Ankle swelling during pregnancy: Is it a concern?

Foot and ankle swelling during pregnancy is common and almost always goes away after delivery. You may notice that it's worse at the end of the day or during hot weather.

So what causes foot and ankle swelling during pregnancy? Your body produces and retains more fluid during pregnancy. Also, your growing uterus puts pressure on the veins to your legs — especially in the later months of pregnancy. This impairs return of blood to the heart and causes more fluid to build up in your legs, ankles and feet. Standing for long periods can increase this pressure.

To manage or relieve leg swelling during pregnancy:

• Take breaks during the day when you can sit with your feet up. When possible, go a step further and lie down with your legs elevated for an hour in the middle of the afternoon.
• While sleeping, lie on your side or elevate your legs slightly with pillows.
• Don't cross your legs when you sit.
• Use a footrest when sitting.
• Avoid standing or sitting with your feet on the floor for long periods.
• Stay cool because heat can make the swelling worse.
• Swim, walk or even stand in a pool at least 4 feet deep. The buoyancy of the water helps lift the baby off your pelvis.
• Avoid tight clothing.
• Wear supportive, elastic hose; regular nylons won't help.
• Exercise regularly.
• Apply cold-water compresses on swollen areas.

Although mild foot and ankle swelling during pregnancy is normal, call or see your doctor promptly if you have:

• Severe or sudden swelling. This could be a sign of a serious condition called preeclampsia. Other signs and symptoms of preeclampsia include severe headaches, blurred vision and dizziness.
• Swelling in only one leg, especially if you have pain or tenderness in your calf or thigh. This could be a sign of a blood clot.

One of the first signs of labor may be a sensation that the baby is settling deeper into your pelvis. This is known as lightening.

The baby's new position may give your lungs more room to expand, making it easier to breathe. On the flip side, you may experience pelvic discomfort, and increased pressure on your bladder may send you to the bathroom more often.

For a first pregnancy, lightening may occur weeks or days before labor begins. For subsequent pregnancies, it may not happen ahead of time. For some women, the changes are obvious. Others may not notice a thing.

Your cervix will also begin to open, or dilate. Your health care provider will measure the dilation in centimeters from zero to 10.

At first, these cervical changes may be very slow. In fact, some women are dilated 2 to 3 centimeters for days or even weeks before labor actually begins. Your progress isn't a good indicator of when labor will begin, but rather a general sign that you're getting ready for labor. Once you're in active labor, expect to dilate more quickly.

You might wake up one morning feeling energetic, raring to attack dust bunnies under the couch, set up the crib and arrange your baby's outfits according to color. This urge to clean and organize is commonly known as nesting. No one knows for sure, but it may be a primal instinct that hearkens back to a time when physical preparation was necessary for a safer childbirth.

Nesting may begin months before your due date, but the instinct is usually strongest just before delivery. Do what you must, but don't wear yourself out. Save your energy for the harder work of labor ahead.

During the last few months of pregnancy, you may experience occasional, painless contractions — a sensation that your uterus is tightening and relaxing. These are called Braxton Hicks contractions. They're your body's way of warming up for labor.

As your due date approaches, Braxton Hicks contractions may become stronger or even painful. Eventually, Braxton Hicks contractions will be replaced by the real thing. To tell the difference, ask yourself these questions:

• Are the contractions regular? Time your contractions from the beginning of one to the beginning of the next. Look for a regular pattern of contractions that get stronger and closer together. Contractions that come at least every five minutes are likely to be the real thing. The contractions of false labor will remain irregular.
• How long do they last? Measure the length of each contraction by timing when it begins and when it ends. True contractions last more than 30 seconds at first and get progressively longer — up to 75 seconds — and stronger. With false labor, contractions vary in length and intensity.
• Can you stop the contractions? True contractions continue regardless of your activity level or position. In fact, they often grow stronger with increased activity, such as walking. With false labor, you may be able to stop the contractions by changing your activity or position, lying down or even taking a walk.
• Where do you feel the contractions? The pain of true contractions tends to begin high in the abdomen, radiating throughout the abdomen and lower back. With false labor, the contractions are often concentrated in the lower abdomen.