Dealing With Back Pain in the Third Trimester

My Back is Killing Me

“Whew, golly,” says Marie, as she sinks sideways into her favorite recliner. She rests her hands on her taut belly, and she slowly huffs her way through a set of breathing exercises. When she’s done, she smiles and directs her too big, too green eyes at me.

That gaze makes me uncomfortable. I know she’s getting ready to complain about something. She doesn’t keep me in suspense.

“I thought the first trimester was bad! Ha! My back is killing me!”

I nod in sympathy, thinking of all that weight hanging cantilever out in front of her. It has to be a strain on her back.

She’s carrying this child, her second, up high and out front, like a basketball.

Some women blossom during pregnancy and Marie is one of them. Her cheeks are red and shine with good health. She’s gotten this far - eight months now - without complications, a model pregnancy. I’m proud of her.

“Have you talked with the doctor about your back?”

“She said to take two Aleve and a warm bath. Ha!”

“Did it work?”

Marie looks at me like I’ve lost it. “Exactly how do you think I should go about gettin’ both her,” with a pat, “and me in the bathtub?”

“With my help?”

Marie grins. “Yeah.”

Marie’s Back

Marie’s back is a marvelous bit of engineering. In the center of everything back there is her spinal cord - a bony structure surrounded by muscles and ligaments that looks like an “S” when viewed from the side. As Marie can attest, this area acts as a focal point for many stresses that are encountered during pregnancy.

The spinal column consists of vertebrae - segments of bone through which the spinal cord passes and through which nerve bundles exit. The rear portion of a vertebra forms a spinous process, or extension. (These are the notches on Marie’s back that I love to run my fingers over when I give her a back rub.) In between the individual vertebra in Marie’s back are discs.

Good posture is important in maintaining the alignment of the spine. Marie normally has a very good “neutral” body posture, with her ears aligned right over her shoulders and hips. It’s usually an attractive feature of her’s, but not when she’s toting around a thirty pound basketball. The baby makes her center of gravity shift forward, and her spine moves back to compensate for it.

She also has a tendency, especially when she’s fatigued, to l-e-a-n those shoulders back, increasing the curvature, or lordosis, of her lower spine.

Lately, her breasts have filled, too, and that’s a strain on her upper back.

Of course, Marie’s got company in this back pain business. About fifty percent of all women experience back pain during pregnancy.

Hormonal Activity in Pregnancy

One of the causes of her back pain is related to the hormone relaxin. This neat hormone, which peaks at around the fourteenth week, is responsible for relaxing the pubic synthesis, or band of fibrous connective tissue in the front of Marie’s hip. This effect allows her pelvis to spread out to make room for that kid.

Unfortunately, it also destabilizes Marie’s lower, or lumbar, spine by causing “joint laxity” in some of her ligaments and her sacroiliac joint. These areas are sensitive to pain, and they let her know!

Marie has an active lifestyle and a trim belly in between babies. Her abs are usually tight. Now, put a baby in the picture, and her abdominals have their work cut out for them. As you can imagine, with her great abs all stretched out for baby, they’re not doing much to stabilize her hip and back!

This puts pressure on the muscles around her spine in her lower back, and the end result is back pain.

During her last pregnancy, Marie quickly learned to sleep on her side. This is important because of the way the baby is situated. Flat out on her back, the baby presses on her lower vena cava, the big vein that returns blood from the lower body to the heart. This can divert blood flow into - you guessed it - the lumbar veins of the lower back and contribute to back pain and spasms. Marie says it’s worse than cramps with menstruation.

Other than trying to maintain a better back posture, are there any other things Marie could try to get relief?

Body Mechanics and Exercise

When sitting or standing, Marie can improve her ergonomics, or body mechanics, by putting a foot up on a stool (standing) or a foot rest (seated). This relaxes a set of muscles called the iliopsoas muscles and tilts the pelvis forward, decreasing the strain on her lumbar spine and the muscles around it.

Low or no heels are important to protect the back, too, but Marie knows that - she’s usually barefooted.

When she sleeps, Marie puts a pillow between her legs and pads her belly by putting pillows under it. She says that prevents night pain, and I’d never disagree with a pregnant woman.

What about exercises? A neat, easy one is the cat stretch. Marie does this by getting on the floor on all fours and arching her back up like a cat. She does a slow count to five, and then relaxes. I love watching her do this.

She’s also a believer in doing her daily stretches. She says it keeps her supple, and I can attest that she’s supple.

One we’ve read about, but not tried yet, is the “double hip squeeze.” It’s supposed to correct the alignment of the pelvis, and it’s described at the Childbirth.org site listed below.

When Marie has muscle spasms in her back, she likes a towel with crushed ice in it positioned just so, but other women may prefer localized heat. Hey, use what works.

Marie likes to swim, too. I tease her about becoming more aerodynamic when she’s big-bellied, but having a kid in tow doesn’t seem to cause her trouble in the pool. This is a good kind of exercise because it encourages fluid, smooth muscle movements - the good kind. Movements that are jerky, like snatching when lifting something, are the bad kind.

I’ll note here that Marie’s excellent ob/gyn knows all about Marie’s antics in the pool, and she approves. I’d think any pregnant woman should check with her doctor before undertaking an exercise program. It might be exactly the wrong thing to do.

What’s also helped her back is Marie’s new maternity bra. She says it’s got enough structure in it to hold up a Mini Cooper, but she says that the additional support has really helped her back.

And the Reward

Adrian Ariel was born on March 24, 2008. She entered this world a hefty 10 lbs 2 ozs and broke her mother’s tailbone while doing so. Marie now carries an inflatable “donut” everywhere she goes, and I know it’s not funny . . .

Marie is determined that this child shall be called “Addy,” but I’m rooting for “Rail.”

I mentioned this notion to Marie, and she looked at me like I’d lost it. Okay, maybe I have, but I’m not the one carrying around a transparent plastic life preserver.

Links

Natural Remedies During Pregrancy FAQ at Childbirth.org

Further Reading

Why Do Kids Talk To Themselves? - Little Jenny is capable of carrying along a happy conversation with herself - and inanimate objects - when not directly supervised. What purpose, if any, does her self-directed speech serve? There are several theories. In this article we’ll look at them from a psychological perspective.