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Put Out The Fire

It was heartburn that got me in the end. I could take the swelling, the back pain, the constant trips to the bathroom, the itchy skin, the fatigue, the sweating, the sleeplessness, and even the psychological shock of seeing the scale tip 200 pounds. But the constant, searing pain of heartburn made the miracle of pregnancy seem more like a curse--by the middle of my third trimester, my mantra had changed from "Please, let him be healthy!" to "Just get him OUT!"

That fiery sensation known as heartburn happens when the lower esophageal sphincter (LES), a muscle responsible for keeping stomach contents in their place, begins to relax or leak. This allows stomach acids to flow upward into the esophagus, explains Suzanne Trupin, M.D., clinical professor of obstetrics and gynecology at the University of Illinois at Urbana-Champaign. Pregnant women are prime candidates for two reasons: First, the hormone relaxin--busy limbering up your joints and connective tissue for an easier delivery--slows your digestion, meaning food stays in your stomach longer and triggers more acid production. Second, your growing baby exerts pressure on both the stomach and the LES, increasing the chance that acids will be pushed up into the esophagus.

So what's an expectant mother to do? Follow these five tips to relieve the pain:

1. eat less, more often.
Overeating exacerbates heartburn, says Rachel Brandeis, M.S., a registered dietitian in Atlanta who specializes in prenatal nutrition. "When you're pregnant, there's less room for your stomach to expand," she explains.

Instead of three meals a day, aim for six mini-meals of no more than 1 1/2 cups of food each, Brandeis recommends. Here's a sample day:

1 cup of oatmeal with nonfat milk and 1 apple
1 cup of yogurt with fruit
1/2 of a peanut butter and jelly sandwich and 1 cup of vegetable soup
1 handful of whole-grain crackers and 1 ounce of your favorite hard cheese
2 ounces of chicken and 1/2 cup of mashed sweet potatoes
1/2 cup of cottage cheese with fruit

2. eliminate trigger foods.
Identify the foods that intensify your heartburn and banish them from your diet. While there are no universally "banned" foods, common heartburn triggers include acidic foods such as citrus fruits and tomatoes, greasy or fried foods, spicy foods, chocolate, coffee and carbonated beverages, and alcohol (which you should eliminate anyway!).

3. focus on fluids.
"Liquid-y foods are less likely to cause problems than solids, since they move through the stomach more quickly," Brandeis says. Soups, smoothies, yogurt, milkshakes, protein shakes and puddings are good choices. Look for liquids that offer plenty of protein such as milk, soymilk and drinkable yogurt. And aim to make solids a little less so: "Chew solid foods slowly and extremely well, until they're almost liquefied," Brandeis adds.

4. sleep smart.
To avoid nighttime heartburn, don't eat anything for at least three hours before bedtime. In bed, elevate your head and shoulders 6 to 8 inches to help keep stomach acids where they belong--you can prop yourself up on pillows or a wedge, or put books under the head of the bed. And if you're not already sleeping on your left side, start now; stomach acids will have to travel uphill to reach the esophagus--no easy feat!

5. a time for Tums.
It's fine to find relief in a bottle of Tums or Rolaids or other calcium-containing antacid. However, "too much calcium can block iron absorption, so don't take Tums at the same time you take your prenatal vitamin," Brandeis advises.

And a word to the wise: Don't go crazy with the stuff. By the time I gave birth I estimate I'd ingested my own considerable body weight in tropical fruit-flavored Tums Smoothies. This overuse created calcium overload, which may have exacerbated my anemia (another dubious gift of the third trimester)--or at the very least rendered the prescription iron medication I was taking ineffective, leaving me weak. If you're reaching for the antacids 10 times a day (or more--as I was), talk to your doctor: She may want to check for ulcers or a hiatal hernia (where part of the stomach protrudes into the chest cavity), or prescribe medication.