Safer Baby Bundle Element 4: Side Sleeping in Late Pregnancy Position Statement

Research suggests that changing sleeping position in late pregnancy can reduce the risk of stillbirth. Sleeping on the side from 28 weeks gestation can potentially avoid 1 in 10 stillbirths. The inferior vena cava compression in the supine position reduces blood flow to the fetus. Health districts are encouraged to embed these safer sleeping practices into clinical care to improve maternal and fetal outcomes.

• Safer Baby Bundle
• Side Sleeping
• Late Pregnancy
• Stillbirth Risk
• Maternal Health

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1. Safer Baby Bundle Element 4: Side Sleeping All Local Health Districts that provide maternity care are encouraged to embed the Safer Baby Bundle Elements into routine clinical care Improving awareness of maternal safe sleeping position from 28 weeks gestation David Antcliff and Dr Christine Marsh June 2020

2. Safer Baby Bundle: Element 4 Clinical Excellence Commission 2

3. The research suggests that 1 in 10 stillbirths The Evidence occurring in late pregnancy (> 28 weeks gestation) could potentially be avoided if women did not go to sleep on their back during this time. New research shows that women can halve their risk of stillbirth by going to sleep on their side from 28 weeks pregnancy compared with sleeping in the A 2019 meta-analysis using all the available world- supine position. wide data on the topic demonstrated an adjusted odds ratio of 2.63 (95% CI 1.72-4.04, p<0.0001) for late stillbirth in women who reported a going-to- The studies found that the chance of having a sleep supine position. Going to sleep on the left or stillborn baby ranged between 2.5 to 8 times right side appeared equally safe. greater for women who went to sleep on their back. Clinical Excellence Commission 3

4. Biological Rationale Studies using MRI show that in late pregnancy, mothers lying supine put pressure on the inferior vena cava, which can reduce the blood flow by 80%. The pregnant woman s aorta is also partly compressed in this positon which reduces the blood flow and oxygen delivery to the pregnant uterus, placenta, and fetus. Other studies have shown that the maternal supine position reduces fetal movements and increases fetal heartrate decelerations Inferior Vena Cava Fully Patent Inferior Vena Cava Compressed Humphries A, Ali Mirjalili S, Tarr GP, Thompson JM, & Stone P, 2018 Clinical Excellence Commission 4

5. Position Statement The purpose of this position statement is to summarise the latest evidence on maternal going-to-sleep position from 28 weeks of gestation and provide appropriate advice for women to reduce the risk of stillbirth Position Statement: Mothers' Goinig-To-Sleep Position in Late Pregnancy Clinical Excellence Commission 5

6. SBB Actions for Implementation All midwives, obstetricians, general practitioners, childbirth educators, and other health professionals who provide pregnancy care should provide women with written and verbal advice about late pregnancy going-to-sleep position as follows: Advice should include: Generally ensuring a high awareness of side sleeping media campaign Education for women to understand the From 28 weeks of gestation, settle to sleep on either side for any episode of sleep, including: adverse effects of supine sleeping Ensure women are well informed. Women Going to sleep at night should not be upset or feel guilty if they wake Returning to sleep after any awakenings up on their back. Day time naps Clinical Excellence Commission 6

7. How will you know women are receiving information about side sleeping? eMaternity, Cerner Maternity, Surveys & Audits: 2. Proportion of women who, by 28 weeks gestation, were given the information brochure on safe going-to-sleep position in late pregnancy 1. Proportion of women after 28 weeks gestation who report safe sleep practices (side sleeping). Clinical Excellence Commission 7

8. Key Performance Indicators continued: 3. Proportion of women after 28 weeks gestation who can describe safe sleep practices (going to sleep on their side) Available: www.stillbirthcre.org.au/safer-baby-bundle Clinical Excellence Commission 8

9. Education & Resources Australia Stillbirth CRE website: https://www.stillbirthcre.org.au/safer-baby-bundle/ Safer Baby Bundle website eLearning maternal going-to- sleep position chapter https://saferbabybundle.org.au New Zealand Sleep on side when baby s inside campaign: www.sleeponside.org.nz The UK Tommy s Sleep on Side pregnancy campaign: https://www.tommys.org/pregnancy-information/sleep-side- pregnancy-campaign Tommy s Video: How To Sleep Safely During Pregnancy Clinical Excellence Commission 9

10. This presentation acknowledges the contribution of others who provided materially to the February 2020 Learning Sets for the NSW Safer Baby Bundle Research sites Contact Details Dr Christine Marsh Improvement Lead Clinical Excellence Commission Email: CEC-saferbabybundle@health.nsw.gov.au Web: http://www.cec.health.nsw.gov.au/keep-patients- safe/Maternity-Safety-Program Clinical Excellence Commission 10