Episode 219 - Restless Legs in Pregnancy
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD, and each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey. Hello and welcome to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I've been a midwife for 18 years, offering care to women through both their pregnancy, birth, and postpartum period. And so this topic of restless legs is very dear to my heart. I've been helping women for 18 years to navigate the symptoms and situations that come up through pregnancy and restless legs is a really common one. I also experienced it myself through my own pregnancy so I was incredibly invested in helping not only myself but my clients solve this problem.
[1:04] This episode has been generously sponsored by Poppy Child, who's a childbirth educator, doula, and creator of the Birth Box and the Oxytocin Bubble. Both of these things are strategic tools used to help you get ready for labor and birth.
[1:21] Historically, Poppy has offered Great Birth Rebellion listeners 25% off the Birth Box, and now Poppy is also offering the Oxytocin Bubble, which is included in the Birth Box. But she's offering the oxytocin bubble as a standalone offer for 25% off for Great Birth Rebellion listeners. Now the birth box gives tools to help you navigate labor and birth and the oxytocin bubble is a soundtrack that accompanies those tools to help you sink into a calm and gentle space as you navigate labor and birth. If you want to access your 25% off offer, check in the show notes below and you'll see the link. So today in this episode, You can pretend that you've come to me as a pregnant woman and you've got restless legs. And this is what I would tell my clients if they were sitting in front of me today telling me they had restless legs. And if you're listening as a midwife, care provider, or doula, this is a great one to pass on to your clients who've come to you with these symptoms. It's actually really tricky to find solutions to restless legs because there's not a vast array of medical solutions or mainstream solutions to restless leg syndrome.
[2:35] There's a lot of speculation about what the cause even is, and it's tricky for clinicians to give their clients and the women in their care helpful advice. So hopefully this episode will help not only women, but care providers know what to do in this scenario.
[2:53] Okay, so what is restless legs? Or sometimes you'll see it referred to as restless leg syndrome. And the thing is, is that restless legs or restless leg syndrome can occur outside of pregnancy too, not necessarily always inside of pregnancy. But it is a common symptom in pregnancy, but it can be experienced otherwise. But today we are going to talk about it in the context of pregnancy. So let's talk about what restless leg syndrome is or what restless legs are. And it's this annoying sensation that usually takes over as you are trying to sleep at night. It's this insatiable urge to want to like move your legs or kick them or stretch them or go for a walk. And up to 20% of women, and it depends where you are in the world, some women are more prone and less prone depending on where you live and your ethnicity. But overall it's quite common about one in five women will experience restless legs during pregnancy at varying levels of intensity. Some women find it incredibly manageable, others are absolutely beside themselves with the symptoms.
[4:04] And so restless legs create this sort of, it's a bit difficult to describe, but it's a situation where you feel like you need to shuffle and stretch and move, the sensation is relieved by movement. It feels a little bit like muscle twitchiness, but not exactly. It's very hard to explain, but the diagnosis of restless legs is based on four symptoms that correspond to a very convenient mnemonic, urge, U-R-G-E. And that equals one, an irresistible urge to move your lower extremities, your legs. Two, it's worse at rest. Three, it's worse at rest.
[4:45] Relieved by getting up and moving and for it's worse in the evening. So if you are experiencing those symptoms, you've got restless legs, and there are some pharmaceutical or medical management strategies that can be used, but these are usually reserved for women who have extreme symptoms where their sleep is so disturbed that it's actually causing them to become mentally unwell because of sleep deprivation and.
[5:15] That whole circumstance. There are undesirable side effects to these medications. And so, as I said, they reserve them for exceptional cases. They're not just given out to any woman who has restless legs. And because of that, women usually just have to navigate the symptoms themselves. There are not really a lot of midwifery or medical solutions to the problem of restless legs. So women are relying on talking with each other, chat rooms, chat GPT, all kinds of places to get information about what to do about restless legs. They're relying on home remedies and nutritional supplements in order to manage the symptoms. And restless legs usually is not so bad in the early trimesters one and two but it starts to build and get worse as your pregnancy goes on so if you're already starting to feel symptoms and you're early pregnant it's time to start doing some preventative things to prevent it from getting worse and I'll tell you what those are in a minute.
[6:21] Now fortunately for most women Then restless leg syndrome and the restless leg
[6:26] symptoms are mild and moderate and possibly treatable if you know what the cause is. So let's have a look at some of the causes of restless legs. So there's unfortunately not actually a lot of research about the exact causes of restless legs, and that's why we haven't really got a solid solution. However, the most promising research seems to be around anemia and iron supplementation. What they've found is that women who are deficient in iron or have a diagnosis of iron deficiency anemia are way more likely to experience restless legs than women whose iron status is well and healthy. What they found is in a few of these studies is that women who, have previously supplemented with iron and prevented iron deficiency in pregnancy by preventative supplementation, they're 40% less likely to report symptoms of restless legs. And so one of the treatment strategies for restless legs is to get a blood test to determine if you're iron deficient or if you're anemic and your clinician will know which tests to send you for but you need to check your hemoglobin and do full iron studies and ferritin.
[7:41] To diagnose iron deficiency and also iron deficiency anemia and in fact one of the great birth rebellion podcast episodes is all about detecting iron deficiency, iron deficiency anemia. So I'll put that episode link in the show notes below. So if you are anemic and restless legs is part of the story and part of the symptom picture of that, I would highly recommend you listen to the iron deficiency anemia episode so that you know how to, remedy that as fast as possible so that you can relieve your restless leg syndrome. It may not work completely, but it's part of the symptom picture and it's part of the management strategy. Now the main frustrating part about restless legs is that it happens at rest and usually when you're trying to go to sleep in the evening and it becomes a reason to keep you awake at night. It's incredibly frustrating when you're already pregnant and possibly already having problems with sleeping and you need so much more rest. The moment you're ready to rest and it's the evening time, you have this insatiable urge to move your legs, move your body.
[8:50] So anything that you can do to increase the chances of you getting to sleep is something that you can do to help with restless legs. So things like reducing the consumption of stimulants like caffeine-rich foods and drinks are.
[9:05] Especially after lunch. So maybe if you need to have those, have them in the early part of the day and avoid any stimulants in the later part of the day. It doesn't necessarily solve the problem of restless legs but it gives you one less reason to be awake in the evening. Now as I said there is not really great research about what causes restless leg syndrome and so we haven't got a whole lot of information on what we can do to prevent or treat it aside from iron supplementation and treating anemia. Now, because of this lack of research, I need to be super clear that my next recommendations are not, I could not find actual research to support this practice that I'm about to talk to you about now. However, as a naturopath, I'm initially, my first career was as a naturopath and I was trained in nutrition and supplementation and all kinds of natural therapies.
[10:02] We know that muscle function and twitchiness can be part of the treatment protocol for those kinds of things is to use magnesium. Now, I did search around for research papers that could give some indication of magnesium dosage or usage for restless legs. However, the majority of papers that I found were using lower dose magnesium and said it didn't actually seem to have any effect on restless legs but wait a second, there were a few case studies that did start to indicate that potentially higher doses of magnesium might be what's needed to help relieve restless legs in one situation it was a case study paper and in this situation there was a woman who had extreme symptoms of restless legs and actually ended up developing pre-eclampsia and part of the treatment for her preeclampsia was high-dose IV magnesium.
[11:03] And as an interesting anecdote, when they gave her the high dose IV magnesium in order to treat the preeclampsia symptoms, her restless leg symptoms also stopped. Now, of course, this was one single case study, but the people who, the authors who wrote this up suggested that maybe there's some truth to the use of magnesium supplementation for the treatment of restless legs, given the circumstance that this woman was in. And interestingly, restless legs is more likely to affect women who have preeclampsia or preeclampsia is more likely to develop in women who have restless legs. Interestingly, there are research papers about the use of calcium and magnesium supplementation in early pregnancy in order to prevent preeclampsia, especially if it's used for women who've had preeclampsia before. So I'm going to postulate, theorize, again, there is no actual scientific evidence aside from a few case study papers and suggest that I think, I think, magnesium and calcium, especially when we know about their function within, their use by the body with muscle function.
[12:23] Had something to do with restless legs. But we are yet to scientifically identify what that is except obviously there was this great case study about this woman who had magnesium to treat her preeclampsia but it also happened to treat her restless legs. She had relief. So.
[12:41] When we're thinking about restless leg management, also be thinking about things that seem to help with muscle relaxation or, you know, exercise recovery, things like that could also work for restless legs. And for any of you who've got restless legs, you'll know that you'll pretty much try anything. And if something works, you will cling to that. And my experience as a midwife is that when I do recommend the use of magnesium for the management of restless legs, and I used it myself as well, the women do seem to report an improvement. And if you go online, I'm not suggesting you should get your health information or maternity care information online, but women talk to each other and they tell each other about what's been working for them. And, you know, there's whole chat threads full of women who are recommending magnesium supplementation.
[13:40] To remedy restless legs and have gotten good effect. So, in my personal experience and in my midwifery experience, I can anecdotally confirm that topical magnesium spray. So, actually, if you want to make your own magnesium spray, you don't have to buy it. There are magnesium sprays on the market for many, many dollars. However, magnesium spray is super easy to make and I've got a recipe for you. If you go to the link in the show notes, there's a little cheat sheet for this podcast episode and it's got my magnesium spray recipe on that cheat sheet for you to use. So, magnesium spray or oral, well, I think and oral magnesium supplementation. I actually, personally, and also women have told me too, the oral magnesium can work. However, you can get faster results by using the topical magnesium spray.
[14:41] Or both together. See how you go. You might be pleasantly surprised. When I used it when I was pregnant, I would spray the magnesium on before bed. And within 20 minutes or so, the symptoms of restless legs were settled enough that I could easily go to sleep. And I noticed on the nights where I forgot to put the magnesium on, I would get restless legs and I would have to wake up, spray magnesium on myself. I also happened to be anemic during that pregnancy. I was supplementing and it did resolve but that's that was my personal experience, and the magnesium spray seemed to be the thing that worked for me, mine was incredibly mild though so when if you do have symptoms of restless legs it's about iron supplement effective iron supplementation you want to correct the anemia again listen to that podcast episode that's linked in the show notes and make sure that you're working with your care provider to get a full understanding of if you are anemic and treating that early. The next possible treatment strategy is with magnesium. Again, there's not a lot of scientific evidence that says that this works, but we use magnesium for situations for muscle relaxation anyway, outside of pregnancy.
[15:55] And there's anecdotal evidence to suggest that this could be effective strategy for you. Worth a try, I think. So magnesium spray that you can apply to your legs prior to bed. Again, the recipe's in the cheat sheet. You could do something different though. If you want the same magnesium salts that you use to make the magnesium spray, you can put those in a bath and have a soak before bed in a magnesium salts bath. I would use the recommended amount on the package, which is usually one or two cups. It's quite a lot in a bath. You may also be able to just soak your feet in a magnesium bath if you want to. There will be a Thank you.
[16:37] Oral magnesium supplements that are taken regularly have a compounding effect. So again, if you talk to some women and if you have a look at those chat forums online, you'll see that some women will say, yep, absolutely one magnesium supplement an hour before bed and that relieved my restless legs. The magnesium spray also has a similar effect. Then another thing you do, as I already said avoiding caffeine second half of the day but anything that actually relieves, muscle tension so you could if your partner is lovely and available a leg massage prior to bed and that could go along with your magnesium spray rub, some women have also talked about applying heat packs to their legs and any strategies that help with muscle relaxation in general is what you could try I'm sure if you've got restless legs you've tried a number of things, Now the other thing that I found a little bit of evidence for, if you're not already doing it, some of the research suggested that being more active in the day, so doing a walk or an exercise or something, seems to kind of get the restlessness out.
[17:49] There's no scientific way to say that but kind of moving through the day seemed to reduce the restless leg symptoms at night. So to summarize the things that you could do if you're experiencing restless leg syndrome iron supplementation in consultation with your care provider and also check out that episode of the great birth rebellion in the show notes below.
[18:11] The use of magnesium, although there's only anecdotal evidence and a few small pieces of scientific research about this, as a naturopath and.
[18:21] In non-pregnant times of life, magnesium is used to remedy muscle pathologies. So you could access that through a magnesium spray. That seems to be the quickest and easiest route and actually quite effective. Women notice it almost instantaneously. You could have a magnesium salt bath prior to bed.
[18:45] Keep up regular oral magnesium supplements, particularly before bed. And magnesium is also used for a restful sleep. And this is a big part of the issue with restless legs. It's not only annoying, but it keeps you from going to sleep. So some of the strategies that you're going to use are to relieve the restlessness. And the other strategies are to aid in sleep. And magnesium is a well-known supplement that is used to assist with a restful sleep. So it's twofold. Avoiding the caffeine in the second half a day. Leg massage before bed. You could apply heat packs if it's getting absolutely horrible and you can't manage any of the other things. But I would lay out a lot of these remedies, in the hope that you can relieve the symptoms enough to get to sleep. And anything that you can do to help with muscle relaxation is likely to help with symptoms of restless legs.
[19:40] All right that's what I would tell you if I was your midwife and you came to me and you had restless legs. The important thing is is to also do when you're making decisions about restless legs and how to manage it speak to your care provider if you feel like it's getting way out of hand and it's absolutely interrupting your sleep to a point where your mental well-being is being affected. It's incredibly important to keep communicating this to your care provider so that you can find the best solution for you.
[20:11] Don't forget, there's also the cheat sheet that goes along with this Great Birth Rebellion podcast episode, which has the recipe to the magnesium spray and lists out these options for you as you come to try and find a solution to your restless legs. That's this week's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson, and I'll see you in the next episode. To get access to the resources for each podcast episode, join the mailing list at melaniethemidwife.com and to support the work of this podcast wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com follow me, mel @melaniethemidwife on socials and the show @thegreatbirthrebellion, all the details are in the show notes.
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