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Back pain is common in pregnancy, can be very debilitating and can worsen in later pregnancy. Estimates of prevalence ranging from 35% to 61% have been reported, with half or more beginning from the fifth month. Back pain is believed to be caused by changing posture and can be worse in the evening. Low to moderate quality evidence indicates that there is benefit from exercising in water, massage therapy, and back care classes. There is a small amount of evidence to suggest that acupuncture, craniosacral therapy, osteomanipulative therapy or a multi-modal intervention (manual therapy, exercise and education) may also be of benefit. Back care classes for pregnancy include a variety of exercises and guidance. General exercise that is not tailored to strengthen the back may not prevent or reduce back pain, but more research is needed to be sure. Maternity support belts have not been shown to reduce low back pain in pregnancy. They may have some adverse effects, including pain and skin irritation for the mother, and potential effects on the fetus.