Pat Thomas with safe and sensible options for treating heartburn in pregnancy

Which is the most uncomfortable symptom associated with pregnancy? In any group of women, heartburn will certainly get its share of votes. It doesn't help that it comes on late in pregnancy, when you're feeling cumbersome and getting bigger every day.

You don't have to be pregnant to get heartburn, but body changes in pregnancy, which put extra pressure on your stomach, can make it an odds-on occurrence (obesity, and chronic constipation can have the same effect). Also, increased levels of hormones in your body have the effect of softening the ligaments that normally keep the valve between the oesophagus and stomach tightly shut. When this happens, food and gastric acid can come back up your throat. The lower part of your throat is sensitive and easily irritated by acid. This irritation is what causes that characteristic burning sensation under your breastbone.

What to do

Over-the-counter remedies for neutralising stomach acid can be helpful. But using them too often and for too long can cause constipation (if they contain aluminium) or diarrhoea (if they contain magnesium).

If heartburn is getting you down, eating small, frequent meals is a good first step. The wisdom of this will become more apparent as you get bigger and your stomach gets squeezed into a smaller space. Don't eat too late at night - give yourself at least two hours to digest your evening meal - and since digestion begins in the mouth, help to relieve the burden on your stomach by chewing your food well.

The kinds of food you eat may also be important. Cut out spicy, greasy, sugary or acidic foods. Some women find that not drinking with a meal helps, since sometimes this can dilute digestive juices. Instead, try sipping a herbal tea such as dill or fennel after a meal to aid digestion (avoid coffee and tea since this can increase stomach acidity).

When you put your feet up, keep your head raised above your feet. If heartburn is particularly bad at night, try using blocks to raise the head of your bed by 5 or 6 inches. Also try to lie on your left side rather than your right. This is because the oesophagus enters the stomach from the right. When you lie on your right side it is easier for food and acids to flow down into your oesophagus.

If you smoke, consider stopping. Nicotine weakens the muscles in the oesophagus that prevent acid backing up. This may be one reason why pregnant smokers seem to experience heartburn more severely than others.

During the day try chewing gum to stimulate saliva. This can help neutralise stomach acid. You might also try to avoid tight-fitting and restrictive clothes that press on the abdomen.

Herbal remedies may also be helpful

Slippery elm powder (available from health food shops) is a soothing herb, which can be taken as a lozenge or mixed into a drink. Ginger, which is also good for nausea, can help. Take it in capsule form or as a tea made from 1-1½ teaspoonfuls of freshly-grated ginger root steeped in a cup of boiling water. Simmer for 10 minutes, strain, allow to cool and drink as needed. Teas made from meadowsweet, peppermint, lemon verbena, camomile and marshmallow may also be helpful.

WARNING: Take care which herbs you use during pregnancy

Hops, rue, gentian and golden seal are sometimes recommended to ease heartburn, but they should not be used during pregnancy. If you are unsure about any herbal preparation, always consult a qualified herbalist.

Homeopathy can be another gentle way to address heartburn

• If your symptoms are accompanied by flatulence and bloating, and are better after belching, cool air and fanning yourself, but worse in the evenings, after eating, fatty foods, coffee or milk, and in warm, damp weather, try Carbo Veg 6C. Take as directed on the package at the first sign of heartburn
• If it feels like a stone in your stomach, you have a bitter taste after burping, and symptoms are better in the evening and after sleep or rest, heat and firm pressure, but worse in the morning on waking, after meals, coffee, alcohol, spices, cold dry weather and stress, consider using Nux vomica 6C
• If you have dyspepsia and no thirst, feel better in the cool open air, after cold food or cool applications, gentle movement and from receiving sympathy, but worse in hot stuffy rooms, humid conditions, too many layers of clothing, lying on the left side, eating rich or fatty foods or emotional upset, use Pulsatilla 6C.
• A homeopathic remedy that may also help tighten oesophageal muscles softened by pregnancy hormones is the tissue salt Calc fluor. Take as directed on the pack.