Pregnancy is one of the most important events in a woman’s life, which accompanies numerous physiological changes in order to accommodate the growing infant (Soma-Pillay, 2016). Although tremendous advances have been made in medical sciences in the 21st century; however, maternity care has only been advising one position (i.e. left lateral tilt position) for pregnant mothers to lie in since the fifties (O’Brien & Warland, 2015). Maternity care has highly advised pregnant women not to sleep in the supine position. Supine position (lying on back) compresses the inferior vena cava, leading to a cardiovascular compromise that translates into a reduced venous return, decreased ejection fraction and cardiac output, and impaired uterine perfusion (O’Brien & Warland, 2015).
Despite the fact that the maternity care community has in-depth knowledge of the profound impact of the position on the developing fetus in the uterus, it has paid little attention to this issue. Recently, it has been found that prone position during pregnancy is safe and comfortable and it may help improve oxygen saturation, reduce systolic blood pressure (SBP) and decrease respiratory rate (Oliveira et, al. 2017). In this paper, we will discuss the prone position along with its benefits as well as disadvantages and how a product called Cozy Bump allows pregnant women to lie in the prone position while offsetting the disadvantages, providing a comfortable place to sleep and even providing some additional health benefits.
Prone Position during Sleep in Pregnancy
Recently, Oliveira et al. (2017) have postulated that prone position during sleep in pregnancy is safe, comfortable and helps improve oxygen saturation, reducing systolic blood pressure and respiratory rate. Similarly, in another study, Nakai et al. (1998) proposed that prone position during pregnancy may offer complete relief of uterine compression on large maternal vessels, improving feto-placental blood flow. However, the assumption that prone position is not a safe sleeping position during pregnancy is due to the fact that the public did not have access to a product like Cozy Bump until recently. Cozy Bump is a carefully designed invention that allows pregnant women to assume the prone position without hurting their fetuses or their backs.
What are the Negative assumptions about the prone position?
The problem with the prone position during pregnancy is that it stresses the lumbar vertebrae, uterine structure, and posterior musculature, resulting in low back pain (Sabino & Grauer, 2008). These effects are induced by physiological, hormonal, psychosocial, and cardiovascular changes during pregnancy. This can be further triggered by the effect of gravity on the weight of the growing abdomen especially when traditional beds are used. Therefore, efforts are required to design specialized beds, like Cozy Bump, which would allow pregnant women to feel greater physical comfort without harming the developing fetus.
COZY BUMP AND ITS BENEFITS
How Cozy Bump offers the solution to unwanted effects of the prone position:
An opening made in Cozy Bump to fit the growing belly while assuming the prone position along with a belly sling to support the abdominal structures would be advantageous for a safe and comfortable pregnancy. Keeping in mind the need for safety and comfort with prone position, we have designed Cozy Bump for pregnant women. One of Cozy Bump’s features is a swaddle placed over the opening where the mother’s belly would be placed. Placing this swaddle over the opening and then placing the mother’s belly in it works like how a sling or a hammock would function. The use of the Belly Sling prevents gravity from pulling on the belly and stressing the lumbar vertebrae, uterine structure, and posterior muscles.
To further strengthen the credibility of the swaddle, the swaddle with Cozy Bump is used in a similar way as the traditional Mexican and Guatemalan fabric called “Rebozo”. Rebozo has been used during pregnancy and childbirth for a very long time. Rebozo reduces pain and improves mutual involvement as well as psychosocial support from the caregiver (midwife) and the woman’s partner (Iversen, et al. 2017). Hence, Rebozo and Cozy Bump with a swaddle are similar in that they both prevent the belly from pulling on the back due to gravity when the mother lies in the prone position. The support from the swaddle ensures that there is no detrimental gravitation pull on the abdomen as the user lies in a prone position on Cozy Bump in a tilted manner. The tilt helps the user to arch over and relieve the stress from the spine and the properly cradled belly in the swaddle prevents any form of gravitational stress. According to Brittany Murphy, who is a certified Hypnobabies Childbirth Hypnosis Instructor from Oklahoma and Gail Tully, an experienced midwife from Minneapolis, a rebozo can be very effective in relieving any kind of gravitational tension on the pelvic ligaments as the pregnant user lies in the prone position (Davis, 2014; Murphy, 2010).
(Rebozo) (Cozy Bump)
Arching posture of the body reduces lumbar and posterior stress.
The Cozy Bump offers an arching posture with a raised part in the center and depressed at the ends – a posture that does not impose lumbar or posterior muscle stress. In other words, it has a decline in the leg section and a slight decline in the head section with a large raised bump where the belly would go. The raised bump area in the middle combined with the decline in the head and legs causes the mother to arch over, releasing all tension so the lumber and posterior muscles are not stressed.
Given the convex shape of Cozy Bump, it becomes possible for the user to arch over and relieve the stress from the spine. According to the researchers at University of Rochester Medical Center, such arching or tilting of the spine (which is well facilitated by Cozy Bump), can provide a significant reduction of strain on the lower back (Adams et al. 2000, Ogiela, 2016).
Images below present the Cozy Bump and its different size parameters showing how it would cause the user to arch over and the other images below show other related products that have been used to perform the same thing that Cozy Bump does.
Similarly, the decline in the leg section combined with the raised bump in the center allows gravity to kick in and decompress the lower back. Decompressing the lower back relaxes the lumber and posterior muscles and eases the pressure on the sciatic nerves, preventing lower back pain – a common complaint of pregnant women.
Cozy Bump offers spinal decompression and relieves low back pain
A decline in the leg section can cause sufficient decompression of the spine that can ease the pressure on the sciatic nerves offering relief from pain. Many medical and chiropractic services practice non-invasive spinal decompression for pregnant women with low back pain. According to Cox (2016), a chiropractic doctor with more than 50 years of experience, spinal decompression is a highly evidence-based approach for spinal manipulation to address the spinal pain that is a common occurrence during pregnancy. Similarly, Kruse et al. (2007) demonstrated that the Cox flexion-distraction decompression technique is effective and safe for pregnant women with low back pain.
As it can be seen in the figure below, the “Cox Table” has a decline towards the leg section and a raised central area, as seen in case of Cozy Bump. This convex shape (also seen in Cozy Bump) can reduce the intradiscal pressure and increase the diameter of the spinal canal foraminal area causing a significant drop in pressure on the spinal nerves. Figure 5 below illustrates the spinal decompression facilitated by the “Cox Table” that arches towards the direction of the leg as seen in case of Cozy Bump. Spinal decompression relieves the pressure on the lumbosacral spinal branches and relieves pain such as sciatic pain. In this regard, Dr. Pragnell (2017) also demonstrates that the Cox™ Technic spinal manipulation is a non-invasive, effective and safe way to relieve low back pain experienced by a large number of pregnant women.
(Drawing of the Cox Table and the Cozy Bump to show their similarities)
Benefits of the Prone Position during Pregnancy
Maternal hemodynamic indices vary with maternal position i.e. right lateral, left lateral, and supine positions. Therefore, the dynamics of the physiological changes that become evident in the mother and the fetus due to the mother’s sleeping maternal sleeping position (Armstrong et al., 2011 ; Jaccoud et al., 2012). Shifting of the body’s center of gravity by the bulging uterus puts a stress on the lumbosacral spine, leading to a pain and discomfort in the back and pelvic regions. An ideal position to treat pain in the back and pelvic region (commonly associated with pregnancy) is the prone position, but due to the increase in the size of the abdomen, it becomes very difficult for a pregnant woman to lie on a stretcher on her stomach. In a study conducted by Oliveira et al. (2017), the efficacy of a specially-modified stretcher that allows pregnant women to lie in the prone position was evaluated. The study also focused on the effect of the prone position on the key maternal and fetal hemodynamic parameters and results that were obtained pointed towards significant benefits. The researchers observed that the prone sleeping position is very safe and comfortable on the modified stretcher and lying on the stomach can significantly improve the oxygen saturation levels of the blood. The prone position can also bring down the systolic blood pressure and markedly improve the rate of respiration (Oliveira et al., 2017). The prototype stretcher is shown in figure 1 below and the researchers focused on the impact of the prone position on the circulatory dynamics of the mother and the fetus and whether the stretcher was able to remove any form of pressure on the abdomen of the pregnant women who participated in the study.
The results were very encouraging in the sense that all the key parameters, such as maternal heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, maternal blood oxygen saturation levels and the fetal heart rate were perfectly within the normal limits. All the study participants reported that they were very comfortable lying in the prone position and the design allows prone position sleeping even during late gestational periods (Oliveira et al., 2017). A study by Samanta et al. (2014) reported the case of a pregnant woman who suffered acute respiratory distress syndrome and another study by Speirs et al. (2014) reported the case of a pregnant woman who had to undergo surgery for cauda equina syndrome and obesity. When a specifically-designed stretcher was used in both the cases, the oxygen saturation improved significantly and there was no unwarranted pressure on the lumbosacral region. The researchers of both the studies stated that the prone position is not recommended by experts because of the lack of availability of any product that can negate the ill effects associated with it. At the time that the researchers stated that Cozy Bump was not yet made available to the general public.
In the study by Oliveira et al. (2017), all the pregnant women who participated stated that they were very comfortable lying in the prone position and most of the cohort members even indicated that the prone position was their favorite position to lie down during pregnancy. The prototype stretcher that was presented by Oliveira et al. (2017) had a convex shape that allowed unhindered movement of the diaphragm so that there was no impact on the blood oxygenation levels. The shape is also very ideal for physical relaxation which could, in turn, bring down levels of anxiety and regulate the heart rate of the fetus (Kafali et al., 2011). Kenn et al. (2009) reported a 34-week pregnant woman with post-traumatic acute respiratory syndrome (ARDS). They recommended the prone position for the woman as she experienced severe hypoxemia with atelectasis in the dorsal parts of her lung. Eight hours after assuming the prone position, a persistent improvement of oxygenation was noted. The researchers then demonstrated that the prone position was safe for the pregnant woman. Similarly, Ali and Sajjad (2016) demonstrated that prone positioning in a pregnant patient with Acute Respiratory Distress Syndrome (ARDS) caused due to Middle East respiratory syndrome (MERS) had a significant mortality benefit. Otherwise, ARDS from MERS in pregnancy has a mortality rate which is as high as 60%.
All these evidence-based benefits of prone positioning during pregnancy can be enjoyed with Cozy Bump:
- Helps maintain the best fetal position
- Encourages a breech position to turn to a vertex position
- Relieves abdominal pressure
- Relieves sciatica pain
- Relieves low back pain
- Enhances intestinal peristaltic movements
- Eases hemorrhoids and varicose veins
- Eases maternal circulation
Cozy Bump can Help Achieve Optimal Fetal Positioning and avoid C-Section:
The best thing about Cozy Bump is that it offers optimal fetal positioning. According to the clinicians, major fetal malpositions may require a cesarean section as the labor can be very painful (Tempest, et al. 2015). Head down is the ideal fetal position for delivery where the face of the baby is directed towards the back of the mother and the back towards the tummy of the mother (stillerman, 2008; El-Mowafi 2016; Guittier et al., 2016). This position is called the anterior position and it makes the process of birth significantly easier. When the face of the baby points towards the tummy, the position is called the posterior position and this often causes painful labor and may even call for a C-section. It is important that the baby assumes the anterior position before birth and Cozy Bump can prove to be an excellent product in achieving the same. Experts recommend that to bring the baby into an anterior position the mother should tilt her pelvis forward in a manner that her knees are at a lower level than her hips. The convex inclined shape of Cozy Bump allows the tilting of the pelvis forward that puts the legs at the level lower than the knees. According to Donna Brooking, who works as a midwifery manager at Community Midwifery in Western Australia, tilting forward with proper support to the bulging tummy can be very beneficial for correction of fetal malposition (Brooking, 2014 Page 77) and Cozy Bump appears to be just the right product for this purpose.
Cozy Bump is the best solution to the problem that pregnant women have been facing for years! It brilliantly fills the market gap, allowing pregnant women to sleep in the prone position with adequate support to the growing abdomen in a manner that there is no pressure on the uterus, no disruption in the maternal and fetal blood flow, and no discomfort to the mother. Additionally, the Cozy Bump allows for the maintenance of the best fetal position. Recent researches have revealed that the prone sleeping position is the safest sleeping position for pregnant women and this finding further validates the structural dynamics of Cozy Bump that allows pregnant women to enjoy the prone sleeping position without having to worry about safety. Besides providing a safe position to lie in, Cozy Bump also provides a way to relieve common pregnancy pains that every pregnant mother experiences and facilitates a position allowing more oxygen to the fetus and the mother. Concisely, Cozy Bump is, in fact, an innovation in the field of obstetrics.
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