5 Ways to Reduce Swelling in Pregnancy
While some swelling (or ‘edema’) is normal in well-nourished pregnancies, nutrition plays a big role in how much swelling a woman might experience. It’s not true that it’s only ‘luck of the draw’ or that you have to ‘just wait it out’ until the baby’s born. As a holistic midwife, nutrition is a part of our very first consultation because of its powerful role in keeping mom comfortable and both of them healthy.
In pregnancy, when a woman has sufficient water, salt, and protein, her body has the ingredients it needs to expand her blood volume about 50% by 20 weeks pregnant or so. (Yes salt! More on that in a minute.) Women can eat plenty but still be malnourished in terms of what her body needs to normally expand her blood volume, circulate it normally, and be able to keep fluids in the cells as normal (and not leak it into the space between the cells).
There are two kinds of swelling in pregnancy, physiologic and pathologic.
Physiologic swelling is generally considered within the range of normal. Typically:
There is usually more swelling below the waist than above.
It develops through the day, women are unlikely to wake up more swollen. Occasionally a few women will wake up a little puffy from the waist down, but in these cases it quickly resolves once they get moving for the day.
It’s relieved by changing position, resting, or walking.
It’s made worse by standing in one position too long or going too long without movement, like riding in a car.
Pathological swelling of pregnancy typically
Progressively increases as pregnancy advances
Does not fluctuate throughout the day
Is generalized (from head to toe) rather than primarily in the lower body..
Results when circulatory fluids seep into the spaces between the cells surrounding the blood vessels.
Usually, the ultimate cause is dietary inadequacy. (Holistic Midwifery, Volume I by Anne Frye)
In my midwifery practice, we’ve always gotten outstanding results when swelling appeared by immediately reviewing mom’s diet for sufficient salt, protein, and nutrient-rich calories. Sometimes they had just been overwhelmed, and hadn’t been eating very well. Or they had been on vacation or at the beach, and had been on their feet or gotten more dehydrated than usual. Without exception, when they make adjustments they report a notable reduction in their edema within a few days, sometimes even completely relieved by the end of the same day!
This is, of course, not medical advice.
Extreme edema, called ‘pitting’ because if you press into it it leaves a dent or ‘pit’, can part of the constellation of symptoms that accompany advanced pre-eclampsia, a serious complication of some pregnancies. It you are having sudden and/or extreme swelling, it would be wise to check in with your care provider.
To the best of my knowledge, my healthy recommendations below are not counter-indicated in any generally healthy pregnancy. Unfortunately, most OB’s and even midwives are not thoroughly educated about the role that nutrition plays in healthy and stable pregnancies. So I encourage you to use your common sense, trust your intuition, ask questions, and seek counsel of those with experienced nutritional backgrounds.
Dr. Tom Brewer was among the first to realize the connection between a healthy diet and pregnancy swelling and high blood pressure. His ‘Brewer Diet’ remains both respected and controversial. If you’d like to hear how he came to his conclusions that sufficient protein and salt in pregnancy was protective of pre-eclampsia, here’s a wonderful interview transcript. Below are the recommendations that make the difference for my midwifery clients:
1.More Salt
Sufficient salt is vital for proper functioning of the kidneys, adrenal glands, and so much more. Midwifery textbooks teach that low salt diets increase the risk of toxemia (Frye, Holistic Midwifery; Varney, Nurse Midwifery), and holistic physicians note that that body’s main response to a low salt diet is to tell the kidneys to retain more sodium, resulting in higher blood pressure and more edema! (Brownstein, Salt). I know that the last few generations have been warned that ‘salt causes swelling’, but this is just not the case with unrefined salt and pregnant women. Lily Nicoles in her well-documented book, Real Food for Pregnancy, states, “No link has been found between sodium intake and blood pressure. AND sodium needs go up in pregnancy.”
Try a little bit and monitor your own results.
I suggest lavishly salting your food to taste with unrefined salt. The kind of salt matters very much! Healthy, nourishing salt is any brand of Celtic salt (such as Edens or Selina’s) , or Redmond Real Salt. Refined sodium chloride, or table salt, is NOT the same, and is missing over 70 trace minerals critical for human health!
Additionally, I encourage my pregnant clients to add in at least ½ - 1 tsp. additional salt, either by sprinkling it in lemon/lime water throughout the day, or in ‘salt shots’, which is putting a healthy pinch of salt on the tongue and washing it down with water. My clients who are starting to have edema will up their extra salt to 1-2 tsp (in addition to everything else below). While this is a rare situation in my practice because of our detailed emphasis on nutrition from the beginning, the extra salt (and protein) works for most of women experiencing any notable edema.
“Even just 2 weeks of inadequate salt intake can begin to cause a reduction in the circulating blood volume due to fluid being shifted into the intercellular spaces outside the blood vessels.”
Here’s my Instagram ‘Reel’ on the value of salt in pregnancy.
2. More Protein
Especially from 20 weeks on, the ideal amount of protein would be about 1 gram/protein per pound of ideal body weight, plus 10-20 grams per fetus. Yes, this is a LOT of protein, probably around 150gm/day for most women. The Brewer Diet and Lily Nichols in “Real for Pregnancy” discuss the higher need for protein in pregnancy. This recommendation, even higher than theirs, is based on those researching and working with higher protein usage such as Dr. Gabrielle Lyon’s recommendations. And also, the beautiful results I see in the healthy mothers and robust babies. Sufficient protein is key to healthy homeostasis in pregnancy. Women often think they are getting plenty, but realize they are short by half once they add up what they are actually eating.
3. More Movement
Exercise is also key to good circulation and healthy lymphatic function.
Ideally, each day will include a brisk walk of at least 20 minutes, brisk to the degree that you feel just a little breathless; you could talk if you have to but don’t feel like it. Make sure your shoes have good support, thin sandals add to overall strain and can add to edema.
Your pace may be quite a bit slower in later pregnancy than you are used to, it’s not speed we are going for, it’s the sweet spot for your cardiac system. Don’t overdue especially while pregnant, swimming and yoga are also excellent activities.
4. Use gravity
If you are experiencing persistent swelling in your lower extremities, put your feet up at least 10 minutes out of every 2 hours. Or even every hour if needed. If you have a seated job, get up and walk for a few minutes every hour. If you stand for your job, make sure your rotate through excellent quality shoes during the week, and stand with one foot up on something (step or low box) whenever possible. In extreme situations, you can put your legs up against the wall, and scooch your bum up against the base of the wall so that your body is at a right angle (90*) for 20 or 30 minutes. Also, while lying flat your partner could also firmly rub the fluids from your feet up towards your torso.
5. The better your diet, the lower your inflammation in general.
The better your diet, the less inflammation you will have, and the better off you’ll be from the beginning. Start by eliminating highly processed foods, and minimizing commercially prepared foods. One reason is that they use the refined sodium chloride to salt the food, which works against having healthy adrenals and blood volume. Then, when you’re ready for the next level, eliminate sugar and minimize refined carbohydrates (like pasta and bread.)
These basic recommendations, while just a place to start, should help reduce most kinds of swelling by quite a bit at least 80% of the time, in my experience.
If you are going into pregnancy there is a lot of tissue congestion, and a history of no exercise with lots of processed food, the edema may be harder to resolve or minimize because of the status at the beginning. But good food, MORE unrefined salt, and more gentle exercise will go a long way. If it does not help you become more comfortable and less swollen within a week, I recommended seeing a naturopath or functional medicine doc to look deeper with you into your adrenal and thyroid function, homeopathic remedies like Nat Mur and Apis, and for nuanced and personalized guidance.
May you have a robustly healthy pregnancy!