Back pain during pregnancy - causes, prevention and treatment

Pregnant woman with sore back in bed

Irritating and inconvenient as it may be, back pain is a very common ailment in pregnancy. It affects more than half of all pregnant women, and can make daily life something of a chore

What causes back pain in pregnancy?

As with most pregnancy health issues, you can blame your hormones largely for this one. During early pregnancy (peaking at 10 to 14 weeks) your body releases a hormone called relaxin (oh, the irony) which loosens your ligaments, forcing your spine and back to take on the strain of carrying your weight. If you’re experiencing lower back pain early in pregnancy, you can likely blame relaxin.

At the same time, increased levels of progesterone relax muscles ready for birth, softening ligaments all over your body. The muscles around the spine tend to try to compensate for this, which means they are overworked and easily pulled.

On top of all that, the additional weight from lugging around your growing baby puts pressure on your back and throws your centre of gravity forward, which causes curvature of the spine, known as lordosis – squashing vertebrae and putting the muscles under extra strain. What a combination!

You might also notice that your pain is worse as the day goes on – that’s because your muscles get tired from the weight of supporting you and your baby.

How common is back pain during pregnancy?

Very common – so you’re not suffering alone (if that’s any comfort). It’s thought that between 50-70% of women experience some variation of back pain while pregnant.

Is it back pain or pelvic pain?

It’s pretty easy to confuse back pain with pelvic pain during pregnancy. Neither of them are much fun, but as a rule of thumb, the difference is as follows:

  • Lower back pain is a dull ache that you feel when you bend forwards, and it restricts the movement of your lower spine. It might also hurt when lower muscles in your back are pressed.
  • Pelvic girdle pain (PGP) is felt at the back of your pelvis, where your sacroiliac joint is. It can feel like a stabbing, shooting, burning or dull pain, and it might come and go. You might also feel it in the back of your thighs – it’s sometimes confused with the less-common sciatica.

If you are experiencing pain on or around your pubic bone, you may have symphysis pubic dysfunction (SPD), a fairly common disorder relating to the ligaments around your pelvis, which can vary in severity from a niggling pain to hobbling on crutches. If you have any concerns, do go and see your doctor who will be able to provide a diagnosis.

You can have both lower back pain and PGP – if you get checked out by a physiotherapist, they’ll be able to help diagnose what’s going on, and suggest some specific actions to help reduce the pain.

Can I do anything to avoid getting a bad back?

There are definitely things you can do to lessen your chances of getting back pain during pregnancy:

I've had horrid back pain around my coccyx since about 14 weeks. The methods I have found to manage it are going to the osteo, doing pregnancy yoga, and swimming. The yoga in particular is brilliant. If my back flares up during the day, I nip to the loo at work and do the movements in there.

  • Being a healthy weight before you get pregnant and not stacking on the pounds once you are pregnant will mean you aren’t putting as much pressure on your back. Obviously if you’re carrying a 10-pounder or twins, there’s only so much you can do.
  • Sit with your back straight and well supported – particularly if you’re working at a desk for long periods of time.
  • Get plenty of rest – though that goes without saying.
  • Doing exercises that strengthen your core, like pregnancy pilates or aquanatal classes, or exercises which aim to improve posture, will help.
  • Try to avoid lifting anything heavy, and if you do have to lift, always bend at the knee, not the back.
  • Take a bit of extra care, and try not to make movements that twist your body – getting out of bed too quickly is a very common way to hurt your back when pregnant
Pregnant woman swimming

How can I treat my back pain in pregnancy?

  • Remain a healthy weight to avoid any additional pressure on the back.
  • Try exercises that can help ease back pain – swimming, where the water supports your weight, or pregnancy yoga, is ideal.
  • A sacral belt helps reduce the pain whilst walking for some women – for others it does nothing at all, or can even make the pain worse. I was advised to get a fitted support belt as the pain is likely to get worse later in pregnancy.
  • Avoid wearing high heels – ideally you should wear shoes with good support that will distribute your weight evenly.
  • A warm bath or hot water bottle might give you some relief – alternatively, you might find than a cold compress works better for you.
  • If you’re finding you get back pain whilst in bed, you could invest in a pregnancy pillow, which allows you to sleep on your side but with your knees apart, stopping your back from twisting as you roll into the mattress.
  • You might also want to try a firmer mattress, which will provide more support for you. I saw an osteopath this week and it was the best thing I could have done as she did loads of things that made my back feel a whole lot better.
  • Acupuncture and massage can help, but always use a practitioner who is fully qualified in treating women during pregnancy.
  • Talk to your midwife or GP about whether you could take pain killers. Some, like paracetamol, are usually safe to take in pregnancy and there’s no point suffering in silence.
  • Your GP may also be able to refer you to an obstetric physiotherapist.

Can back pain be a symptom of something else?

Occasionally back pain can be an indication something else is wrong. Contact your doctor if:

  • Your back pain is severe, gets progressively worse, or occurs after trauma or an accident.
  • You also have a fever, vaginal bleeding, or a burning feeling when you urinate.
  • You’ve lost feeling or have persistent pins and needles in either or both of your legs, or you feel dizzy and weak.
  • You have persistent pins and needles in your buttocks, groin or genital area.
  • You’ve lost feeling or control of your bladder or bowels, making it difficult to go to the toilet or making you incontinent.
  • You have pain in your side just under your ribs, on one or both sides, particularly if you have a fever, nausea or blood in your urine – this can be a sign of a kidney infection.

If you have lower back pain late in your second or third trimester, this could be a sign of premature labour, particularly if you hadn’t experienced any pain previously in your pregnancy.

When should I see a doctor?

If your pain is really bad and you’re struggling, definitely go and see your doctor. They may be able to refer you to an obstetric physiotherapist, who can help you out with exercises and techniques for making you a bit more comfortable. Similarly, if it lasts for more than two weeks, don’t suffer in silence – your GP or midwife should be able to help.

Additionally, if you have experienced back problems prior to becoming pregnant, it’s worth letting your GP know about this so they can keep an eye on you throughout pregnancy.

Will back pain affect my labour?

I don't have any surefire solutions except hot water bottles, paracetamol and sleeping with an ever more creative arrangement of pillows.

It's very unusual for back pain that has come on during pregnancy to affect the way you labour and give birth.

If you suffered with back pain, an injury, or a condition such as scoliosis prior to pregnancy, you should talk to your doctor about whether any special arrangements will need to be made for birth.

Does back pain go away after birth?

There's good and bad news here. Providing it isn’t trauma-related, your back pain should go away once your baby is out – but it can take some time. Pregnancy hormones hang around for a while, particularly if you’re breastfeeding, so everything doesn’t miraculously return to normal the day after birth.

If you already have a weakness, it’s also very easy to hurt your back picking up your baby and dealing with the buggy, cot, car seats and myriad other pieces of equipment that seem to be designed to cause you injury – just when you need it least. Try to take it easy, and if you’ve got a partner, get them to do the heavy lifting for the time being.