Credit...Rachel Levit

Pregnancy Pains Got You Down? Read This

Most cases of pain during pregnancy aren’t an emergency and can be managed, though there are some warning signs to watch out for.

I was 35 weeks pregnant with my first daughter when I began to feel an intense, intermittent pain that radiated from my lower back and pelvis and into my leg. Like a lightning rod, it would flare unpredictably, making it impossible to move without gritting my teeth. My physical therapist deduced that the combination of my expanding belly, my scoliosis (which I’d dealt with for decades) and the pregnancy hormones loosening the connective tissue of my pelvis had caused serious misalignment issues in my hip area. The result was pain in my pelvic joints and possibly some pinched nerves in my sacrum.

“It is very, very common for women during all stages of pregnancy to have discomforts, pains and body aches,” said Dr. Christine Isaacs, a professor and head of obstetrics and gynecology at Virginia Commonwealth University School of Medicine, in Richmond. “A lot of that comes with the natural, normal physiologic changes of pregnancy, and many of these symptoms are nature’s way of preparing us for birth.”

Of course, some pregnancy pains can signal more dangerous conditions. Fortunately, according to the experts I interviewed for this guide (including four ob-gyns, two midwives and a physical therapist), most cases of pain during pregnancy aren’t an emergency and can be managed. It’s crucial, though, that you aren’t too quick to dismiss the discomfort. Discuss your symptoms with your practitioner to help identify the problem, find relief and rule out any issues that could be a serious threat to you or your baby.

Cramping. The first weeks of pregnancy can usher in a range of ailments including nausea, breast tenderness and spotting. But one of the most common pains is cramping, said Dr. Sherry Ross, an ob-gyn at Providence Saint John’s Health Center in Santa Monica, Calif., and author of “She-ology: The Definitive Guide to Women’s Intimate Health. Period.

While these symptoms are uncomfortable, they’re usually a sign that the pregnancy is progressing normally and that the body is preparing for birth and breastfeeding. But cramping that does not subside or is severe (particularly if it’s accompanied by bleeding) can be a sign of a miscarriage or an ectopic pregnancy, the latter of which can occur when a fertilized egg implants outside of the uterus, often in a fallopian tube. The egg can’t grow properly outside of the uterus and, if left untreated, can rupture other internal organs (such as the fallopian tube) and cause life-threatening bleeding.

How to relieve it. Before you do anything, call your doctor or midwife. Your practitioner will ask how severe your pain is and, if you’re bleeding, by how much. If your symptoms signal an ectopic pregnancy or a miscarriage, your practitioner may want to see you immediately or send you to the emergency room.

After ruling out anything more serious, try to ease your discomfort by sitting or lying down (to give your body a rest); soaking in a warm bath (which can help calm cramping by relaxing your muscles); and staying hydrated by drinking at least eight glasses of water per day (dehydration can cause muscle cramps).

If none of these strategies help, acetaminophen (Tylenol or generic) can be helpful and safe to use during pregnancy, though it’s best to take the lowest dosage possible and not to use it for prolonged periods of time. The American College of Obstetricians and Gynecologists and other expert organizations advise against using ibuprofen (Advil or generic) while pregnant, as it can harm the fetus. Always consult with your provider before taking any prescription or over-the-counter medicines.

Headache. Headaches can flare during pregnancy, especially during the first trimester when a surge in estrogen levels can make them worse, said Latisha Barfield, a certified nurse-midwife and clinical assistant professor of nursing and midwifery at Florida International University in Miami. Headaches can also be brought on by an increase in blood volume during pregnancy, which can cause blood vessels in the head to dilate. Other headache triggers can include lack of sleep, stress, muscle tension, dehydration and inconsistent eating (which can cause low blood sugar).

How to relieve it: Though it’s hard to rest when you’re uncomfortable, nauseated or feeling anxious about your new pregnancy, try to prioritize sleep and stress-relieving activities such as massage, prenatal yoga or quiet downtime, said Dr. Isaacs. Prevent dehydration by sipping from a water bottle regularly. And avoid dips in blood sugar by eating small, frequent snacks. Your practitioner may also suggest acetaminophen.

Headaches that are persistent, severe or wake you up at night can be cause for concern. If they don’t go away with Tylenol or if they feel like “the worst headache of your life,” said Dr. Shannon Clark, an associate professor of obstetrics and gynecology in the maternal-fetal medicine division at the University of Texas Medical Branch, in Galveston, let your doctor know because it could signal something more serious. Unexplained severe headaches can be a sign of pre-eclampsia (pregnancy-induced hypertension), which can be life threatening.

(Nausea, though not technically a “pain,” can be debilitating — especially early on in your pregnancy. For tips on how to manage it, see our guide here.)

Pelvic pain. The hormones released in your body during pregnancy can loosen the joints and ligaments in your pelvic region in preparation for labor, which can cause a lot of discomfort beginning in the second trimester, said Marianne Ryan, a physical therapist in New York City and author of “Baby Bod.”

When the joints and ligaments are lax and the expanding uterus begins to weigh on them, it can destabilize the back joints of the pelvis (the sacroiliac joints) and the front cartilaginous joint of the pelvis (the pubic symphysis). This results in groin, thigh and lower back pain, which can make walking or even seemingly simple movements difficult, such as turning in bed or getting up from a chair. To compensate for the added weight and imbalance, said Ryan, moms often tighten the muscles in their buttocks unintentionally: “The muscles can stay in spasm and that can cause a whole slew of dysfunctions including painful sex and incontinence.”

How to relieve it: Explain your symptoms to your practitioner so that she can get an accurate sense of the problem. She may recommend solutions such as rest, massage, physical therapy or a pregnancy belt to offset pressure on the pelvis and to alleviate muscle strain.

Carpal tunnel syndrome. Swelling tissues can crowd the nerve that runs through the carpal tunnel (a passageway inside the wrist), causing tingling, pain and numbness in the wrist and fingers.

How to relieve it: Talk to your practitioner. She may recommend that you avoid repetitive hand movements, wear a wrist splint, apply ice to reduce swelling or try physical therapy. After you give birth and the pregnancy swelling dissipates, the carpal tunnel pain should lessen too.

Gastro-esophageal reflux. Heartburn usually starts toward the end of the second trimester, said Dr. Barfield, and can feel like a burning in the chest, often accompanied by belching and regurgitation. Pregnancy hormones can cause the gastrointestinal system to slow down and the sphincter at the top of the stomach to relax, which can force food and stomach acid up the esophagus, she said. The growing baby in the uterus can also displace the stomach so that there is less room for it to empty, which can push stomach acid up.

How to relieve it: Dr. Barfield recommended eating small, frequent meals so as not to overload your stomach and to facilitate gastric emptying. She also suggested sitting up while eating (to help the food travel down the digestive tract more easily); avoiding late-night meals (to allow your food to digest before you lie down); limiting high-fat foods (such as butter-based dishes), cold foods and spicy foods (which can aggravate the gastrointestinal system).

Back pain. The main causes, according to ACOG, are strain on the back muscles, weak abdominal muscles and pregnancy hormones that loosen and destabilize the ligaments and joints in the lower back and pelvis. The overall effect is often poor posture and weakened, sore or tight back muscles.

How to relieve it: According to Dr. Isaacs, most people can navigate back discomfort with simple solutions. ACOG recommends wearing shoes with arch support; being mindful of good body mechanics when bending or lifting (bending from your knees, for instance, rather than from your waist; and keeping your back in a neutral position when lifting items); using lumbar support when sitting; and sleeping on your side with a pillow between your legs.

You can also try a pregnancy belt to take some pressure off your lower back or ask your practitioner about core strengthening exercises. “I always remind women to stay active and exercise in pregnancy,” said Dr. Isaacs, who suggested trying prenatal yoga, massage or hydrotherapy (swimming or soaking in baths).

If you feel sharp, unbearable pain or severe aching, discuss it with your provider. “You always want to rule out [other dangerous possibilities] like a kidney infection or kidney stones,” said Dr. Ross.

Round ligament pain. Sharp jabs or achy cramps on either side of the lower abdomen are some of the most common pains during the second trimester, said Dr. Cynthia Gyamfi-Bannerman, an ob-gyn, maternal-fetal medicine specialist and co-director of the Preterm Birth Prevention Center at Columbia University Medical Center in New York City. They occur when the ligaments that support the growing uterus begin to stretch. The pain is usually intense and intermittent and often gets worse with sudden movements such as coughing or sneezing.

How to relieve it. Though it’s a natural consequence of the growing uterus, round ligament pain can be jarring. “I’ve had some women who said it was severe enough that they thought they had appendicitis,” said Dr. Clark. If you’re feeling intense pain, especially if it’s accompanied by other symptoms such as fever or bleeding, call your practitioner, who will want to rule out dangerous conditions such as appendicitis or kidney infection. If it turns out that you’re dealing with round ligament pain, you may be able to lessen the discomfort by changing positions, applying a warm compress to the painful area or avoiding sudden movements that strain the abdomen.

Leg cramping. It’s not uncommon for pregnant women to experience sharp, sudden contractions of the calf muscles, according to Nola Holness, a certified nurse-midwife and clinical assistant professor of nursing and midwifery at Florida International University in Miami. The leg cramps are usually brought on by deficiencies in calcium or magnesium; or poor blood flow, which could be worsened by dehydration.

How to relieve it: In most cases, staying hydrated and eating foods rich in calcium and magnesium (such as kale, almonds or yogurt) will help. “Women may also find relief from leg cramps with a calcium or magnesium supplement,” said Dr. Holness; or you can relieve pain from a muscle spasm by stretching the calf muscle. But it’s key to talk with your practitioner about the pain so that you can be evaluated for more concerning conditions, such as blood clots.

Braxton Hicks contractions. If you feel your uterine muscles tightening and you’re nowhere near your due date, you may be experiencing Braxton Hicks contractions (also known as false labor). While the sensation can feel a lot like labor contractions, Braxton Hicks contractions tend to be short and erratic as opposed to long and regular. Braxton Hicks contractions may also subside when you change positions, whereas labor contractions will not stop, no matter how you position yourself.

Braxton Hicks contractions are a response, of sorts, to a growing and moving fetus without the cervical dilation necessary for labor, said Dr. Isaacs. “For most women, the uterus doesn’t just sleep for 40 weeks and then wake up and you’re in labor,” Dr. Isaacs added. “It’s a muscle. It’s dynamic.”

How to relieve it: Getting off your feet, resting and drinking fluids can ease discomfort. But if you’re concerned about the frequency of the contractions and you think you’re in labor — or if you’re also experiencing bleeding, unusual discharge or intense pain — visit your practitioner so she can check for more serious conditions such as preterm labor or placental abruption.

“Your complaint of pain — any kind of pain — should never not be taken seriously,” said Dr. Ross. While most pregnancy aches won’t lead to dangerous complications, it’s vital that you listen to your body, keep your practitioner in the loop and get examined if you experience symptoms such as persistent pain, bleeding, dizziness or fever.

Rachel Rabkin Peachman is an investigative health journalist, a mom of two girls and is writing a book on children’s pain management.

This guide was originally published on May 14, 2019 in NYT Parenting.