What Is Sciatica in Pregnancy?

Back pain during pregnancy is quite common and often due to carrying extra weight on the front of your body. But while it is normal to experience some pain in the middle of the back or butt, some people will struggle with a painful condition called sciatica.

Sciatica causes sharp, shooting pain that starts in the lower back or buttocks and radiates down the backs of the legs. This happens because the sciatic nerve—the largest nerve in the body—becomes compressed or irritated.

The frequency of sciatica will increase as your pregnancy progresses. Sciatica is more common in the third trimester. Fortunately, sciatica is a temporary condition that often resolves after childbirth.

Learn more about sciatica, including its signs and symptoms, causes, treatment, and when to reach out to your doctor.

Symptoms

Back pain in pregnancy is a common complaint, and it can harm your quality of life. Sciatica, on the other hand, is less frequent, affecting 1% of people in pregnancy.

On each side of your body, your sciatic nerve starts in your lumbar spine (lower spine), runs into your buttocks, and extends into the back of your thigh, ending just above the back of your knee. Your sciatic nerve then extends into other nerves, which continue into your leg, foot, and toes.

Pain associated with sciatica will be dull, deep, or shooting. It can range from mild to severe. But the pain is manageable and can resolve with treatment.

Additional symptoms of sciatica include:

• Pain that travels down the leg
• Numbness or weakness that is felt in the lower back, buttocks, leg, or foot
• Pain that gets worse with movement or reduced movement (e.g., sitting or lying down for a long period)
• A “pins and needles” feeling in the legs, feet, or toes
• Difficulty with walking, standing, or sitting for long periods

Causes

Sciatic nerve pain is generally caused by lumbar spine problems, such as a bulging or herniated disk. It can also be caused by a bone condition that affects the spine, such as spinal stenosis, spondylolisthesis, or osteoarthritis. These conditions can put pressure on the sciatic nerve, which leads to symptoms.

During pregnancy, sciatica symptoms, unrelated to another condition, can be caused by muscle tension and unstable joints. This is the effect of a hormone called relaxin that is increased during pregnancy.

Relaxin readies the pelvis for childbirth by relaxing ligaments and widening the hips. As the pregnant belly grows and the ligaments start to loosen up, the center of gravity shifts, causing the sciatic nerve to become irritated or pinched.

The baby’s weight can also add to the pressures already affecting the pelvis and hip joints. In some cases, the baby’s position within the uterus can place pressure on the sciatic nerve.

Treatment

Treatment for sciatica during pregnancy includes a variety of self-care therapies. This might include massage, stretching, gentle exercise, hot and cold therapy, maternity support belts, and practicing good posture. Medicinal therapies are rarely considered during pregnancy.

Massage

Prenatal massage might help ease pain, inflammation, and discomfort in the back and other body areas affected by the sciatic nerve. When looking for a masseuse, it is best to find someone who specializes or has experience in pregnancy massage. Massage strokes should be light, and the masseuse should stop if there is pain or significant pressure.

Stretching

Gentle stretching during pregnancy can strengthen your back and abdominal muscles to reduce back pain and stiffness. Light stretching can also loosen up tight muscles and relieve sciatic nerve pain. 

The American College of Obstetricians and Gynecologists recommends avoiding exercises that require you to stand still or lie flat on your back. Lying on your back puts pressure on the large vein in the uterus that returns blood to the heart. Standing motionless can increase blood to your legs and feet. Both positions can also cause decreased blood pressure.

Safe Exercises

Brisk walking, using a stationary bike, yoga, and swimming are all safe ways to exercise when you are pregnant. Swimming, in particular, can help support the weight of your pregnant belly and reduce pressure on joints and muscles.  

You should always talk to your doctor to make sure specific exercises are safe for you during pregnancy.

Hot and Cold Therapy

Cold therapy can reduce pain and swelling. Apply an ice pack or a bag of frozen vegetables wrapped in a towel to the painful area. Apply for 20 minutes, several times daily.

You can switch to a heating pad after using cold therapy for a few days. Apply for 20 minutes at a time.

You can switch between hot and cold, depending on what improves symptoms. Do not apply a cold pack or heating pad to your belly or to your back for longer than 20 minutes at a time.

Maternity Support Garments

Some research suggests that wearing maternity support garments (i.e., a pelvic girdle) can help to ease sciatic nerve pain. These support garments work because they distribute pregnancy weight evenly and support posture.

A 2019 systematic review looked at studies supporting the use of maternity support garments to relieve lower back and pelvic girdle pain. The review determined that the use of the garments could help relieve pain, enhance balance, reduce falls, and improve function and mobility during pregnancy. The types of support garments studied were those that are commercially available.

Practicing Good Posture

Make it a habit to maintain good posture when sitting, especially when you are working at a computer. Try not to slump or slouch. Placing a support pillow behind your back can help you to sit more comfortably and reduce back pain and pressure. It is also helpful to get up and move around every half hour to one hour.

Medical Treatment

Doctors can recommend more advanced options for treating sciatica, such as steroid injections and nerve blocks, but these are considered unsafe options during pregnancy. If sciatica doesn’t resolve after your baby is born, you should talk to your doctor about medicinal treatment approaches.

The Centers for Disease Control and Prevention (CDC) cautions against using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen during pregnancy because NSAIDs might be related to an increase in birth defects.

If you find that natural therapies are not helping manage sciatica pain and your quality of life is affected, talk to your doctor about whether acetaminophen or another pain reliever is an option for you during pregnancy.

Prevention

It is not always possible to prevent sciatica, especially during pregnancy. Maintaining a healthy weight and not sitting for long periods can help.

You can protect your back by regularly exercising and stretching. Also, aim to avoid heavy and incorrect lifting during pregnancy.

When to Call Your Doctor

Mild sciatica will go away with time and resolves with childbirth. However, you should call your doctor when self-care and home remedy measures fail to help symptoms or if the pain gets worse, becomes severe, or lasts more than a week.

Get immediate medical help for sudden severe pain in your low back or leg, accompanied by muscle weakness of the leg, or if you have problems controlling your bowels or bladder. These might be signs of a condition called cauda equina syndrome, which is a medical emergency and requires surgical intervention.

Summary

Sciatica during pregnancy can be painful and uncomfortable. It is caused by pressure on the sciatic nerve. Stretching can help improve pain, decrease muscle tension, and improve hip, leg, and back movement. Sciatica pain worsens with sitting or standing for long periods, so it is wise to switch positions and not sit for long periods.