I have had several questions about back pain in pregnancy recently. Studies suggest that about half of expectant mothers have back pain issues by late second trimester, though that seems low to me from the number of ladies I see with it. Accordingly, I, who have not been pregnant ever, will share some common questions and some answers.
Bodies are designed with balance in mind. When you sit, stand, or walk, your muscles and skeleton work in concert, efficiently managing your body mass as it moves or holds its position against gravity. Your sense of equilibrium is the result of an amazing and complex series of command and control impulses in your nervous system going into the brain from the periphery and to the extremities from the brain. As King David put it, we are "fearfully and wonderfully made."
In the course of pregnancy, 35-40 pound weight gain is common, and some moms gain considerably more. As pregnancy progresses, much of this weight concentrates itself around that marvelous bundle that will need a name, 2 o'clock feedings, and clothes. The result is an increase in the curve in the lumbar spine—at the base of the back—that puts pressure on that part of the spine, especially the facet joints of the vertebrae.
Late in pregnancy, it is common for the sacroiliac joints to misalign. Part of this is due to the extra stress on them, but part of the cause is a hormone that relaxes ligaments to get the pelvis ready to stretch for the big delivery day. Because all your weight goes through these joints, it can get uncomfortable.
Additionally, more muscle power is needed to stand erect. By late in the second trimester, mom is having to lean backward to carry the weight up front, so back muscles are working overtime. And we have not even talked about leg muscles yet.
Sometimes, too, a baby may settle in the pelvis in such a way that he/she dances on a sciatic nerve, producing pain that radiates into the legs and feet. This is painful and exasperating.
What can a girl do? Here are some ideas.
Don't stay still. Talk to your doctor about safe, sensible exercise during pregnancy that can help strengthen your muscles and prevent discomfort. Try exercising at least three times a week, gently stretching before and after exercise. Walking, swimming, and stationary cycling are relatively safe cardiovascular exercises for pregnant women because they are low-impact. Be sure to exercise in an area with secure footing to minimize the likelihood of falls. Your heart rate should not exceed 140 beats per minute during exercise. Strenuous activity should last no more than 15 minutes at a time. Stop your exercise immediately if you notice any unusual symptoms, such as vaginal bleeding, dizziness, nausea, weakness, blurred vision, increased swelling, or heart palpitations.
For your safety, wear flat, sensible shoes. High or chunky heels can exacerbate postural imbalances and make you less steady on your feet, especially as your pregnancy progresses. When picking up your already existing children, or anything else, bend from the knees, not the waist. Never turn your head when you lift. Avoid picking up heavy objects if possible.
Get plenty of rest. Pamper yourself and ask for help if you need it. Take a nap if you're tired, or lie down and elevate your feet for a few moments when you need a break. Sleep on your side with a pillow between your knees to take pressure off your lower back. Full-length "body pillows" or "pregnancy wedges" may be helpful. Lying on your left side allows unobstructed blood flow and helps your kidneys flush waste from your body.
If you have to sit at a computer for long hours, make your workstation ergonomically correct. Position the computer monitor so the top of the screen is at or below your eye level, and place your feet on a small footrest to take pressure off your legs and feet. Take periodic breaks every 30 minutes with a quick walk around the office.
Eat small meals or snacks every four to five hours— rather than the usual three large meals—to help keep nausea or extreme hunger at bay. Snack on crackers or yogurt—bland foods high in carbohydrates and protein. Keep saltines in your desk drawer or purse to help stave off waves of "morning sickness." Supplementing with at least 400 micrograms of folic acid a day before and during pregnancy has been shown to decrease the risk of neural tube birth defects, such as spina bifida. Check with your doctor before taking any vitamin or herbal supplement to make sure it's safe for you and the baby.
You can't take pain medication while pregnant, so see your chiropractor when your back bothers you. There is no contraindication to gentle adjustments when pregnant. More frequent adjustments may be needed in the pelvis toward the end of pregnancy. Gentle stretching of the lumbar spine may make all the difference in the world to you. And get a massage therapist if you don't already have one. Some of them used specialized techniques for pregnancy. I work with two very closely, so call for referrals.
Last, but not least, congratulations! I hope everyone is healthy and happy!
Not long ago, I wrote about a fellow I called "Ron," who heroically and sacrificially took care of an uncle who was ailing. I am sad to report that "Ron," who was actually "Ray," went to the hospital with a severe infection. In the course of his hospitalization, advanced cancer was discovered. Ray left us last week. He kept his sense of humor and dignity throughout, showing little sign of the suffering he must have experienced. He was a wonderful Southern gentleman, and he will be sorely missed./RAH