Australian guidelines recommend exclusive breastfeeding for babies to around six months of age. Breastfeeding is then recommended to continue alongside suitable foods for infants until 12 months or age and beyond, for as long as the mother and child wish.
Whether to breastfeed or not, or for how long, is a very personal decision. Even mothers without arthritis can have issues that can prevent breastfeeding, or make it very difficult.
There are usually no physical reasons that prevent women with arthritis from breastfeeding, apart from possible discomfort if you and your baby are not positioned correctly during feeding. You can get advice on this from your child health nurse or lactation consultant at your local hospital. The choice to either breast or bottle feed your baby will depend on many factors, such as your milk supply, your baby and the medications you are taking.
Breastfeeding and Medications
Many arthritis medications are safe to take during breastfeeding as they do not pass into breast milk, or only in very low levels that are safe for the baby. Others can pass into your breast milk and will not be safe for your baby. Talk to your healthcare team, including your rheumatologist, about your plans for breastfeeding so that the best treatment plan, for both you and your baby, can be put into action when your baby is born.
See the table above for a summary of the safety of arthritis medications during breastfeeding.
Breastfeeding and Joint Pain
If you decide to breastfeed, here are some tips to make it more comfortable on your sore joints:
- Find a comfortable position. You might have a supportive chair at home already, or you might choose to invest in a breastfeeding chair, but make sure your neck and back are supported in a comfortable position. New babies feed all the time so make sure the chair is very comfortable as you will be spending a lot of your day (and night) in it. Some women find breastfeeding more comfortable lying on their side, so you may have to experiment with different positions before you find what works best for you.
- Breastfeeding pillows are a great way to support your baby, without putting strain on your hands, arms, shoulders and back.
- Seek advice from a lactation consultant or child health nurse if you are finding breastfeeding difficult or painful. They may be able to recommend a range of different equipment or aids that can make all the difference.
Bottle Feeding and Joint Pain
Bottle feeding can also cause strain on sore arms, hands, necks and upper backs.
Here are some tips:
- Find a comfortable position. Make sure you sit in a comfortable chair that supports your neck and back. Use cushions or pillows to bring your baby to a height that’s comfortable for you to hold the bottle in their mouth.
- You could also try feeding your baby in a baby carrier, sling or rocker if it’s difficult holding your baby in your arms for long periods.
- Look for wider bottles that are more comfortable to hold in your hands.
- Ask your partner, family or friends who are visiting to help when they can.
- Consider asking for help if you can’t open the cans of formula or ask your partner to prepare the bottles if you’re going to be alone for a long period of time.
- Ask someone to help you with washing all the used bottles, or use a steriliser or dishwasher to clean the bottles.
Post-natal Flare
Just as you’re trying to cope with the sleep deprivation, and the physical and emotional demands of being a new mum, you might also have a flare of your arthritis symptoms.
Many women with arthritis find that their symptoms return or flare in the months after the baby is born. Post-natal flares are common, with studies suggesting up to 40% of women with rheumatoid arthritis experience a flare in the six months after giving birth.
This flare can make caring for your newborn extremely challenging. All the usual baby-care activities such as holding your baby during feeding, changing nappies, bathing, carrying and lifting your baby can be nearly impossible if you have severe joint pain and stiffness. You might also feel completely exhausted with arthritis-related fatigue on top of the sleep deprivation that comes with new babies.
It is a good idea to have an appointment booked with your rheumatology team four to six weeks after the birth.
If you notice your arthritis symptoms worsening in the weeks or months after the birth, get in touch with your rheumatologist straight away for advice about your treatment options and make an earlier appointment than planned.
A physiotherapist, occupational therapist or child health nurse may also be able to give you some practical advice about how to look after your baby during a flare. Using a baby carrier/sling and other equipment can make caring for your baby easier on your joints. See the section below for some tips about caring for a new baby when you have arthritis.
Most importantly, plan to get extra help. Have a support crew of family and friends on call for extra help if your arthritis flares. Don’t be afraid to ask for help from your network during this time when you might be struggling with even the most basic tasks.
Seeking Support
Who can help?
- Rheumatologists are doctors who specialise in diseases of the joints. Your doctor will need to refer you to a rheumatologist. They may recommend a rheumatologist or you can contact the Australian Rheumatology Association to find a rheumatologist.
- A rheumatology nurse, if available, can help you understand your treatments, provide support and refer you to other health professionals.
- A physiotherapist (physio) can use various treatments to keep your joints as flexible, strong and pain-free as possible. They will also show you exercises and pain-relief techniques to use at home.
- An occupational therapist (OT) can provide advice on how to care for your baby without putting strain on your joints, including suggesting equipment and aids that can help.
- Talk to your GP if you are finding your feelings and emotions are getting in the way of enjoying your life. They can suggest ways to cope, recommend medications that can help or refer you to a psychologist who can help you work through your feelings. You may be eligible for a Mental Health Care Plan, via your GP, which will provide subsidised sessions. You can also see a psychologist without needing a referral.
- Perinatal Anxiety and Depression Australia (PANDA) supports women, men and families across Australia affected by anxiety and depression during pregnancy and early parenthood.
- beyondblue provides information and advice about depression, anxiety, available treatments and where to get help.
- Child health nurses are a wealth of information and support as you learn to care for your new baby. Ask your obstetrician or midwife, or contact your local community health centre to find out about services in your area.
- Lactation consultants can help you with any problems you might have with breastfeeding. Find out if your local hospital or child health clinic provides this service, otherwise you can pay for a private consultation.
- The Australian Breastfeeding Association has a helpline 1800 mum 2 mum (686 268) and online forum to help you with any breastfeeding concerns.
- The Independent Living Centre has information about aids and devices that can help with day-to-day activities.