This chapter discusses back pain in pregnancy. Back pain and/or pelvic pain during pregnancy affect approximately 50–70% of women. Because back pain in pregnancy can be caused by any etiology found in the nonpregnant patient as well as obstetric-related causes, the most important step in management is accurate triage and diagnosis. Careful history and physical examination (H and P) are the mainstays of diagnosis. History should include gestational age. Imaging may be beneficial in diagnosing acute emergencies, and may occasionally aid in the diagnosis of nonemergent etiologies. Conservative treatments for pelvic girdle pain and low back pain include exercise (both water and land-based exercise), pelvic belts, transcutaneous electrical nerve stimulation (TENS), spinal manipulation, acupuncture, and complementary medicine. Interventional injections appear to be of low fetal risk and have demonstrated relief to women with pelvic girdle pain, but more studies are needed in this area.