These archives contain extracts from discussions held on the UK Midwives and Consumers email list, a discussion group for people interested in midwifery in the UK. Open to midwives, students, mothers, and anyone interested in improving maternity services in UK. Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives.
Veins are superbly designed tubes with a series of one-way valves which are structured to prevent the contents, blood, from flowing any other way than forwards towards the heart when they are in good health.
When, for any of a number of reasons, a valve becomes incompetent, and allows a back-flow of blood, the vein becomes distended, its walls stretch and, like tired elastic, sag, allowing the vein to swell in that region into a miniature balloon.
This is a varicosity.
From Varicose Veins and Hemorrhoids: Prevention and Treatment, by Leon Chaitow N.D., D.O., M.R.O.
Ankle oedema may relate to compression of inferior vena cava and to vasodilatation due to increased hormones. If no associated proteinuria or hypertension, it is best treated by rest with leg elevation, or natural diuretics such as celery or Vitamin B6.
Varicosities occur for the same reasons, and relief after confinement can be dramatic. Once recognised, the early use of support stockings is wise; while the short term use of pelvic elevation and ice packs can ease the symptoms of vulval varicosities.
From The Principles of Antenatal Care by
Dr Sue Page
(www.medicineau.net.au/clinical/womenshealth/Antenatal.html)
I am looking for some helpful hints to relieve the discomfort of varicosities.
Here are a few suggestions for Varicose veins:
Tania
The following is taken from Your Natural Pregnancy by Anne Charlish published by Boxtree (1995):
Recommended herbs: Marigold flowers, rosewater, oak bark, comfrey, plantain leaves, elderflowers.
Steep in or combine with a cupful of distilled witch hazel for an hour, then apply with flannel or cotton wool to affected areas 2 or 3 times a day.
Recommended herbs: Cleavers, yarrow, St John's wort, stone root, shepherd's purse, bistort root, peppermint.
Infusion or decoction from single herb or combination; a wineglass 2 - 3 times daily. Tincture; 1 teaspoon in a little water, 2 - 3 times daily.
Also recommended is the tissue salt Calc fluor - take 1 - 2 times a day.
Aromatherapy massage with oils used to promote circulation - consult qualified aromatherapist or purchase good book for obvious reasons.
My favourite is yoga which I know may be difficult with small children but if you can get to a yoga class even just once a week it's the best thing for all round physical, mental and spiritual well being. I know there are several postures particularly good for varicose veins.
Susie
Dietary suggestions were: vitamin E and C and bioflavonoids. I prefer to get vitamins through food sources, and found this interesting as about the time I got the dodgy veins, I started craving avocados - rich in vitamin E...
Postural approaches can also help, eg yoga, Alexander technique, in case posture is not allowing optimal blood flow in the pelvis. A simple yoga position which I found useful was lying on my side holding one leg in the air (loop a belt or tie round the foot to help hold it up if you can't reach your foot), stretching the leg away from you. This helps drain blood down, and is relaxing. If you can still ie on your back, you can lie with both legs raised against a wall.
Some sources advise against massaging the legs in case it causes trouble with blood clots - breaking up clots into large lumps which could travel round the body, instead of allowing them to gently disperse naturally.
Angela
Adelle Davis "Let's Have Healthy Children" says Vit. E is the thing for varicose veins, so I started taking 400 i.u. daily and have increased it to 800 this week.
I have heard that Vit.C and B. complex are also helpful. Any other advice/information (how much vit. E is too much?) would be appreciated.
Monica
I recommended vitamin E supplements to a friend who is suffering, and she was told by her Australian midwife that it makes the placenta "sticky"!! Anyone got any theories on this?
I would like some hard evidence about this idea of vit E supplements making the placenta sticky!
My first reaction to it, I have to say, is that it has to be nonsense!
I took vit E supplements myself with all three of my pregnancies since varicose veins run in my family (I too used Adelle Davis's book as a nutrition bible during pregnancy). I also wore support tights, and very itchy, hot and uncomfortable they were too. I have never developed varicose veins, either during pregnancy or since. I have never worn support tights since my last pregnancy, eighteen years ago now. None of my births were cursed with sticky placentas either.
Since qualifying as a midwife, I have looked after a lot of women with varicose veins or a family history of them. I have recommended all of them to the regime which I followed. I cannot vouch for the after-effects of ceasing to wear support tights, except in my own case, but I can state quite categorically that none of the women I looked after who followed this regime suffered any third stage problems.
Anecdotal, I know, but I suspect the sticky placenta theory is also one person's observational comments. There are far too many other variables. As my tutor would have said : "multi-factorial".
Hope this may help to reassure a few people. My firm belief is that varicose veins can be successfully dealt with through pregnancy by a combination of support and vit E supplements (have to take them apart from any iron supplementation, as iron inhibits absorption of vit E). They seem to resolve, and not be a problem after the birth.
Melanie
Having sprouted varicose veins, I have rushed out to get support stockings. I have also read that I should walk more (no problem, do lots already), avoid standing around, and sit with knees *below* hips, which I do anyway for OFP purposes. Apparently I can look forward to them getting a bit better after this pregnancy, but then getting progressively worse with each subsequent pregnancy :-(
In 'Spiritual Midwifery', Ina Mae Gaskin says not to rub or massage the area as it could disperse blood clots through the veins which would otherwise break up harmlessly on their own. Does anyone know anything else about this? Massaging the vein upwards would seem to me like a sensible way to help pooled blood move up the leg, but I don't want to do it if it's dangerous.
Varicose veins run in our family and the most successful natural prevention I know is to eat the white skin of the inner orange peel. Sounds strange, but this home remedy has been proven to strengthen the walls of blood vessels and veins. I have loved that part of the orange since I was a little girl and have always eaten the peeling, seeds, fruit and all! I am the first female in our family who shows no sign of varicose problems. Also, research shows that many pain relievers destroy the veins and lead to bruising, bad circulation, and other problems. Acetaminophen (paracetamol) is the safest, but still not risk free.
-Beka
One trick that I've used for varicose veins is a sitz bath with five drops of essential oils of cypress and five drops of lavender.
My mentor, Dr. Rolf, always maintained that varicose veins were caused by the pelvis being tilted too far forward, and pressing on the venous return. This excess pressure causes the valves to fail.
Our Western life styles don't assist us to maintain good posture. From an anatomical perspective it would be far better for us to be squatting for long periods, and for using the toilet and giving birth. Children also find it much easier to use low level toilets common in the East.
Rayner
I sprouted varicose veins on the back of my left thigh and knee at 33 weeks into my second pregnancy, and at 17 weeks the next time. They did go away fairly quickly after the birth of my second child, but I'm told that they will diminish less and less after each pregnancy, and will start earlier and earlier with each one.
Support hosiery certainly helped me, even with the ones behind the knee. It is best if you put it on before getting out of bed, and leave it there until you are back in bed at night - so blood does not have a chance to pool in your veins and stretch them further. I found pregnancy support tights to be useless - most badly shaped and not supportive enough. However, prescription medium support stockings were great - I used a large suspender belt (size 14-16, long garters) to hold them up,as I couldn't locate a pregnancy suspender belt. Although a struggle to get on, the stockings were wonderful - stopped my legs aching, and I'm tempted to use them again next time I have a long shopping trip, even if the veins go away!
I have had a slight varicose vein since 14 weeks (now 24 weeks and the other leg is beginning to hurt but no sign so think it is a deep vein). This is my fourth baby and my mother has an awful history of veins so I think I'm doing OK to have escaped till now!
I'm not using support tights as my independent midwife reckons you can get dependent on them and your muscles won't do their job.
Monica
From what I've read, the purpose of support hosiery is to support the external veins, just under the skin, which aren't woven through your muscles.. these are the ones which your muscles can't support. The ones which are deeper and woven through the muscles, should be squeezed enough by the contractions of the muscles to stop blood pooling in them. But the ones just under the surface rely entirely on the vein walls being firm. When pregnancy hormones make the vein walls softer and stretchier, if you have a predisposition to varicosities then there is apparently nothing to stop them becoming so baggy that the valves gape and blood can pool.
I can understand why someone might worry that support stockings would take work away from muscles, just as abdominal support is said to, but in this case I wonder if it really can? Any thoughts?
The worst thing about support hosiery so far seems to me that a) tights are manky as a sweaty crotch is unpleasant enough at the best of times, let alone in late pregnancy, but b) stockings and suspenders look ludicrous at this stage of pregnancy!!
How about hold-ups? Are these available in the support type? Otherwise the thick opaque ones are quite supportive.
I think hold-ups would defeat the object as they often cause broken, thread veins etc.. in the legs - because the strong elastic at the top necessary to hold them up, impedes blood flow back up the leg.... as I know to my cost after experimenting with them in my late teens. I suppose this shows that I'm prone to troublesome veins anyway, but for anyone who has varicose veins I suspect hold-ups would be a bad idea.
Try the opaque white stockings, used to avoid DVT in post surgical patients. Very very comfortable, very very supportive, very very sad that I am talking about white support stockings!!!! Suppose you could always dye them black or wear them under a pair of American Tan!! They come in various varieties i.e. ones which attach to a belt, ones which are hold-ups, etc.
The thick white support stockings I have worn in hospital are hold-ups and although I don't have the thinnest legs on record, the elastic didn't cut in any more than the support stockings did (same amount of pressure I think).
Support stockings of this denier do not need suspenders. They stand up on their own even without legs in (!). But are mighty comfortable.
Sue H.
If by hold-ups you mean those stockings with thick elastic round the top to hold them up, then they will without a doubt be causing varicose veins! They are a no-no during pregnancy for that reason (in my opinion a no-no at any time, being prone to varicose veins anyway).
Melanie, midwife
Has anyone come across little spots, that look like blood blisters (only way to describe them) very dark blue/purple in colour, almost black, on the vulva?
I've just noticed one very sore one and two others on the other side. Can't get a close look, belly too big ;-) not sure if I've had them long, although I don't think so. I feel like I want to put something very cold on them, they don't itch, just very sore. Is this a GP job?
Sometimes life is like a bus...you don't see one for ages...then 3 come together :-)) I had *never* heard of this until 2 weeks ago. A postnatal woman had called out her GP because she had felt a lump on the inside of her labia. I happened to be there when he arrived. It looked just as you said...a blood blister. He said it was like a varicose vein, just a tiny swollen vessel, and would go down eventually. I then had another woman ask me about a "blood blister" that she had "down below"...and now you !!! So nothing to worry about :-))
)Janet
Has anyone got any advice I can pass on to a client suffering with vulval varicose veins? I've read up and the info is very scanty and says to treat as with varicose veins in legs i.e keep off them as much as possible.
The lady suffered with them first time around last year and we encountered no problems during the birth but they are worse this time. She says they do get better when she is not on her feet for too long.............so gravity makes them worse. Any suggestions?
Virginia, midwife
In my experience of caring for women with vulval varicies there is usually little or no problem at the birth. As the head descends the veins empty as the pressure from the head distends the vulva. Episiotomy is contraindicated - not that I perform this without compelling reasons, but it really is to be avoided in this condition. I have helped women give birth with really bad VVs and vulval VV and I have never had a problem.
I usually advise women to be on their hands and knees or squatting to birth their babies, but women with varicosities will often want to recline and like all births one should try and listen to what the woman's body is telling her to do. I have a lovely photo of a woman giving birth in the semi-reclining position which she had chosen despite my best efforts to get her off the bed. She had awful VVs and semi-reclinng was right for her - and her variscosities.
Mary
Although vulval varices feel very uncomfortable, I've never found that they cause any problems at the actual birth and they resolve very quickly afterwards. the clients I've had who've had them often worry that the varices might rupture as they push, or bleed like a haemmorhoid can, but they don't seem to, and they don't seem to get in the way when pushing either.
There are homeopathic remedies which i've seen clients use to good effect so you could get her to try a homeopath as well.
Sarah
Denise Tiran in "Natural Remedies for Morning Sickness and other Pregnancy Problems" suggest mother sits in shallow bath to which is added witch hazel.
Or bath with essential oils of cypress, juniper berry and or lemon but no juniper berry if history of kidney disease. Also homeopathy.
Jenny
Try an acupuncturist!! I know this may sound wacky but we have a senior physio who does wonderful things with vulval varices, ie reduces them dramatically with acupuncture. I'd like to think there's a good female one out there for you!
Judy
I am pregnant and have varicose veins on my vulva. Does anybody have any ideas that will help with the pain? I am using a support garment called the V-brace that I got from Fembrace. I put it on in the morning and it helps me a lot.
Fembrace -
(www.fembrace.co.uk)
Tel. 020 8442 9309 (UK)
I have a Fembrace which is a sort of support knicker mentioned on the list before. Unfortunately I have been pretty disappointed with it - definitely a case of the cure being worse than the disease. It ended up costing around £60 and is one of the most uncomfortable things I have ever worn. Think of a cross-your-heart bra; this is like a cross-your-fanny pair of giant knickers! It consists of a thick band of elastic to go round your waist or over your bump, one thick band of elastic which goes under your crotch, and two thinner bands of elastic which cross from one side at the front to the other side at the back, ie they cross over under the crotch. There is some padding over all the elastic. Then there are special pants which all this gubbins slots through, so you can remove the pants to wash them, without washing the rest. The whole lot is trimmed with a bit of lacy stuff to make it look "feminine"! You can see them at www.fembrace.com .
I understand that some women find them very helpful, but personally so far I am doing without. The waistband bit presses down on my bump and is very uncomfortable. It could be that I have too small a size, but I don't see how it can work at all without holding you quite firmly at the top. The pants are a polycotton mixture - with not that much cotton, which I don't like as it would not be good if you were prone to thrush, and personally I don't think polycotton mixes are a very good fabric for pants. The other (big) problem IMO is that, although in theory you only need to wash the removeable pants after each wear, and not the brace bit, in practice you may need to wash both.
Some people use a sanitary pad and tight trousers, to get some pressure to hold the veins in. Others swear by cold compresses, eg sitting on a pack of frozen peas. I have been fortunate in that my varicosities in this area have been like those in my legs - they hurt a lot when they first develop, I suppose because there is bruising in the area, but after that they settle down a bit and aren't so bad. Basically it just feels a bit 'heavy' and throbs.... charming, eh?!
As for complementary therapies - I think anything for varicose veins in general would be applicable. Taking vitamin E is often suggested, as are inverted yoga poses such as headstand or arm balance. Try to avoid positions which would cause blood to pool in the pelvic area - eg lying with your back propped up and your legs up, so you are sort of V-shaped, puts your pelvis at the lowest point of your body.
Some people really rate acupuncture for varicose veins - haven't tried it yet, mainly because it's so much hassle to organise seeing anybody with two other children in tow!
Maybe I'm over-optimistic, but I'm not worried about these veins causing problems in labour - would have thought that contractions would be improving blood circulation in the pelvic area, and presumably as the baby's head comes down and presses on the vulval area, and the tissue there thins out, wouldn't the excess blood which is pooled there (which causes the pain) get pushed out anyway? And once the baby's out, they should start to go away....
My friend was told to sit on a bag of frozen peas and it helped!
We use Instillagel on a guaze pad for pain from sutures after the birth. I don't know whether it could be used for this sort of problem as well.
Would counter pressure such as double sanitary pads in close fitting pants help for general comfort?
Carrie
Many people experiment with tight elastic knickers, lycra bike pants, two pairs of underwear or thick sanitary pads in order to find relief from Vulvar varicose veins.
It may be worth trying the specially designed V Brace by Fembrace. They say "Designed by women for women, specifically to bring comfort and support for women suffering from the painful condition of Vulvar Varicosities".
Daisy
Who does a patient with Vulvar varicosities (varicose veins in the vulva) turn to in the UK? A Midwife, Gynaecologist or a Urogynecologist?
If she has any sense she will try to find a confident experienced midwife who will know that as the presenting part descends and distends the perineum and vulval area the VVs empty and the area stretches nicely. It is in my experience better if the woman can let her body do the first bit of pushing by itself without her actively pushing though this is sometimes almost impossible. The squatting position or use of a birth stool is also best avoided and if the woman can cope with lying in the left lateral that seems to be best position. Believe it or believe it not the stranded beetle position also seems good for awful VVs.
Mary
Varicose Veins and Hemorrhoids: Prevention and Treatment, by Leon Chaitow N.D., D.O., M.R.O.
(www.healthy.net/asp/templates/article.asp?PageType=Article&ID=500)
USA Midwife Archives page on misc. discomforts has sections on varicose veins
(www.gentlebirth.org/archives/miscdisc.html#Varicose),
Vulval varicosities
(www.gentlebirth.org/archives/miscdisc.html#Vulvar), and Haemorrhoids (piles)
(www.gentlebirth.org/archives/miscdisc.html#Hemorrhoids)
AH updated 14 September 2002