Brunilda Nazario, MD
Amy Louise Nelson, 34, relied on her Boppy support pillow while nursing her two children. While many new moms find comfort with this fluffy U-shaped pillow when breastfeeding, Nelson physically depended on hers to take the strain off her arms. Diagnosed with rheumatoid arthritis (RA) in 1998, this mother of two says she may not have been able to breastfeed without her trusted pillow.
RA is an autoimmune disease in which the body attacks its own joints and other tissue. It primarily strikes women of childbearing age like Nelson. While the disease often goes into remission during pregnancy, many women experience a flare a few months after giving birth, and this can make newborn care even more challenging.
“I flared five months after my first pregnancy, and three months after my second,” Nelson recalls. Breast-feeding was not the only thing that proved daunting for Nelson in the postpartum period. She had trouble getting up and down from the floor with her newborn. She quickly learned to position herself near a couch or sturdy end table so she could use it as leverage.
“It’s about making everything more convenient so there is no added strain on the body,” she says.
From breastfeeding and sleep loss to tummy time and rocking your baby to sleep, motherhood is challenging for us all. Factor in the joint pain and inflammation that are the hallmarks of RA, and the situation can reach critical mass. But taking care of yourself, leaning on friends and family (or couches and end tables, as the case may be), and with simple strategies like using a support pillow can make a big difference to new moms with RA, experts tell WebMD.
Although the health benefits of breastfeeding for mom and baby are well known, it can be trying for new moms. Those with RA are certainly no exception, says Shreyasee Amin, MD, a rheumatologist at the Mayo Clinic in Rochester, Minn.
“If a new mom with RA has involvement of elbows, hands, and wrists, it may be difficult to position the baby for breastfeeding,” she says. That’s why Nelson relied on her pillow. If you need more support or guidance, an occupational therapist can prescribe splints to take the pressure off affected joints and allow for easier, more comfortable breastfeeding, Amin says.
Some arthritis medications are safe during breastfeeding, while others are not. That can mean women who want to breastfeed may have to make some careful decisions.
“Steroids and Plaquenil [hydroxychloroquine] are OK, but the more traditional disease-modifying anti-rheumatic medications would be problematic in breastfeeding as well as during pregnancy,” says M. Elaine Husni, MD, MPH,vice chairwoman of rheumatology and director of the Arthritis and Musculoskeletal Center at the Cleveland Clinic. Some women find they can get enough relief with these drugs to breastfeed before returning to their regular medications. In other cases, says Emilio B. Gonzalez, MD, chief of rheumatology at University of Texas Medical Branch in Galveston, “If the RA is more severe, women may want to consider treating their RA and using formula to feed their baby.”
Ask any new mom how they are sleeping, and they will probably crack a wry smile or look at you like you are crazy.
“Sleep is always a challenge for new moms, and poor sleep can contribute to more aching in the joints,” Amin says. “We don’t recommend additional medications because we don’t want you to be groggy for those late-night or early-morning feeds,” she says.
So what is a new mom with RA to do? Drink lots of fluids and eat small, nutrient-dense meals, Husni suggests. “Dehydration can make you feel worse or more tired,” she says. “It is also very easy to want to skip meals, but make sure you eat smaller meals more frequently."
New moms are at risk for baby blues or more serious postpartum depression after birth, and depression and RA tend to travel together. There are no studies on how common postpartum depression is in RA, but new moms with RA may be at greater risk. In addition to having a chronic illness -- a risk factor for depression -- new moms are often sleep-deprived and may feel stressed out, which can also raise the chance of becoming depressed.
“Those with RA may be more susceptible if they don’t take care of themselves,” Husni says. “Get help even just for a couple of hours so you can take a bath and relax. Lean on friends and family, or if you have the means, hire help,” she says.
Nelson agrees. “Take care of yourself first. Motherhood is physically draining with RA,” she says. She leaned on her husband when things got rough and her joints began to ache. “I am lucky that I have a supportive husband who has been there every step of the way.”
SOURCES:Shreyasee Amin, MD, rheumatologist, Mayo Clinic, Rochester, Minn.Elaine Husni, MD, MPH,vice chair of rheumatology; director, Arthritis and Musculoskeletal Center, Cleveland Clinic.Emilio B. Gonzalez, MD, chief of rheumatology, University of Texas Medical Branch, Galveston.Amy Louise Nelson, Rochester, Minn.
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