Every pregnancy comes with its own set of unique quirks and challenges, but heartburn is one of the most unpleasant and uncomfortable. When it is really bad, it can motivate some women to swear they will never get pregnant again, and pray for time to move faster so they can get that baby out of them.
Sometimes it can be so bad that mom stops eating out of fear of the pain. This brings on a whole new set of difficulties. Malnourishment is something you definitely want to avoid during pregnancy – both for the growing baby, and for mamma.
So I’m going to give you a battle plan for avoiding and fighting heartburn as best you can. But first, let’s take a look at the reasons why it can occur, and why it may be worse for some women.
What causes heartburn?
Before we get into the nitty-gritty details, we must dispel some myths about heartburn. The most common belief regarding heartburn and acid reflux, is that it is the result of too much stomach acid (hydrochloric acid). Sufferers often devour antacids in an effort to ease their symptoms.
The truth is that acid reflux is very rarely the case of too much hydrochloric acid. Heartburn occurs when the lower esophageal sphincter (between the bottom of the esophagus and the top of the stomach) fails to close properly, allowing food and hydrochloric acid to push up into the esophagus, causing the burning pain of acid reflux.
And guess what triggers the closing of that sphincter? Hydrochloric acid. So if you don’t have enough hydrochloric acid in your stomach, that little sphincter won’t be closing properly, and you’ll experience heartburn.
And the great majority of us have insufficient hydrochloric acid production, especially as we get older.
So now that we know the basic mechanism of how heartburn happens, let’s look at why it is so common during pregnancy.
There are two main triggers for heartburn during pregnancy (note: this only applies to pregnancy heartburn, not heartburn at any other time).
They are: Hormones, and mechanics.
Three main hormones produced heavily during pregnancy affect digestion. They are estrogen, progesterone and relaxin.
Estrogen decreases the production of hydrochloric acid in the stomach – which we know is most often the contributing factor to the development of acid reflux. The lower esophageal sphincter won’t be triggered to close properly, and heartburn can occur.
Progesterone acts to relax muscles and tissues during pregnancy, including that lower esophageal sphincter, leading to the same outcome as with high estrogen – the sphincter doesn’t close enough to prevent food from entering the esophagus.
Relaxin is a very well-known pregnancy hormone, and from the name, you may have guessed its function. It relaxes everything – muscles, ligaments, organs, skin – everything becomes loosey-goosey (which allows for an easier delivery and room for baby to grow). So not only does this hormone work in tandem with progesterone to relax the lower esophageal sphincter, but it also relaxes digestion. This means that food stays in the stomach a bit longer than normal, giving it more of a chance to be regurgitated into the esophagus.
Additionally, the growth of the baby pushing on the stomach can put a lot of stress on digestion, and physically push food upwards into the esophagus from the stomach. This is more common towards the end of pregnancy.
What to do about it?
There are many ways to deal with acid reflux, and the correct course of action will depend on what specifically is causing your heartburn. If heartburn is occurring in the early stages of pregnancy, you can be pretty sure it is hormone-related, whereas if it is only occurring at the end of a pregnancy, it could be simply mechanics.
If you experienced heartburn before pregnancy, you are much more likely to struggle with it during pregnancy. This may indicate that your digestion needs some TLC, and you are most likely not producing enough stomach acid.
Here are some tips to support healthy digestion and prevent hormone/stomach acid – related heartburn:
- Eat smaller meals, more frequently. Large amounts of food will be digested slower, and be more likely to push up on the lower esophageal sphincter – especially in the later stages of pregnancy when the stomach shrinks.
- Chew and eat slowly. This is a general suggestion for better digestion, especially if you have low stomach acid. The less hydrochloric acid you have, the less amount of food your stomach will be able to process properly at any given time.
- Practice proper food combining. The theory goes that some foods get digested faster than others, such as fruits, sugars, and liquids. These foods should be consumed on an empty stomach so they don’t get held up by the processing of more complex foods (which can lead to fermenting, causing gas, bloating, and general indigestion). The most important rule of food combining to follow to prevent heartburn, is to drink fluids in between meals, as opposed to with a meal. Small sips of water or other liquids are okay with food, but be sure to drink the majority of your fluids on an empty stomach.
- Keep a food journal and try to figure out which foods trigger your heartburn. This will be different for everyone, so keep track of which foods you eat and which symptoms you experience throughout the day. Look for patterns, and do this for as long as it takes to narrow down your individual triggers.
- A teaspoon of apple cider vinegar (raw and with the mother in it) in a small glass of water before a meal helps to stimulate hydrochloric acid and enzyme production in the stomach. It also helps stimulate bile production. So overall, digestion will be more efficient and complete, and the increased stomach acid should be enough to trigger that sphincter to close and not allow any back-flow up the esophagus.
- Ginger, fennel and peppermint teas are also very beneficial to digestion and can help soothe the digestive tract.
- Consuming more fluid foods also helps speed up digestion and prevents food from lingering in the stomach. Try smoothies, soup, bone broth, tea and yogurt.
If your heartburn is more mechanical, and you are at the end of your pregnancy and your baby is putting lots of pressure on your stomach, here are some ways to help prevent heartburn in this situation:
- Don’t lie down after meals. Stay upright for at least 2-3 hours following a meal to allow gravity to help prevent acid reflux.
- If heartburn only occurs at night when you are sleeping, try propping yourself up with lots of pillows so that your upper body is above your hip level. Also try not to eat any food within 3-4 hours of going to bed.
These recommendations should help most women overcome their heartburn. Above all, try to resist the temptation to take antacids. As we have seen, too much stomach acid is rarely ever the problem, and depressing hydrochloric acid production even further with antacids will exacerbate heartburn over time.