Birthlight Forums

Hi, 

I have a student who had two bad car accidents before pregnancy resulting in sever back pain and now that she's pregnant she's in agony most of the time. Physiotherapy treatment has not helped, although she had only had a couple of sessions. She told me that she only gets relief at night time when she's completely flat on her back. The last class I asked her to lie on her back with her legs supported on a chair and she got a lot of relief. However her tummy is really quite large and she's 32 weeks pregnant. Does the rule about not being flat on the back in late pregnancy always apply, or are some women ok to do this? If this would cut off the oxygen supply to the baby, would the pregnant woman automatically feel sick or uncomfortable in this position and therefore know no to do it? I have heard rumours of women who have got themselves through the discomfort of the entire pregnancy, precisely by lying flat on the floor. I just want to double check that I'm giving my student the right advice. I would appreciate your comments.

Debica 

Hi, you are right to be concerned about lying flat on the back, as it can compromise blood flow & exchange of oxygen to baby (as there is alot of pressure from weight of baby water placenta uterus and increase in blood).  However...I have many ladies in my classes who find that they are only comfortable being on their backs and this always creates a bit of a debate in class from time to time.  A bit of advice I was given many years ago, and that I pass on to my ladies is, to place a small cushion or bit of padding beneath the left buttock (!) this then prevents complete pressure on the back (as a small gap is created) and therefore reduces the risk of oxygen starvation.  I always explain the pros and cons to the women so that they can make their own informed choice. 

After lying on the back for any period of time during pregnancy, it is always a good idea to have them roll and lie on their right side for a few minutes to allow the blood pressure to stabilise (as it changes when flat on the back) before getting up.  This helps prevent dizzy feelings etc.

 I don't know whether this would still be as effective for your lady when considering her back condition.

Hope this helps in some way?

Claire

Don't forget when side lying to put a cushion between the knees to keep hips in alignment or you risk putting strain on sacroilliac joint/pelvis (particularly important when there's a history of back pain).

Hi, you are right to be concerned about lying flat on the back, as it can compromise blood flow & exchange of oxygen to baby (as there is alot of pressure from weight of baby water placenta uterus and increase in blood).  However...I have many ladies in my classes who find that they are only comfortable being on their backs and this always creates a bit of a debate in class from time to time.  A bit of advice I was given many years ago, and that I pass on to my ladies is, to place a small cushion or bit of padding beneath the left buttock (!) this then prevents complete pressure on the back (as a small gap is created) and therefore reduces the risk of oxygen starvation.  I always explain the pros and cons to the women so that they can make their own informed choice. 

After lying on the back for any period of time during pregnancy, it is always a good idea to have them roll and lie on their right side for a few minutes to allow the blood pressure to stabilise (as it changes when flat on the back) before getting up.  This helps prevent dizzy feelings etc.

 I don't know whether this would still be as effective for your lady when considering her back condition.

Hope this helps in some way?

Claire

oops - had a few techy probs and it's posted me twice!!!

Thanks Claire for your information.

That's a good idea about putting a small cushion under  the left buttock. However is it significant to put it under the left one only and then turn to the right or can you change, in order to avoid muscular imbalance?

B rgds

Debica 

 

For someone at this stage in Preg, I would use a few pillows/cushions.  placed evenly along the pelvic brim - around the area of the s.i.joints.  The lumbar region must also be supportedso the pillows should slant from the pelvis to the base of the ribs raising the buttocks to around 25 /30 degrees.  which I could draw a little match stick person !!!!! but hope you get the drift  Liz

Thanks. It sounds like a wedge cushion might do the trick, with the highest part under the buttocks and tapering down to the lower back. Debica

Hi Claire

I know you posted this ages ago but I've just had a question from one of my ladies. Her husband is a trainee in obstetrics and he says the wedge should go under the right buttock and not the left. He says that when women have caesarean sections the right side has to be raised to protect an important nerve.

Also, doesn't the advice to put it under the left buttock contradicted the advice to sleep mainly on the left for optimal foetal positioning?

Can anyone throw any light on this, please?

And while I'm on, does anyone know if certain types of incense are contraindicated for pregnancy? I haven't had a bad experience but someone mentioned to me that some incense can bring on early labour and I would rather this didn't happen in one of my classes!

Many thanks in anticipation. Kate

Hi Kate

Mmm...this poses a really good question.  I did my Active Birth and Pregnancy Yoga training with a midwife and the recommendation was always left side (and it's always stuck with me).  I would desperately love to know if this certainly is not the case for obvious reasons!  Beyond 30 weeks + in pregnancy, caution needs to be taken with being on the back anyway, and for this reason I only use the legs up the wall (Viparati Kirani) for those who have experience. 

This is such an important area to get clarification on, as the benefits of this type of posture are of importance to women who have vulval varicosities, as well as varicose veins in the legs, as it really supports the venous flow of blood back towards the heart.  I have a couple of ladies now who are pregnant with both 3rd and 4th babies, and this is the one thing that above all else, brings a smile to their faces, as the relief they receive is immeasurable.

So like Kate, if anyone can shed light on this, please let us know!

Regarding the incense, I don't use it in pregnancy classes as I had read something similar too, but I don't know if there's any evidence to support it.  I guess after reading it, I've errd on the side of safety.  However, many of the London yoga centres burn incense all the time and they run pregnancy classes throughout their weekly schedules?

Again, anyone out there who can help, please let us know!

Sorry I can't come back with anything definite at this time Kate

please be aware the guidelines (from govt) have changed dramatically regarding ladies lieing on their backs when pregnant.  Ladies should now NOT be on  their backs from 16 weeks gestation.

this has been for at least two years.  Shame I think as there is so much we can no longer offer

 

lizzie33:

guidelines (from govt) have changed dramatically

 

Hi Lizzie

Can you please give a citation for this Government advice, if possible with a weblink? This 16 weeks rule seems to fly in the face of the advice I have received from Francoise (in 2006/7), my own experiences (well, those of my students) and the research I have done online as a result of this thread, so I would love to know more about the Government's reasoning for this advice.

That research involved medical sites relating to pregnancy and more specifically to the issue of Supine Hypotension, which is where the venous return is inhibited by pressure of the uterus on the inferior vena cava and the aorta. The 2 best articles I found were http://www.manbit.com/OA/c28.htm and http://www.anesthesia-analgesia.org/cgi/content/full/97/1/256.

In summary, these articles suggest that Supine Hypotension occurs in:

"1. late pregnancy,
2. the supine, and to a lesser extent, the sitting position, and
3. more frequently in those with varicose veins."

It generally takes 3-7 minutes of lying supine to occur, and the body has compensatory measures that make up for this compression, such that only 10-20% (depending on the study) of women actually suffer hypotension from lying on their backs unelevated. It is also very common (up to 86% of women) during labour in such positions (much of the research appears to surround the larger problem of Supine Hypotension during caesarian births).

The sypmtoms are dizziness and a drop in blood pressure. It is fully relieved by left lateral position (lying on your side). Elevating the mother's RIGHT hip by 10-15 degrees completely relieves it in 58% of full-term women (also implying that a greater number of women would be relieved of the problem in earlier stages).

The second study I cited above makes the following conclusion:

"In conclusion, to avoid any detrimental effect on maternal cardiac output, the pregnant woman would ideally be kept in the full lateral tilt position, but this is often impractical. When it is necessary to lay the woman on her back, then tilting her to the left is preferable. We were unable to demonstrate any advantage by increasing the amount of lateral table tilt up to 12.5°".

So, the order of preference of position when lying still for longer than 3-7 minutes would be first lying completely on the left side, and if that is not possible then lying with the right hip elevated by about 10 degrees. Lying on the RIGHT side actually seems to make the situation worse in terms of cardiac output and heart rate.

However, I think it is important to bear in mind that these studies reckon this happens in a relatively small percentage of women, being more likely in women with existing venous return problems (as someone else said above, this is a great shame given the benefits of Vipariti Karani, however it is easily overcome by having the mum-to-be go into this position several times for less than 3 minutes each time). And since it has an obvious symptom (i.e. dizziness), the decision in the end can safely be left with a well-advised mum-to-be.

Hope that all makes sense...

Cheers,

Scott

I'm an ex midwife with 19 years experience of teaching pregnancy yoga.  I discussed the Govt guidelines with a consultant obstetrician yesterday.  He had no knowledge of such guidelines and said he felt certain this guideline was not evidence based.  His view is that the aorta can only be compressed by the weight of the heavy uterus of late pregnancy and that women could lie on their backs at any time in pregnancy unless they had symptoms of aorta/vena caval occlusion.  He pointed out that the aorta can only be compressed above where it divides into the 2 iliac arteries.  This division ocuurs at the level of the 4th lumbar vertabra where not even the top of the uterus would have reached at 16 weeks in a singleton pregnancy.  I have looked at the NICE guidelines today and can find nothing relating to this subject. I've also asked  a midwife to see if she can find any written evidence on this subject and will feedback if anything comes to light.  The obstetrician said that women have been lying supine until late pregnancy for years and he knows of no evidence to suggest that any babies have been damaged by this.  It seems essential to actually read the Govt statement so please give the reference.

My personal view at present is that I will continue to follow the Birthlight guidelines, allowing women to lie on their backs until 30 weeks (obviously not if symptoms occur or this is a twin/triplet pregnancy) unless there is good evidence that this is not wise.

Regarding the woman who Debica asked about, she is very likely to have a collateral circulation that takes over if there is aortic/vena caval occlusion.  However in the light of our current uncertainty on the subject, I feel it might be wise to suggest she asks her midwife or obstetrician if they feel supine lying is OK for her.

Marion

Hi Marion

Thanks for this - very helpful. With your background, can I please ask you about the left versus right issue I asked about before? My training with Birthlight taught a flat cushion under the left hip but an obstetrics trainee who is currently working in theatre says they always elevate the right side to avoid putting pressure on an important nerve. If women past 30 weeks find they cannot sleep comfortably on their sides would you say they can still sleep safely on their backs? Would you advocate the flat cushion? And if so, on which side?

Thanks in anticipation.

Kate

Hi Marion

Thanks for this - very helpful. With your background, can I please ask you about the left versus right issue I asked about before? My training with Birthlight taught a flat cushion under the left hip but an obstetrics trainee who is currently working in theatre says they always elevate the right side to avoid putting pressure on an important nerve. If women past 30 weeks find they cannot sleep comfortably on their sides would you say they can still sleep safely on their backs? Would you advocate the flat cushion? And if so, on which side?

Thanks in anticipation.

Kate