Parenting Choices and RA: Extended Nursing and Medication

Cathy Health Guide
  • Breastfeeding is one of the greatest gifts I have given to my two children and myself.   It is a gift that has benefits far beyond providing nourishment to an infant/toddler.  It is a gift that bonded us early, kept us bonded during growing spurts, provided safety and calm during difficult transitions, plus numerous other benefits that I will forever be grateful for.


    Nursing didn't come easy for me with my first child.  I had to work at it, but once the two of us figured it out together, it wasn't something we were about to give up quickly.  Luckily for me, I was introduced to La Leche League during my first few weeks of nursing.  The lessons I learned from this group of nursing moms forever changed my outlook on parenting and health.  I felt empowered to follow my heart when it came to my children in all aspects of their lives.  As the person who knows them best, I learned I had earned that right to make decisions that felt right to me, rather than what society or even "professionals" felt was right for them.  The closeness we experienced together through nursing gave me a unique look into their lives.  The empowerment I learned through nursing my children continued into the decisions I would later have to make about my own health with rheumatoid arthritis. 

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    As we celebrate World Breastfeeding Month, I reflect on the timing of my rheumatoid arthritis.  It came at a time when my oldest child had nursed until he felt he was naturally ready to move on in life, something I whole heartedly wanted for my chidlren.  You see, during my early days of breastfeeding, I was also introduced to the works of anthropologist Katherine Dettwyler by my own anthropologist brother, who purchased her book of research for me as a gift that I treasured during my years of nursing.  According to Dettwyler's work, the natural weaning age of a human child is quite higher than most Americans believe to be the age for weaning.   Although I know it is unpopular in our society, I am a momma that agrees with Dettwyler and the World Health Organization's recommendation of "Exclusive breastfeeding up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond."  I wanted my two children to wean naturally at an age that felt right for them as individuals.


    My daughter came very close to weaning on her own.  She was almost to a stopping point when I was diagnosed with rheumatoid arthritis.  Since my diagnosis came the introduction of drugs, something I had kept far away from since the day I discovered I was pregnant with my first child, weaning was rushed along.  When my rheumatologist discussed the combo of Plaquenil and Methotrexate he wanted me to take, this is the type of information I had in regards to nursing and Methotrexate as found at


     "Methotrexate (MTX) is excreted into human milk in low concentrations. Because of the potential for serious adverse reactions from MTX in breast-fed infants, it is contraindicated in nursing mothers. The American Academy of Pediatrics considers MTX to be contraindicated during breast-feeding because of several potential problems, including immune suppression, neutropenia, adverse effects on growth, and carcinogenesis."  Since I already knew the side effects of taking Methotrexate myself and felt scared beyond belief, I wasn't about to expose my daughter to even a smidgen of the drug."

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    I did find this information on that doesn't make it sound as terrible to nurse while taking Methotrexate, although personally I don't think I could do it. 


    "Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. Limited information indicates that a maternal dose of methotrexate up to 65 mg (or 50 mg/square meter) produces low levels in milk, leading some authors to state that low single or weekly doses, such as those used for rheumatoid arthritis, are of low risk to the breastfed infant.[1][2][3][4] If methotrexate use is undertaken, monitoring of the infant's complete blood count and differential is advisable. Exclusively breastfed infants should be monitored with a complete blood count with differential if methotrexate is used during lactation."

    When I was presented with my choices at the time, I didn't have a rheumatologist who was knowledgeable about extended nursing nor who I felt comfortable discussing my extended nursing with, I hadn't yet started working with my naturopath who would have been a tremendous help during this time period, and besides that, I was so freaked out by the side effects of the medication at the time that I couldn't imagine allowing even minute amounts of it to enter my daughter's body.  I felt conflicted.  I wanted to allow my daughter to wean in her own time as my son had done, but I was also to a point that I was struggling to get dressed by myself and even to get out of bed without assistance. 


    When I look back now, I don't regret the choices I made because overall they came very close to what I wanted for my kids.  I realize now though how fortunate I was that my diagnosis came after my children were born.  It came after both of my children had nursed freely to an age that they were for the most part ready to move on.   I will forever be thankful that rheumatoid arthritis made its way into my life after we were able to experience this most perfect gift together and I didn't have to choose between finding relief from my own symptoms over my parenting values.  I was able to give the gift of nursing to my children and not have to make choices for them that they weren't ready for themselves.


    My heart goes out to the young women I read about today who struggle with the choices they have to make about having children and/or nursing while also making choices of medications to treat their autoimmune diseases.  If my diagnosis would have come several years earlier, I know that my rheumatoid arthritis path would have turned out quite differently.  The personal choices I would have had to make would have been much more difficult.  Fortunately for my daughter and me, we were able to discuss the need to stop nursing and since she understood the pain I was in at the time and wanted nothing other than for her momma to feel better, it was an easy transition - another gift of nursing, empathy that developed at a young age.


    Cathy can also be found writing at her personal blog The Life and Adventures of Cateepoo



Published On: August 15, 2011