■ 3rd trimester

More than half of all pregnant women get heartburn — and for many, it's their first experience with it. Heartburn, also called gastroesophageal reflux disease (GERD), actually has nothing to do with your heart. It's caused by the backward flow of stomach contents passing up into the esophagus, the tube that carries food from your mouth to your stomach. When this happens, stomach acids irritate the lining of the esophagus. The resulting burning sensation at about the level of the heart gives the condition its misleading name.

Heartburn is more common during pregnancy for a number of reasons. Pregnancy hormones cause your digestive system to slow down. The wave-like movements of the esophagus that push food down into your stomach become slower. Your stomach also takes longer to empty. These changes give nutrients more time to be absorbed into your bloodstream and to reach the fetus. But they can also cause indigestion and heartburn. The muscle between the stomach and the esophagus also relaxes, which may allow stomach acids to move upward.

In addition, during the later months of pregnancy, your growing uterus continually pushes on your stomach, moving it higher and higher and compressing it. The pressure can force stomach acids upward, causing heartburn.

The typical symptom of heartburn is a burning discomfort behind the breastbone or a burning feeling in your chest. It may feel like indigestion, a sour stomach, pain in the upper abdomen or a feeling of fullness after eating a small amount of food. You may have a burning sensation in your chest when you lie down, bend over or exercise. Some people describe a backing up of sour liquid into their throat or mouth, especially when they're lying down or sleeping. You may belch, feel bloated or have more saliva than usual. Occasionally, GERD will also give the sensation of a lump in the throat.

Prevention and self-care for heartburn

Heartburn is unpleasant, but you can take steps to prevent it or treat it:

• Eat more frequent but smaller meals. For example, have five or six small meals a day rather than three large meals.

• Some foods are more likely to cause irritation than are others. Determine which foods give you heartburn, and avoid them. Stay away from fatty, greasy or fried foods, coffee and tea, chocolate, peppermint, alcohol, carbonated beverages, very sweet foods, acidic foods such as citrus fruits and juices, tomatoes and red peppers and highly spiced foods.

• Drink plenty of fluids, especially water.

• Don't smoke. Cigarette smoking increases stomach acidity — and, of course, it's bad for your baby.

• Sit with good posture when eating. Slouching can put extra pressure on your stomach.

• Wait an hour or longer after eating before you lie down.

• Avoid eating for two to three hours before you go to bed. An empty stomach produces less acid.

• Avoid movements and positions that seem to aggravate the problem. When picking things up, bend at the knees, not the waist.

• Avoid lying flat on your back. When resting or sleeping, prop yourself up on pillows to elevate your head and shoulders, or raise the head of your bed 4 to 6 inches.

■ Medical care for heartburn

If heartburn is a significant problem, your health care provider may prescribe an antacid to reduce stomach acid. Don't take any antacid or acid blocker without consulting your health care provider, however. Antacids often are high in salt and can increase fluid buildup in body tissues during pregnancy.

Avoid heartburn medications that contain aspirin, such as Alka-Seltzer. Report to your health care provider any history of ulcers, gastrointestinal disturbances or hiatal hernia. Rarely, the problem is severe enough to warrant a procedure called endoscopy to view the inside of your esophagus. When GERD is severe, it can be treated appropriately during pregnancy.

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