Back Pain and Sciatica in Pregnancy: What Helps and the Warning Signs

How can you ease back pain and sciatica in pregnancy?

ACOG and the NHS recommend changes to how you sit, sleep and lift, supportive shoes and gentle exercise to prevent or ease back pain in pregnancy, and ACOG adds heat or cold. ACOG says to call your OB-GYN or other obstetric care provider if the pain is severe or lasts more than two weeks, so they can rule out other causes.

For sciatica, the NHS advice (written for everyone with sciatica) is to carry on with your normal activities as much as you can, start gentle exercise, use heat packs, and avoid sitting or lying down for long periods.

ACOG says back exercises can strengthen and stretch the muscles that support your back and legs, and that staying active reduces back pain if you have no complications. A 2015 Cochrane review found low-quality evidence that exercise on land or in water may reduce pregnancy-related low back pain. ACOG says to check with your OB-GYN before starting, and to stop any exercise that causes pain; exercise during pregnancy covers what is safe.

The NHS describes one exercise for the stomach muscles: start on all fours with your back straight, pull in your stomach muscles and raise your back towards the ceiling, hold for a few seconds, then return slowly to a straight back. It suggests doing this 10 times, slowly.

Once other causes have been ruled out, ACOG says your OB-GYN may suggest a physical therapist. The NHS says that if your backache is very painful, your GP or midwife may refer you to an obstetric physiotherapist, and that you can take paracetamol (acetaminophen) for back pain in pregnancy unless they say not to. Cleveland Clinic says not to take any medicine without talking to your pregnancy care provider. Acetaminophen in pregnancy covers what ACOG and the FDA say.

Why does your back hurt during pregnancy?

ACOG points to your growing uterus, which shifts your center of gravity and stretches and weakens your abdominal muscles, changing your posture and straining your back. ACOG adds that the extra weight means more work for your muscles and more stress on your joints, which is why your back may feel worse at the end of the day.

ACOG says pregnancy hormones contribute as well: a hormone relaxes the ligaments in the joints of the pelvis to prepare for birth, and back pain can occur if the joints become too flexible. The NHS describes the same softening of the ligaments, which can strain the joints of the lower back and pelvis.

Cleveland Clinic says you may feel more back pain if the fetus's head is against your tailbone or lower back, and that you are more at risk if you had back pain before pregnancy or in a previous pregnancy.

Is back pain normal in early pregnancy?

Yes, back pain can start early: the NHS says backache is very common in pregnancy, especially in the early stages. ACOG calls it one of the most common pregnancy problems, especially in the later months.

A 2023 meta-analysis of 28 studies in BMC Pregnancy and Childbirth put back pain at 40.5% of pregnant women overall, with 28.3% in the first trimester, 36.8% in the second and 47.8% in the third. Cleveland Clinic gives a similar figure of about 40%, more common in the second and third trimesters. A 2011 review in Hippokratia says pregnancy-related low back pain usually begins between 20 and 28 weeks, but may start earlier.

Is it sciatica or pelvic girdle pain?

Sciatica usually runs from your bottom down the back of one leg, often to the foot and toes, according to the NHS, while pain from the pelvic joints can spread to the thigh, knee and calf but not to the foot, according to the 2011 Hippokratia review. The NHS describes sciatica as sharp or burning pain, tingling, numbness or weakness, and says you probably do not have sciatica if you only have back pain.

True sciatica is uncommon in pregnancy: the Hippokratia review puts it at only about 1% of pregnant women and says it may come from a herniated or bulging disc pressing on the nerve.

Pain in the joints at the front or back of the pelvis is pelvic girdle pain, and the Hippokratia review says telling it apart from lower back pain matters because the treatment differs.

Does back pain go away after pregnancy?

ACOG says back pain usually goes away after the baby is born, but that for many women it lingers for months after the birth. The Hippokratia review says most women recover during the first months after childbirth.

When should you call your doctor or midwife about back pain?

Call your OB-GYN or midwife if back pain is severe or lasts more than two weeks, which is ACOG's advice. ACOG says back pain can be a sign of preterm labor or a urinary tract infection, and the NHS says to contact your doctor (GP in the UK) or midwife urgently if back pain comes with any of the first three signs below.

• Fever, burning when you pee or vaginal bleeding along with back pain (ACOG, NHS).
• Pain in one or both sides, under your ribs (NHS).
• Back pain in the second or third trimester, which the NHS says could be a sign of early labor.
• A constant, low, dull backache, especially with cramps, pelvic pressure, more discharge or a change in it, regular tightenings or your water breaking: ACOG lists these as signs of preterm labor before 37 weeks and says not to wait: call right away or go to the hospital.

Cleveland Clinic says to contact your provider if the pain starts suddenly and sharply, feels like cramping in your hips or abdomen, or is so intense that it stops you doing everyday activities, as these could be signs of labor. The NHS says to see a doctor (GP in the UK) if sciatica is getting worse, is stopping you doing your normal activities, or has not improved after a few weeks of home treatment.