Swelling During Pregnancy

What can cause it?
Swelling or edema can be caused by impaired blood circulation related to an enlarging uterus and baby. Sometimes baby can be positioned in such a way that blood flow is not optimal. It can also happen as a result of being in one position too long. Diet can affect swelling: a diet low in potassium, a high level of caffeine intake or a low salt diet during pregnancy can all lead to swelling. Even the weather can contribute to swelling, warm and humid temperatures can increase a tendency towards swelling. It can be a normal part of later pregnancy for many women. It is common for ankles and feet to swell as pregnancy progresses, especially on days when you are on your feet a lot or when temperatures are warmer.
Other reasons include:

• Increased fluid volume: During pregnancy, your body produces approximately 50% more blood and other body fluids. This extra fluid is essential; it helps create the amniotic fluid, cushions your baby, supplies nutrients, and prepares your body and pelvic joints for delivery.
  

• Hormonal changes: Pregnancy hormones cause your veins to become more relaxed, making them less effective at returning blood to your heart and kidneys. 
  

• Pressure from your growing uterus: As your baby and uterus expand, they put pressure on the veins in your pelvis and legs. This pressure can reduce or slow blood flow back to your heart, causing fluid to leak out of blood vessels and collect in your lower limbs.
  

• Gravity and lifestyle factors: The extra water in your body tends to gather in the lowest parts, especially if you've been standing a lot or if the weather is hot. Long days of activity, a diet low in potassium, or protein can also affect swelling. You might notice your shoes feel tighter and rings are harder to remove as you get closer to delivery.
  

What are the signs that swelling is normal and not concerning?

• Swelling develops gradually.
  

• Swelling primarily affects the lower limbs (legs, ankles, feet).
  

• Worsens at the end of the day or after prolonged standing.
  

• Improves with rest or by elevating your legs. You may find that swelling resolves after sleeping all night.
  

What can I do to reduce pregnancy swelling?

• Elevate your feet and rest.
  

• Stay active with light exercise: Regular walks can improve blood circulation and reduce swelling.
  

• Hydrate Adequately: It might seem counterintuitive, but drinking plenty of water (8-10 cups daily) can actually help reduce swelling by flushing out excess sodium and fluids from your body.
  
• Increase potassium intake. Foods rich in potassium include bananas, oranges, papayas and figs.
  
• Increase protein intake.
  

• Choose comfortable clothing and footwear: Wear comfortable shoes and socks, avoiding anything with tight straps or anything that might pinch if your feet swell. Loose clothing, particularly around the legs and waist, can aid circulation.
  

• Consider compression stockings: These can gently squeeze your legs, promoting blood return and reducing fluid buildup. Put them on in the morning when your lower leg swelling is decreased.
  

• Immerse yourself in water: Soaking your feet in warm water with Epsom salts, or immersing your body in a deep bathtub or swimming pool, can help hydrostatic pressure push fluids back into your veins for excretion by the kidneys
  

• Massage therapy: Massaging your feet from toes to heels to ankles can help.
  

• Avoid prolonged standing or fitting with feet dangling. Take breaks, change positions and get off your feet..
  

• Minimize outdoor time in the heat since hot weather can contribute to swelling. 
  
• Chiropractic care can help with alignment which can help reduce swelling.
  
• Applying cold compresses to areas with swelling.
  
• Avoid wearing heels.
  

When should I be concerned about swelling?
If you experience any of the following symptoms, you should contact your medical provider immediately.

• A sudden increase in swelling, especially in your face, hands, or one leg.
  

• A very bad or severe persistent headache that doesn't go away with rest or medication.
  

• Problems with your vision, such as blurring, flashing lights, or seeing spots.
  

• Severe pain just below your ribs or upper abdominal pain.
  

• Pain in your back just above your hip bones.
  

These can be signs of pre-eclampsia which is a very serious condition that requires immediate medical attention.   

Sources:
Davis, E (2012). Heart & Hands: A Midwife’s guide to Pregnancy and Birth (5th ed.)  Ten Speed Press
Frye, A. (2008). Holistic Midwifery, Vol 1. Portland, OR: Labry’s Press
Sinclair, C (2004). A Midwife’s Handbook. Elsevier Ltd
https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/swollen-ankles-feet-and-fingers/
https://www.medicalnewstoday.com/articles/preeclampsia-swelling-vs-normal-swelling
https://midwivesofnj.com/feeling-puffy-10-ways-to-reduce-swelling-in-pregnancy/
https://americanpregnancy.org/healthy-pregnancy/pregnancy-health-wellness/swelling-during-pregnancy/
https://share.upmc.com/2022/03/is-swelling-during-pregnancy-normal/