The day you’d been hoping for has arrived…you’ve had a positive pregnancy test and you are now taking your first steps towards parenthood. Congratulations!
How will I feel during pregnancy?
The greatest myth of pregnancy… the pregnancy glow!
How your body will respond to pregnancy, and how you will feel during the next nine months, will be different for everyone. Every woman is unique and every woman’s pregnancy is also unique.
Some women sail through pregnancy and even find that that their arthritis symptoms go into remission (their symptoms improve or completely disappear) during pregnancy. But that does not happen for every mother-to-be.
However the pregnancy ‘glow’ that fills our newsfeed is a myth for many women, even without arthritis. Pregnancy can bring with it many unpleasant symptoms, which can be even more challenging if you have arthritis.
Pregnancy and arthritis remission
During pregnancy, your immune system goes through some changes to allow your baby to grow and develop.
For some women with arthritis, these changes to the immune system also bring a benefit of reducing the activity of their arthritis. It is thought that about half of women with rheumatoid arthritis will find that their symptoms, such as pain, stiffness and flares, improve during pregnancy.
However there are many women with arthritis who continue to have active disease during their pregnancy. You may even find that your symptoms worsen, or you have disease flares, particularly if you’ve had to stop or change medications.
Physical effects of pregnancy
Pregnancy brings with it many physical changes to your body. If you are living with arthritis, some of these changes may even make your arthritis symptoms feel worse. Here are some common symptoms in pregnancy and tips for managing:
- Symptom: Extra pain and pressure on your hips, knees, ankles and feet as you gain weight
- What you can do: Wear comfortable, supportive footwear. Exercise in water rather than walking or standing. Reduce time standing - sit on a stool as you are preparing food and think about how you can do things differently at work to avoid prolonged time on your feet.
- See your healthcare team if: You need advice about how best to stay active during pregnancy or how to adapt your exercise program. Your joints are unusually warm, swollen and painful - seek advice from your rheumatologist.
- Symptom: Increased lower back pain as your tummy grows and your posture changes, or due to loosening of the pelvic ligaments
- What you can do: Sit and stand with good posture. Stay as active as you can within your pain limits. Sleep with a body pillow to support your hips/pelvis as you sleep. Use heat packs on your sore back.
- See your healthcare team if: Your back pain is limiting your ability to move, walk or stand. A physiotherapist can advise on suitable exercises to support and strengthen your back, and how best to move without putting strain on your back.
- Symptom: Swelling of your feet and hands
- What you can do: Elevate your feet when you can. Try splints and braces. Use aids and devices to reduce stress on hands.
- See your healthcare team if: Swelling becomes severe, or your joints are more painful and feel warm to touch - seek advice from your rheumatologist.
- Symptom: Tiredness / fatigue
- What you can do: Stay active and continue with your exercise plan. Give yourself periods of rest throughout the day if possible. Eat a health, balanced diet.
- See your healthcare team if: Your arthritis symptoms are worsening - seek advice from your rheumatologist.
Emotional health during pregnancy
Pregnancy can have a powerful effect on your mood, thoughts and emotions. Changes in your hormone levels can leave you feeling like you’re on an emotional roller-coaster at times, not to mention the impact of possible morning sickness, physical changes and bone-crushing tiredness. Some emotional ‘ups and downs’ are a normal part of pregnancy. However if are feeling constantly sad, worried, scared or nervous, thinking negative thoughts about yourself, or are finding it difficult to sleep, eat or do the usual activities in your life, seek support.
Changes in your hormone levels can leave you feeling like you’re on an emotional roller-coaster at times
Talk to your GP or obstetrician about how you’re feeling and they can suggest the best treatment options. You can also call the Perinatal Anxiety & Depression Australia (PANDA) National Helpline on 1300 726 306 for advice.
Lupus and pregnancy
Many women with Systemic Lupus Erythematosus will have normal, safe pregnancies. However, having lupus can increase the risk of complications during pregnancy, so your healthcare team will closely monitor you throughout your pregnancy. You may also be referred to an obstetrician and hospital that specialises in high-risk or complex pregnancies.
Women with very severe or uncontrolled lupus may be advised against having a baby. If organs, such as the heart, lungs and kidneys, have been damaged by lupus, they can be put under greater, even life threatening, strain by pregnancy.
During pregnancy
Many women with lupus will have safe, healthy pregnancies. Some women with lupus will have a higher risk of complications, such as:
- Miscarriage. This can also occur later in the pregnancy, up to 24 weeks. This is more common if you also have antiphospholipid syndrome (APS) which affects about one in four women with lupus.
- Flares of your lupus symptoms, either during pregnancy or after giving birth.
- High blood pressure.
- Your baby being born prematurely.
- Your baby having low birth weight. This is more likely if you have APS as this can affect the ability of the placenta to supply your baby with enough nourishment, resulting in your baby’s growth slowing.
- Developing pre-eclampsia. This is a condition where you have high blood pressure and/or protein in your urine. It is a serious condition that can put the lives of both yourself and your baby at risk, and your baby might have to be delivered early.
Your obstetrician and healthcare team will monitor you regularly to help detect and treat any complications early, and keep you and your baby as healthy as possible.
Neonatal lupus
About one in three women with lupus have the SSA-A/Ro antibodies (proteins made by the immune system). These can cause symptoms of lupus in the baby when it’s born. This is called neonatal lupus. The baby may have a skin rash, unusual blood count and, in one to two percent of cases, an irregular heartbeat that may need specialist treatment. If you have this antibody it is very important you attend your regular antenatal appointments. In most babies, neonatal lupus goes away after three to six months and does not return.
Labour and delivery
Throughout your pregnancy, you will no doubt hear many birth stories – some good, some bad and others you would rather not have heard! As these stories reveal, each birth is unique and rarely are they perfectly what the parents imagined.
Towards the end of your pregnancy, talk to your rheumatologist, obstetrician and/or midwife about how your arthritis could potentially impact on your delivery, such as:
- The positions you could use during labour and delivery. For example, there might be some positions that might be more comfortable if you have difficulties with your hips or lower back.
- Your ability to deliver your baby vaginally.
- The likelihood of requiring a caesarean section. Remember, while a caesarean section is more common in women with rheumatoid arthritis, many women without arthritis are also advised not to deliver their babies vaginally. A caesarean section may be the best option for a healthy baby.
- Your ability to have an epidural or spinal anaesthetic (pain relieving medications into the spine) during labour, especially if you have arthritis that affects your spine.
It is easy to get overwhelmed by the pressure to have a ‘normal’ vaginal birth. However the most important goal at the end of your pregnancy is for both you and your baby to be healthy. Try not to get too preoccupied by the idea of a perfect birth. Instead, surround yourself with healthcare professionals who you trust, and keep your focus on that all important end goal, a healthy, happy baby and mum.
Talk to your healthcare team about how your arthritis could potentially impact on your baby’s delivery.
Life with a new baby
The arrival of your tiny bundle of joy will undoubtedly change your life forever. Caring for a new baby is equal parts exciting and exhausting for all new parents. And, as a parent with arthritis, you may even experience some additional challenges.
Caring for a new baby
It is physically and emotionally demanding to care for a new baby, and even more so when you have arthritis either as a mum or dad. Here are a few tips that may help:
- Nappy changing
- Have change stations set up in different parts of the house, with everything you may need to change your baby’s nappy, to make it easier if your mobility or ability to carry your baby is very limited.
- A change table on wheels may make it easy for you to move it around the house.
- Look for baby wipes and creams with easy to open lids.
- Ask someone to open the nappy packets for you or open them with scissors as they can be a challenge to get into with sore hands.
- Set up a change table that is at a height where you don’t need to bend over, or one where you can even sit while changing your baby’s nappy.
- While cloth nappies may be more environmentally friendly, disposables tend to be more absorbent, meaning you won’t need to change them as often. They will also save you a few extra loads of washing each week too. If using cloth nappies, look for ones with Velcro closures to make it quick and easy to change.
- Bathing
- Look for baths that can be filled and drained in the sink or bathtub. Some baths come on trolleys that can be wheeled around.
- If you’re bathing your baby in a bathtub, look for supports or slings that they can lie on. Remember you will always need to closely supervise your baby in the bath.
- When your baby is very young, it might be easier to bathe him/her in the laundry trough/sink.
- Cots, bassinets and high chairs
- Look for items that are easily height adjustable, lightweight and on wheels to make it easy to move them around the house.
- Test the clips, release mechanisms and brakes to ensure they are easy to use.
- Dressing
- Look for clothing that is easy to put on and take off your baby, such as elastic waists and wide opening envelope necks. These will be easier on sore hands. Avoid snap closures, buttons and zips.
- Avoid socks and shoes for your baby if you have sore hands. Instead use jumpsuits that cover your baby’s feet.
- Out and about
- Use a lightweight stroller or pram that is easy to fold, unfold and lift into your car. Test the harness to ensure it is easy to clip/unclip and adjust, and ensure the brakes are easy to use. Check the height of the handle and comfort for walking. A 15kg pram versus a 6kg pram may make all the difference. It’s worthwhile testing lots of different prams before you buy as sometimes the most expensive or popular ones are not necessarily the most user friendly.
- Use a pram caddy and baby bag to keep all your essentials close to hand when you are out. Try to keep your baby bag as light as possible. Consider using a backpack instead of a bag that sits on one shoulder, or hang it off your pram.
- Try different baby carriers and slings to find one that can help you carry your baby without straining your hands, arms or shoulders.
- Ask for, and accept, help
- Organise a network of supportive family and friends who can help you when you need it. This will be particularly important if you have a flare of your arthritis symptoms, or even just if you and your baby are having a bad day.
- New mothers without arthritis often need a support network too during the early months of life with a new baby.
- If you don’t have a support network of family and friends, investigate external help that may be available. Ask your obstetrician, midwife, community nurse or GP about support services that may be available in your area. Cleaners, nannies, au pairs, meal delivery services or other community-based supports in your area may be helpful.
- Make use of online shopping and home delivery services.
- Listen to your body
- Pace yourself and be gentle with yourself. If you’re feeling exhausted, the house chores or tidying up can wait. Rest when your body is telling you it needs rest.
- Try to decide what tasks are a ‘must do’, what can wait and what can be outsourced to family, friends or hired help. Prioritise the tasks that absolutely need to get done as well as resting and enjoying your new baby. Don’t push yourself to get non-essential tasks done.
- Consider your own clothing; for example can you manage clips on maternity bras and tops, or is a pull down/up version easier?
Taking care of yourself
It can be a huge adjustment in the first days, weeks and months with your new baby
Most women experience ‘the baby blues’ in the first days after your baby is born. This is very normal and may make you feel teary, irritable and overly sensitive. The baby blues usually go away after a few days.
If you’re feeling low in mood and energy, having trouble sleeping or eating, feeling scared, sad, hopeless or angry for more than two weeks, seek help.
You can talk to your GP, child health nurse, the Perinatal Anxiety and Depression (PANDA) Helpline (1300 726 306), your partner, friends and family. Getting the right support and treatment will help you manage post-natal depression and have you feeling better sooner.
Get advice from your healthcare team
If you’re struggling to look after your baby because of pain or other symptoms, see your rheumatologist to talk about your treatment options.
See a physiotherapist or occupational therapist for advice about looking after your joints and equipment that can make caring for your baby easier.
Get advice from a child health nurse or lactation consultant for ways to make it easier to care for, and feed, your baby.