Having a baby is a difficult decision to make when you're healthy, but when you are chronically ill, it takes a lot of thought and planning to figure out if it's even possible.

When I was diagnosed with Rheumatoid Arthritis (RA) it changed everything...my career, my health, my goals, and my ability to do so many things that most people take for granted. And yet, despite being on full time disability and my continuing daily struggles with my health, I've suddenly found myself wanting to have a baby. The idea of having an amazing little person growing inside of me and bringing new light and life to this tired body of mine has given my husband and I much to think about and discuss lately. There are so many factors to look at and so many questions to consider. Here are some of the realities that we came up against while trying to decide if having a baby is the right thing to do.

Your Health & Fertility

One of the first things you need to assess is your own health. Is it physically possible for you to have a baby? Those of us with RA have taken many prescription drugs over the years, including chemotherapy medications, DMARD's and strong immune suppression medications that may have an effect on overall fertility levels. Just having RA itself has been shown to lower overall fertility. Many people with RA also have other autoimmune (AI) diseases that can contribute to fertility problems and/or the ability to carry a baby safely to term. For example, I learned the AI liver disease that I have, Primary Biliary Cirrhosis, can cause a higher than normal level of complications and spontaneous miscarriages during pregnancy. It's critical to talk with your doctor and find out whether its safe for you to think about pregnancy before making any quick decisions.

Your Baby's Health

Next on your list of considerations should be the health of your baby, both during your pregnancy and after. Although risks tend to be low, RA and other diseases can be passed down through the genes, so are you willing to accept the fact that your baby could end up fighting the same diseases you have? You and your spouse need to think about your family histories of disease and possibly even speak with a genetic counselor to help you decide if the risks are something you are ready to deal with.

It's also important to talk to your doctor to determine if your medications are safe to take during pregnancy and/or during breastfeeding. Many people with RA are on medications and are fairly well controlled disease-wise. Are you ready to go off those medications if they are not safe for your baby's development? For example, I use Fentanyl pain patches and the likelihood that they could cause problems with the fetus is pretty high. Not to mention that the baby could be born dependent on the pain meds and have to go through a painful withdrawal cycle after being born. By talking with your doctors early on, you may be able to make changes that allow you to feel your best while also allowing the baby to grow healthy and strong.