Puff plus

photo by Omgayeo

All I can say is that I am so swollen this weekend!

Granted, the fact that this is my number one complaint is an improvement over other weeks, when I've been unable to keep down nourishment or have been in excruciating pain, but still. Rampant discomfort is no picnic either.

It started toward the end of last week and it started where it always does: in my hands. Even before I was pregnant, my hands have swollen in response to heat and/or exercise. So it's no surprise that at 7 months pregnant and with the thermometer tipping 90 degrees this weekend, I finally had to take my wedding ring off (or face the idea of having someone cut it off).

By Saturday, my feet had joined in the party and I was rocking full-on cankles. There are those who would say that a hotdogfest around an open fire probably didn't help things any, but as this article aptly points out, too little salt can actually prevent your body from being able to keep fluids in your bloodstream and contribute to swelling as well. In general, my salt intake is pretty moderate, so I'm not too worried that this is my problem. It also felt like everything I drank just stayed on board, despite my best efforts to flush my system with water, cranberry juice, and decaf iced tea. I can see it in my face, too, in the pictures we took on our camping trip this weekend. Uff. Few things leave a person feeling less sexy (or even particularly mobile) than feeling like you've bloated up with a few extra pounds of water weight...

And summer hasn't even begun yet. So, the game plan: acupuncture (which I got yesterday, after skipping a week due to working nights last week), regular swimming, forcing myself to drink more fluids, and staying as cool as I possibly can, since I know that heat is always a trigger for me.

A few new weapons in the arsenal

The thing about aches and pains when you're pregnant is that there's really no throwing in the towel and just taking a pill. Your commitment to natural and alternative means of pain relief is all you have.

So I've been forced to continue my quest to cope with or eradicate my pubic bone pain as best I can, without the aid of traditional pharmaceuticals. In addition to those I've already mentioned, here are a few I'm currently trying:

http://www.inspiredliving.com/body-pillows/pillow-pregnancy.htm

A maternity body pillow. This is one of those things I'd always dismissed as kind of silly and unnecessary, but which really seems to be a lifesaver in my current situation. I was prepared to shell out for one, but first put out a call on my local Freecycle instead--and boy, was I glad I did. Within hours I had a high-quality, full-length down one in a washable pillow case. I slept with it last night and didn't wake up once, not even to pee.

http://www.twin-pregnancy-and-beyond.com/exercise-during-twin-pregnancy.html

Swimming. You hear a lot about the benefits of swimming during pregnancy--relief from gravity, decreased swelling, low impact on the joints--but it really hits home once even walking becomes too painful an exercise to bear. Matt and I are lucky enough to live in a community where we have a wonderful indoor pool (discovered last night) as well as 14 community outdoor pools, all of which are well-maintained and very affordable. For $3 apiece last night, we spent about half an hour swimming laps in a just-comfortably-warm and nice-sized pool (the only caveat for those with symphysis pubis dysfunction is to avoid breaststroke and sidestroke), then spent 5-10 minutes loosening up in their hot tub--which was huge, not hot enough to have me concerned, and which had steps that allowed me to sit with my pelvis submerged but my belly and upper body out of the water.

http://www.gaiaherbs.com/product.php?id=168

Arnica oil. Known for its anti-inflammatory, healing, and pain-relieving qualities when taken internally (homeopathically) or topically (as an oil or gel). It has been shown to be as effective as an ibuprofen gel for reducing soreness and stiffness. I'm using arnica oil directly on the painful area, as well as taking internal homeopathic arnica.

http://www.householdgoods.com/tens-unit-two-channel-machine-pads.html

A TENS unit. In other countries, TENS is one of the first modalities used for back and labor pain. It works by blocking the transmission of pain signals from the spinal cord to the brain, and also results in endorphin release. Here's a link to an article from Australia discussing TENS unit use for SPD.

The only thing I'm not yet currently using is the TENS unit--my parents are mailing me one that my dad used to use for back pain. I am, however, using the body pillow at night, applying the arnica oil before bed, taking the arnica internally 1-4x a day, utilizing hot and cold packs as necessary, sitting on my exercise ball whenever possible, and planning to swim a couple of times a week for exercise and buoyancy. I'm also continuing with chiropractic and acupuncture at least 1x a week, each.

What's the cost of all these things? The TENS unit and body pillow were free for the asking, and both could probably be obtained used for $20-50. I already had the exercise ball. The arnica preparations were each around $8-11 and will last quite awhile. Acupuncture costs a minimum of $15 a session, except that Matt and I have been doing a few hours of a volunteer work at the clinic per week and have thereby earned a number of free sessions. My chiropractic co-pay is $30. Swimming is $3 a day. So on a weekly basis, I probably spend an average of:

$30 chiropractic
$15 acupuncture
$6 swimming
$1 arnica preparations
______
$52

Which is not cheap. Neither, however, would medication or physical therapy be, nor would allowing myself to become debilitated so that I'm unable to work for the duration of my pregnancy. And there are certain things in live you just aren't given a choice about; in terms of maintaining a healthy body and a healthy pregnancy, as my dad would say, "Those are the things your money is for." We'll make up for the cost by cutting corners in other ways.

Like I've done before...

photo by X-it

I spoke too soon. After working three days last week, by Friday night, my pelvic pain was back with a vengeance. We went for acupuncture Saturday morning, and I was suffering enough even after that to call my chiropractor and ask her to stay late to see me that day--which she did. But while last time it seemed like everything I tried helped at least a little bit, this time, nothing seemed to help at all. Not the acupuncture, not the chiropractic, not a hot shower or two hot baths, not ice packs. No position was any more comfortable than any other and the only thing that made it more excruciating than it already was was trying to ride in the car--I don't know if it was the vibrations or the position or what, but it was just intolerable. I spent a decent portion of Saturday afternoon literally writhing on the couch and crying, until I feel into an exhausted sleep for about half an hour. When I woke up, it seems like things had quieted down to a dull roar. I slept OK last night, and much of today was fine, but late afternoon found me back on the couch in the same state I was in yesterday.

One more thing I've found that does seem to lend a little relief is sitting on an exercise ball. It seems to offer the right mix of stability and "give," and I think is also helpful because it's not a static sitting position--I'm constantly shifting around. And that's sort of what I've found to be the most helpful thing--just constantly changing positions, because no one position is very comfortable, and especially not for very long. Unfortunately, that's kind of exhausting. It's discouraging because my pelvis feels too painful and unstable for any real activity--like walking or hiking--but at the same time, I feel exhausted and drained, just from dealing with the pain. Needless to say, this is a huge setback and disappointment for me right now. I'm hoping that maybe things were just stirred up by the acupuncture and chiropractic, and that by mid-week I'll be feeling better again, but it seems like by then going to work, I get myself into a vicious cycle that's hard to break. Though again--resting it doesn't seem to help substantially either, and it's really way too early for me to be off work anyway. Matt has been wonderful, quick to draw me a bath or help with massage or suggest something he's read about, and most of all, just lots of moral support during this very trying time for me. And that helps. In the meantime--we'll just keep our fingers crossed, and keep trying.

Me & my belly

Symphysis pain gone!

Contrary to what I'd expected, which was worsening pelvic pain up until the time of birth, it instead seems to have subsided entirely. This seems nothing short of miraculous to me, considering how much pain I was in just a few weeks ago. The acupuncture seems to have set off the initial healing reaction, helped along by an activator adjustment by my new chiropractor. I can't recommend these two things highly enough, and you can go to this site to find out whether there are any acupuncturists offering sliding-scale fees in your area.

The things that helped me most during the actual flare-up were an ice pack to the area, and also doing the exercise described in the previous post which involves putting your fist or a flat pillow between your knees and squeezing it for a count of five. That one sounds counterintuitive, but I found it to give me an almost instantaneous measure of relief, especially if I did it a few times before standing up from a sitting position (which previously really exacerbated the pain). It resulted in kind of a "good hurt" during the exercise, like a good deep stretch, and then the area felt better afterward.

I was able to go to a conference last week on support techniques for natural birth, and was fortunate enough to hear the Bagnells, a husband-and-wife chiropractor team, speak on their techniques for pregnancy adjustments and resolution of fetal malpresentation. While my chiropractor doesn't specifically practice the Bagnell technique, she is very hands-on with pelvic adjustments, and hearing the Bagnells speak made me glad that I was able to find effective interventions for my symphysis pain so early on. One interesting point they made was that any time a pregnant woman experiences severe round ligament pain, especially early on, one should suspect pubic bone malposition. As you may recall, I started with round ligament pain in the first trimester, and interestingly, so did my coworker who also developed pubic bone pain (and actually referred me to my current chiropractor). A misalignment there is associated with a much higher incidence of malpresented babies, including breech, posterior, and transverse presentations, which is not anything that I am interested in!

A good site for those who want to learn more about the interaction between maternal tissues and fetal position, and how that affects the duration and ease of labor, is Spinning Babies.

Another good resource for understanding the physiology of pregnancy and birth and beyond, and what you can do to maximize it, is Elizabeth Noble's Essential Exercises for the Childbearing Year. I got mine used off Amazon for $0.01, bringing my total to $4 with shipping--an investment that is well worth it.

Symphysis pubis pain

I mentioned in an earlier post that around 22 weeks, I started suffering from pain in the front of my pubic bone, or symphysis pubic dysfunction (SPD). This is the best online resource I've found so far, which includes a good explanation of the physiology of SPD, frequently asked questions, medical and alternative relief options, and considerations for birth.

This article details the use of a support belt and stabilizing exercises to treat SPD. I recently obtained a maternity support belt (a lot like this one) and wear it when working or walking for long periods, and I think it's somewhat helpful. I don't wear it all the time, because I want my muscles to have to work to maintain their own stability as well, but a 12-hour shift is a lot to ask out of anyone's back and pelvis and so the extra support is nice. The subjects were given the following instructions with regard to exercise and lifestyle:

Abdominals: "Sitting with your feet resting on the floor, gently pull in your lower abdominal muscles abdominal muscles as if you are hugging your baby. Hold for 5 seconds. Repeat 5 times, continuing to breathe normally."

Pelvic floor: "Sitting tall, squeeze to close around your openings. Lift and hold for 5 seconds. Repeat 5 times. Breathe normally throughout."

Gluteus maximus: "Sitting or standing, squeeze buttocks together. Hold for 5 seconds. Repeat 5 times."

Latissimus dorsi: "Sit on a chair in front of a table or a closed door. Grasp door handle or table with both hands and pull toward you. Hold for 5 seconds. Repeat 5 times."

Hip adductors: "Sitting down, put your fist or a rolled towel between your knees. Squeeze knees together. Hold for 5 seconds. Repeat 5 times."

Self-help Management

The aim is to reduce stress on the joint.

It is essential that you tighten the muscles of your pelvic floor and lower abdomen before and during the following activities.

When getting into bed:

* Sit on the edge of the bed, keep knees close together, then lie down on your side, lifting both your legs up sideways. Reverse this to get out of bed.

* Do not attempt to pull yourself up from lying on your back.

When rolling over in bed:

* Keep knees together.

* Do not roll with your knees apart.

When getting up from a chair:

* Keep knees close together, put your hands on your knees, and lean nose over toes to stand up.

When sitting down:

* Do the reverse to sit down.

* Ensure that you feel the chair at the back of your legs first.

When getting into a car:

* Sit down first and then swing legs in, keeping knees together.

When walking:

* Take smaller steps.

When using stairs:

* Step up sideways one step at a time.

* Avoid stairs if possible.

Remember to:

* Sleep with a flat pillow between the legs.

* Take rest breaks.

* Move within the limit of pain.

Avoid:

* Sitting on soft sofas and chairs.

* Walking as an exercise.

* Active stretching.

I've started sleeping with a flat pillow between my knees, and I try to use the body mechanics suggestions whenever I can. I've heard conflicting things about whether walking is contraindicated as an exercise, and it's free and healthy, so I haven't given that up yet. I am planning to start to implement the exercises.

However, I was perhaps most interested in this article from the British Medical Journal, which reports a greater decrease in pelvic pain in subjects who underwent acupuncture than those who underwent interventions involving exercise, support belts, or both.

I'm figuring I can't go wrong with all three. This morning I had my first acupuncture appointment with a delightful acupuncturist in Frederick, Maryland, who has made a name for herself offering treatments on a sliding scale from $15-35 per session. This was my first experience with acupuncture and I was very pleased. A couple of the needles stung a little as they went in, but on the whole I was very comfortable during the approximately 20-30 minute treatment. My pelvis has felt sort of achy and sore all day, and it's hard to say if that's left over from yesterday or if it's a sign that things are resettling themselves, but time will tell. I'm placing a lot of hope in this, because otherwise it's going to be a long next four months...

24 weeks

15 weeks, 18 weeks, 20 weeks, and 24 weeks

Every time we take a picture, I look at it and think how big my belly has gotten, and how I can't imagine it getting any bigger. Then, by the time we take the next picture, I think the same thing about that picture, and look back a little wistfully at how tiny I look to myself in the previous picture. It's crazy and you'd think I'd be used to it by now, but the thought process is remarkably similar each time.

First, the good news: I'm measuring perfectly at 24 cm for 24 weeks. (Which strongly dispels the likelihood of twins, despite what my round girth might suggest.) The baby is delightfully active and literally feels bigger and stronger every day. The heartbeat sounds great, my blood pressure is good, and by every other objective measure of pregnancy, I'm doing very well. The number on the scale is a lot to wrap my mind around, but we're eating incredibly well and I take at least a 30-minute walk most days, along with a variety of prenatal exercises, so I'm doing my best to let my body be my guide on that front.

On a less-pleasant level: the hormonal discomforts of pregnancy (morning sickness, etc) have all too quickly been replaced by the mechanical ones, as I mentioned in my last post. My symphysis pubis pain can literally bring me to tears, especially if I've been working all day, and I'm going to do a separate post on the efforts I'm making to correct that. Bending over has become rather a challenge, and I have a job that requires me to do that many times in a 12-hour period. Changing positions requires ever more (and noisier) efforts, and I had a recent tearful episode remembering what a wonderful, active summer we had last year and mourning the fact that I will most likely not be doing all of my grocery shopping by folding bike this summer, nor will I be doing any 7-mile hikes in the Shenandoah mountains. (Matt is wonderful about comforting me through such times, however, and pointed out, "We'll just plan to have a really active fall!") I'm also getting up probably 3-4 times a night to pee (during the day, I go at least once an hour). My mom says I've had a tiny bladder since I was a baby, and pregnancy has certainly brought out that condition. Also being crowded out of the way: my lungs and my stomach.

Otherwise, though, we're happy and thankful. We're getting more and more excited about the birth, and talk all the time about what it will be like when the baby gets here. We went to an excellent cloth diaper information session put on by a locally owned Web-based business, Abby's Lane, which we were completely impressed with. We've decided that we'll most likely go with prefolds, pins, and wool covers to start with. We'd originally thought we might go with an all-in-one, but she convinced us that these are often not a good fit for newborns and we want something that we can start with and that will then grow with the baby, as opposed to changing systems midstream. It's also much more economical and seems like a better fit for our lifestyle and philosophies. We've also been incredibly blessed by Freecycle and hand-me-downs from friends, so that we feel like we have a good stock of what we'll need to at least get started. Which is good; now that the weather is warm, it's starting to feel like summer and this baby are just around the corner.

At least, that's what I keep telling myself, when four more months of pelvic pain and a waddling gait and going to the bathroom 20 times a day starts to sound like a very long time...