Author: Dr. Stephanie Athanas, PT, DPT, RYT®
Time and time again I see pregnant women start walking (or waddling) into my physical therapy office right at their 36-week mark. The tale tends to start with, “the pain started about 2 weeks ago…” Ah, yes, the beloved 34th week of pregnancy. This has become known to me as the turning point when the body starts unquestionably noticing the toll that pregnancy has had on it.
After working with women prenatal and postpartum for over 5 years as a physical therapist, and for over 10 years as a yoga instructor, I wanted to share with you a few “top tips” that I have noticed myself repeating to nearly all of my pregnant patients at some point throughout their care.
1. Compression Socks
Graded compression socks are a must have during pregnancy, especially in your third trimester. Compression socks have been used to reduce swelling, increase energy levels, reduce risk for blood clots and varicose veins, and reduce aches and pains in your feet and legs. How? Small blood vessels in your feet and legs have a system of tiny muscles and valves that do all the work to pump blood from your feet and legs back up to your heart, and with an increase in fluid volume during pregnancy they have to work extra hard. Graded compression socks provide compression that is stronger in the toes and lighter in the calf which helps your blood vessels pump blood from your feet back to your heart, preventing blood pooling and improving circulation.
Make sure to wear compression socks only during waking hours, and take them off at night for bed. They are particularly helpful on days that you anticipate to be more active, travel (long car rides or flights), or stand for long periods of time.
Which ones should you get? That’s up to you, of course! As long as they cover the toes and calf with a graded compression (more compression at the toes, less compression at the top of the calf), then you’re all set! Pressure of 20-30mmHg is the ideal amount, though be mindful that the higher the pressure the more challenging it is to get the sock on and off. I personally wear and strongly recommend PRO Compression Marathon Elite because they have extra heel and toe cushioning making my feet extra happy! If you decide on PRO Compression, please don’t pay full price. They run sales like every weekend is Black Friday and you can get a hefty coupon for signing up for their emails.
2. Toileting Health
This could be a blog topic in and of itself, and it likely will be (keep an eye out). To keep it simple, you want to avoid straining for both urinating (peeing) and defecating (pooping). Two major ways to avoid this are toileting positioning and timing.
In terms of positioning the Squatty Potty is no joke, even if their amusing yet educational commercial is. The goal here is to keep your knees higher than your hips like a squat (but please don’t hover). When doing this squat position it creates a relaxed position for the pelvic floor muscles and aligns the organs for optimal elimination (emptying). This reduces the need to push or “bear down”, which in turn reduces the risk for hemorrhoids and prolapse while also taking you overall less time to use the facilities. Instead of buying a squatty potty you can always use books, boxes, a step stool, or whatever your brain can imagine.
Timing can be slightly different for everyone and depend on what you eat or drink, but the average time it takes for peristalsis (the natural digestive contractions that move your food from throat to rectum) to occur is 20 minutes after you eat. Yes, just 20 minutes! No, you’re not pooping the same food that you just ate. However, this means that if you scarf down your bagel and coffee at 6:30AM, be ready to sit on a toilet by 6:50AM versus sitting on the subway, bus, taxi, or driving your car – yikes! The first signal your body gives you that you need to urinate or defecate is when you have to say “yes” in order to avoid straining. No prairiedogging. No just in case (JIC) peeing. No “I can make it another 5 minutes”. The moment it hits you is when you must go. It’s now or never my friends, at least if you want to avoid straining to reduce your risk for developing hemorrhoids or a prolapse.
Happy peeing and pooping!
3. Water is your best friend, inside and out!
Fun fact: our bodies are made up of 60% water. Drinking plenty of water is important for feeling your best as a general rule, and this is particularly true during pregnancy. Fluid retention rises with pregnancy as your blood volume increases. Because you are naturally expending far more energy than you did before you were pregnant doing the same tasks, your need for water increases as well because your oxygen demand increases. As always, the best way to tell if you are drinking enough water is if your urine is clear or nearly clear. It just may take a few more glasses to get there now than it did before.
For every cup of caffeinated beverage you drink, it takes two glasses of water to off-set the dehydration that comes from caffeine due to its diarrhetic nature. (Some women chose to drink small amounts of caffeine during pregnancy if their bodies were used to a daily dose before getting pregnant. Please check with your doctor before consuming caffeinated beverages when pregnant.)
Water on the outside of your body is also beneficial during pregnancy via two primary means: pool exercises and soaking. Exercise during pregnancy has been shown to provide significant physical and emotional benefits, and one tip I stress the most to patients is exercising in a body of water such as a lake or a pool. When you stand in a body of water that is deep enough for the surface level to be between your naval and nipple levels the buoyancy creates a natural traction of your spine that allows your discs to rejuvenate some fluid and height. This creates less pressure on the nerve roots that come out of your spine, increases blood flow to the nerves, and thus reduces the feeling of tiredness in your back, pelvis, and legs during pregnancy. An activity as simple as walking forward, backward, and sideways in water at this depth can be relieving and help with postural control. Since there is added compression on all of our joints in our body caused by the expected rising pregnancy pounds and postural changes, pool exercises are a gentle way to unweight the body and aid in joint revitalization and postural restoration. Be mindful to not spend excessive amounts of time exercising in a pool as pool exercises have a delayed fatigue, meaning you will be tired an hour or two later versus in the moment. Start with a 10 minute session and increase each session duration gradually as tolerated. Soaking is naturally going to occur when exercising in a body of water which is another reason why I love encouraging swimming activities for expecting moms.
Similar to compression socks, soaking is a wonderful way to manage swelling, fluid retention, and soreness during pregnancy. If you don’t have a pool you can still get soaking benefits by taking a slightly warm bath. Since there is a natural increase in body temperature during pregnancy we want to avoid overheating and increasing the heart rate significantly, therefore its best to avoid hot baths. Soaking while pregnant can help reduce the feeling of fullness or throbbing in the pelvis and abdomen because by simply being in water our lymphatic system is stimulated which assists in proper fluid dynamics in the body as well as digestion and inflammation control as the lymphatic system is heavily present in our intestines. As fluid dynamics shift while we soak it causes a release of fluid retention, so we also need to remember to replenish this flushing of our lymphatic system by… you guessed it: drinking lots of water!
Feel free to mention your “top tips” in the comments section below! Pregnancy is a highly individualized experience. Please be aware that what has helped others may not be right for you. As always, ensure you discuss any significant changes in your diet or activity levels with your OBGYN prior to implementation.
For further information or to receive individualized physical therapy to achieve optimal function before, during, and/or after pregnancy please set up an appointment at our office in Union Square with Dr. Stephanie Athanas, PT, DPT, RYT® by calling us at (212) 253-9383.