The Burn!!Prenatal Heartburn: What Is It, and What To Do About It.

What is it

Heartburn is an extremely common pregnancy discomfort. It is caused by the digestive fluids in your stomach backing up into your esophagus, which causes an acidic, burning sensation, often accompanied by an acrid taste. It can manifest in a variety of ways, including:

• A fiery feeling in your chest or throat

• An burning taste in your mouth

• A gnawing sensation in your stomach

• A cough

• An acidic throat

What causes it

Heartburn during pregnancy is caused by hormonal changes. Large amounts of the hormones progesterone and relaxin soften our smooth muscles and slow down our digestion. The purpose of this is to prolong the digestive process to maximize foetal nutrition: our body has more time to divert nutrients to the baby when we digest more slowly. The downside is that this can cause heartburn, also known as acid reflux, or a burp-back, in which stomach acid rises in the back of our throat:

Heartburn occurs when the ring of muscle that separates the esophagus from the stomach relaxes (like all the muscles in the GI tract), allowing food and harsh digestive juices to back up from the stomach to the esophagus.

These stomach acids irritate the sensitive esophageal lining, causing a burning sensation right around where the heart is located; thus the term heartburn, though the problem has nothing to do with your heart.

From   What to Expect 

While some pregnant people never experience heartburn, for others it can range in severity from mildly uncomfortable to distractingly painful.

What doesn’t work very well

The most common approach to dealing with pregnancy heartburn is actually the least likely to be effective; Antacids. Or rather, they may help in the short term but ultimately they can make matters worse. 

Antacids, such as TUMS, work by inhibiting digestion. Stomach acids are generated to break down our food so that it can be absorbed by the intestines. Pregnancy slows this process down, and relaxes the ring that usually keeps digestive acids down in our stomachs. This can result in that fiery burp-back feeling we get when the acids rise up, causing the familiar burning sensation in our chests and throats: heartburn. 

Antacids such as TUMS are meant to control excess stomach acids, which is the cause of regular heartburn. But in pregnancy, we don’t have excess stomach acids. Our problem is almost the opposite: our digestive system is relaxed, rather than overactive. Thus, the result of using TUMS is that we reduce or neutralize our available stomach acids, which provides immediate relief, but compounds and exacerbates the cause, so that heartburn is likely to get worse and worse the more we use them. 

While acid-suppressing drugs may offer temporary relief of the symptoms of heartburn, antacids create many more problems. By alkalizing the lower stomach (antrum), the hormone gastrin is released, causing a huge rebound output of acid, thereby requiring more antacids to neutralize the increased acid output in response to the gastrin. Eventually, the partial cell mass that manufactures the acid ceases to function normally, resulting in low stomach acid (hypochlorhydria) or worse, no stomach acid (achlorhydria).

From  Brenda Watson

Even though antacids are considered safe for pregnancy, they are not a very effective or helpful longterm tool. While they appear to provide relief in the moment, antacids interfere with the digestive process, which causes increasingly severe heartburn with prolonged use. This can elevate the risk of a few secondary problems, including:

• Poor nutrient absorption, caused by interference to digestion

• Water retention, resulting in swollen ankles or oedema

• Food sensitivities, resulting from a frequency of poorly digested foods

• Low iron absorption, caused by the calcium in antacids

• Kidney stones, caused by the shift in PH from frequent antacid use, making the body overly alkaline 

While antacid use does not directly cause any of these problems, it can elevate the likelihood of them occurring. (From Mom Junction)

Remedies for heartburn

So what can we do when heartburn strikes? Here are a few home remedies you can try. Different approaches work for different people, so don’t be discouraged if the first few don’t provide much relief. Chances are that at least one of the suggestions on this list will help.

Commonly known remedies

• Eat small portions more frequently. Rather than eating large meals in a single sitting, try a grazing approach throughout the day.

• Avoid trigger foods. If you notice that spicy or acidic foods cause your symptoms, try avoiding them for a while.

• Stay upright for some time after eating. Or even better, go for a short walk. This will allow gravity and motion to assist in the digestive process.

• Drink lots of water, all day.

• Avoid alcohol, which is known to exacerbate heartburn.

Less-commonly known remedies 

• Chew more. Chew your food until there’s no texture left at all. This encourages your digestive acids to accumulate so that your food will be processed more thoroughly. Chew as much as you can.

• Chew gum right after eating. This has a similar effect and will help your body digest.

• Avoid beverages while eating. What? True! Drink lots of water all day, but not during meals. Digestion of nutrients can actually be diluted by drinking water along with food, so try separating the two.

• Apple cider vinegar. Try using ACV with your food, or putting a dash in your water. It helps break down food to facilitate digestion. Lemon juice can work too.

• Eat almonds, or almond milk. Almonds help soothe stomach acids, so these can provide some relief.

• Eat papaya. There is an enzyme in papayas that can be extremely helpful for heartburn. Either eat papayas (fresh, dried, frozen) or take papaya enzyme capsules.

• Drink aloe vera juice or syrup between meals. Some people report that this provides immediate relief.

• Herbal teas that help: Peppermint, licorice, ginger, fennel, marshmallow root. You can also add these herbs/roots to cold water, or chill the tea.

• Lozenges that help: Slippery elm, ginger. Suck on them between meals.

• Take probiotics, or eat probiotic foods. These improve gut health which can also improve your resistance to heartburn.

As with any pregnancy symptoms, please seek the advice of your caregiver if you are not sure if what you’re experiencing is actually heartburn, or if you have any other concerns about your health. 

Heartburn is a very common annoyance during pregnancy that affects a majority of people (about two thirds of pregnant people). While it might provide some small consolation to know that you are not alone, we hope one or more of these remedies also provides actual relief. Commiseration can speak to the heart, but solutions can lessen the burn.

Stephanie Ondrack is a retired birth doula (or maybe on an extended sabbatical) and has been with The Childbearing Society since 2003. She lives in East Van with one partner, four kids, four chickens, and five cats. You can read more of her rants on birth, parenting, and learning at www.thesmallsteph.com