In addition to compression, periodi-

cally elevating the legs can provide some relief. The most effective way to improve blood circulation is to raise the legs above heart level. The perfect position is to lie on a couch with your back on the cushions and feet up on the armrest, so feet are at a slight angle higher than the heart. (Lying down with your legs resting on three or four pillows also works well.)

What About After? After labor, most women who had

significant venous disease during pregnancy notice a big improvement after the baby is born, but it doesn’t always resolve com- pletely. If women still have symptoms that persist several months later, they should consider evaluation by a board-certified phlebologist (vein specialist) and, possibly, treatment.

Patients can be safely treated for vari-

cose veins 6-8 weeks after delivery. Hor- monal levels are back to normal within that time (if the patient is not breastfeeding), and water retention and any clotting risks have usually returned to baseline.

Depending on the type of treatment, breastfeeding may be an issue for some patients. Treatments that require a local anesthetic, such as endovenous laser abla- tion (ELVA) have been proven safe. Sclero- therapy is not recommended if the patient is breastfeeding, as certain medications used during this procedure have not yet been proven safe and may be excreted in breast milk. However, if the patient is willing to forgo breastfeeding for 24 hours, sclerotherapy is possible.

If a woman was uncomfortable because of her veins during the first preg- nancy, then she should seriously consider seeking treatment between pregnancies— the next one could be worse if veins go untreated. Some vein specialists may recommend that women seek treatment for problematic veins before their first preg- nancy, especially if there is a strong family history of vein issues.

Dr. Cindy Asbjornsen is the founder of the Vein Health- care Center in South Portland, Maine. Certified by the Ameri- can Board of Venous and Lym- phatic Medicine, she cares for

all levels of venous disease, including spider veins, varicose veins and venous ulcers. She is the only vein specialist in Maine to be named a Fellow by the American Col- lege of Phlebology. You can contact Dr. Asbjornsen at 207-221-7799 or See ad on page 12.


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