Here is what mums asked our midwives this week: tightening and pelvic pressure at night in the third trimester

As you get closer to your due date, your body has a way of making its presence very known, particularly at night when you are trying to rest and your baby decides it is the perfect time to get active. This week a mum at 36 weeks asked us about the tightening and pelvic pressure she had been experiencing at night when her baby was moving. Here is what our midwives had to say.

Is tightening and pelvic pressure normal at 36 weeks?

Yes, and it is one of the most common complaints we hear from mums in the third trimester. By 36 weeks your baby is running out of room, and every movement they make has a much bigger impact on your body than it did earlier in pregnancy. When your baby moves, it can irritate the uterus and cause it to tighten. This is completely normal and not a sign that anything is wrong.

The pressure you feel in your pelvis at this stage is also very common. Your baby is larger, heavier and likely in a head-down position, which puts significant pressure on your pelvis and the surrounding area. Many mums find this pressure is worse at night when they are lying down and the body is no longer upright to distribute the weight differently.

What about pelvic girdle pain?

Pelvic girdle pain, sometimes called PGP or symphysis pubis dysfunction, affects up to one in five pregnant women and can cause pain over the pubic bone, across the lower back, in the perineum and spreading into the thighs. Some women also feel or hear a clicking or grinding in the pelvic area. PGP can make walking, going up stairs, turning in bed and getting in and out of the car particularly painful.

If you have been experiencing pelvic girdle pain, tightening and pressure in the third trimester can sometimes feel similar, or it can feel like a different sensation altogether. Both can be present at the same time. If you notice a change in how your symptoms feel, mention it to your midwife at your next appointment. This is always the right thing to do.

If your pelvic pain is making it hard to move around, getting out of bed or a car is painful, or going up and down stairs is difficult, speak to your midwife or GP. You may be referred to a physiotherapist who specialises in obstetric pelvic joint problems. Getting diagnosed as early as possible can help keep pain to a minimum and avoid long-term discomfort.

What can help with tightening and pressure at night?

There are a few things that can make a real difference to how comfortable you feel in those final weeks.

A pregnancy pillow is one of the most helpful things you can invest in at this stage. Placing a pillow between your knees when lying on your side takes pressure off your pelvis and hips and can significantly reduce discomfort overnight. Sleeping on your left side is generally recommended from 28 weeks as it improves blood flow to your baby and reduces pressure on major blood vessels.

Changing position when you feel the tightening can help to ease it. If you are lying flat, rolling onto your side or propping yourself up slightly may reduce the sensation.

Staying well hydrated throughout the day is also important. Drinking two to three litres of water over the course of the day supports your body and can help ease some of the physical discomforts of late pregnancy. Try to spread your fluid intake throughout the day rather than drinking large amounts in the evening, which can add to the nighttime wake ups.

If you have been diagnosed with pelvic girdle pain, your physiotherapist may recommend a pelvic support belt to help ease your pain, or crutches if moving around has become very difficult. There are also simple things you can do at home to help, including wearing supportive shoes, putting equal weight on each leg when standing, sitting down when getting dressed or undressed, and avoiding lifting heavy objects.

Gentle movement during the day such as walking or pregnancy yoga can also help to ease pelvic pressure and discomfort, though always avoid anything that makes the pain worse.

Planning for birth with pelvic pain

If you have pelvic girdle pain, it is worth having a conversation with your midwife about your birth plan. Most women with PGP can have a vaginal birth. Being in water can take the weight off your joints and allow you to move more easily, so a water birth is worth discussing with your midwife if this appeals to you. Write in your birth plan that you have PGP so that everyone supporting you during labour is aware and can help you find the most comfortable positions.

When should I seek help?

While tightening and pelvic pressure at this stage is usually normal, there are signs that warrant contacting your maternity unit straight away. If the tightening becomes regular and rhythmic, it could be a sign of early labour. If it increases in intensity, becomes painful, or is accompanied by any bleeding, a change in your baby's movements, your waters breaking, or any other symptoms that concern you, do not wait — call your maternity unit immediately.

At 36 weeks you are considered nearly full term, so even if it does turn out to be the start of labour, you and your baby are in a good place. Never feel like you are wasting anyone's time by calling. You know your body better than anyone.

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