Back pain after pregnancy: why it happens, feeding and carrying tips, safe stretches and when to see a physio

Back pain after pregnancy is common, and most of it comes from what your body went through plus what you now do all day: feeding with your shoulders rounded, lifting a baby out of a cot, hauling a car seat and bending over a changing mat. KKH's pregnancy planner says it takes about six weeks for most pregnancy changes to return to normal, and HealthHub says most lower back pain gets better within a few weeks with self-care. What helps most is a supported feeding position, lifting with your knees close to your baby, gentle walking from the first days, and simple stretches. Staying in bed for the whole confinement month doesn't help your back. See a doctor promptly if the pain comes with numbness, leg weakness, fever or trouble passing urine.

Why your back hurts after giving birth

SingHealth's guide to body changes after pregnancy lists back pain from carrying heavy loads among the common ones. KKH's women's anaesthesia team also says backache is common after childbirth "with or without" an epidural, and that studies have failed to link epidurals with long-term backache.

Feeding without hurting your back

You will spend hours a day feeding in the first months, so this is where small changes pay off. HealthHub's breastfeeding guide says to "sit comfortably making sure that your back and the arm with which you hold your baby is well supported (with a pillow or cushion)", and to hold your baby at breast level, chest to chest.

• Bring your baby up to you, not your breast down to your baby. A firm feeding pillow or two cushions on your lap does the lifting.
• Sit back in the chair with a cushion behind your lower back and both feet flat. A low stool under your feet stops you perching forward.
• Try lying down for night feeds. HealthHub suggests lying on your side with a pillow under your head and behind your back, which also suits mothers after a caesarean.
• After a caesarean, HealthHub suggests the football hold, with your baby tucked under your arm.
• Bottle feeding works the same way: sit back, support the arm holding your baby, and switch sides each feed.
• Look up between sucks. Rolling your shoulders back and looking up at the wall now and then eases the neck.

Our breastfeeding support guide covers latch and positions, and a hospital lactation consultant can check your position if feeds keep hurting.

Lifting and carrying your baby safely

SGH's pain management director, writing on HealthXchange, gives two rules that apply to every baby task: keep what you carry close to you, so its weight sits near your spine, and "always bend your knees, and not your back."

Watch your wrists too. HealthXchange says de Quervain's tenosynovitis, pain at the base of the thumb and side of the wrist, is "common in carers of newborn infants due to awkward wrist and hand postures when carrying the newborn baby." Scoop your baby up with your palms and forearms rather than with your thumbs spread wide, and keep your wrists straight when you lift, as HealthXchange advises. Our guide to baby carriers in Singapore compares carriers by fit.

Safe stretches and exercise after birth

KKH's going-home advice asks you to rest your back as much as you can in the first days, and also encourages postnatal exercise and pelvic floor exercises once you're home. HealthHub says complete rest in bed isn't recommended for back pain, because "when you avoid movement, your body generally becomes weaker", and SGH's pain specialist says prolonged bed rest makes your muscles "lazy". So rest, but don't stay in bed all day through confinement.

Gentle moves most mothers can start in the first weeks, if they don't hurt:

1. Short walks around the house, then outside, building up a few minutes at a time. HealthHub suggests walking as a starting point.
2. Pelvic floor squeezes. KKH's routine: tighten for three seconds, relax for three, build up to 10 seconds, for 15 minutes three times a day.
3. Pelvic tilts lying on your back with knees bent: flatten your lower back into the bed, hold for a few breaths, relax.
4. Cat and cow on hands and knees, slowly rounding and arching your back.
5. Shoulder rolls and a chest stretch in a doorway, for feeding hunch.

Wait for your doctor's go-ahead before crunches, running or lifting weights, especially after a caesarean or if your tummy muscles have separated. KKH runs postnatal exercise classes, and HealthHub notes your pain shouldn't get worse with exercise. Our guides to postnatal yoga, prenatal and postnatal pilates and pelvic floor recovery have more. For short-term relief, HealthXchange suggests ice or hot packs. Ask your doctor or pharmacist which painkillers and medicated plasters are fine while you breastfeed.

When to see a doctor or physio

HealthHub and SingHealth list the signs that back pain needs a doctor rather than self-care:

Hospital physiotherapists in Singapore treat exactly this. KKH's physiotherapists provide postnatal education including back care, assess women with musculoskeletal pain, and run a postnatal care programme on the wards and a pre and postnatal fitball class (KKH Patient Education Centre 6394 1268 for exercise classes; central appointments 6294 4050). SGH says its physiotherapists teach exercises to restore your pelvic floor and tummy muscles after birth. Ask your gynae or a polyclinic doctor for a referral. Many private physios also offer postnatal sessions; check the price first, and note that our guide to postnatal massage covers what massage can and can't do.

Frequently asked questions

How long does back pain last after pregnancy?

KKH says most pregnancy changes take about six weeks to return to normal, and HealthHub says most lower back pain improves within a few weeks with self-care. See a doctor if it is no better after six weeks or keeps getting worse.

Can an epidural cause back pain after birth?

KKH's women's anaesthesia team says studies have failed to link epidurals with long-term backache, and that backache is common after childbirth with or without one.

Is it OK to carry my baby in a carrier with back pain?

Usually, if the carrier fits well and spreads the weight over both shoulders and hips. Start with short spells and stop if the pain gets worse.

What is the best breastfeeding position for back pain?

Any position where your back and the arm holding your baby are supported, says HealthHub. Lying on your side works well at night, and the football hold suits mothers after a caesarean.

Should I stay in bed during confinement to protect my back?

No. HealthHub says complete bed rest isn't recommended for back pain, and gentle activity helps recovery. Rest when you can, and walk a little every day.