Understanding maternal sleep position behaviour in the third trimester of pregnancy: A national cross-sectional mixed-methods study

BACKGROUND: Going-to-sleep position from 28 weeks' gestation has been identified as a modifiable risk factor for stillbirth. This study assessed awareness of, and barriers to, adopting advised maternal sleep positions in Ireland. METHODS: A national online survey was conducted in September 2024 across the Republic of Ireland among women who had given birth beyond 28 weeks' gestation in the previous two years. A total of 769 responses were analysed using descriptive statistics, chi-square tests, and logistic regression. Findings were interpreted using the Capability, Opportunity, Motivation-Behaviour (COM-B) framework. RESULTS: Most respondents reported an advised going-to-sleep position in the third trimester (85%, n = 645) and recognised advised positions when asked about third-trimester recommendations (90.4%, n = 628). While 73% believed following recommendations benefited the baby, only 60% linked recommendations to stillbirth prevention, and reported that stillbirth risk was rarely mentioned by healthcare professionals. Employment predicted accurate knowledge of recommended sleep position (OR=2.54, p = .011), while having received information about sleep position approached significance (OR=1.61, p = .054). Key predictors of adopting an advised sleep position included accurate knowledge (OR=4.22, p < .001), good sleep quality (OR=2.87, p < .001), and bed-sharing (OR=2.49, p = .019). Citing "it was better for the baby" as a reason to choose a sleep position in the third trimester increased the likelihood of adopting an advised position (OR=2.69, p < .001), whereas citing reflux relief as the reason, reduced it (OR=0.14, p < .001). CONCLUSIONS: Findings highlight gaps in stillbirth prevention awareness and missed opportunities for antenatal education in Ireland. Clear, consistent messaging and COM-B-informed behavioural approaches may improve adherence to advised sleep position recommendations.