Oedema in Pregnancy

By Lindsay Furness, Pregnancy Massage practitioner with Bristol Massage Therapy

What is Oedema and what causes it in pregnancy?

Oedema is a collection of fluid in the spaces between cells of the body. The swelling, or edema, is from excess fluid that collects in your body tissues.

It’s normal to have a certain amount of swelling during pregnancy, particularly in your ankles and feet, because you’re retaining more water. Changes in your blood chemistry also move fluid into your tissue.

Also, your growing uterus puts pressure on your pelvic veins and your vena cava (the large vein on the right side of the body that carries blood from your lower limbs back to the heart). The pressure slows the return of blood from your legs, causing it to pool and force fluid from your veins into the tissues of your feet and ankles.

Hormonal changes, such as an increase in the levels of progesterone, estrogen, hCG, and prolactin, lead to changes in vascular permeability, leading to edema.

Towards the end of the day, the extra water tends to gather in the lowest parts of the body, especially if the weather is hot or if you have been standing a lot. The gradual swelling isn’t harmful to you or your baby, but it can be uncomfortable.

Towards the end of your pregnancy, the swelling may also affect your hands. If you’re wearing rings, they may feel tight on your fingers, and you may have to stop wearing them for a while.

This extra retention of fluid is needed to soften the body, which enables it to expand as the baby develops. Extra fluid also helps prepare the pelvic joints and tissues to open for delivery. The extra fluids account for approximately 25% of the weight women gain during pregnancy.

How common is swelling in pregnancy and when should you be concerned?

Swelling in pregnancy is very common, particularly in the third trimester.

Up to 80 per cent of healthy pregnant women have swelling of the lower legs in late pregnancy. Although swelling in pregnancy is normal – and annoying – it’s not usually a worry. However,

very occasionally it can be a sign of serious illness.

If you have sudden or severe swelling in your face, hands or feet, call your doctor or midwife. It could be a sign of pre-eclampsia, which is a serious condition for you and your baby.

Nutritional advice to reduce swelling

During pregnancy, you must opt for healthy diet rather than relishing on junk foods. Include a lot of fruits and vegetables in your diet. Cut down on sugar, salt, and fats. Avoid processed and pre-packaged foods. Ensure that you eat food rich in vitamin C (potatoes, pepper, broccoli, and tomatoes) and vitamin E (wheat germ, sunflower seeds, sweet corn, and nuts). Include foods rich in antioxidants (cranberries, blueberries, raspberries, artichokes, and prunes), and potassium (green beans, sweet potatoes, clams, bananas, and molasses).

While it may seem counterintuitive, drink plenty of water throughout your pregnancy. Water rids waste from your body and reduces water retention. Drinking plenty of fluids, at least 6-8 glasses of water or juice per day will help flush out excess fluids by keeping the kidneys functioning normally.

Protein

Protein helps build, repair and maintain body tissues and cells. This important nutrient also helps your body produce hormones and enzymes. Protein plays an important role in regulating and balancing the amount of fluid in your tissues, as well as making your muscles contract. Protein consists of various amino acids that work together. Protein requirements vary between individuals, depending on your size and sex. Women of average height and weight require 46 grams of protein per day, while most men require about 56 grams of protein. A variety of foods -- including beans, nuts , whole grains, vegetables and lean meat -- all boost your protein intake.

Massage for edema

Massage therapy works by directing pressure to the skin and muscle areas affected by edemea. The lymphatic system is activated during the process and the fluid drains away naturally.

The activation of the lymph nodes is the key to getting the body to naturally drain away the excess fluid accumulation that causes edema.

You have to think of the swollen foot or ankle as being the end of the line, and you want to send the blood flowing upward, back the way it has come. The massage should start from the feet and move up toward the calves and thighs. The upward strokes will help to draw the blood and fluid away from the ankles and feet to reduce the swelling.

The most common techniques used to reduce swelling include effleurage, deep strokes and lymphatic drainage.

Effleurage is often used to help reduce swelling. Effleurage involves applying a gentle pressure to the treatment area using flattened hands and fingers. The gentle pressure used throughout effleurage means that areas that are tender to touch can still be treated. Effleurage is used to gently push the excess fluids within swelling towards glands located at different areas in the body such as armpit, groin and behind the knee. Pushing excess fluids towards different glands within the body using long, direction strokes within effleurage helps to remove them from the body. Removing excess fluids from the body reduces swelling.

  1. Start by massaging the feet only - in an upwards motion go from the toes up to the ankle. Keep firm, steady pressure and repeat for 3-7 minutes.

  2. Next, massage from the ankle to the knee. Again, use steady pressure with both hands wrapped around the leg (as much as is comfortable) and make single strokes in one fluid motion. Do this for anywhere from 5-10 minutes.

  3. Finally, massage from the knee up the thigh. Continue to keep steady pressure and retain fluid motions, alternating positions so the whole leg is massaged. Repeat for 3-7 minutes.

Foot exercises

You can do foot exercises sitting or standing. They improve blood circulation, reduce swelling in the ankles, and prevent cramp in the calf muscles:

  • bend and stretch your foot up and down 30 times

  • rotate your foot in a circle eight times one way and eight times the other way

  • repeat with the other foot

Photo by Erandy Ramirez on Unsplash