The commonest pressure symptoms are swollen feet, varicose veins, hemorrhoids, cramps in the legs and shortness of breath, and though they may appear at any time during the last half, of pregnancy, they grow progressively worse as pregnancy advances.
Swelling of the feet is very common, and when very slight may not be serious nor particularly uncomfortable. The edema may be confined to the back of the ankle, which grows white and shining, or it may extend all the way up the legs to the thighs and include the vulva. Sitting down, with the feet resting on a chair, or lying down with the feet elevated on a pillow will naturally give a certain amount of relief. If the swelling and discomfort are extreme the patient may have to go to bed until they subside, but very often she will secure adequate relief by elevating her feet for even a little while, several times a day. But while employing these harmless, and clearly indicated measures, to make her patient comfortable, the nurse must be keenly alive to the fact that while edema of the feet, legs and vulva may be of solely mechanical origin, they are also symptoms of toxemia, about the most dreaded complication of pregnancy. And as recognition of the earliest signs of toxemia is among the triumphs of prenatal nursing, even the slightest swelling must be reported to the doctor and immediate steps taken to have the urine measured and examined.
Fig. 40.—Right angled position, to relieve edema or varicose veins of feet and legs. (By courtesy of The Maternity Centre Association.)
Varicose veins are not peculiar to pregnancy, but are among the pressure symptoms which frequently accompany this condition during the later months, particularly among women who have borne children. The superficial veins in the legs will often be equal to the tension put upon them the first time, but will give way as the strain is repeated during subsequent pregnancies. The distension of the veins is not serious as a rule, but may be very uncomfortable; this, coupled with the unsightly appearance, sometimes has a bad mental effect. Varicose veins may occur in the vulva, but they are usually confined to the legs, and both legs are about equally affected. But as the position of the child in utero may exert greater pressure on the right than on the left side, the veins on that side may be more distended; or the right side alone may be affected.
Relief is obtained by keeping off the feet, and particularly by elevating them and also by the use of elastic bandages. When a woman finds it difficult or nearly impossible to sit or lie down for any length of time, she may accomplish a great deal in a few moments by lying flat on the bed with her legs extended straight into the air, at right angles to her body, resting against the wall or head board, as shown in Fig. [40]. This right-angled position for five minutes, three or four times a day will accomplish wonders in reducing varicose veins.
In addition to posture, a spiral elastic bandage will give relief and help to prevent the veins from growing larger, if applied freshly after each time that the leg is elevated. The most satisfactory bandages, from the standpoint of expense, comfort and cleanliness, are of stockinette or of flannel cut on the bias, measuring three or four inches wide and eight or nine yards long. If made of flannel, the selvedges should be whipped together smoothly so that there is neither ridge nor pucker at the seam. The bandage should be applied spirally with firm, even pressure, starting with a few turns over the foot to secure it, and leaving the heel uncovered, carried up the leg to a point above the highest swollen vessels. As a rule, it may be left off at night.
There are satisfactory elastic stockings on the market, but they are expensive, often cannot be washed and seem to offer no advantage over the bandages.
Engorged veins in the vulva may be relieved by lying flat and elevating the hips, or by adopting the elevated Sims’ position for a few moments, several times a day. (Fig. [41]).
