What causes heartburn in pregnancy?

The top of your stomach has a valve to keep down the food you’ve swallowed and the stomach acid that digests your food.

The pregnancy hormone progesterone relaxes this valve, meaning stomach acid, and sometimes partially digested food, can squeeze back up into your gullet (oesophagus). You may feel a burning sensation in your chest when this happens.

Heartburn, indigestion and acid reflux are common in pregnancy.

In early pregnancy, heartburn or indigestion may make your pregnancy sickness worse.

In later pregnancy, your growing baby squashes your stomach, making you more prone to bringing up a little food.

Your heartburn may be worse if:

• You are pregnant with more than one baby.
• Your baby is very large (macrosomia).
• Your baby is in a breech position (bottom-first) in late pregnancy, as his head may press up under your diaphragm.

Tell your midwife or GP if your heartburn doesn’t go away. Severe, persistent heartburn can be symptom of pre-eclampsia, a serious illness of late pregnancy.

How can I prevent heartburn?

It’s often simply a case of trial and error to find out which foods affect you most – and then avoiding them.

Eating small meals often, rather than large meals that are hours apart, will prevent your stomach from becoming too full and pushing up under your diaphragm.

Try to eat your main meal of the day at lunchtime. Eat your evening meal early in the evening, so your body has time to digest it before you go to bed.

Avoid spicy, rich, fatty and fried foods , and anything else that triggers your symptoms. Sugar, tea, and coffee may also make your heartburn worse.

Some women find that foods containing garlic make their heartburn worse. However, for others, eating a clove or two of raw garlic every day, or using whole cloves in cooking, can actually help.

Or you could take a garlic capsule to relieve the intensity of your symptoms. Garlic capsules should be rich in allicin to be effective. Ask your midwife before taking any supplements in pregnancy.

If you’re taking iron tablets that make your heartburn worse, talk to your midwife or doctor about changing to a liquid supplement instead.

Drink water between meals rather than with a meal. Drinking while you eat dilutes your digestive juices, meaning they don’t work as well to break down food.

Try to cut down on meat and fizzy drinks, if you have them often. Both can cause heartburn. A little lean meat is healthy during pregnancy, but fizzy drinks have no nutritional value.

Try to stay sitting upright after eating, as lying down may cause you to bring up a little food. Sleeping propped up on two or three pillows in later pregnancy may help.

Heartburn may also be worse if you smoke. It’s another reason to stop, as smoking is harmful to your baby.

Which complementary therapies can ease heartburn?

There’s mixed evidence about how effective complementary therapies are for treating heartburn. If you want to use a therapist, see one who’s registered, insured and experienced in treating pregnant women.

Acupuncture and acupressure

These therapies work on the principle that points in your body can be stimulated to improve your symptoms. There’s some limited evidence that acupuncture may help with heartburn.

However, the use of needles during an acupuncture treatment may release natural painkillers called endorphins in your body. It may be the endorphins that are easing your symptoms.

You’ll have to pay for an acupuncture session, but you could try acupressure for yourself. Press acupuncture point (pericardium point 6) on your wrist to try to relieve your symptoms.

To locate pericardium point 6:

• Use one hand on the inside of your opposite wrist, measuring up three finger-widths from the crease between your hand and arm.
• At the point where your third finger is, lift the pressure off until you are just touching the skin, and feel lightly for a slight dip. Press into this dip quite deeply and it will feel bruised.
• When your heartburn is severe, press this point on each wrist for between 20 times and 30 times at one-second intervals.

Aromatherapy

Try adding four drops of lemon, orange or neroli (orange blossom) essential oils to a teaspoonful of grapeseed base oil. Massage this into your chest and upper back, or put the blend in your bath so you can inhale the vapours.

Herbal remedies

Check with your midwife before using herbal teas as a regular remedy. Peppermint tea may help your digestion. But don’t drink other teas that are reputed to aid digestion, such as fennel. Fennel contains chemicals that may make your womb (uterus) contract.

Ginger, camomile and dandelion herbal tea may help to relieve heartburn, with the following precautions:

• If you’ve had any bleeding, it’s best to drink ginger tea in moderation, as it contains chemicals that can slow down clotting.
• If you’re taking medication for diabetes, don’t drink dandelion tea, as it can interfere with your medication.
• If you’re suffering from insomnia, drinking a lot of camomile tea may actually make it more difficult to sleep.

Homeopathy

Though there’s no evidence that homeopathic treatments work, if you want to try them, consult a qualified, registered homeopath.

Osteopathy and related therapies

Osteopathy, chiropractic and Alexander Technique are therapies that aim to realign your posture. There’s no strong evidence that these therapies will be effective to treat your heartburn. However, if you don’t want to take over-the-counter remedies, and you think these therapies would generally help your posture during pregnancy, they may be worth a try.

Relaxation therapies that focus on posture can also help, for example yoga, or qi gong. These therapies have other health benefits, such as reducing stress and helping to prepare you emotionally and physically for labour.