Coping with the demands of a small baby is exhausting for any new mother, and if you have arthritis the stresses can be much greater. Women with rheumatoid arthritis may find that their arthritis flares up again in the weeks after the birth (often after going into remission during the pregnancy).
To help prevent flares in arthritis during and after pregnancy it's important that you don't stop safe treatment during pregnancy or breastfeeding.
Before the birth it may be worthwhile to arrange for extra help from family and friends for once the baby is born. If necessary, extra help can be arranged - discuss this with your doctor or with Social Services.
Following the birth, a physiotherapist or occupational therapist may need to be involved in the aftercare; holding, dressing, washing and feeding a baby can all be difficult because of stiffness.
There are practical steps you can take to reduce impact on your wrists, hands and back. For example, a high changing station would mean you don't place undue strain while you're bent over changing your baby's nappy. Or, a changing station which you could use sitting down might help.
There are alternatives to carrying your baby in your arms, for example there are products that allow you to safely strap your baby to your chest to reduce the load on your hands and wrist. Ask your doctor how to go about getting help.
If you already have another small child or children, you may need to arrange for extra help in caring for them. Extra support from a partner, other family members or friends is crucial in sharing the care of a small baby, and help from Social Services can also help you to manage in the first few months after birth.
What about my medication?
If any drugs for arthritis were stopped before or during your pregnancy most doctors recommend going straight back on them, except where you've been put on alternative drugs which are safe in pregnancy and when breastfeeding or when the drugs would stop you breastfeeding.
It's important that women continue safe treatments during breastfeeding and not wait until after their arthritis flares up again before returning to their medication. Ask your doctor or rheumatology nurse specialist for advice on this.
If you have a flare-up shortly after the birth, perhaps before the disease modifying anti-rheumatic drugs (DMARDs) have started working again, then your doctor may give you a short course of steroids. If only one or two joints are troublesome these can be injected with steroids. Physiotherapy can also be helpful during this time.
Will I be able to breastfeed?
Breastfeeding is best for your baby. Even if you only breastfeed for a few weeks it will still benefit your baby, so the doctors and midwives will try very hard to keep you on drugs that won't affect your baby through your milk. Drugs you take while breastfeeding may pass into the breast milk, although only in small amounts, so it's sensible to take as few as possible.
The section on drugs, pregnancy and breastfeeding will give more details on which drugs you're able to take while breastfeeding.