Low back pain (LBP) during pregnancy is often accepted as normal - and even though multiple research studies suggest that the quality of life for patients is adversely affected, many are still advised to self-manage.
Low back pain characterised by pelvic girdle pain (PGP) and/or generalised lumbar pain (LP) is a common complaint during pregnancy (Katonis et al. 2011).
(Katonis et al. 2011)
Both types of pain can significantly impact the patient during their pregnancy and should be diagnosed and differentiated as soon as possible (Liddle et al. 2019).
For many patients, the level of pain experienced is high enough to significantly impact their quality of life, interfere with sleep and compromise their ability to work. As Katonis et al. (2011) suggest, it’s also a common reason for induction of labour or elective caesarean section.
Pregnancy profoundly affects the human body, especially within the musculoskeletal system. Hormonal changes cause laxity in the joint ligaments, weight gain and a shift in the centre of gravity, which also leads to lumbar spine hyperlordosis and anterior tilting of the pelvis. These changes can all cause discomfort (Casagrande et al. 2015).
LBP is the most common musculoskeletal complaint in pregnancy, with an estimated prevalence of 4 to 84% (Walters et al. 2018). Patients frequently rate the pain as moderate to severe (Shiri et al. 2017).
LBP can also extend into the postpartum period, with the severity of pain typically being about half of that experienced during pregnancy (Shiri et al. 2017).
Effective management of LBP can be challenging, not least because many of the treatment options are outside the scope of professional practice for most midwives and birthing assistants. This means that self-help techniques and multimodal management are common (Bishop et al. 2016).
As Katonis et al. (2011) point out, most patients consider LBP as an inevitable, normal discomfort during pregnancy, with only 50% choosing to seek advice from a healthcare professional.
Close et al. (2016) pick up on this point, suggesting that a general sense of dissatisfaction with routine advice and treatment results in many people seeking alternative solutions to cease their discomfort.
With relatively few effective treatment options available within conventional maternity care, many patients are turning to self-help measures and complementary therapies to find relief.
In a few special cases, midwives may be in a position to refer onward to another professional such as an acupuncturist or massage therapist.
For most midwives, however, giving advice about therapies they are not specifically trained in could place them in breach of their professional code of conduct.
The answer for many patients is either self-help or private complementary or alternative healthcare. In either case, even though midwives may not be able to prescribe alternative therapies, it can be helpful to have a broad idea of how certain evidence-based therapies can be of help.
The most popular therapies and self-help techniques patients turn to for relief include:
Exercise during pregnancy is widely reported to reduce low back pain, but there is still no clear evidence of benefits for pelvic girdle pain (Shiri et al. 2017).
Even for low back pain, the protective effect is small, but given the other general benefits of exercise, it seems to be a safe and popular option for primary care practitioners to suggest.
There is some limited evidence to support the use of manual therapies such as osteopathy and massage as an option for managing LBP and PGP during pregnancy.
In the view of Hall et al. (2016), however, further high-quality research is needed to determine the effectiveness of these treatments.
Hughes et al. (2018) point out that over half of patients who seek treatment from a GP or physiotherapist are dissatisfied with the outcome of their care.
Their study found that 81% of women use complementary and alternative medicine (CAM) to manage their lower back pain, and 85% found it useful (Hughes et al. 2018).
The most commonly used CAM treatments during pregnancy are:
Shirazi et al. (2016) comment on an interesting study into the efficacy of topical rose oil in the carrier almond oil, in patients with pregnancy-related low back pain.
The results showed that rose oil was beneficial as well as being a popular and pleasant treatment option, reducing the intensity of pregnancy-related low back pain without any significant adverse effects.
The use of acupuncture for the management of persistent non-specific low back pain is generally considered beneficial even though its use in the management of pregnancy-related low back pain remains limited.
A few maternity units may have the benefit of an on-site acupuncturist, but as Waterfield et al. (2015) suggest, physiotherapists, who often provide acupuncture services, can be reluctant to treat pregnant patients due to a pervasive professional culture of caution, with fears of inducing early labour and risks of litigation.
Reflexology is also a popular treatment option and has been shown to help nonspecific low back pain and may be equally valuable in the management of pregnancy-related low back pain, however, as Close et al. (2016) suggest, further research is needed to confirm this.
Patients may be able to manage LBP by:
(Pregnancy, Birth and Baby 2022)
With LBP causing physical and emotional distress to so many people during pregnancy, the question needs to be asked: could more be done to provide effective treatment within the scope of traditional maternity care?
Perhaps patients themselves need a better awareness of how to manage low back pain, as fear and anxiety can also add to the perception of pain.
Maybe, it’s time to embrace this problem within the scope of traditional maternity care, offering a wider range of evidence-based care options, so that fewer patients need to suffer in silence.
Assign mandatory training and keep all your records in-one-place.
Find out more
Ausmed Education is a Trusted Information Partner of Healthdirect Australia. Verify here.
New 