# 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

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629373  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

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

## 보기

1. 1, 2 and 3
2. 1, 2 and 4 **✔ 정답**
3. 1, 3 and 4
4. 2 and 4

**정답: 2**

## 해설

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.

## 심화 해설

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].References (research sources)

- [1]Interventions for preventing and treating low-back and pelvic pain during pregnancy.Research articleLiddle SD, Pennick V (2015) · DOI: 10.1002/14651858.CD001139.pub4

- [4]Identification and management of pregnancy-related low back pain.Research articlePerkins J, Hammer RL, Loubert PV (1998) · DOI: 10.1016/s0091-2182(98)00032-9

## 임상 시나리오

Pregnancy Low Back Pain ManagementSafe positioning and posture strategies after 20 weeks
Pregnancy back pain results from increased lumbar lordosis and relaxin-related joint laxity. Effective care includes pelvic tilt exercises daily, wearing low-heeled supportive shoes, and using proper body mechanics such as bending the knees rather than the waist when lifting.

Avoid lying flat on the back after 20 weeks gestation because the gravid uterus compresses the inferior vena cava, which can cause supine hypotension. A pillow under the knees does not eliminate this risk.

CautionDo not recommend supine rest even with knee support for patients beyond 20 weeks. If the patient reports dizziness, nausea, or lightheadedness while lying down, reposition her to a left lateral or semi-sitting position immediately.

## 핵심 개념

- **Pelvic tilt exercise** — Gentle exercise that flattens the exaggerated lumbar curve and strengthens abdominal and gluteal muscles to reduce low back strain in pregnancy.
- **Lumbar lordosis** — Increased inward curvature of the lower spine during pregnancy due to forward shift of the center of gravity from the growing uterus.
- **Relaxin** — Hormone elevated in pregnancy that loosens pelvic and lower back ligaments, reducing joint stability and contributing to back pain.
- **Supine hypotension** — Drop in blood pressure when lying flat on the back after 20 weeks gestation due to compression of the inferior vena cava by the gravid uterus.
- **Body mechanics** — Use of proper posture and movement patterns, such as bending the knees instead of the waist when lifting, to protect the spine.

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