Back pain in pregnancy: causes, treatment and prevention

Back pain and backache are some of the most common complaints in pregnancy, caused by changing hormones and the weight of your growing bump. We look at how to treat it as well as ways to prevent it happening in the first place.

As exciting as being pregnant is, there's no doubt that it takes its toll on your body. Whether you've been suffering from morning sickness or plagued with heartburn, everyone gets slightly different symptoms.

But one thing the majority of us will get is back pain, which is estimated to affect between half and three quarters of mums-to-be.

And it doesn't just appear towards the end of our pregnancy, thanks to a blossoming bump, either.

According to the NHS:

'It is very common to get backache or back pain during pregnancy, especially in the early stages.'

So whether you've got a niggling ache, stiffness and soreness or full-on discomfort, here's a look at what's causing it and how to treat it safely and effectively.

What causes back pain in pregnancy?

The NHS puts back pain largely down to pregnancy hormones.

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It says:

'During pregnancy, the ligaments in your body naturally become softer and stretch to prepare you for labour.

'This can put a strain on the joints of your lower back and pelvis, which can cause back pain.'

Other reasons for your back pain could include:

• Postural changes – as your baby grows, your centre of gravity shifts. This can mean you over-arch the small of your back to compensate, causing strain on your spine.
• Pelvic girdle pain (PGP) – another condition that causes pelvic pain is (PGP), formerly known as Symphysis Pubis Dysfunction (SPD). This can also lead to back pain. It's sometimes mistaken for sciatica (see below) but is actually much more common.
• Sciatica – this can occur when the sciatic nerve gets irritated. Although the pain is usually felt more in your bottom, legs and feet, it can also cause back pain, too. While lots of women feel symptoms similar to sciatica during pregnancy, actual sciatica is fairly uncommon.

Constant back pain can be a real nuisance, affecting your sleep and making everyday life that little bit harder. Fortunately, there are a few things you can do to help ease the pain, sleep better and stay healthy and strong throughout your pregnancy.

When does back pain during pregnancy start and end?

This can vary from individual to individual, however in many cases, back pain can start fairly early on in your pregnancy.

Some women experience it in the first trimester, but for many women, back pains starts around week 18, early in the second trimester.

It can persist or sometimes worsen as the second trimester progresses and especially in the third trimester when you are carrying the extra load, right up until you give birth.

For those unlucky few, it's then sometimes replaced by postpartum back pain.

How to avoid back pain in pregnancy

The best way is to strengthen your core muscles before becoming pregnant. Great ways to do this include practising yoga and pilates.

However, if you're already pregnant there are plenty of things you can do to protect yourself from back pain in pregnancy.

Here's what the NCT (National Childbirth Trust) and Tommy's recommend doing:

• Keep an eye on your posture: straighten your lower back and gently draw your bump in. Imagine your baby being tucked into the pelvis, close to your centre of gravity.
• Be sensible about lifting objects: always lift bending your knees rather than your back and try to avoid lifting anything heavy which puts stress on your back, or you could risk further injury.
• Wear flat or low-heeled shoes.
• Sit up straight and with your lower back supported.
• If you work from home, ensure you have a comfortable, supportive chair, and perhaps a back lumbar support cushion too.
• Keep an eye on your weight, and try to keep as active as possible. Even if it's just going for a short walk once a day. Too much weight gain can put pressure on your back.
• Use a firm mattress. A body pillow to sleep with can also help.
• Try to avoid lying flat for long periods of time. It’s better for your back and your baby to lie on your side. Using a pillow between your knees can make this more comfy.
• If you work standing up, adjust the work surface to avoid stooping.
• Consider going to a group or individual back care class.

Gentle physical exercise like pregnancy yoga, walking and swimming can help you stay supple and toned, which can help.

Keeping your pelvic floor toned will also help support your back so make sure you're doing those tightening exercises, too.

The NHS also recommends patients try the following exercise, which is designed to help strengthen stomach (abdominal) muscles, which can ease back pain in pregnancy:

• start on all fours (a box position) with knees under hips, hands under shoulders, fingers facing forwards and stomach muscles lifted to keep your back straight
• pull in your stomach muscles and raise your back up towards the ceiling, letting your head and bum relax downwards gently – don't let your elbows lock
• hold for a few seconds then slowly return to the box position
• take care not to hollow your back – it should always return to a straight, neutral position
• do this slowly and rhythmically 10 times, making your muscles work hard and moving your back carefully
• only move your back as far as you comfortably can.

Doing prenatal yoga or aquanatal classes (gentle exercise classes in water) with a qualified instructor can also help build your muscles to better support your back. Ask at your local leisure centre about anything suitable they might have.

Working with back pain in pregnancy

If you sit at a desk for your job, make sure HR do a desk assessment or review once they know you're pregnant.

NHS advice recommends that pregnant workers:

• sit correctly at your workstation - your HR should be able to provide guidance if you're unsure
• if you're sitting for long periods, get up for a minute or two at least once every half hour
• use an adjustable chair

If you drive to work, make sure you have a lower back support in your car seat.

You can buy a lower back support for your car or chair – we like this one that has memory foam. See more details here at Amazon.

Safe ways to treat back pain during pregnancy

In terms of painkillers, the NHS says:

'You can take paracetamol to ease back pain while you are pregnant, unless your doctor or midwife says not to. Always follow the instructions on the packet.'

Read more about taking painkillers in pregnancy.

Other safe ways to treat back pain include:

• getting plenty of rest – back pain often gets worse towards the end of the day or if you have been on your feet for a long time
• pregnancy massage
• warm baths - or, use a shower head with the massage function if you have it
• hot water bottle (not too hot)
• physiotherapy
• strengthen your stomach by doing pelvic tilts to strengthen your core, which in turn, helps support your back
• gentle exercise

If your backache still persists and is becoming unmanageable, speak to your doctor about alternative treatments. They may recommend acupuncture, or seeing a chiropractor who might be able to help. They may also be able to refer you to an obstetric physiotherapist.

A pregnancy support belt can also help with relieving backache. See more details here at Amazon.

Is acupuncture for back pain safe during pregnancy?

Acupuncture is a therapy that involves a qualified practitioner inserting thin needles at particular points on your body, with the aim of controlling and relieving pain. Research has shown that it may help with back pain for pregnant women.

According to Tommys, acupuncture is generally safe to have when you’re pregnant but, you must talk to your midwife or GP before you book a session.

They say: 'If you do want to try it, make sure your acupuncturist is fully qualified and that they use disposable needles at every treatment session. Tell your practitioner that you’re pregnant because certain acupuncture points can’t be used safely in pregnancy.'

Some NHS doctors and physiotherapists can give acupuncture alongside regular medical treatment. Talk to your GP or midwife to find out more. Most people need to pay privately for acupuncture. 

Is back pain the sign of a miscarriage?

Common symptoms of miscarriage include:

• bleeding
• vaginal discharge
• loss of pregnancy symptoms such as sickness stopping or no longer having tender breasts.

Pain – including back pain can also be a symptom, but will usually be in conjunction with bleeding.

According to Tommy's, the UK charity supporting and researching stillbirths and miscarriages:

'...cramping or tummy pain may accompany the bleeding, or come alone. It may be mild or severe, a dull ache or sharp pain or feel like backache.'

If you're concerned about any aches and pains during your pregnancy, always contact your GP or midwife.

Is back pain a sign I'm in labour?

Whether it's down to a heavy bump or poor posture as you near your due date, an achy back is pretty common.

However, back pain in the later stages of your pregnancy can also be an early sign of labour.

According to the NHS:

'Backache often comes on in labour. You may get backache or the heavy, aching feeling that some women experience during their period.'

So if you're near your due date and are experiencing period-type backache, contact your midwife or antenatal triage.

Find out more about the signs and symptoms of early labour.

When to get help with back pain during pregnancy

If your back pain is severe, talk to your GP or midwife who may be able to refer you for some gentle physiotherapy. If it's PGP, this can be very effective in reducing the pain.

However, according to the NHS you should always seek medical help if you have back pain and:

• are in your second or third trimester – this could be a sign of early labour
• also have a fever, bleeding from your vagina or pain when you pee
• lose feeling in one or both of your legs, your bum, or your genitals
• have pain in one or more of your sides (under your ribs).

Are you experiencing back pain in your pregnancy? Any tips for easing it? Share your experience over on our forum below:

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