The infamous “mom pooch” can make moms feel as if they look pregnant long after they have delivered their babies. While it may sound superficial to be worried about a small bulging belly postpartum, it is a legitimate medical condition called diastasis recti.

Diastasis recti affects more than just your self-image and confidence; it can cause symptoms from pain to balance issues and more. Fortunately, it is usually diagnosed and treated easily. We will examine the condition, its causes, symptoms, prevention, and treatment.

What Is Diastasis Recti?

Your “six pack” comprises two columns of abdominal muscles called the rectus abdominis. They run vertically from your ribs to your pubic bone. The linea alba is a band of tissue that separates the left and right sides. When these two columns of abs separate and the linea alba widens, this is called diastasis recti. This usually happens due to increased intra-abdominal pressure, such as during pregnancy.¹

While there is always some degree of separation between the rectus abdominis muscles, diastasis refers to an abnormal degree of separation.² Many experts consider separation of more than two centimeters abnormal. However, diagnosing diastasis recti depends just as much on symptoms as the numerical distance.¹

How To Check for Diastasis Recti

Diastasis recti can usually be diagnosed with a simple test. You might even identify it on your own. Lie on your back with your knees bent and feet on the floor, lift your shoulders off the ground, and notice the shape of your belly. If you have abdominal separation, you might see the vertical center line between your abs bulges. You might also be able to feel a significant gap between your abs.³

If you suspect you have diastasis recti, your provider can examine you. They may palpate or feel your abdomen in different locations — above, at, and below your belly button. They may use their fingers to measure the gap, or they may use a tool called a caliper to get a more precise measurement. Sometimes, they may use an ultrasound to observe the abdominal gap.^2,3

How Common Is Diastasis Recti?

Diastasis recti is very common during pregnancy and postpartum. Some sources report that around 60% of women are affected by it.³ However, exact percentages can be hard to identify because experts and practitioners use different diagnostic and cutoff values.²

For example, even if two centimeters is the universal threshold, is this in a flexed or relaxed state? And is the separation measured above, at, or below the belly button? It is also important to remember that abdominal separation is common even in women without true diastasis recti, especially above the umbilicus.¹

One study had physiotherapists assess diastasis recti in pregnant and postpartum women. They classified diastasis recti into mild, moderate, and severe cases based on fingerbreadths between the recti muscles at, above, or below the navel while performing a crunch.⁴

If the therapist could see the linea alba protruding during the crunch, this was considered diastasis recti, even if the width of the gap was less than two fingerbreadths.⁴ Based on these criteria, this study found that 60% of women had the condition at six weeks postpartum, and 33% of women still had diastasis at one year postpartum.⁴

What Are the Risk Factors for Developing Diastasis Recti?

Little is known for sure about the risk factors, but these are some theories on contributing influences:

• Older maternal age⁴
• How many babies you have had and how close together they are^2,3
• Body mass index²
• Frequent heavy lifting⁴
• Having a large baby or multiple babies⁴
• Multiples, like twins or triplets⁴

Although some of these risk factors may contribute to the development of diastasis recti, it is a common condition and can occur even without any of these risk factors.³

What Causes Abdominal Separation?

Abdominal separation happens during pregnancy because of increased volume and pressure in the abdomen. Your growing baby and uterus stretch the abdominal muscles, so the linea alba widens, thins, and protrudes. The linea alba is elastic and typically shrinks back together after delivery. If the linea alba stretches too much and does not retract after pregnancy, this causes diastasis recti, in which the ab muscles remain separated postpartum.³

Diastasis Recti Symptoms

Diastasis recti often begins during pregnancy as your abs separate to make room for your baby.³ This separation can cause some of the following symptoms:

Feeling of Instability

Diastasis can weaken your abdominal muscles, and your core aids a lot in balance. With a weak core from diastasis recti, you may feel unstable.^1,3

Midline Bulge

When the ab muscles are separated, your abdominal center line may bulge, especially under increased abdominal pressure.¹ This pouch can sometimes feel soft or jelly-like.³

Coning During Pregnancy

In cases of diastasis recti during pregnancy, your bump may form a point where your abs meet instead of appearing perfectly round. This means that, besides the gap between your abdominal muscles, the linea alba protrudes, especially under pressure. Coning may begin in pregnancy but can persist postpartum, and you should watch for this triangular shape in your abdomen when engaging your core.⁵

Incontinence

Your core muscles and pelvic floor muscles are interconnected, so separation and weakness in the abdominal muscles can cause the leaking of urine during pregnancy and postpartum.³

Pain

While the abdominal separation should not be painful, the weakening it causes of the abdominal muscles can contribute to pain elsewhere. Core and pelvic floor weakness and instability can lead to pain during sex, back pain, and chronic pelvic and hip pain.^1,3

Diastasis Recti Treatment

If you are experiencing these symptoms or have found a wide gap between your abdominal muscles even without other symptoms, you are probably wondering how to fix diastasis recti and bring your core back together. Most of the time, treatment consists of physical therapy exercises for diastasis recti combined with increased bodily awareness. Some people choose to wear abdominal binding devices or pursue surgery, though surgery is rarely necessary.³ Different treatments for diastasis recti are outlined here:

Exercise

If you wonder about working out with diastasis recti, you may find conflicting information about the best way to rebuild core stability. However, certain movements and exercises are essential to regaining core strength and stability. Many sources say that when you have diastasis recti, you should avoid traditional core workouts and poses, such as crunches, plank, downward dog, and boat pose. These can increase abdominal pressure, push ab muscles out, and worsen separation. Many sources also recommend avoiding heavy lifting, and a good rule of thumb is not to lift anything heavier than your baby.³

However, one study demonstrated that curl-ups could strengthen and thicken abdominal muscles without increasing separation.⁶ The key is to ensure you are performing these diastasis recti exercises properly and with awareness — watch your belly as you do the curl-up to ensure no noticeable protrusion or coning is occurring.⁶

Another study implemented a deep core stability exercise program that significantly decreased abdominal separation and increased quality of life. The program involved diaphragmatic breathing, Kegel exercises, plank poses, and isometric abdominal contraction.⁷

A physical therapist who specializes in core and pelvic floor concerns of pregnancy and postpartum may be able to help tailor a core rehabilitation program for you. While diastasis recti physical therapy can sometimes improve the appearance of a midline bulge, it is more effective at regaining the proper function of the ab muscles, regardless of how they appear.¹

This means that while you may be looking for a dramatic difference between diastasis recti before and after photos, the more important thing is you regain proper function of your abdominal muscles to improve symptoms such as instability, incontinence, and back and pelvic pain.

Abdominal Binders

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Some women wear abdominal binders postpartum to hold their abdomen in place and provide low back support. Wearing a binder can remind you to use good posture and engage your core muscles properly; however, these binders do not strengthen the core or heal diastasis recti.³

Surgery

Surgery can reconstruct, repair, or strengthen the linea alba to decrease bulging.¹ It can be performed laparoscopically or open, but it is usually reserved for severe cases that do not respond to therapy.¹ Some consider this surgery controversial because it is mostly performed for cosmetic purposes. Diastasis recti may be improved in a “tummy tuck” procedure.⁸

Those who have had repair surgery may feel dissatisfied if their symptoms or appearance do not improve as they expected. Surgery can also cause complications such as infection, bruising, scarring, and other abdominal damage, and a relapse of the diastasis is also possible.¹ If you choose to pursue surgery, you should wait at least two years following childbirth, and you should not be planning for any future pregnancies.⁸ Surgery is necessary in the case of an umbilical hernia, in which part of an organ pops through the linea alba.³

Can You Prevent Diastasis Recti?

You may not be able to completely prevent abdominal separation during pregnancy, as this naturally happens to accommodate your growing baby. However, you can do things to decrease the severity of the separation and lower your risk of diastasis persisting postpartum:³

Be Aware of Abdominal Pressure

Core-specific exercises like sit-ups and planks can increase belly pressure and cause abdominal separation. These are best avoided after the first trimester of pregnancy. Similarly, heavy lifting of weights or even groceries or toddlers can cause strain. Limit heavy lifting to prevent excessive abdominal pressure. When heavy lifting cannot be avoided, engage your deep core muscles to support your rectus abdominis muscles. Watch your belly for linea alba protrusion during lifting, and modify your motions to decrease coning.³

Log Rolling

One way to avoid undue pressure in your abdomen during pregnancy and postpartum is to log roll when getting out of bed. Instead of doing a sit-up or crunch to rise from a reclined position, roll to one side, then use your arms to press yourself up. Decreasing abdominal pressure in everyday activities like this may help prevent diastasis recti from developing or worsening.³

Diaphragmatic Breathing

Belly breathing engages your core with each breath, releasing pressure and tension. This can help prevent abdominal separation. To practice belly breathing, place one hand on your chest and the other on your belly. Inhale. Your belly should press out while your chest remains stationary.^3,9

Exercise

Multiple studies have shown that prenatal and postpartum exercise can reduce the width and severity of the ab gap. This may be because exercise helps you maintain core strength during pregnancy and postpartum and also helps with weight management.¹⁰

Healthy Weight Gain

One study found that body mass index and weight gain during pregnancy are related to the development of diastasis recti. Awareness of weight gain during pregnancy and keeping your weight gain healthy may help prevent diastasis recti.²

Is It Ever Too Late To Fix Diastasis Recti?

Fortunately, it is never too late to fix diastasis recti. If it has been years since you have had a baby and you are still dealing with diastasis recti, you might be wondering how to fix it years later. You can almost always repair abdominal separation with the right physical therapy exercises. The same exercises, core engagement, and bodily awareness that can repair diastasis recti in the early postpartum days can improve your diastasis years later.³

After all your body has been through in pregnancy and postpartum, it can be frustrating and disheartening to experience lasting effects on your abdominal muscles. While it can be tempting to jump back into core workouts to sculpt your body and regain strength, this may be counterintuitive. Fortunately, diastasis recti can drastically improve with the right therapy and some time.

The changes your body goes through during pregnancy are essential for your baby’s healthy growth and your body’s preparation for delivery. Physical and hormonal changes during pregnancy often result in acid reflux, which causes heartburn. The discomfort can be mild for some mothers but intensely painful for others. Either way, there are steps you can take to get relief.

What Is Heartburn?

Heartburn refers to the uncomfortable burning or painful sensation in your chest when acid moves upward from your stomach into your esophagus. Your esophagus is the muscular tube that moves food from your mouth toward your stomach for digestion. At the bottom of your esophagus is a circular muscle called the lower esophageal sphincter. When functioning normally, this muscle prevents acid from leaving your stomach. But when this sphincter doesn’t close completely, stomach acid can reflux or travel upward into your esophagus.¹

What Causes Heartburn During Pregnancy?

Pregnancy can cause an increase in acid reflux and, thus, heartburn because of a hormone called progesterone. Progesterone, aka the pregnancy hormone, can slow digestion and cause the lower esophageal sphincter to relax.² Besides hormonal changes, physical changes can contribute to heartburn. As your baby grows, your uterus expands. This can increase the amount of pressure placed on your stomach.³

When Does Heartburn Start in Pregnancy?

For some women, thanks to progesterone, heartburn starts during the first trimester of pregnancy. For other mothers, they may not experience it until the third trimester.⁸ The frequency of heartburn typically increases as your pregnancy progresses.²

How Common Is Heartburn During Pregnancy?

Heartburn is one of the most frequently experienced symptoms during pregnancy since it is reported by over half of all pregnant women. It happens more commonly in mothers who have either been pregnant before or suffered from heartburn before becoming pregnant.¹

How To Treat Heartburn During Pregnancy

Thankfully, there are effective options for heartburn relief in pregnancy. Be sure to talk with your OB care provider before trying home remedies for acid reflux or taking over-the-counter medications during pregnancy. Antacids, such as Tums, can help reduce heartburn symptoms. However, it is essential to discuss with your OB care provider which medications are safe to take while pregnant.³

Some antacids contain high amounts of sodium, which can cause water retention. Others have aluminum, which you should not take while pregnant.¹ Also, you should avoid taking antacids within two hours of your folic acid or iron supplements because they may reduce your body’s ability to absorb these nutrients.⁴

If your OB care provider recommends taking over-the-counter medications, you can use these to ease the discomfort quickly. But what if you are at work or traveling and don’t have access to antacids when the burning sensation strikes? Knowing how to get rid of heartburn during pregnancy using other remedies can also help provide fast relief:

• Milk: Fortunately, heartburn does not necessarily require taking medication — simply drinking milk or eating low-fat yogurt can help.¹ Of all the milk options, skim is your best bet, as the fat in whole milk can sometimes worsen acid reflux.⁵
• Ginger tea: You may also find relief by drinking ginger tea with a tablespoon of honey.⁶ Ginger is known for its anti-inflammatory properties and is a commonly used digestive aid.⁵
• Lemon water: Even though lemon juice is acidic, drinking a small amount with honey and warm water can help neutralize the acid in your stomach.⁵

Can You Prevent Heartburn During Pregnancy?

There are several steps you can take to reduce acid reflux and heartburn symptoms during pregnancy:

• Diet: Choose foods that won’t cause heartburn during pregnancy, especially ones that are high in fiber (oatmeal, sweet potatoes, or carrots), less acidic (bananas, melons, or nuts), and contain plenty of water (watermelon, celery, or cucumbers).⁵ Avoid greasy or spicy foods and caffeine since these can worsen heartburn.¹
• Take your time: Eat your meals slowly and try eating smaller meals more frequently.⁷
• Alcohol and smoking: Avoid both of these. Alcohol and smoking not only contribute to heartburn, but they can also negatively impact your baby’s growth and development.¹
• Posture: Pay attention to your posture while you eat. Sitting up straight when eating can aid in preventing acid reflux.¹
• Sleep position: Don’t lie on your back immediately after eating, and try to elevate the head of your bed.⁷ You can try sleeping with a wedge-shaped pillow or pillows under your shoulders.¹

The good news is that some of the more uncomfortable pregnancy-related symptoms don’t last forever. If you are experiencing heartburn during your pregnancy, you don’t have to suffer. There are things you can try to reduce the discomfort. Talk with your OB care provider about your options, and keep in mind that as hormones return to their pre-pregnancy levels, for most mothers, heartburn resolves shortly after delivery.

Linea nigra, also called the pregnancy line, is derived from Latin and means “black line.” The dark line develops on a pregnant woman’s belly and is usually seen in the second trimester, roughly around 20 weeks of gestation. It happens to over 90% of pregnant women. According to dermatologists (skin doctors), women always have a line on their belly, but when they aren’t pregnant, the line is light and not noticeable. It is called the linea alba, or “white line” in Latin. The dark pregnant belly line goes vertically up the belly from the pubic area to the belly button and sometimes even up to the chest. It is also darker in women with darker skin tones because they have more pigmentation or color in their skin tone compared to more fair-skinned ladies.^1,2,3,4,5

When Does Linea Nigra Appear?

The black or dark line that runs vertically up and down a pregnant woman’s belly, called linea nigra or the pregnant belly line, is typically seen in the second trimester of pregnancy. It usually starts to show around 20 weeks or the fifth month of gestation and is about ¼- to ½-inch wide. This can be a little unnerving if this is your first pregnancy and you aren’t familiar with the pregnancy line. But the linea nigra is a normal part of pregnancy.^1,2

What Causes Linea Nigra?

Linea nigra automatically happens when you’re pregnant due to the pregnancy hormones that increase the melanin production in the skin. Melanin is what gives skin and other areas of the body darker colors. For example, melanin is what makes freckles. It also makes the vaginal area on women, nipples, and the area around the nipples (areola) a darker color than the other skin. Darker skin areas are called hyperpigmentation of the skin. With pregnancy, these already darkened areas become even darker, starting in the first trimester. But the pregnancy line on the belly usually doesn’t show until the second trimester, around 20 weeks. Sometimes, it will get darker as your pregnancy progresses, which is normal, too. It can be fun to show other siblings where the new baby is! You just point to the line.^1,2,3,5

Does Everyone Get Linea Nigra?

Linea nigra is such an ordinary part of being pregnant that over 90% of women get the pregnancy line.¹ Some women don’t get the pregnancy line at all, or it might be there but be faint.² Most women who get linea nigra during their first pregnancy will likely have the same experience with additional pregnancies.⁶

Other people than pregnant women can also develop linea nigra. It can happen to non-pregnant women, children, and men. It isn’t always known why this happens. Some people may have an underlying medical problem that needs to be addressed (usually in men over 50 years). Others will have it as children, but as they become older, it fades away. Linea nigra can also appear in older children during puberty when they have increased hormone levels. It typically is considered a normal condition, but it’s worth a call to your provider just to be sure.^1,2

Can You Prevent Getting a Pregnancy Line on Your Stomach?

Unfortunately, the answer is no. You cannot prevent or get rid of the pregnancy line. It shows up due to your pregnancy hormones, and there is no way to change that.² Some women feel it looks unattractive on their beautiful pregnant belly. They have even tried to bleach the pregnancy line, against the doctor’s advice, but with unsuccessful results.

Here are a few things that can help with linea nigra, but not necessarily take it away:^1,2,4

• Use sunscreen to prevent your linea nigra from getting even darker in the sun.
• Applying pregnancy-safe makeup to the pregnancy line to help hide it can be an option that your doctor might allow.
• Bleaching the area is not allowed until after you deliver the baby and if you are not breastfeeding. Discuss this with your doctor to be sure you wait for the appropriate amount of time after giving birth.
• Folic acid might help decrease the darkness of the linea nigra, but it isn’t scientifically proven. Common foods with high folic acid levels are leafy green vegetables, whole wheat bread, oranges, and beans.

When Does Linea Nigra Go Away?

Linea nigra will fade on its own after you deliver the baby. It may take a few weeks or months for the line to disappear because it happens gradually as your hormones return to normal after pregnancy. There are some cases where the line fades but does not clear completely. Each woman is different. So, if you are concerned that it is taking too long or has not faded enough, discuss it with your provider. Typically, the doctor will tell you to let them know if the line hasn’t faded or disappeared three months after delivery.^2,3,5

Embracing Your Changing Body

Your body undergoes many changes during pregnancy. Linea nigra is only one of them. And honestly, compared to the other changes, such as constant nausea and heartburn, your feet getting bigger, swelling pretty much everywhere, and your hair possibly falling out, linea nigra is the least of your worries.

It might be easier for some women to accept and adopt the body changes that come with pregnancy, including the pregnancy line. For others, it’s not so simple. But we should try to embrace our changing bodies during pregnancy. At the time, it can seem like pregnancy goes on forever, and you can’t wait until it’s over. When you look at the bigger picture, pregnancy is a tiny blip in the time frame of our lives. Try to enjoy as much of it as you can. Women are exceptional since we can carry a child and give birth to a brand-new life. It’s truly amazing!

While pregnancy is a miracle, there are times when it can be uncomfortable and not so glamorous. People hear about morning sickness and swollen feet, but not necessarily about pregnancy complications. Pregnant women need to know what is normal and abnormal in pregnancy so they can know what to look for regarding any concerns. One of the first tips today’s guest shared on this episode is choosing a primary care provider you like and trust. Having a good relationship with your doctor or midwife and having continuity of care throughout your pregnancy can help you have a healthier pregnancy.

We learned a lot of insightful tips from our special guest, Dr. Alison Cowan. If you are interested in learning more about pre-eclampsia, tips for self-advocacy, common pregnancy complications and what to look for, this episode is for you!

Who is Dr. Alison Cowan?

Dr. Alison Cowan is an OBGYN, a mom of three (ages 10, 7, and 3), and the Head of Medical Affairs for Mirvie. Mirvie is a maternal health company pioneering a new way for women, expecting parents, and their doctors to predict potential pregnancy complications early on.

Alison attended Emory University Medical School, where she also received a master’s in clinical research before moving on to do her OBGYN residency at Northwestern University. With over a decade of bedside experience, Alison has delivered hundreds of babies. She is now on a mission to help change the status quo for pregnancy health. She is passionate about sharing tips for self-advocacy, having the healthiest pregnancy possible, and advocating for change and equity in pregnancy health at every opportunity. Alison resides in Colorado with her husband, Patrick, and three children.

What Did We Discuss?

In this episode, we chat with Alison about the facts behind common pregnancy complications, like pre-eclampsia, how women can advocate for themselves during pregnancy, and equity in pregnancy health. Here are several of the questions that we covered in our conversation:

• What steps can women take to ensure they have the healthiest pregnancy possible?
• Why is self-advocacy an important part of a woman’s pregnancy?
• What tips do you have for self-advocacy during pregnancy?
• What are some common pregnancy complications? And what symptoms should women look for?
• Can you tell us more about the science and facts behind some of these common pregnancy complications?
• How common is pre-eclampsia?
• What causes pre-eclampsia? Can it be prevented?
• Are some women at a higher risk for developing pre-eclampsia than others?
• What are the symptoms of pre-eclampsia?
• Does pre-eclampsia go away after delivery?
• I know you advocate for equity in pregnancy health. Can you elaborate on this and what it means?

Dr. Cowan’s passion and knowledge about women’s health is evident in this episode. We learned some helpful information that can help every person have a healthier pregnancy. We hope you learned something new, too! Cheers to healthy pregnancies!

Mentioned in the Episode

• ACOG.org
• Comprehensive care plan to prevent pre-eclampsia
• Care providers should be mindful of these CUS words from their patients:
  • I’m Concerned.
  • I’m Uncomfortable.
  • Safety: I feel unsafe.

Dr. Alison Cowan’s Resources

• Website: Mirvie.com
• Instagram: @mirviedx
• Facebook: @MirvieDx
• X: @MirvieDx
• Dr. Alison Cowan’s LinkedIn

Pregnancy has its fair share of aches, pains, and other health concerns and discomforts. Because many common medical treatments can be expensive and may cause side effects to both mom and baby, women and providers are turning toward complementary and alternative treatments to ease discomfort. One of these interventions during pregnancy is acupuncture.

Acupuncture has been used during pregnancy in an attempt to relieve many common pregnancy ailments, such as morning sickness, back pain, and pelvic pain. It has also been trialed for turning a breech baby and for pain relief and natural induction of labor.¹ We will examine acupuncture’s uses, effectiveness, and safety during pregnancy.

What Is Acupuncture?

Acupuncture is a traditional Chinese medicine that balances energy throughout the body to relieve pain and optimize physical and mental health. An acupuncturist inserts very thin needles through the skin into specific points throughout the body. These points are located along meridians corresponding to specific organ systems.²

The locations of needle insertion throughout the body vary depending on the ailments you’re attempting to treat. Multiple points can also be stimulated at once.³

Sometimes, after the needles are placed, an electrical current can be applied through the needles into the skin and body tissue, called electroacupuncture. This is thought further to increase healing and pain relief.⁴

While some view acupuncture as a way to balance body and life forces, Western medicine believes that acupuncture’s effectiveness may be attributed to nerve, muscle, and tissue stimulation to promote healing and recruit “natural painkillers.”³

Is Acupuncture Safe During Pregnancy?

In the general population, acupuncture is regarded as very safe.⁵ Prenatal acupuncture is probably safe as well. Traditionally, acupuncturists avoid certain points during pregnancy, as there is concern they may stimulate early labor. However, research has not substantiated this risk of acupuncture during pregnancy.⁶

Side effects linked to prenatal acupuncture are generally mild, if they occur at all.⁵ These side effects may include fatigue, arm heaviness, dizziness, bruising, and headache.^7,8

While these effects of acupuncture are mild and severe effects are considered rare, increased caution is recommended during pregnancy.⁵ If you feel dizzy or lightheaded after acupuncture, sit, drink water, and have a snack.

When seeking acupuncture treatment in pregnancy, speaking with your doctor first is essential. If you do seek out acupuncture treatment, be sure to choose an acupuncturist specializing in fertility and pregnancy, and be sure to share with them that you are pregnant, even if you’re early in pregnancy.

Benefits of Acupuncture During Pregnancy

Acupuncture has been used to treat or relieve a multitude of pregnancy ailments. You can also address multiple symptoms in one acupuncture session and reap multiple benefits from stimulating a single point. Here are some of the benefits of acupuncture during pregnancy:

Acupuncture for Morning Sickness

Over half of pregnant women experience morning sickness, and contrary to that name, nausea and vomiting in pregnancy can last all day through the first trimester and beyond. This affects a mother’s comfort and ability to function, work, and socialize, and if the vomiting is severe, it can even cause dehydration and malnutrition.⁹

The medications often used to treat morning sickness are neither effective nor safe. Therefore, the Western world has been adopting and testing traditional Chinese medicine interventions for relief.⁹

Prenatal acupuncture for morning sickness may be effective at decreasing nausea and vomiting during pregnancy. Some points that may be stimulated include ST36, PC6, CV12, SP4, SP6, TE5, N12, and CV17.^7,9

Some studies even conclude that acupuncture is more effective than many nausea drugs and very safe.⁷ If morning sickness is significantly affecting your life, acupuncture may be a treatment to consider.

Acupuncture for Back and Hip Pain

Pain in the pelvis, lower back, and hips can become increasingly common as pregnancy progresses. It can be severe and interfere with daily life for a pregnant woman. Not all pain medications are safe to take during pregnancy, and those that are safe may not be effective at relieving pain.¹⁰

Studies have demonstrated that acupuncture can reduce pelvic pain in pregnancy when compared with either standard care alone or with tailored exercises for pain relief.^8,10

Some specific acupuncture points that may be stimulated for pelvic pain relief during pregnancy include BL32, BL54, GB30, and KI11.¹¹

Acupuncture for Breech Presentation

One study examined the effect of acupuncture and moxibustion on the turning of breech babies.¹² Moxibustion is the burning of ground mugwort flower, often at specific acupuncture points.¹³ When acupuncture and moxibustion were applied at the BL67 point, located at the tip of the pinky toe, the number of breech babies at term was reduced, and the C-section rate decreased compared to an observation group.¹²

Acupuncture To Induce Labor

If there comes a point when remaining pregnant puts you or your baby at risk, your provider may recommend labor induction. There are many methods of inducing labor, from a Foley bulb to vaginal medications to Pitocin. However, some of these interventions can be painful and may involve risks.¹⁴

Acupuncture may be a less invasive, non-pharmaceutical way to kickstart labor. Studies have shown acupuncture may be 83% effective at inducing labor.¹⁵

Experts believe acupuncture may trigger uterine stimulation via hormones or the nervous system. In particular, acupuncture has been shown to increase cervical readiness or ripeness for labor.¹⁵

Some acupuncturists individualize point selection to each patient, while others use a fixed set of points for labor induction. Some common acupuncture points used to induce labor include ST36, LR3, CV4, TH6, LI4, GB41, KI6, SP6, HT7, LU7, BL31, BL32, BL60, BL67, and GV20.¹⁵

Acupuncture Points To Avoid During Pregnancy

While not all acupuncturists agree on the exact list of forbidden points during pregnancy, generally, it is recommended to avoid any points that may stimulate the uterus, at least until 37 weeks of pregnancy, and any points near the abdomen and sacrum that could accidentally puncture the uterus.¹⁶ It is commonly recommended to avoid points GB21, BL60, BL67, BL32, and BL33; however, some of these forbidden points overlap with treatment points for certain ailments in pregnancy.¹¹

A systematic review examining traditionally “forbidden” pregnancy acupuncture points concluded no greater risk of preterm or stillbirth when these points were stimulated.¹⁶

As always, weighing the risks and benefits of all treatments and no treatment is best. Always consult your doctor before considering treatments like acupuncture.

Tips for Getting Acupuncture When Pregnant

Seeking acupuncture when pregnant can be exciting but also nerve-wracking, especially if you do not know what to expect. To prepare your mind and body for acupuncture, review these tips:

• Talk to your provider about your interest in acupuncture. They may have an acupuncturist they recommend.
• Find an acupuncturist specializing in pregnancy acupuncture and the condition you seek to treat.
• Be sure to share that you are pregnant when making your appointment.
• Fill out all forms and answer questions honestly so your acupuncturist can appropriately tailor your treatment.
• Carve out enough time so you are not rushing to or from the appointment.
• Wear loose, comfortable clothing and dress in layers. You may need to remove long sleeves and pants to access points.
• Avoid excess jewelry, particularly in the ears, as acupoints in the ears may be stimulated.
• Eat a snack before your session, particularly if you are prone to light-headedness. Also, pack a small snack for after the session.
• Bring water and ensure you are well-hydrated before the appointment, but not so much that you must use the bathroom mid-session.
• Bring music that is relaxing to you. After the needles are inserted, you may be instructed to lay in the same position and rest for some time. Some people doze off, but having something to listen to in the background can be nice.
• Follow up on your appointments as recommended, as it may take several sessions to see results.³

Acupuncture during pregnancy can be a great alternative or additional way to relieve certain pregnancy stress, aches, and pains. It is relatively safe, probably effective, and an easy intervention. Be sure to choose a reputable acupuncturist and share with your provider that you seek this treatment. You will be well on your way to an easier, more comfortable pregnancy!

Pregnancy is an incredible journey to motherhood, but it can also be an exhausting one. Pregnancy fatigue, the overwhelming sense of tiredness, often hits hardest during the first and third trimesters. It results from hormonal changes, increased blood volume, and the body working hard to create a new life.¹

Let’s look into what causes pregnancy fatigue and how long it lasts and explore helpful tips to get you through the exhaustion and increase your energy.

What Does Pregnancy Fatigue Feel Like?

Everyone may experience pregnancy fatigue differently. It may feel like you can never get enough sleep, and extreme tiredness in early pregnancy is very common. Pregnancy fatigue feels like:²

• Having difficulty waking up in the morning
• Being constantly sleepy throughout the day
• Finding it difficult to complete daily tasks
• Having trouble focusing
• Feeling like you never have enough energy

If you are one of the lucky ones, you may not experience it at all!

What Causes Pregnancy Fatigue?

Pregnancy fatigue lets you know it’s time to slow down and adjust to all the changes inside your body. You will likely feel the brunt of your fatigue during the first trimester, and then third-trimester fatigue will start back up as you get closer to delivery.³

Your developing placenta requires the heart to pump faster and stronger as your blood volume increases to keep up with your fetus’ needs. All this activity can leave you sleepy and sometimes out of breath. Progesterone, the hormone responsible for helping you stay pregnant and suppress contractions, also rises sharply in the first trimester and plays a big part in making you feel exhausted.^3,4

When Does First Trimester Pregnancy Fatigue Peak?

Most women begin to experience fatigue, one of the earliest symptoms of pregnancy, during the first 12 weeks, and it can last through the end of the first trimester.⁵ You may be unable to stay awake the whole day without taking a nap. If you are feeling sluggish and tired all day despite sleeping well at night, don’t worry — it’s perfectly normal. That first-trimester fatigue should subside by about 13 weeks.

How Long Does Pregnancy Fatigue Last?

Pregnancy fatigue usually shows up at the beginning of the first trimester and eases off at the beginning of the second trimester.¹ After 13 weeks, you may have more energy and feel like your old self again. Take advantage of this newfound energy to do what you must before the baby comes. More than likely, your pregnancy exhaustion will tiptoe back in during the third trimester as your baby (and you) continue to grow.

How To Get Energy While Pregnant

Consider these tips on how to overcome tiredness during pregnancy and bring you some much-needed energy:

Prioritize Rest and Sleep

Aim for seven to nine hours of quality sleep per night, and take short naps during the day whenever you feel your pregnancy fatigue. Create a comfortable sleep environment by dimming lights, using a pregnancy pillow for sleeping support, and maintaining a comfortable room temperature. Having a comfortable place to sleep and establishing a regular sleep schedule can help you get the rest you and your growing baby need.

Stay Hydrated

Dehydration can exacerbate feelings of tiredness. Drink eight to 12 glasses of water daily to stay hydrated. Sip water, herbal teas, and natural fruit juices, and try to limit caffeine intake.⁶

Drinking water helps you digest your food, helps nutrients circulate in the body, and aids in excreting waste. Staying hydrated also helps form amniotic fluid around your baby.⁶

Eat a Balanced Diet

Eating a balanced diet is essential for combating pregnancy fatigue. When you feel nauseated, it is hard to even think about eating, but try to eat small, frequent meals and snacks every three to four hours to stabilize your blood sugar and prevent energy dips. It is okay to indulge occasionally, but try to consume various foods, including lean proteins, whole grains, fruits, vegetables, and healthy fats. These foods provide essential nutrients that can boost your energy levels.⁷

Exercise Regularly

While pregnancy fatigue may have you feeling exhausted and wanting to curl up on the couch, gentle, regular exercise can help increase your energy. Moving your body can help improve your mood, strength, posture, and endurance. Exercise can also help with those annoying pregnancy symptoms like bloating, constipation, and aches and pains. Physical activity during pregnancy can decrease your risk for C-section rates, gestational diabetes, and high blood pressure.^7,8

Prenatal yoga, pilates, swimming, and walking are excellent low-impact options that help boost your energy, improve circulation, and reduce swelling. Try to exercise for about 30 minutes five days a week or as much as you can handle. Always consult your healthcare provider before starting or continuing any exercise routine during pregnancy.⁸

Listen to Your Body

Pay close attention to your body’s signals. When you’re tired, take a break to rest. Napping may not always be an option when the overwhelming fatigue hits, but taking a few minutes to sit down can be helpful, especially at work. Overexerting yourself will only lead to increased fatigue and discomfort. Remember that pregnancy is not the time to push yourself to the limits.⁹

Manage Stress

Stress can contribute to feelings of fatigue. You can practice relaxation techniques such as deep breathing, meditation, and prenatal massage to reduce stress, relieve pregnancy hormones, and promote a sense of calm. Surround yourself with supportive, understanding people who can provide emotional support.¹⁰

Delegate and Ask for Help

Don’t be afraid to ask for help from family and friends. Pregnancy is when you need to prioritize yourself, and accepting assistance with household chores, childcare, or other responsibilities can be immensely helpful.

If you can, hire a cleaning person to help lessen your load around the house. If you have other children, ask a trusted friend or family member to help take them to activities or give you a few hours to rest.

Plan for Restorative Activities

Every expecting mama needs to practice self-care. Engage in activities that recharge your energy and spirit. Reading, meditating, taking a warm bath, or enjoying a soothing hobby can provide a welcome break from daily life and pregnancy demands.

When To Call Your Doctor

Although it’s natural to feel more tired during pregnancy, you should call your doctor if you experience extreme fatigue, especially if it is accompanied by dizziness. Chances are, you may be experiencing anemia (a low red blood cell count), where insufficient oxygen is transported throughout your body, making you feel tired and weak.^11,12

Fortunately, boosting your diet with more iron-rich foods such as lentils, liver, shrimp, turkey, enriched cereals, beans, and iron supplements can help. Extreme cases of anemia may require an iron transfusion. Your doctor will discuss your best options depending on your iron levels.^11,12

Prioritizing rest, staying hydrated, maintaining a balanced diet, and engaging in regular exercise can help you feel more energized. Listen to your body, manage your stress, and don’t be afraid to ask for help to ensure you don’t get burned out. Taking care of yourself and implementing these tips can help reduce pregnancy fatigue and allow you to enjoy a healthier, more comfortable pregnancy.

You’ve made it through the first trimester, and now you’re in the second trimester! Woohoo! At this point, you’re hopefully feeling a lot better and more like yourself. You will still probably use some of the things off our first-trimester must-haves list, but below is my list of second-trimester must-haves that include products and services essential for a happy second trimester! Also, these would make great gifts for someone you know who is pregnant! 😉

10 Second Trimester Must-Haves

In my opinion, the second trimester is the best part of pregnancy. Hopefully, your nausea has subsided, you’re sleeping a little better, and you’re finally looking legitimately pregnant. Also, if you have suffered miscarriages in the past, this is the point when you can relax a bit, enjoy your pregnancy, and treat yourself. You deserve it! So, here are my must-haves for the second trimester:

1. A Good Probiotic

Now that you have been taking a good prenatal vitamin and prenatal DHA supplement (what I recommended in our first-trimester must-haves list), here’s another great supplement to start taking . . . a probiotic! It is generally safe to take a probiotic supplement while pregnant, and there are many great benefits to taking probiotics during pregnancy.¹ As with any supplement, consult your healthcare provider before taking one.

So, why take a probiotic? One of the main reasons I recommend it is it can help reduce the colonization of Group B Streptococcus (GBS). This bacterial infection naturally lives in the intestines and migrates down to the urinary tract, vagina, and/or rectum.² GBS is tested at 36-38 weeks of pregnancy, and about 10-30% of women are GBS positive during pregnancy.³ If the expectant mother is GBS positive, she must receive antibiotic treatment during labor (usually penicillin or ampicillin) through an IV to prevent it from passing to the baby during birth.⁴ Taking a good probiotic can reduce your chances of being GBS positive, helping you avoid more interventions during labor.¹⁴

2. Body Moisturizer

They say “prevention is key” for all things skin-related. So, investing in a good body moisturizer during pregnancy is helpful. Many belly butters, oils, and belly lotions are marketed to help prevent stretch marks, but none have been scientifically proven to 100% work since stretch marks can be genetic.⁵ However, it never hurts to try, and moisturizing your growing skin is good. A few stretch mark creams, like body butters and oils I recommend are Burt’s Bees Mama Bee Belly Butter, Motherlove Pregnant Belly Oil, Palmer’s Cocoa Butter, and my very fave, Mama Mio’s line of products.

3. Bath Pregnancy Flakes

Now that you are in your second trimester of pregnancy, your body might be experiencing more aches and pains from your growing baby.¹⁵ When you have an achy back and feel tired and weary, a long soak in a bath with some bath pregnancy flakes is the perfect little luxury. This is why these bath pregnancy flakes are on our second-trimester must-haves list!

I like these bath pregnancy flakes because they are pure magnesium. Magnesium is a wonderful mineral that has many benefits. It helps relax muscles, regulate body temperature, maintain healthy blood sugar levels, build strong teeth and bones, and much more.⁶ It can also help you get a more restful sleep and aid in mood stabilization.^7,8

I recommend pouring half a cup into a warm bath and then relaxing and soaking in the tub for at least 20 minutes to allow the magnesium properties to absorb into your skin. You will enjoy some self-care time, and your body and mind will also thank you.

4. A Pregnancy Pillow

Finding a comfortable sleeping position when you’re expecting can be challenging. This is especially true as your belly grows, and you have to get up several times throughout the night to use the restroom. A pregnancy pillow is a second-trimester must-have item because it can help you get some sleep. Getting one during your second trimester allows you to enjoy it for a longer duration of your pregnancy (and even a few months postpartum).

A good quality pregnancy pillow can make it much easier to get comfortable and catch some Zzzs. Rather than using and trying to arrange several pillows in your bed, a pregnancy pillow replaces all of them and provides support in the right places. We know how hard your body is working to grow your sweet baby and how important sleep is. Invest in a good pregnancy pillow and give yourself the gift of sleep!

5. A Cozy Blanket

Now that you have a pregnancy pillow, you also need a cozy blanket to go with it! You want a blanket that will be soft on your skin, not too heavy (to avoid overheating), and not too light (so you stay warm). This ultra-soft throw blanket is one of my favorites, and I feel confident it will be one of yours, too! It’s perfect for snuggling up on the couch or in bed if you’re tired, feel nauseous, or want to put up your feet after a long day. I’ve even had my doula clients bring this blanket to the hospital with them for their postpartum room to stay comfortable. For the quality and the great price, it’s definitely a must-have!

6. Nasal Strips

Not enough people talk about this, but some women experience congestion during pregnancy, also known as pregnancy rhinitis. If you have a stuffy nose that won’t go away, you may be experiencing this. It’s common for it to get worse when you lie down, disrupting your sleep.⁹ To help you breathe easier, sleep better, and hopefully stop your snoring, use these drug-free nasal strips. They help open your nose and relieve nasal congestion by increasing nasal airflow. When you sleep better, you’ll wake up less tired and can conquer another day of growing your tiny human.

7. Audible

Another (not-so-fun) experience that can happen during pregnancy is pregnancy insomnia. Even though you have your pillow, blanket, and nasal strips to help you go to sleep, sometimes your mind won’t “turn off.” I get it. There’s much to think about now that you’re about to have a baby. But I have found that listening to something soothing can help you drift off to sleep. That’s why getting an Audible membership is a second-trimester must-have. You can use it to listen to a good pregnancy and birth book or parenting book when you can’t fall asleep. Listening to a book or podcast will put you to sleep or help you learn something new!

8. Loose Dresses

Clothes are getting tighter at this point in your pregnancy, so you’ll want to invest in some new items you can enjoy wearing for the rest of your pregnancy. I recommend loose dresses because they are comfortable, can grow with you, and can even be worn after you have the baby. Maternity clothes are great, but having pieces in your closet that can be worn beyond pregnancy is a win in our book. This beautiful black floral smocked maxi dress is a perfect example. It even has pockets!

9. A Good Bra

Hello, boobs! It’s no secret your belly isn’t the only thing that grows during pregnancy. Your breasts are also growing to a size you may have never experienced before, and underwires are probably not your friend. A good, supportive bra that fits properly is what you need! If you’re staying active, try Shock Absorber Bras. I also found a few great bralettes (like this or this one) that can work for you for months to come. They still provide support but are more breathable than other bras. They also make great sleeping bras! Getting a few good maternity bras or nursing bras is also a wise investment if you plan to breastfeed. I love the Bravado bras, and several of them come with a conversion kit to make them into regular bras when you’re done nursing!

10. A Doula

A birth doula supports every woman and family for any type of labor and birth you choose. Whether you want a natural birth, a medicated birth, or a planned C-section, a doula is a great person to add to your support team to help you have the positive experience you want and deserve.¹⁶ This is the time during your pregnancy to start interviewing and choosing the right doula for you. Many of the good doulas book up quickly, so the sooner you start looking, the more options you will have available. Look at DONA International or DoulaMatch.net to find birth doulas near you. (Read more about what a doula is and why you should hire one here.)

Not only does your doula support you during birth, but they will also support you during your pregnancy. They will let you know all of the options available to you and resources in your area. They will answer your questions and help you prepare for your birthing day. And they will give you continuous labor support with massage, breathing techniques, comfort measures, being your advocate, and so much more.¹⁶ Having a birth doula has many benefits, and we want every soon-to-be mama to be supported and have the best pregnancy, birth, and postpartum experience possible. You can also listen to our podcast episode, where two doulas talk about all things doulas.

More Helpful Things for the Second Trimester

The list below isn’t necessarily essentials or must-haves for the second trimester (though some women might beg to differ). However, they can be very beneficial to have! Here are items and activities that can be helpful during the second trimester of pregnancy:

1. Exercise

Now that your nausea is subsiding (I hope!), it’s important to get active. Many women have good intentions to work out regularly but find themselves out of the habit after an exhausting and nauseating first trimester. The second trimester is perfect for taking up exercising during pregnancy. It will keep you fit, and because it makes you stronger and healthier, it can help you have a better labor and birth experience.¹⁰ Some great workouts are walking, prenatal yoga, and pilates. Whether joining a class in your area or buying a DVD and doing it at home, be sure to get up and get moving. The breathing and some of the poses you will do in these classes can also help you during your labor and birth.

2. Stay Hydrated

As mentioned in our first-trimester must-haves list, staying hydrated during pregnancy is essential. It’s just as crucial in the second trimester, too.¹⁷ If you’re getting tired of water, you can also start drinking raspberry leaf tea! Raspberry leaf tea is a tremendous uterine toner that can help prepare your uterus for labor and delivery.¹¹ I recommend drinking 1-2 cups per day in the second trimester and up to 3 cups in the third trimester. Grab your water bottle that you got in the first trimester and continue to fill it up!

3. Take Notes

Something you may have heard of during pregnancy is “pregnancy brain” or “mommy brain.” I experienced this during both of my pregnancies. It felt as if my babies were taking all my brain cells because I couldn’t remember even the simplest things! I recommend keeping a notebook handy to write all your lists and ideas that come to mind — baby-related or not. You can also keep your Notes app open on your smartphone, leave yourself voice recordings, or set reminders. I have found these things helpful when you’re in a rush and don’t want to forget something.

4. Eat Protein

Protein during pregnancy is critical for your baby’s growth. Since many women usually feel better in the second trimester, this is an excellent time to focus on your diet and eating protein. It’s recommended for pregnant women to have about 70-100 grams of protein per day, depending on their weight.¹³ Protein is especially important during the second and third trimesters when the fetus grows rapidly. This is why I suggest adding protein to each of your meals. Some good second trimester foods and protein sources are lean meat, poultry, seafood, eggs, Greek yogurt, cottage cheese, beans, peas, nuts, seeds, and soy products.¹²

5. Surround Yourself With Support and Positivity

Now that you can announce your pregnancy to the world, surround yourself with positive birth stories, positive birth images, positive affirmations, and positive women who will support you during this exciting time. Find a local support group, attend some prenatal yoga classes to meet other pregnant women, and reassure yourself that you can do this! You and your body are capable of having an enjoyable birth experience.

These are my second-trimester must-haves! What couldn’t you live without during your second trimester?

“Sleep while you still can” is considered good pregnancy advice. But what if you cannot sleep? Pregnancy insomnia seems like a cruel joke; at the exact time you should be capitalizing on sleep before a newborn arrives, there is often an unrelenting inability to fall or stay asleep. What is pregnancy insomnia, and what can you do about it?

What Is Pregnancy Insomnia?

Insomnia is the inability to fall asleep, difficulty falling back to sleep following nighttime awakenings, or waking too early from sleep. Sleep deficiency, while not considered insomnia, is inadequate sleep of less than seven hours a night.¹

Don’t worry! You are not the only pregnant one struggling with sleep. Sleeping difficulties and insomnia impact an estimated 66%-94% of pregnancies.⁴ The more pregnant you are, the greater your sleeping difficulties may be.¹

You or your obstetric provider may not fully recognize or address the lack of quality sleep. Adequate sleep is essential for a healthy pregnancy. Carefully consider any sleeping challenges or insomnia you may experience. Discuss them with your provider and become proactive in finding ways to battle pregnancy insomnia.

When Does Pregnancy Insomnia Start?

Unfortunately, first-trimester insomnia and sleep challenges can impact about 13% of pregnancies.^1,3 Hormones and classic first-trimester pregnancy symptoms may cause early pregnancy insomnia. Insomnia and sleep challenges may start or worsen as pregnancy progresses. Third-trimester insomnia can affect nearly 75% of pregnancies, with night waking being the most significant complaint.¹

Causes of Pregnancy Insomnia

Pregnancy is an intense time of physical, hormonal, and emotional body changes that have the potential to impact sleep quality and duration significantly. Causes of pregnancy insomnia may include:^1,3

• Nausea and vomiting
• Hyperemesis gravidarum
• Frequent urination
• Pelvic or back pain
• Nasal congestion
• Fetal movements
• Contractions
• Heartburn
• Uncomfortable sleep positions
• Intense dreams or nightmares

Other Causes of Pregnancy Insomnia

Other pregnancy-related complications can contribute to or cause insomnia. Speak with your obstetric provider if you have concerns that you may be suffering from any of the following:

Sleep Disordered Breathing (SDB)

SDB includes obstructive sleep apnea that can cause snoring, nighttime awakenings, headaches, dry mouth, and extreme fatigue.^3,7 SDB may increase your risk of miscarriage.⁷

Restless Leg Syndrome (RLS)

RLS is characterized by troublesome feelings in the legs, often described as creeping, crawling, burning, and itching. These feelings are generally worse at night when your body is at rest. The cause of restless leg syndrome during pregnancy is not fully understood. Some studies have discovered an association between RLS and iron deficiency. Pregnancy is a risk factor for iron deficiency, and iron supplementation may be helpful.⁷

Anxiety or Mood Disorders

Mental health disorders such as major depressive disorder (MDD), bipolar disorder, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD) can all negatively contribute to pregnancy insomnia or sleeping difficulty.³

How Long Does Pregnancy Insomnia Last?

Unfortunately, sleeping difficulties do not necessarily end when pregnancy does. Pregnancy insomnia can last well into the postpartum period.⁸ Sleep challenges and insomnia can be further complicated by spending many potential sleeping hours caring for your new baby. A whole night’s sleep may not be possible in this early postpartum period, but many of the tips below, in addition to addressing any mental health issues, can provide a more restful night’s snooze.

Complications of Pregnancy Insomnia

Sleep can greatly influence critical female hormone cycles, including estrogen, progesterone, and prolactin.⁷ Pregnancy is also physically demanding, internally and externally. Pregnant people require adequate rest for optimal function and a thriving pregnancy. Sleeping difficulties, disturbances, and insomnia during pregnancy are associated with increased risks of the following:^1,3

• Perinatal depression and anxiety
• Postpartum depression
• Gestational diabetes
• Low birth weight newborns
• Preterm delivery
• Prolonged labor
• Cesarean section

Tips for Coping With Pregnancy Insomnia

Developing healthy sleep hygiene habits and trying non-pharmacological strategies is the first defense for insomnia treatment:^1,3,6

• Establish a regular sleep-wake cycle.
• Reserve naps for the earlier part of the day
• Maintain a dark, cool sleep environment
• Avoid caffeine before bed
• Avoid screens before bedtime
• Limit fluids in the later half of the day to limit nighttime awakenings (be sure to hydrate earlier in the day adequately)
• Consume frequent, light meals throughout the day while avoiding heavy meals in the evening.
• Aim for 30 minutes of daily exercise or movement if your healthcare provider approves.
• If you have difficulty falling asleep, do a non-stimulating activity like reading.
• Prioritize sleep comfort using pillows for support
• Consider alternative therapies such as acupuncture, acupressure, massage, and meditation

Your obstetric provider can guide you in finding an approach that may work for you. Additionally, other treatments may be necessary if you suffer from sleep-disordered breathing, restless leg syndrome, or an anxiety or mood disorder.

Can I Take Melatonin During Pregnancy?

Melatonin is a frequently used and highly marketed supplement that can promote a more restful sleep. But can you take melatonin while pregnant?

Melatonin is a hormone produced by your body that assists in regulating your sleep cycle. It is also vital during pregnancy. Some studies have concluded that melatonin secretion positively impacts pregnancy, from maternal egg quality through birth. Melatonin has a developmental impact on your baby’s nervous and endocrine systems. It can also act as an antioxidant to protect the developing organs from oxidative stress.⁵

Though the studies are limited, several have suggested that melatonin use in pregnant and lactating persons is probably safe and without side effects.^4,5 However, melatonin supplementation for sleep purposes during pregnancy is not officially recommended. Because the Food and Drug Administration does not regulate the quality of melatonin supplements, the product’s safety cannot be assured.⁴

Consult your obstetric provider if you have questions about taking melatonin during pregnancy.

Can I Use Sleep Aid Medications During Pregnancy?

If melatonin use during pregnancy is up for debate, what about other sleep aid medications? If you are experiencing significant sleeping difficulties and natural remedies have proved ineffective, sleep aid medication may be an option.

Over-the-counter antihistamine medications such as diphenhydramine (Benadryl) and doxylamine (Unisom) are considered safe during pregnancy.⁹ However, not all prescription sleep aids are considered safe during pregnancy and postpartum, including benzodiazepines, zolpidem (Ambien), and barbiturates. But that doesn’t mean they can’t be taken, especially if the benefits outweigh the risks.^10,11 Always speak with your obstetrician or midwife about your sleeping difficulties and interest in medication options.

Poor sleep quality and insomnia symptoms during pregnancy are not something to overlook. Restful sleep is vital for your growing baby and your well-being during pregnancy and postpartum. Do not hesitate to discuss your challenges and symptoms with your obstetric provider. Together, you may find solutions for a more restful night’s sleep during this perinatal period.

While the idea of pregnancy can be quite exciting, the symptoms of pregnancy can be uncomfortable. From experiencing morning sickness to pelvic pain, many women find themselves wishing they could fast forward through these issues to meet their baby. One complaint during pregnancy can be constipation.

Coming from someone who was very regular before pregnancy, pregnancy constipation can be frustrating and uncomfortable. It left me and many other women wondering why this happens and how to relieve it. Here, we will look at common pregnancy constipation issues and treatments.

What Is Pregnancy Constipation?

Constipation is a term that can mean something different to everyone, depending on how often you have bowel movements. Constipation during pregnancy generally refers to infrequent bowel movements and difficult or painful bowel emptying.¹ Besides infrequent and difficult-to-pass bowel movements, constipation can cause bloating, abdominal pain, and sluggishness.²

What Causes Pregnancy Constipation?

If you were used to a regular stooling schedule pre-pregnancy, you might wonder what causes constipation during pregnancy. Many factors contribute to slowed motility through the intestines while pregnant.

Hormones

The hormone progesterone increases early in pregnancy and remains elevated until delivery. Progesterone increases the time it takes for food to move through the bowels. The hormone motilin decreases in pregnancy, further slowing down intestinal movement.^1,3

Stool becomes harder when food moves slower because more water is absorbed as food sits in your bowels for longer. The harder the stool becomes, the less frequently and easily it will be evacuated.¹

Decreased Activity

Exercise and body movement help to move food through the digestive system. The fatigue and busyness of pregnancy can make you slow down and exercise less, increasing the likelihood of constipation.³

Vitamin Supplementation

Many pregnant women take a prenatal vitamin and are advised to supplement with iron. Does your iron supplement cause constipation? The answer is it’s possible. Iron has been associated with slowed intestinal transit time and increased bloating and constipation.⁴ Calcium supplementation may also contribute to pregnancy constipation.¹

Anatomy

As pregnancy progresses and your uterus grows, it may increase pressure on your bowels and slow movement. The changes in the structure and layout of your abdomen and intestines during pregnancy may contribute to pregnancy constipation.¹

When Does Constipation Start in Pregnancy?

Constipation can start at any point in pregnancy. Some women experience it early in the first trimester, while others do not feel it until later. Some don’t experience it at all.³

The hormone progesterone rises after ovulation, continues to increase, and remains elevated if you become pregnant. Since progesterone may contribute to constipation, some women experience constipation starting very early in pregnancy.^3,5

However, the onset of constipation for others may be later in pregnancy, as your baby grows significantly and adds pressure inside your abdomen. Some women do not experience pregnancy constipation at all, and some may feel it one week and not the next.³

Is Constipation a Sign of Pregnancy?

While constipation can begin early in pregnancy and might be linked in some cases, constipation can happen for different reasons.

Many causes of constipation are not pregnancy-related, so constipation is not necessarily a sign that you are pregnant. There are more specific early pregnancy symptoms that might signify you are pregnant. It can be tempting to “symptom-spot” or speculate whether you are pregnant based on physical symptoms you are experiencing, but the best way to know for sure if you are pregnant is to wait until your missed period and then take a pregnancy test.³

How Common Is Pregnancy Constipation?

Constipation during pregnancy is common, with some studies reporting over a third of women experiencing it.¹ But just because constipation is common during pregnancy does not mean it should be ignored.

How Can I Prevent Pregnancy Constipation?

To prevent pregnancy constipation and get your bowels moving, there are nutrition, hydration, and exercise goals you should aim to reach:

Fiber

While it can be difficult to stomach certain foods during pregnancy, shoot for 25-30 grams of fiber daily from fruits, vegetables, legumes, and whole grains. Fiber helps to soften stool and move it through the intestines. It can help produce a bowel movement and prevent constipation.³

Fluids

Your need for water increases during pregnancy, from increased blood volume to amniotic fluid production. You may become constipated if you do not increase your water consumption to meet these needs. Aim for 8-12 cups of water per day to prevent constipation during pregnancy.³

Exercise

While pregnancy can make movement more difficult and uncomfortable, waste is more likely to accumulate in your gut when you are sedentary. Getting 20 to 30 minutes of moderate exercise during pregnancy three times per week can help keep things moving. If you have any concerns or doubts, speak with your provider about safe exercises and activities during pregnancy.³

Probiotics

Good gut bacteria help move food through the digestive system quickly and efficiently. Adding a daily probiotic may alter the intestinal flora and increase gut motility.¹

What Is Safe To Take for Constipation While Pregnant?

If you are feeling desperate to have a bowel movement, you might be wondering how to relieve constipation during pregnancy immediately. Many stool softeners and laxatives are available over the counter. While many medications are safe for pregnancy, you have to be careful, especially before full term, because many that stimulate bowel contractions can also stimulate uterine contractions. You do not want to end up in early labor because of constipation.⁶

The best stool softener during pregnancy can vary from person to person. Most laxatives are not absorbed systemically, meaning they stay in the gut and do not reach the baby.¹ However, your provider knows your medical situation and history and can recommend the best pregnancy constipation relief. The various options for stool softeners in pregnancy are outlined below.

There are many stool softeners and laxative options during pregnancy. It may take some trial and error before you find a solution that works for your pregnancy constipation. Always consult your provider before starting any new medications.

Bulk-Forming Agents

For some people, bulk-forming agents or fiber supplements such as bran or psyllium are effective at relieving pregnancy constipation. They are safe to take but can increase gas, bloating, and cramping in some women. Fiber supplements can also take up to three days to work.¹ Chia seeds can also help relieve constipation due to their high fiber content.⁷

Stool Softeners

Stool softeners such as docusate sodium or Colace increase your stool’s salt and water content, making it softer and easier to pass.^1,7 Other substances that soften stool during pregnancy include magnesium and polyethylene glycol or Miralax. These draw water into the bowels and soften stool, relieving constipation. However, prolonged use of these stool softeners may lead to electrolyte imbalance in you or your baby.¹

Laxatives

Stimulant laxatives act directly on the nerves and muscles of the intestines, causing food to move more quickly through. Examples of these include bisacodyl or Dulcolax, and senna. These medications are also poorly absorbed and will likely not reach your baby. Therefore, they are likely safe for pregnancy but can cause intense intestinal cramping. In some cases, intestinal cramping can irritate the uterus as well. They can also cause electrolyte imbalance and dependence on the medication.¹ They should only be taken at your doctor’s recommendation and only for short periods.

Castor oil is a laxative that is also known for inducing labor in overdue pregnancies.⁸ Whether you are trying to evacuate your bowels or evict your baby, extreme caution should be used when taking this substance during pregnancy.

Can Constipation Hurt the Baby?

No. While constipation can be uncomfortable and frustrating for you, the increase in abdominal pressure due to constipation will not hurt your growing baby.³

Constipation can cause fecal impaction, which can be a severe complication, but this is rare.¹ Although your baby is safe, you still want to get ahead of pregnancy constipation so it does not reach the point of danger. Constipation can also cause anal tears or fissures and can cause or worsen hemorrhoids.³ Softening your stools and passing them more easily and frequently can prevent these side effects of pregnancy constipation.

While constipation during pregnancy is rarely severe, you still want to get ahead of it for both comfort and safety. If fiber, fluids, and movement are not working, talk to your provider about getting occasional relief from a stool softener or laxative. As you progress through pregnancy, they can help you find a balance between diet, exercise, and medication that works for you.

Exercise during pregnancy is a great way to help you and your baby have a healthy journey together. Whether you did regular physical activity before you became pregnant or want to start exercising now, there are important things to know about how to work out when pregnant safely.

About Working Out When Pregnant

Talk to your obstetric care provider about exercise at your first prenatal visit.³ Healthy women are encouraged to get at least two and a half hours of moderate-intensity aerobic exercise during pregnancy per week. However, there are a few conditions in which exercise may harm you or your baby.^1,4 If your OB care provider does give you the green light to work out when pregnant and you were already active before, you can discuss modification recommendations. If you were not physically active before pregnancy, they can help you develop a pregnancy workout routine to help promote your and your baby’s health.²

If you already have a packed schedule, you may wonder how you can make time to get the recommended 150 minutes a week of exercise.³ You can get creative and break it up into 30 minutes of activity at least five days a week. If that doesn’t sound feasible, try dividing 30 minutes into 10 minutes of activity three times daily.^3,4

Changes in Pregnancy

As your body undergoes significant changes, your ability to work out when pregnant may require some adaptations due to the following:

Relaxin

This pregnancy hormone helps soften your pelvic ligaments to make room for your growing baby.² Relaxin also loosens ligaments in other joints, making them more mobile, which can put them at an increased risk for injury. Try to avoid high-impact jerking movements that may strain your joints.³

Balance

As your baby grows, the distribution of weight in your body changes, causing your center of gravity to shift forward. This can impact your ability to keep your balance when performing certain exercises.² To increase your stability and avoid falling, try to move mindfully and perhaps a bit more slowly during your prenatal workout.³

Breathing

During pregnancy, your body demands more oxygen.⁴ You may notice some shortness of breath performing activities that you could previously do without much effort, such as walking uphill. This is due to an increase in progesterone, a pregnancy hormone that can cause you to breathe faster even in early pregnancy. As your uterus grows, this reduces the space your lungs have to expand, so feeling winded during exercise is common.⁵ It is okay to scale back your workout intensity to breathe more comfortably.

Heart Rate

The natural progression of pregnancy causes the average heart rate for pregnant women to increase.³ Your heart must beat harder and faster, even without physical activity, To keep up with your body’s and baby’s oxygen demands.⁴ During exercise, your pre-pregnancy target heart rate is no longer helpful in monitoring the intensity of your workout. Your goal is to exercise at a moderate level of intensity, which means you are sweating, but you can talk throughout your activity.¹⁰

Benefits of a Workout When Pregnant

Here are some of the physical and psychological benefits you can gain when you exercise during pregnancy:^2,4,10

• Increased energy level
• Maintenance of or increase in physical fitness
• Less back pain
• Healthy weight management
• Quicker physical recovery after childbirth
• Stress reduction
• Better-quality sleep
• Prevention or relief from constipation
• Possible decrease in risk for developing gestational diabetes or
• Preeclampsia
• Lower risk of Cesarean delivery

The Dos: Exercise When Pregnant

Fatigue during pregnancy can make it hard to want to be physically active. To maintain motivation, you’ll want to choose things you will enjoy. There are lots of ways to work out that are safe to do when pregnant, such as walking, riding a stationary bike, and doing pregnancy exercises like prenatal yoga.⁴ But what about other activities?

Can You Run While Pregnant?

If you were a runner before your pregnancy and have talked with your OB care provider, continuing to run should not hurt your baby’s health.⁷ If you want to begin running during pregnancy, let your OB care provider know before starting a running regimen.⁸

Can You Lift Weights While Pregnant?

If your pregnancy is uncomplicated, strength conditioning with weights or resistance bands can be beneficial during and after pregnancy. Discuss weight lifting with your OB care provider for individualized weight amount recommendations.⁹ After your first trimester, try to avoid overhead weight lifting to prevent worsening of lower back discomfort.¹

Can Pregnant Women Bowl?

Bowling is a low-impact activity, and as long as your OB care provider clears you, it should be safe. You may need to modify your form to keep your balance, as your growing belly causes your center of gravity to move forward. Also, remember that loosening joints increases your risk of injury, so bowl gently.⁹

What About Swimming When Pregnant?

Swimming is one of the safest pregnancy exercises you can do, and many OB care providers recommend it for their patients who are healthy enough to do so. Swimming gives you the benefit of getting a good aerobic workout while being gentle on your joints and without having the risk of losing your balance and falling.⁸

The Don’ts: Exercises To Avoid During Pregnancy

Certain activities are not recommended if you’re looking to work out when pregnant due to their increased risk of causing injury to you and your baby. These include anything that puts you at risk for:

• Getting hit in the abdomen. Examples include boxing, ice hockey, martial arts, and other contact sports.^2,3
• Falling. Examples include downhill skiing, horseback riding, mountain biking, and gymnastics.³
• Overheating. Examples include exercising outside on a hot and humid day and “hot yoga” or “hot Pilates.” ^3,4
• Experiencing extreme changes in pressure. An example would be scuba diving.²
• Exercising at a high altitude. An example would be hiking above 6,000 feet if you don’t already live at a high altitude.³

If you are uncertain if a specific workout is safe when pregnant, check with your OB care provider before trying it. Also, tune into your body. If you don’t want to work out on a day you had planned to exercise, it’s okay to rest and conserve your energy.²

When Can You Work Out Again After Giving Birth?

After delivery, you and your OB care provider can discuss when it is safe to resume workouts. If you have an uncomplicated vaginal delivery, it may be as soon as a few days after giving birth if you are feeling up to it. If you have a C-section, you may need to take things more slowly, as this is a major abdominal surgery, and your body will need more time to recover.⁴

Gradually increasing the intensity of exercise is vital postpartum. Physical activity postpartum has been shown to decrease the incidence of postpartum mood and anxiety disorders like postpartum depression. Physical activity is also encouraged in lactating women and should not affect your milk supply.¹⁰

If your OB care provider has given you the go-ahead, regular exercise during pregnancy is a great way to take care of yourself and your growing baby. Try to choose low-impact activities that you enjoy and make modifications as needed. This may mean reducing the intensity of your pre-pregnancy workouts or slowly building up your activity level if you weren’t physically active before pregnancy.⁴ When deciding how to work out when pregnant and achieve the recommended two and a half hours or 150 minutes a week of exercise, make it fun, be safe, and appreciate what your body can do.