Situation: A 30-year-old primigravida at 30 weeks' gestation attends a prenatal check-up at a lying-in clinic. Her pregnancy has been uncomplicated so far. She complains of heartburn after meals and low back pain at the end of the day. She takes the iron–folic acid tablet from the health center each morning. The nurse plans care for her low back pain. Which measures should the plan include? 1. Pelvic tilt exercises done daily 2. Low-heeled, supportive shoes 3. Resting flat on her back with a pillow under the knees 4. Bending the knees, not the waist, when lifting

Back pain in pregnancy comes from increased lumbar lordosis and relaxin-related joint laxity. Pelvic tilt exercises, low-heeled supportive shoes, and good body mechanics relieve it. After 20 weeks she should avoid lying flat on her back because the uterus compresses the inferior vena cava and can cause supine hypotension.

Why the answer is 1, 2 and 4

Pregnancy-related low back pain is not simply “muscle strain.” It develops because the growing uterus shifts the woman’s center of gravity forward, which increases lumbar lordosis—the inward curve of the lower spine. At the same time, rising levels of relaxin loosen the ligaments of the pelvis and lower back, reducing stability and making the joints more vulnerable to mechanical stress. These two changes explain why more than two-thirds of pregnant women experience low back pain, and why the pain typically worsens as pregnancy advances ^[1].

Effective nursing care for low back pain therefore focuses on restoring postural balance, reducing ligament strain, and protecting the lumbar spine during daily movement.

Pelvic tilt exercises work by gently flattening the exaggerated lumbar curve and strengthening the abdominal and gluteal muscles that support the pelvis. When performed daily, they help counteract the forward pull of the enlarging uterus and reduce strain on the lower back ^[4]. This is a core recommendation in conservative management.

Low-heeled, supportive shoes address the postural problem from the ground up. High heels increase lumbar lordosis and shift body weight further forward, while completely flat, unsupportive shoes offer little shock absorption. A low, wide heel with good arch support helps maintain a more neutral pelvic alignment during standing and walking ^[4].

Body mechanics—specifically bending the knees rather than the waist when lifting—protect the already lax lumbar and pelvic joints from sudden flexion stress. Because relaxin loosens the ligaments, the spine is less protected against improper loading. Squatting to lift keeps the back straight and transfers the work to the stronger leg muscles ^[4].

The measure that should not be included is resting flat on the back with a pillow under the knees. After approximately 20 weeks of gestation, the gravid uterus can compress the inferior vena cava when the woman lies supine. This reduces venous return to the heart and can produce supine hypotensive syndrome, with symptoms such as dizziness, lightheadedness, nausea, and a drop in blood pressure. A pillow under the knees does not reliably relieve this compression. The safer resting position is the left lateral position, which shifts the uterus off the vena cava and also improves uteroplacental perfusion.

Measure	Why it helps	Included?
Pelvic tilt exercises	Reduces lumbar lordosis, strengthens support muscles	Yes
Low-heeled supportive shoes	Improves pelvic alignment, decreases forward weight shift	Yes
Resting flat on back with pillow under knees	Risk of vena cava compression and supine hypotension	No
Bending knees, not waist, when lifting	Protects lax lumbar and pelvic joints from flexion strain	Yes

Watch out! Supine positioning is a common distracter in maternity questions. Any option that places a woman beyond 20 weeks flat on her back should be evaluated for inferior vena cava compression, regardless of whether pillows are added under the knees.

Key point! The three correct measures—pelvic tilt exercises, supportive low-heeled shoes, and proper lifting mechanics—all target the two underlying causes of pregnancy back pain: increased lumbar lordosis and relaxin-mediated joint laxity. Conservative, nonpharmacologic strategies remain the first-line approach for managing pregnancy-related low back pain ^[4].