetal movement monitoring and perception of foetal movements during the last two weeks of pregnancy.
The data were analysed using logistic regression modelling and summative content analysis for free text responses. Women who experienced a stillbirth were less likely to monitor foetal movements and to have been advised to do so by a healthcare professional than the healthy controls. Stillbirth was also associated with abnormal foetal movements in the two weeks prior, normally reduced activity. However, one single episode of extreme foetal activity was also more frequently reported by women who had a stillbirth compared to controls.
The authors concluded that changes in foetal activity are associated with an increased risk of stillbirth.
Heazell A, Warland J, Stacey T et al (2017) BMC Pregnancy and Childbirth. 17, 369.
The impact of stillbirth on bereaved parents: A qualitative study
The experience and personal impact of stillbirth on bereaved parents were explored in this qualitative study.
In-depth semi-structured interviews were conducted with a purposive sample of the parents of 12 stillborn babies among 12 mothers and five fathers. Interpretative Phenomenological Analysis (IPA) was used to analyse the data to try and comprehend how the participants made sense of their experience.
Stillbirth had a far-reaching and ongoing impact on many aspects of the lives of the bereaved parents. Four main themes occured from the data; maintaining hope, the importance of personhood of their baby, protective care towards them and relationships with their partner, baby and staff.
Their experiences of care following diagnosis of stillbirth and the aftercare were recounted in detail. Post diagnosis was an important time for enabling them to process their loss with the support of health care professionals.
The findings will inform best practice when supporting parents bereaved through stillbirth and that perceptive communication is significant.
Nuzum D, Meaney S, O'Donoghue K (2018) PLoS One. 13, 1. e0191635.
Flenady V, Wojcieszek AM, Middleton P et al (2016) Stillbirths: recall to action in high-income countries. The Lancet 387, 691-702
Sue Davies is an independent researcher