Tuesday, February 26, 2013

" I am in my third trimester and I can't get my shoes on! "

As your pregnancy progresses swelling of feet and ankles and even fingers can be an annoying problem. Most of us have heard or read that swelling can be a red- flag for more serious issues in pregnancy. "When should I call the provider about swelling?" is a very common question during childbirth preparation sessions.

Many things cause swelling of extremities as pregnancies progress. We retain more fluid during pregnancy and make a lot more blood to nourish the fetus. That ever enlarging uterus ( and fetus ) puts a lot of pressure not only on your pelvis and back but your entire venous system which makes it more difficult for blood to return to your heart. Often we have to be proactive about literally encouraging that blood back to the heart.  Heat is a factor. Hormones play a huge role. Are you getting tired of hearing to drink more water?

Sudden or extraordinarily increased swelling warrants a call. As does severe headaches, swelling in only one ankle ( and especially with redness and tenderness in that same leg ), rapid weight gain, blurred vision  and what we call epigastric pain, not heartburn but severe pressure under your sternum. I often remind my clients that you are not issued a call-coupon book with your first prenatal appointment. You are entitled to unlimited calls.

Do not call for diuretics, like you mom may have. Put your feet up whenever you can, at work and at home. Above the level of your heart if possible, this enables blood to flow back to return to the heart, back to the kidneys for excretion. Don't cross your legs. If you must stand for long periods, move your feet around, rotate your ankles, shift your weight. In bed, sleep with your feet up on pillows and it never hurts to lie for while on your left side. If you must, retire your rings before it's too late to remove them and must visit the ER for help. If you are concerned about the absence of your rings, wear them on a chain around your neck.

Drink lots of water. About two liters. Sounds counter-intuitive, but it is not. More when you exercise and you really should be exercising, you know that. Swimming is great, the pool is a life-saver and not just for relief when the weather is hot. Just the compression of the water when you stand in the water may make a difference, like compression hose.

Foot massage ( time for your partner to hone those skills for labor anyway ) and cold compresses might offer relief from discomfort and again help that blood and fluid move back to the heart.  Almost all of the time swelling is just considered an inconvenience at best and painful, of course, during pregnancy. But every once and awhile it is a red- flag and bed- rest, medical intervention and increased medical supervision is a MUST. When in doubt about swelling, call your provider.