“I had acid reflux so badly by the end of my twin pregnancy that I couldn’t lie down at all for the last six weeks,” says Kelly Smith, a mom of two in Minneapolis. “I ate Pepcid every couple of hours and ‘slept’ in a reclining treatment chair from my acupuncture practice. My stomach was so displaced that I could only eat three or four bites of food at a time (like every hour), and often had to choose between eating—since I was always starving (twins)—or drinking water because I had the thirst of a trillion deserts.” Ah, pregnant life with acid reflux. Why is it so, so horrible? And what can you do about it?
What is acid reflux and what does it feel like?
A hot, burning feeling in your chest. The constant need to burp. A feeling of pressure around your throat. An inability to eat or drink without burning in your chest or the feeling of wanting to hurl: This is what acid reflux feels like. Unfortunately, it’s very, very common. “Acid reflux woke me up in the middle of the night,” says Sarah Tucker, mother of one in Los Angeles. “I had to sleep propped up on a wedge pillow my husband called ‘the ski slope.’ Not comfy!” “With my second pregnancy, I took so many Tums I started twitching and having charley horses multiple times a day, and still I got no relief,” says Ashley Patronyak, who lives in New York City with her two boys. “The nurse at my doctor’s office told me there were no other options and to take even more Tums, so I went to Dr. Google for a second opinion, then went to Duane Reade that same afternoon and bought the biggest box of Zantac they had.” “I felt awful all the time, and didn’t want to eat anything because I thought it would make the sensation worse,” recalls Becky Weiss, a physician in LA. “The heartburn was worse at night and I tried not to eat too much at dinner because if I got into bed too soon afterwards, I would feel the acid in my chest.”
What causes acid reflux?
Acid reflux occurs when the acid in your stomach—which should stay in your stomach!—travels back up into your esophagus. This happens because pregnancy causes the body’s musculature, including the esophageal sphincter, to relax. Acid reflux can be particularly bad if you lie down soon after a meal, and it occurs for two main reasons. The first is that your level of progesterone is much higher, which slows digestion down and makes you feel fuller faster. There’s also a basic anatomical reality to it: There’s a lot of pressure on your stomach. “It’s both hormonal and structural,” explains Jocelyn Brown, a licensed and certified professional midwife in Los Angeles. “A woman can make all the lifestyle adjustments in the world, but sometimes they just have to ride it out, and it’s miserable.” For some women, acid reflux is particularly acute in the first trimester, when hormones begin slowing digestion down (so that the fetus can absorb the nutrients in your food). For many women, though, acid reflux begins or noticeably worsens in the third trimester because of the baby’s size and its effect on your stomach’s ability to take in and digest food.
Will acid reflux hurt me or my baby?
The good news is that neither the acid nor the Tums hurt the baby, says Brown. But there is a risk for you: overdoing it on the antacids. “Women go to Tums because it’s easy and they are miserable, but antacids neutralize the hydrochloric acid in your stomach,” she explains. “When the drug wears off, the feeling of heartburn gets worse because your stomach actually needs acid to digest your food. As a result, your body will overproduce it.” This causes a vicious cycle. Sometimes women have this reaction in 20 minutes—they’ll feel great and then instantly worse—or it’ll happen over the course of a few weeks. “If a woman is 39 weeks, I say, ‘pop all the Tums you want.’ But if she’s 24 weeks, I’m worried that the antacids will backfire over time and we look for another solution.” Rachel Sinex Graves, MD, who works in family medicine and obstetrics in Portland, Oregon, agrees that lifestyle changes are always the first approach to treating acid reflux, but she doesn’t think women should suffer unnecessarily by staying away from medication: “There’s enough suffering in pregnancy,” she says. “Acid reflux can add one other thing that can really weigh on people. Women get depressed about their acid reflux! They can’t eat or drink anything, which makes them feel terrible.” Graves also points out that Tums can be an incredibly useful tool for women who feel awful and assume it’s morning sickness. “If a woman is miserable—not sleeping, so uncomfortable she can’t eat; if she’s vomiting or gaining weight—she usually assumes she has morning sickness or hyperemesis, but it might just be acid reflux.” There’s no harm in using Tums to make your life a little easier. Graves says that acid reflux usually goes away right after the baby is born, so taking something for six months to make your life manageable is not the same as taking Tums indefinitely for the rest of your life. One adverse effect it can have, however, is to make you constipated, which can exacerbate the reflux.
Tums don’t work for my acid reflux. Is there anything stronger?
“If women are munching on Tums several times a day, and still symptomatic, then I look at medications,” Graves explains. These medications come in two categories: histamine-2 (H2) blockers, like Zantac, and proton pump inhibitors (PPIs), such as Nexium, Prilosec, or Prevacid, which should only be taken with a prescription.
Will acid reflux medications hurt my baby?
There is very little research on most matters related to medication and pregnant women because pregnant women are usually unwilling to enter a randomized control trial—no one wants anything terrible to happen to their baby! “With all medication, we minimize use as much as possible and don’t use it if we don’t need it,” explains Graves. “But a woman’s level of suffering is really important to take into consideration. Maternal suffering is not good for baby either.” The research shows that if you’re taking a PPI for your acid reflux once a day so you can sleep, the potential for harm is very low. A very recent study published in Pediatrics suggests that acid reflux medications—such as PPIs like Prilosec and Prevacid and H2 receptor antagonists (H2RAs) such as Pepcid and Zantac—can be linked to childhood asthma. “Overall, pregnant women who used PPIs and H2RAs were 45% more likely to have children with asthma than women who didn’t use these drugs during pregnancy,” the study concludes. If you’ve been tossing back the Tums, don’t panic just yet: “Tums are just calcium carbonate,” explains Brown, “so they don’t fall into this category, but some of my moms will graduate from Tums to the PPIs and I can no longer say, ‘don’t worry about it!’” Speak to your doctor before considering more intensive medication.
Reducing (or Preventing) Acid Reflux During Pregnancy
“What is magical for one woman might not work for another woman,” says Brown. “It’s a crapshoot.” As a result, there are a laundry list of things you can try before popping the antacids.
- Avoid triggers in your diet, says Amanda Broomell, a certified holistic health coach. These include acidic citrus drinks (like orange juice and lemonade), carbonated beverages (even La Croix; sorry!), grains and processed foods (breads and cookies), tomatoes and tomato sauce, and anything with hydrogenated oil. It can also be helpful to avoid eating too much meat. Other triggers: chocolate (boo!), onions, garlic, mint, caffeine.
- Instead, Broomell suggests, consume easy-to-digest foods: organic fruits and veggies, bone broth, and organic meat.
- Avoid greasy, fried, or spicy foods. If you eat something spicy, pair it with a cooling food, like cucumbers, avocado, melon, or coconut.
- Eat smaller portions. Remember Kelly with the twins? She could only eat a bite or two an hour. You may not be that desperate, but it’s best to go easy. The more food in your (already cramped) stomach, the harder it will be to digest it.
- Get some protein in. Make sure you get protein in every meal—and even with snacks (almonds are a great one).
- Chew, chew, chew. Broomell recommends chewing 30 to 40 times with every bite. It’s easier to process if the food has already turned to liquid when it gets to your stomach.
- Suck on hard candies. Lemon and ginger can be especially helpful.
- Chew gum. “I couldn’t go anywhere without Tums and Orbit gum,” says Megan Heuer, a mom of one in New York City. (For natural gum, we love Simply Gum.) This can be particularly helpful right after a meal.
- Try drinking organic raw unfiltered apple cider vinegar (it must be organic, raw and unfiltered). Broomell suggests 1 tablespoon in a cup of water 10 minutes before a meal. “Apple cider vinegar supports the digestive system, has natural probiotics, as well as acids and enzymes that restore a natural pH,” she explains. Try it by itself for a week—just so you can be clear about whether it’s working—then add in other remedies over time so you can figure out what’s really working.
- A digestive enzyme can be super helpful. It can boost the digestive process. We need hydrochloric acid to digest meat, and this can move that process along.
- Take a probiotic. This can help maintain good gut flora, but there is some controversy over how effective it is for acid reflux in pregnancy because nothing can change the fact that you have an 8-pound baby pressing on your stomach! But there’s no harm in taking one. If it’s too costly, Graves recommends either eating good yogurt with active cultures or taking ¼ teaspoon of baking yeast.
- Food relief: Try raw almonds, coconut water, aloe vera juice, ginger tea, fennel tea (steep for 10 minutes), and papaya.
- Sleep propped up or on your left side. Stack pillows, or sleep in a La-Z-Boy if you have to. Lying on your right side actually positions the stomach higher than the esophagus, which can cause even worse heartburn.
- Eat pickles! There’s a reason women often crave them, explains Brown. They are very acidic and help with digestion—so do all pickled foods. “A woman’s body usually craves what she needs in that moment,” she says. (Tell that to anyone who side-eyes you for your third chocolate shake of the week.)
- Wear loose-fitting clothing. Wearing tight bras or waistbands that squeeze can also make acid reflux worse.
- Breathe slowly and deeply. Focus on your breathing; you may be surprised by what breath exercises can do for you.
- Go for a short walk after eating to stimulate the digestive system (exercising heavily after meals, however, may contribute to heartburn).
- Try an herbal tea. Teas that contain even trace amounts of peppermint, chamomile, ginger, licorice root, and catnip can help the stomach lining repair itself and improve digestion.
Can I use essential oils for acid reflux during pregnancy?
Essential oils aren’t a cure for acid reflux, but Broomell says that they can help support healthy digestive functioning. “Essential oils are one component of overall lifestyle shift,” Broomell explains. “If people are consuming acidic food and drinks, it’ll be hard to slap on essential oils and feel great.” You should always consult your doctor before using oils during pregnancy. Broomell advises women in the first trimester to stay clear of ingesting them, but even smelling or diffusing them can make a difference if you’re really suffering. The most powerful oils for digestion are ginger, cardamom, and peppermint. You want to dilute these with fractionated coconut oil (FCO)—1 drop of each oil in 4 to 5 drops of FCO—and you can apply them to the back of your neck, behind the ears, or inhale it. Dealing with acid reflux is never fun, but when you’re pregnant it’s even worse. Hang in there, mama. Soon you’ll have your sweet babe in your arms—and hopefully no more acid reflux to boot!