Nearly 75% of pregnant women experience swelling during the last trimester of their pregnancy and most of the time it is relieved by good posture, massage, staying cool, elevation of legs and rest. However, when something like pre-eclampsia develops, severe swelling or ”pitting oedema” is merely one symptom of sometimes a more serious condition known as pre-eclampsia.
Pre-eclampsia affects 2 in every 100 pregnant women.
This is a severe type of high blood pressure, where the only known cure is to deliver the baby.
Until now, the only way to diagnose pre-eclampsia has been to check for high blood pressure and to measure the level of protein in the urine but both tests can be unreliable, meaning the condition can be both missed or misdiagnosed with babies being delivered prematurely for no reason.
Doctors have also had no way of telling how severe the condition was for each individual woman.
In the UK there is now a blood test which gives an accurate result in just 15 minutes, by measuring the level of Placental Growth Factor (PIGF) in the blood.
Those that show a very low PIGF level have severe pre-eclampsia and will be admitted to hospital for birth, and those with a high level PIGF are unlikely to have a severe form of the condition, regardless of any other symptoms present, and therefore can carry their baby to full term.
Having enquired about this blood test to King Edward Memorial Hospital recently a spokesperson confirmed that this test is not available in WA at the moment; however steps are being taken to be able to perform this blood test in the near future.
Generally speaking, the fluid retention that causes mild swelling the last few weeks in pregnancy is a normal defense mechanism against blood loss during childbirth. Your body will be able to quickly replace lost fluids and begin breastfeeding at the same time, with these fluid stores in place.
Pregnant women experience dilation in the blood vessels, especially in the lower extremities, and “pooling” of blood, which causes oedema (swelling). The best way to deal with excess fluid is not to restrict it, but to mobilize it. Keep it from staying in areas that cause the most discomfort, such as in the legs, feet, fingers and abdomen. Assisting the kidney function is one way of doing this. Rest and fluids are the two best ways to help the kidneys rid themselves of excess fluid.
So, what are the differences between normal and pitting oedema?
Normal Swelling in Pregnancy
Normal swelling is usually limited to the feet, ankles and lower legs but can also affect the wrists, hands and fingers. It generally gets worse after long periods of standing or sitting upright (like driving a long distance or flying). Normal swelling usually decreases after resting, especially resting with your feet raised and whilst sleeping overnight. Also, normal swelling will not usually leave a pitting oedema mark in the skin.
Pitting Oedema in Pregnancy
A major sign of pitting oedema is when you depress the skin and it does not go back to normal within a few seconds – it stays indented. This basically means that if pressure is applied to an area of oedema with the finger or thumb for 20-30 seconds and then removed, the area being compressed will have a ‘pit’ or hollow in it, which can be both seen and felt easily and does not subside within 30 seconds.
Oedema will be obvious both to the sufferer and to those around her. A very good example of this was when one of my colleagues had a client who placed a 20c piece on her lower leg and left it for 30 seconds and when she took it off she was able to see the imprint of the design of the coin on her leg clearly for several minutes. This is definitely cause for concern and should be checked out immediately.
Severe headaches and visual disturbances (flashes or blurry vision), pain in the upper right abdominal area under the ribcage or right shoulder are also warning signs that you should contact your doctor or midwife immediately.
Another warning symptom of serious swelling during pregnancy is swelling that extends above the feet and legs; particularly if you find your face or arms are swelling contact your health care provider.
If this is the case, then pregnancy massage is highly contraindicated, which means that massage must not be performed until the client has been to her health care provider to be tested for the onset of pre-eclampsia or any other serious condition such as a deep vein thrombosis (DVT).
This is why it is so very important for women to go to qualified pregnancy massage therapists who have been specially trained to identify conditions that are contraindicated for massage particularly this one.
I’ve had a real interest in working with women who are diagnosed with pre-eclampsia.
I have had first-hand experience of dealing with pre-eclampsia that quickly went on to become eclampsia and toxemia. This was not diagnosed even though during all my prenatal visits I had high levels of protein and high blood pressure, which I had never suffered prior to pregnancy.
The swelling in my feet and legs was incredibly noticeable, (I went up two shoes sizes and still they were tight) however I was being told that swelling was normal during pregnancy and I shouldn’t be concerned.
It wasn’t until I passed out going up the stairs at the shopping centre that it suddenly became a serious concern. I was rushed to King Edward Memorial Hospital and had an emergency caesarean at 32 weeks. I was then transferred to intensive care and closely monitored with my blood pressure still at 160/100 and my baby girl Hannah was taken to the Special Care Nursery.
For 48 hours we were separated – I was just too sick to visit her and all I had was a polaroid photo that one of the midwives had kindly taken for me.
In milder cases of pre-eclampsia pregnancy massage would be beneficial for the woman’s well-being and obviously the baby as well, however the massage is quite different to your usual massage.
Lymphatic massage of arms and legs will reduce oedema by forcing the excess toxins into the excretory system to be eliminated. However, if the pre-eclampsia is severe, massage would in fact add more strain on the kidneys. Protein in the urine is already a sign that the kidneys are struggling to process the wastes.
Previously I had a client who came for pregnancy massage who we referred back to her health care provider before we could do the massage, and it was found that she did in fact have pre-eclampsia bordering on eclampsia. What this means is that her kidneys are already over functioning to try and remove toxic waste from the body, therefore having massage would have put even more strain on the kidneys and could have had a really negative effect on her wellbeing.
Only a fully qualified pregnancy massage specialist can provide massage to a client with pre-eclampsia, as this is a very specific type of massage and can have huge benefits to the mum if done correctly.
I am trained and qualified through Pregnancy Massage Australia to perform this type of massage and can be contacted on (08) 9303 9111.
For more information about the signs and symptoms of pre-eclampsia go to the Pre-eclampsia Foundation: