Pregnancy Pain: Normal Aches vs Warning Signs

Why pregnancy causes pain

• Hormones: relaxin and progesterone soften ligaments so the pelvis can widen for birth. Joints become less stable.
• Weight and posture: the growing uterus moves your center of gravity forward, increasing the curve of the lower back.
• Stretching: the uterus and its supporting ligaments stretch rapidly.
• Pressure: the baby presses on the bladder, bowel, nerves and veins.
• Slower digestion: progesterone relaxes the gut and the valve at the top of the stomach.

Common pregnancy pains by area

Belly and groin

• Round ligament pain: brief, sharp or pulling pain in one or both sides of the lower belly or groin, triggered by standing up, turning in bed, coughing or sneezing. Common from 14 to 26 weeks.
• Early pregnancy cramping: mild period-like cramps from the uterus growing, without heavy bleeding.
• Braxton Hicks contractions: irregular, painless or mildly uncomfortable tightening that eases with rest, water or a change of position.
• Constipation and gas: crampy pain that improves with a bowel movement.

Back and pelvis

• Low back pain: affects most pregnant women, worst in the evening and later in pregnancy.
• Pelvic girdle pain: pain at the front of the pubic bone (symphysis pubis dysfunction) or the back of the pelvis, worse walking, climbing stairs, turning in bed or standing on one leg.
• Sciatica: pain shooting down the buttock and leg.
• Pelvic pressure as the baby drops in late pregnancy. See pelvic pressure.

Chest and upper belly

• Heartburn: burning behind the breastbone after meals or lying down, very common in the third trimester.
• Rib pain: the baby pushing upward, or rib cage expansion.

Head, hands and legs

• Headaches: common in the first trimester with hormone changes, caffeine withdrawal and tiredness.
• Carpal tunnel syndrome: tingling, numbness and pain in the hands from fluid retention.
• Leg cramps: sudden calf cramps, usually at night in the second half of pregnancy.
• Varicose veins and swelling: aching legs, worse at the end of the day.

Pain by trimester

Serious causes of pain in pregnancy

• Ectopic pregnancy: a pregnancy outside the uterus, causing one-sided pain, spotting and dizziness at 5 to 10 weeks.
• Miscarriage: cramping with bleeding in the first 20 weeks.
• Preterm labor: regular contractions, low back pain, pelvic pressure and discharge changes before 37 weeks.
• Placental abruption: the placenta separates early, causing sudden constant pain, a hard tender uterus, and often bleeding.
• Preeclampsia: high blood pressure after 20 weeks, with severe headache, vision changes and pain under the right ribs. HELLP syndrome is a severe form.
• Urinary tract and kidney infection: burning, frequency, and back or side pain with fever. Infections are more likely to spread to the kidneys in pregnancy.
• Non-pregnancy causes: appendicitis, gallstones and kidney stones still happen in pregnancy, and appendicitis pain may be higher up than usual.
• Blood clots: pregnancy raises the risk of deep vein thrombosis (calf pain and swelling) and pulmonary embolism (chest pain, breathlessness).

Safe relief for pregnancy pain

Medicines

• Acetaminophen (paracetamol) is the preferred pain reliever in pregnancy. Use the lowest effective dose for the shortest time, following the label.
• Avoid NSAIDs such as ibuprofen, naproxen and aspirin for pain, especially from 20 weeks, unless your doctor recommends them. They can affect the baby's kidneys and heart. Low-dose aspirin prescribed to prevent preeclampsia is different.
• Antacids containing calcium are safe for heartburn. Ask your pharmacist before other medicines.

Practical measures

• Back and pelvic pain: a maternity support belt, a pillow between the knees when lying on your side, keeping knees together when turning in bed, avoiding heavy lifting, warm (not hot) compresses, prenatal yoga or swimming. A physical therapist can help with pelvic girdle pain.
• Round ligament pain: move slowly when standing or turning, bend and flex the hips before coughing or sneezing.
• Heartburn: small frequent meals, avoid lying down for 2 to 3 hours after eating, raise the head of the bed.
• Leg cramps: stretch the calf by pulling the toes toward you, stay hydrated, and keep active.
• Headaches: rest, regular meals, fluids and a cool compress.
• Carpal tunnel: a wrist splint at night.

For more on pain that comes with specific pregnancy symptoms, see pain during pregnancy.

Frequently asked questions

What pregnancy pains are normal?

Normal pains include mild early cramping, round ligament pain in the groin, low back ache, pelvic girdle pain, heartburn, rib discomfort, leg cramps, headaches early in pregnancy and irregular Braxton Hicks tightenings. They are usually brief or mild and ease with rest or a change of position.

When should I worry about pain during pregnancy?

Seek care for severe or constant belly pain, pain with bleeding or fluid leakage, severe headache with vision changes, pain under the right ribs, fever, calf pain and swelling, chest pain, or regular contractions before 37 weeks. Trust your instincts and call your provider if unsure.

What does round ligament pain feel like?

It is a sharp, jabbing or pulling pain in one or both sides of the lower belly or groin, lasting seconds to a few minutes. It is triggered by sudden movement, standing up, turning in bed, coughing or sneezing, and is most common in the second trimester.

Can I take ibuprofen for pain while pregnant?

Generally no, unless your doctor recommends it. NSAIDs like ibuprofen and naproxen are usually avoided, particularly from 20 weeks, because they can affect the baby's kidneys and heart. Acetaminophen (paracetamol) at the label dose is the preferred option.

Is back pain a sign of labor?

It can be. Low back pain that comes and goes in a regular pattern, with belly tightening, pelvic pressure or discharge changes, may be labor. Before 37 weeks, this needs prompt assessment for preterm labor. Constant mild back ache without these features is usually postural.