Dr Danie Schneider
Obstetrician and Gynaecologist, Somerset West

Swollen limbs in Pregnancy

Why do my feet swell?

Your body produces approximately 50% more blood and body fluids to meet the needs of the developing baby. Swelling is a normal part of pregnancy and is caused by this additional blood and fluid. The growing uterus also puts pressure on your veins, which slows down the return of blood to your heart. This can lead to swelling in the legs, ankles and feet. Hormonal changes also contribute by affecting your thirst center and help the release of hormones that retain water. Water retention is then clinically evident as edema/swelling of the ankles and legs.

What are the signs of “normal swelling”?

Swelling may be experienced at any point during pregnancy, but it tends to be noticed around the fifth month and can increase while you are in the third trimester. Normal swelling, which is also called edema, is experienced in the hands, face, legs, ankles and feet. The “normal swelling “of pregnancy is influenced by summertime heat, standing for long periods, long days of activity, high levels of caffeine and sodium intake.

When should I seek medical advice?

Although mild foot and ankle swelling during pregnancy is normal, sudden, painful swelling — especially if it is only in one leg — could be a symptom of a blood clot (deep vein thrombosis). A sudden increase in swelling also might mean that your blood pressure is higher than normal, which could be a sign of pre-eclampsia. Both conditions require prompt evaluation and treatment.
You should seek medical attention immediately if your face, feet or hands swell up suddenly.
Sudden weight gain greater than 2 kg per week, as well as facial edema, are more common in women who develop pre-eclampsia and therefore warrant diagnostic evaluation.

What can I do about the swelling?

Foot and ankle swelling during pregnancy is common and usually goes away after delivery. It can help to stay off your feet and avoid standing for long periods. Sit with your feet up and occasionally rotate your ankles or lie down with your legs elevated. Wear comfortable shoes. It can further help to sleep on your side, especially on your left side to take pressure of your veins. Some women find relief in the wearing of compression stockings. Staying active by walking, swimming or stationary cycling can improve blood circulation. There is anecdotal evidence that water immersion and standing/walking in a pool can offer relief. Some research suggests that foot massages might help decrease foot and ankle swelling during pregnancy. It’s important to note that swelling doesn’t mean you should cut back on fluid intake. A general guideline is to continue drinking about 10 cups (2.3 liters) of fluids a day during pregnancy.

What about swelling after birth?

Many women are surprised to find that the swelling in their body actually increases postpartum, leading to general discomfort or even pain which can interfere with the tasks of motherhood. Even women who experience no swelling during pregnancy may find themselves with swollen feet or
hands after delivery. The extra fluid and blood your body produced during pregnancy can remain in your hands and feet for several weeks following delivery. In addition, the hormonal fluctuations that occur after birth can trigger swelling and extra buildup of fluid. Edema can also develop if you sit or lie for long periods of time, such as when feeding your baby or recovering from birth or a Caesarean section. Remember that the re-occurrence of your menstrual period can also trigger fluid buildup. Some medications, such as anti-inflammatory drugs, calcium channel blockers and estrogen drugs can also contribute to hand and feet swelling after childbirth.

Note that the swelling after birth should never be limited to just one leg and you should seek medical advice if this happens or if you have pain and swelling in one leg. You should be seen promptly if swelling is accompanied by pain in your chest, headache, breathing difficulties, severe pain in the hands and feet or shortness of breath.