The time directly after your baby is born —postpartum — can be overwhelming for anyone. You’re now completely responsible for a new human being and on top of that, you have to recover physically from the pregnancy and birth, which can both be hard on your body. Adding rheumatoid arthritis (RA) into the mix makes for extra challenges.
“With progressive knowledge gained over the past decade, the woman facing the postpartum period can do so with optimism, though there are some significant caveats,” said Robert G Hylland, M.D., fellow of the American College of Rheumatology, and assistant clinical professor at the Michigan State University College of Osteopathic Medicine.
Planning ahead helps
“Preparing for the postpartum period should begin before the decision to becoming pregnant is even entertained,” Dr. Hylland said. He also suggested family counselling to make sure your partner and family understand that their support is essential to your ability to cope with the challenges you’ll no-doubt face.
Certain RA medications must be stopped before trying to become pregnant due to risk of birth defects. If you are taking methotrexate or leflunomide (Arava), make sure you have a conversation with your rheumatologist before conceiving. These medications should also not be taken while breastfeeding.
Other drugs are considered safe during pregnancy and breastfeeding, Dr. Hylland said. Several RA meds are considered safe to use while pregnant and breast-feeding. He particularly indicated anti-TNF biologics, low-dose prednisone, hydroxychloroquine and most NSAIDs. If you want more information about medications and other products that may be passed to you baby, Dr. Hylland recommended checking MotherToBaby and Lactmed.
Respect your own physical needs when caring for your baby
Taking care of a baby is physically demanding, even when they are tiny. Depending on the severity and level of activity of your RA, you may have problems doing the physical work of new motherhood. Body pillows can help during breastfeeding, limiting the strain of supporting your baby with your arms. If you are experiencing problems breastfeeding, talking to a licensed lactation consultant can be very helpful.
Taking a look at equipment used by parents with disabilities can offer options that may ease the physical work of caring for a newborn.
“An occupational therapy referral to discuss braces, energy-conservation techniques, and body mechanics can be very beneficial,” Dr. Hylland said.
Staying healthy as a new mom
A newborn takes up a lot of time and space in your life, but when you have RA it’s important to not ignore your own needs. It’s essential that you get the sleep you need. Dr. Hylland recommended that you eat “several small meals per day and drink copious amounts of water to avoid dehydration. And don’t forget vitamins, especially vitamin D and calcium if breastfeeding.”
Coping with the postpartum RA flare
With the possibility of continuing RA medication during pregnancy, many moms are experiencing continued control of their RA. This can also be true if you stop taking medication during pregnancy, as approximately two-thirds of pregnant women with RA experience remission. Unfortunately, this respite is usually short-lived.
“A postpartum flare within two to six months is almost guaranteed,” said Dr. Hylland. “Active RA may require cessation of breastfeeding to accommodate more aggressive therapies.”
Having to choose between nursing your child and treating your RA may feel like an impossible choice. Keep in mind that a healthy you is essential to having a healthy baby. Dr. Hylland said it’s important for new moms to realize that their own health is of ultimate importance to the health and wellbeing of their baby.
Watch for postpartum depression
Up to 80 percent of women experience “baby blues” within a few days of the birth of their baby. Symptoms include irritability, crying, anxiety, mood changes, and more. The exact cause is not known, but it’s thought to be related to hormone changes. Baby blues usually disappear within a couple of weeks.
Postpartum depression or anxiety, on the other hand, can occur anytime within the first year after giving birth. There are many symptoms of these conditions, including insomnia, deep sadness, not feeling bonded to the baby, having disturbing thoughts, and a feeling of dread.
If you are having any of these feelings and believe you may be experiencing postpartum depression, talk to your doctor right away. Additional support is available via organizations such as Postpartum Progress.
Although there are challenges to face after having a baby, there are also many joys. You are a mother now — a role that will bring you a deeper love than you imagined, as well as deeper frustrations and an inability to use the washroom alone for years. The support of your family or friends is an essential part of being able to find the joys more than the frustrations. You may also want to join Mamas Facing Forward, a private Facebook group where you can talk to other mothers who have RA.
See more helpful articles:
Caring for a Newborn When You Have RA
What You Need to Know about RA and Pregnancy
Rheumatoid Arthritis, Pregnancy and Parenthood: an Interview With Suzie Edward May