Overview

Many physical changes during pregnancy can impact your back and cause pain or discomfort. Back pain during pregnancy is almost always lower back pain within three categories: lumbar spine pain, posterior pelvic pain, or a combination of these two. The prevalence of back pain in pregnant women is estimated to be 50% in the first trimester, 40-70% in the second, and 70-80% in the third trimester. Just because back pain is common doesn’t mean you should have to suffer through it. This episode will discuss the causes of back pain during pregnancy, considerations for prevention, and techniques and tools to relieve pregnancy back pain.

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Back pain during pregnancy is almost always lower back pain, and it falls into one of three categories: lumbar spine pain, posterior pelvic pain, or a combination of these two. For simplicity, this article classifies all of this as back pain.

Back Pain During Pregnancy

Pain and discomfort in your back can impact all aspects of your life. This includes your quality of life, work, sleep, and social life. The prevalence of back pain in pregnant women during the first trimester is estimated at 50%. In the second trimester, it ranges between 40% and 70%. In the third trimester, the prevalence of back pain is between 70% and 80%. Taking care of your back is even more critical if you have a history of back pain. A history of back pain makes it more likely that you will experience back pain during your pregnancy. There is also evidence that someone with back pain in a previous pregnancy is more likely to experience back pain in a future pregnancy.

Just because back pain is common doesn’t mean you should have to suffer through it. This episode will discuss the causes of back pain during pregnancy, considerations for prevention, and techniques and tools to relieve pregnancy back pain.

Back Pain During Labor and Postpartum

Back pain can also affect you during your labor and birth and in your postpartum period. Ideally, you go into your labor feeling good and without the back pain that could affect the positions you can utilize during your labor. After your baby is born, back pain can be a problem as you are constantly carrying around a new baby and trying to find comfortable positions to breastfeed for many hours each day. It is also possible for back pain to persist long after you have your baby. One study found that 20% of women who experienced low back pain in pregnancy were symptomatic three years later.

Quality of Life

Quality of life is the degree to which an individual is healthy, comfortable, and able to participate in or enjoy life events. Researchers utilize questionnaires to assess the quality of life, which consider the main areas of health, including physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health. Research has identified back pain as one of many pregnancy-related factors influencing your quality of life.

One study examined the relationship between low back pain and the quality of life of pregnant women. They found a significant difference in mental health, physical health, and social relations between the group with back pain and the control group. Another study found lower back and pelvic pain in pregnancy negatively impacts perceived health and sexual life. Women with back pain also reported more sick leave from work. There is even evidence that back pain increases your risk of anxiety and depression.

Causes of Back Pain Due to Changes in Pregnancy 

You go through many physical changes during pregnancy that can impact your back and potentially cause issues like pain or discomfort. 

Weight Gain

A higher weight is a predictor of back pain. One study that followed women in their mid-twenties to mid-thirties found for every 5 kg (about 11 pounds) higher weight at baseline, there was a 5% increase in the risk of back pain during the following 12 years.

Weight gain during pregnancy is inevitable. The American College of Obstetricians and Gynecologists recommends that you gain between 25-35 pounds during your pregnancy, assuming you start your pregnancy at a healthy weight. Even with these guidelines, most pregnant women are not gaining weight within the suggested ranges. One study  that examined over 18,000 pregnancies found that just 25.8% of women gained weight within the recommended ranges, with 21.3% gaining less and 52.9% gaining above. The higher your weight, the more pressure and stress your spine and joints feel. Maintaining a healthy weight before, during, and after pregnancy can decrease your risk of experiencing back pain.

Your doctor or midwife will monitor your weight as a health metric during pregnancy. Your energy is better focused on healthy habits than the number on the scale. Any steps towards overall improving your health by eating well, engaging in physical activity, and prioritizing basics like sleep and hydration will positively impact your weight in the long run. See this episode for more information on healthy weight gain during pregnancy.

Shifting Center of Gravity

Most of the weight you gain during pregnancy is in your belly. As your pregnancy progresses, your growing belly shifts your center of gravity forward. To compensate for this shift, you may lean back, which can strain the muscles in your lower back.

Posture

Weight gain and a shift in your center of gravity can change your posture during pregnancy. Poor posture can put additional strain on your spine. Good posture means sitting or standing tall with your back straight, your chest high, and your shoulders are back and relaxed.

If you are sitting, choose a chair with good back support. Consider supporting your lower back, especially if you spend much time sitting at a desk. You can add lumbar support with a specific pillow or attachment designed for lumbar support. Before running out and buying lumbar support, you may try any small pillow you already own.

Sitting in a comfortable position with good posture is also essential after you have your baby. As a new mother, you will spend significant time sitting and feeding your baby. Take an extra minute to adjust your position, add a pillow, or prop your feet up. Pillows designed for nursing your baby can tremendously help support your baby’s weight while breastfeeding or bottle feeding. Nursing pillows are also helpful in positioning your baby for a good latch while breastfeeding.

Relaxin

Your ligaments are the connective tissues that help keep bones, joints, and organs in place. Relaxin is a hormone that relaxes your ligaments. This is necessary and will help when you are in labor and giving birth. The downside is that relaxin doesn’t only concentrate its effects on your pelvis and hips before birth. This hormone can affect your entire body throughout your whole pregnancy. This can cause back pain when the ligaments that help support your spine are relaxed, which can cause instability. When your ligaments are looser, you have less stability in your joints, and it is easier to overstretch them, which can cause pain or injury.

Considerations in Preventing and Relieving Back Pain

Many changes during pregnancy can contribute to back pain or discomfort. There are a few key considerations for taking care of your back and preventing or relieving back pain during pregnancy.

Sleep 

There is mounting evidence of the importance of sleep for every aspect of your physical and emotional health. Back pain can significantly impact your sleep duration and quality. One study found that 49.6% of pregnant women reported lying down and sleeping positions were associated with back pain. Another study reported that 43% of women with low back pain reported sleep disturbances; 14% could only sleep less than 2 hours, and 10% could sleep for an average of 4 hours. The majority reported that pain woke them up at night.

Getting comfortable for sleep can make a big difference in relieving back pain and helping you sleep better. The American College of Obstetricians and Gynecologists recommends sleeping on your side later in pregnancy. Keep one or both knees bent. It also may help to place a pillow between your knees and another under your belly. You also can try a full-length body pillow.

Exercise

Studies have found that a sedentary lifestyle increases your risk of back pain compared to those who engage in a more active lifestyle. Exercise can help strengthen and increase flexibility. One study found that women who had not engaged in physical activity were more likely to experience lower back pain. Exercise may not help improve existing pain. A Cochrane Review found low‐quality evidence that exercise may reduce pregnancy‐related low‐back pain and moderate‐ to low‐quality evidence suggesting that exercise improves functional disability and reduces sick leave more than usual prenatal care. If you are experiencing back pain, you may need to tone down your workouts and take it easy. You can modify nearly any exercise to be safe during pregnancy. If your back feels good, exercise is a long-term strategy to strengthen your body and prevent back pain.

Lifting

Due to an increase in the hormone relaxin,your ligaments are looser. This means you have less stability in your joints, and it is easier to overstretch your ligaments, which can cause pain or injury. ACOG states that lifting, in particular, poses a risk of musculoskeletal injury and low back pain.

You should be cautious lifting anything and have proper form to prevent injury. Instead of bending at your waist, bend at your knees and keep your back straight. Imagine this as a squat rather than leaning over to pick up an object. When lifting, you should avoid any sudden movements that jerk your body. There is an episode with in-depth information on lifting weights and strength training.

The National Institute of Occupational Safety and Health recommends limits for lifting in the workplace and has recommendations specifically for pregnant workers. The limits vary based on where you are in your pregnancy, the height of the lift, the distance from your body the item is, and how often you are lifting.

Routine Movements

One study identified 16 kinds of motion that participants thought induced pain. Most pregnant women thought the three motions most related to lower back pain were sitting up, standing up from a chair, and tossing and turning while lying down. Interestingly, everyday movements were more associated with pain and intensity of pain over special motions that require extra tasks or effort. These daily movements all require rotation and extension or flexion of the trunk. Anytime you go from a lying to a sitting position or from sitting to standing, you want to be mindful of how you move.

Back Pain and Your Job

ACOG acknowledges that physically demanding work such as heavy lifting, excessive repetition, awkward postures, and prolonged periods of sitting or standing is associated with low back pain and musculoskeletal disorders in the general population. For most people, this describes your job. One study found that 38.7% of pregnant women identified sitting positions as one of the most significant factors causing lower back pain. Spending a large part of your day sitting or at a desk can be an issue for back pain. Ensuring you sit in a comfortable chair with proper support is crucial. If you have a job requiring standing for long periods, take breaks to sit, stretch, or move around.

Please discuss any questions about work-related activities and your pregnancy with your doctor or midwife. They can provide information and resources to help you understand your employment rights. They may also be able to provide documentation that you can provide to your employer requesting accommodations. Take care of your back and make adjustments or modifications proactively rather than wait until an issue arises and you are in pain. 

If you are experiencing back pain affecting your ability to work, you may need to take sick days or time off. Many moms try to avoid taking time off during pregnancy to save as much time as possible for maternity leave. If you are experiencing back pain, you must give yourself time to heal and a break from the positions or motions that aggravate your back. If you don’t, you risk your pain getting more intense.

Additional Interventions and Tools

You may want to employ various interventions and tools to prevent or treat back pain. Many of these are inexpensive, with minimal downsides.

Hot or Cold Compresses

An intervention for back pain ACOG recommends is applying heat or cold. You may need to play with both to find what provides more relief for you. Cold constricts blood vessels, decreases inflammation, and can numb the pain. Cold compresses tend to be more effective earlier on. Heat is more effective in increasing blood circulation, which can help in the healing process. ACOG cautions that pregnant women should use heating pads at the lowest possible temperature setting. Wrap your heating pad or warm water bottle in a towel to help prevent burns. They also state you should limit the time you use heat or cold.

Support Belt

Wearing a support belt can alleviate strain on your spine and muscles by supporting some of the weight from your growing belly. If you are experiencing lower back pain, you can try wearing a support belt to relieve some pressure off your back. You may also find it easier to maintain proper posture with a support belt.

Footwear

The American College of Obstetricians and Gynecologists recommends wearing supportive shoes to prevent or ease back pain during pregnancy. ACOG states you should wear low-heeled (but not flat) shoes with good arch support, such as walking or athletic shoes. Avoid high heels—they tilt your body forward and strain your lower back muscles.

One way to ensure your shoes have good arch support is to use insoles. Insoles slide right into your flats, boots, or athletic shoes, instantly making any shoes more comfortable. More importantly, having good arch support helps your posture. There is research demonstrating that wearing insoles can help with lower back pain. I highly recommend the insoles from Mommy Steps. Not only can they help with back pain, but they can help in preventing many issues that can happen to your feet during pregnancy. Save 20% off with the code FEET.

Prenatal Massage

Prenatal massage is another intervention to alleviate back pain. Ideally, a massage during pregnancy is with a trained and experienced therapist. Check out this episode for more information on prenatal massage. Massage doesn’t have to be limited to an expensive spa. Even a massage from your partner may help relax your muscles and alleviate pain.

Acupuncture

Another technique often used for pain relief is acupuncture. This is a key component of traditional Chinese medicine. Practitioners believe chi flows through your body’s pathways (called meridians). Inserting extremely thin needles into specific points along these meridians aims to rebalance your energy flow. Many Western practitioners view acupuncture points as places to stimulate nerves, muscles, and connective tissue. Some believe this stimulation boosts your body’s natural painkillers and increases blood flow.

Overall, the adverse effects associated with acupuncture are minimal. The most commonly reported negative effect is needling pain. There is evidence this is a safe practice during pregnancy. If you plan to utilize acupuncture, ensure you visit a reputable practice using sterile disposable needles. You should also seek treatment with a licensed acupuncturist with knowledge and experience in treating pregnant women. 

Chiropractor

Another professional who may be able to relieve back pain is a chiropractor. A chiropractor typically uses their hands or an instrument to manipulate the joints of the body, particularly the spine, to restore or enhance joint function. This often helps resolve joint inflammation and reduces the patient’s pain. One study found most pregnant patients undergoing chiropractic treatment reported clinically relevant improvement. As with any practitioner, please seek treatment with a knowledgeable professional who specializes in or has experience with pregnant patients.

TENS Machine

A TENS machine is a small handheld device with wires attached to electrodes in pads that you stick to your skin. TENS stands for transcutaneous electrical nerve stimulation. Patients who suffer from chronic pain commonly use TENS. There is a study that compared TENS application to exercise and acetaminophen. The researchers found TENS improved lower back pain more effectively than exercise and acetaminophen and TENS is an effective and safe treatment modality for lower back pain during pregnancy. Check out this episode to learn more about using a tens machine for pain relief during labor.

Medications for Pain Relief

Many people who suffer from back pain find temporary relief with pain medications. There are additional considerations for taking medications during pregnancy. Before taking any over-the-counter or prescription medicines, you should discuss them with your prenatal care provider. If you are breastfeeding, the LactMed database is a fantastic resource for the safety of medications while breastfeeding.

Over-the-Counter Medications

The primary over-the-counter pain medications include aspirin, nonsteroidal anti-inflammatory drugs (including ibuprofen), and acetaminophen.

NSAIDs include aspirin, ibuprofen, and some other pain relievers. Aspirin is usually not recommended during pregnancy or breastfeeding for pain relief. There are exceptions for low-dose aspirin for the prevention of preeclampsia. Ibuprofen is also usually not recommended during pregnancy. The FDA recommends pregnant mothers avoid ibuprofen after 20 weeks because it can result in low amniotic fluid. There is also evidence that ibuprofen and NSAIDs can increase your risk for miscarriage early in your pregnancy.

Typically, medical professionals prefer acetaminophen over ibuprofen during pregnancy. Acetaminophen may also be referred to by the brand names Paracetamol or Tylenol. Acetaminophen has long been thought to be safe during pregnancy, but some recent research may challenge this.

In one study, researchers related an increased risk for asthma in children to maternal use of acetaminophen during pregnancy. Another study in the Journal of American Medicine found an association between acetaminophen use during pregnancy and behavioral problems in children. More recently, 91 scientists, clinicians, and public health officials released a consensus statement cautioning against using acetaminophen during pregnancy. They examined many studies on both humans and animals. They found the use of acetaminophen might alter fetal development, which could, in turn, increase the risks of certain neurodevelopmental, reproductive, and urogenital disorders. The professionals behind this statement called for agencies like the FDA and obstetric and gynecological societies (like ACOG) to review the evidence and reevaluate the risks of this drug.

Days after this statement cautioning against the use of acetaminophen, ACOG released its statement that “This consensus statement, and studies that have been conducted in the past, show no clear evidence that proves a direct relationship between the prudent use of acetaminophen during any trimester and fetal developmental issues.” ACOG goes on to say, “clinical guidance remains the same, and physicians should not change clinical practice until definitive prospective research is done. Most importantly, patients should not be frightened away from the many benefits of acetaminophen. However, as always, any medication taken during pregnancy should be used only as needed, in moderation, and after the pregnant patient has consulted with their doctor.”

You should discuss any over-the-counter medication in detail with your doctor or midwife. The severity and frequency of your back pain play a role in weighing the risks and benefits in your discussion with your care provider.

Prescription Medications

Opioid medications are the last line of defense for back pain. ACOG states for chronic pain, practice goals include strategies to avoid or minimize the use of opioids for pain management, highlighting alternative pain therapies such as nonpharmacologic (e.g., exercise, physical therapy, behavioral approaches), and nonopioid pharmacologic treatments.

When to Contact Your Doctor or Midwife

You should contact your doctor or midwife if your back pain is severe. The quick onset of back pain could be a sign of preterm labor. If a fever accompanies your back pain, you should also contact our care provider because that could be a sign of infection. ACOG says you should contact your doctor if the pain lasts more than two weeks. Two weeks is a long time to have pain in your back that will inevitably affect all aspects of your life. You should be comfortable contacting your care provider if you have any concerning symptoms or trouble relieving them. If it will put your mind at ease, contact your doctor or midwife, and don’t wait two weeks or until your next appointment.

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