Week 34: Sleeping Problems

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This is your Pea in the Podcast for week 34 of your pregnancy. I'm Bonnie Petrie joined by Dr. Laurie Swaim, an obstetrician with Houston Women's Care Associates in Houston, Texas.

Sleeping shouldn't be this tough if you're tired should it? But as you move through the waning weeks of your pregnancy a good nights sleep may be a distant memory. First off, you just can't get comfortable no matter what you do and everyone seems to be telling you there's only one safe way to sleep, on your left side. "There's sort of some scientific reasons for it and sort of not. Every labor and delivery nurse in the country tries to get the patient to lay on the left side and the onus for that is there were studies done, actually they were done right here in Houston years ago, where these catheters, that can measure the amount of work the heart does and the amount of pressure on the heart, were placed in women in different trimesters. The women were then asked to stand, sit and lay on their back and on either side. It was determined in which position the heart worked best, the cardiac output was the best. Actually I think it was worst standing but no one stands still all of the time, you're moving your legs so it's kind of not really all that important and it was best laying on the left side. But it turns out that it was only marginally better than laying on the right side. So anyway, the mommy books have picked up on this and try to tell women they need to sleep on their left side. The reason I get a little annoyed about this is because as you just said, it's hard for women to sleep, they're not comfortable and also what are you going to do? pin yourself, tie yourself? You move in your sleep and as far as I know there are very few fetal deaths that have ever been attributed to maternal sleeping position, like none. So I just tell my patients to be comfortable."

Now for some moms-to-be position while lying down is a concern and does impact cardiac output. "The reason we care about cardiac output is because the amount of blood the heart is pumping every minute means that it's pumping more blood to the baby and more blood to the mom's brain. Some women when they lay flat on their back develop something called supine hypotensive syndrome where they essentially pass out when they lay on their back. That's because the uterus compresses the great vessels to and from the heart, if they don't get a lot of blood flow to their brain they don't feel good. But they know who they are. It's like 'hey I passed out the last time I did this I don't think I'm going to do it again'." But many moms-to-be will admit they've woken up in a panic because they found themselves on their right side or even flat on their back. "But meanwhile you're laying flat on your back and your baby is moving a mile a minute, why? Because it's getting plenty of oxygen." So Dr. Swaim says most of you should just find a comfortable position and if you can get some rest, talk to your doctor or midwife to find out if you need to be concerned about sleeping on your left side. A pregnancy pillow may help you get more comfortable that way. They're crazy looking pillows, sort of hook shaped. While resting on your side you and put your head on one end and hug the pillow while it hooks between your bent knees. You can also get a similar effect with several regular pillows; it really does help many women get comfortable. Some women struggle with side sleeping because of intense hip pain, if this is you, and it was me, then you can buy soft egg crate foam mattress pad or some other kind of mattress pad like that that may take some pressure off your hip. Also some moms-to-be find they can get some sleep if they prop themselves up on pillows elevating their upper body, or if they sleep in a recliner particularly if reflux is bothering them. Now some of you find you can't sleep because you have to get up to pee every five minutes or because you're so stuffed up you can only mouth breathe. The frequent pee problem is the worst when you haul your giant self all the way to the bathroom to be rewarded with a mere trickle, that's what happens when your big old' baby is pressing on your bladder. Now other reasons you have to pee more often include increased blood volume we've been talking about. That leads to a lot of extra fluid getting processed through your kidneys, that's got to go somewhere, got to go to your bladder. Also if you're swollen some of that fluid you're accumulating during the day, it makes its way back into your blood stream and ends up in your bladder.

About the stuffiness, it is called rhinitis of pregnancy. It is caused by higher amounts of estrogen which can cause swelling in the mucus membranes lining the nose and can cause you to make more mucus. What do you do? "The peeing thing: some women are actually drinking a bunch before they go to bed. So review that: what goes in is going to come out. The congestion thing: they can take Benadryl, there are some over the counter things that might help." Like saline spray by your bedside, talk to your doctor or midwife, they really can help you if congestion is making your sleep fitful. Leg cramps may rudely jar you awake sometimes. To ease those you can avoid standing or sitting with your legs crossed for a prolonged period of time. Stretch your calf muscles regularly, particularly before bedtime. Rotate your ankles and wiggle your toes when you think of it and take a walk every day. Stay hydrated during the day by drinking water regularly but remember to cut yourself off a while before bed to avoid trading leg cramps for those more frequent sprints to the bathroom, sprints yeah sure you can't sprint anymore, those more frequent trips to the bathroom. And some suggest adding more potassium or magnesium to your diet, how about a banana a day.

You may notice too that you're starting to leak a little colostrum as your body prepares to feed your baby. Now this may have been going on for a long time in fact as the hormones that trigger your body's milk production have been ramping up throughout your pregnancy. This is normal and it is also normal if it hasn't happened yet. "Just some people do and some people don't. As long as it's not bloody, as long as it's not just unilateral or some funky color then yeah if it's milk, it's milk, it's fine." Some people are thrilled that their body is producing milk because they think it is sure success for them with regard to breastfeeding. Dr. Swaim says that's not necessarily true. "Because successful breastfeeding has a lot more to do with other things like latching and position and stress than it has to do with the actual milk production. The majority of women make plenty of milk, every once in a while people have a problem with it but there are too many factors that go into it to say whether just the presence of colostrum before delivery means that someone will be a successful breastfeeder." In fact, though breastfeeding your baby is really the most natural thing in the world, it may be hard for you at first. To improve your chances of successfully nursing your baby you may want to get a book or two, there are some great ones out there that you can read over the last weeks of your pregnancy and line up some support now to. If you have friends who've successfully nursed ask them if they'll be there if you have any questions and believe me you will have questions. And also make sure you have the number for an organization called La Leche League. La Leche League is staffed by moms, volunteers who've been there, done that and they want to help you as you and your baby become nursing pros. Most hospitals will have a lactation consultant but they are very busy and they may not be available when you need it. That's why it's good to hook up with La Leche League beforehand. The lack of support combined with the rush of post pregnancy hormones has led many a mommy to give up nursing before she really even got started. A preset support system can avert that. We have links that can help you get started setting up that support system at peainthepodcast.com. Giving nursing a try is important because the benefits of breastfeeding are enormous. When your baby is first born you are producing that colostrum that you may be producing right no. Colostrums is a thick, yellow milk, low in fat, which is hard for your baby to digest, and high in carbohydrates which they need, proteins and antibodies to keep your baby healthy. Now colostrums is very easy to digest which is important because baby digestive systems are still quite immature. There isn't very much of it which scares some moms into thinking they're starving their babies but it is high in concentrated nutrition for the newborn, a little goes a very long way. Colostrum also has a laxative affect on the baby which helps remove excess bilirubin if your baby has jaundice. Now if you nurse just one time you can stabilize your baby's blood sugar. If you nurse for one day you're giving your baby natural immunity from infection and you're helping your uterus contract to its pre-pregnancy size. If your baby is a preemie the benefits are compounded by the fact that your colostrums changes composition so it contains more of what a premature baby needs to grow and thrive. So even if you don't nurse for two years, you just nurse twice you're doing something great for your baby.

Speaking of infection, this week your baby is beginning to develop some of its own immunity to fight mild infections. Its skeleton is hardening although its skull remains pliable for its trip down the birth canal. It's getting more pink and pudgy every day and right now he or she is almost five pounds and just shy of 20 inches long. That big baby has now pushed your uterus to just about five and a half inches from the top of your bellybutton. You're now 34 weeks pregnant; you have six weeks to go until week 40.

That's your Pea in the Podcast for week 34 of your pregnancy. Dr. Swaim and I look forward to talking to you again next week. Enjoy this week. For a transcript of any of our Pea in the Podcasts go to our website peainthepodcast.com. For Pea in the Podcast, I'm Bonnie Petrie, thanks for listening.