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Parenting with Arthritis

Parenting with Arthritis

Taking care of a newborn can be exhausting and physically taxing for anyone. New parents with arthritis or other rheumatic disease may have even more challenges with the lack of sleep, feedings every two hours or so, lifting an infant for dressing or diaper changes, bathing the infant, and other everyday parenting tasks. If your disease flares after delivery, pain, joint swelling or stiffness, fatigue and other symptoms may make these tasks very hard to do.

After delivery and recovery, you and your new baby will go home to begin your new life together. Caring for a newborn is both exciting and tiring for just about every new parent! Newborn babies wake up, cry, and need diaper changes, cuddling and feeding every few hours. It can be very hard for new parents to get any sleep.

Treating Post-partum Flares

Some rheumatic diseases may flare one to six months after delivery. Before the routine use of medications, about 75% of new mothers with RA experience a flare within three months after their delivery. This may be the last thing you want to experience as you are trying to care for your newborn. Even with help from your partner, friends and family, or a home health aide, caring for a new baby means lifting, carrying, stooping, bending, changing diapers, holding the baby during feedings, bathing and other physically taxing tasks.

To avoid having a post-partum flare, your rheumatologist will go over your options to resume disease-modifying medications within a few weeks of your delivery. Treatments can ease inflammation and get your flare under control. However, you may be concerned about whether or not your treatments are safe to take during lactation, or breastfeeding.Almost all treatments for rheumatic diseases are safe to use while you are breastfeeding. Your rheumatologist should be able to create a treatment plan for you that will not put your baby at risk. As we discussed earlier in this guide, every drug has its own risk profile for use during either pregnancy or lactation.

Rheumatic disease treatments that are considered safe to use during breastfeeding:

  • NSAIDs: All except aspirin
  • Corticosteroids
  • Acetaminophen (Tylenol®)
  • Hydroxychloroquine
  • Sulfasalazine
  • Azathioprine
  • Tacrolimus or Cyclosporine
  • TNF-inhibitor biologics
  • Heparin and warfarin

Rheumatic disease treatments that may NOT be safe during breastfeeding:

  • Methotrexate
  • Mycophenolate
  • Cyclophosphamide
  • Leflunomide

These treatments may be safe to use during lactation, although there isn’t enough evidence yet to be sure. Because they are large molecule biologics, it is unlikely that they will pass through the maternal blood barrier into the breast milk. Talk with your rheumatologist about the risks and benefits of taking these drugs while you are breastfeeding, and if you have any other options:

  • Rituximab
  • Secukinumab
  • Tocilizumab
  • Tofacitinib
  • Ustekinumab

Feeding Your Baby: Choosing the Right Option For You

There are many treatment options that are safe for you to use to control your rheumatic disease in the weeks and months after delivery.

There are other things to consider when you’re making the choice to breastfeed or not. This is a personal decision for you and your partner to make. You can talk with your physician or your baby’s pediatrician about any concerns or questions you have about breastfeeding, and other options you have if you choose not to breastfeed. Some moms choose to pump their breast milk and feed their new babies by bottle, or use formula that is fed to the baby in a bottle. Some moms may try breastfeeding for a period of time, and then switch to formula later.

It’s up to you to decide how to feed your baby. When you have a rheumatic disease like RA, PsA, lupus or AS, you may have joint pain or damage that makes it hard to hold your baby as he or she feeds several times of day and night. If you’re having a flare, you may not feel up to breastfeeding during that time.

However, there’s no reason why new mothers who have rheumatic diseases can’t breastfeed as long as they’re not taking any medications that could be harmful to the baby. Talk with your rheumatologist about any concerns or questions you have about breastfeeding while you take any medications.

Why is breastfeeding a good idea?

  • Breast milk is a safe, natural food for your baby. It contains healthy antibodies and hormones that help your baby build up its immune system.
  • Colostrum, the thick, yellowish fluid you produce in your breasts at the start of nursing, contains nutrients that help your baby fight off infections.
  • Research shows that breastfeeding your baby your own milk can reduce your baby’s risk of developing health problems like asthma, diarrhea, ear infections, eczema, lower respiratory infections, SIDS, some pediatric cancers, and type-2 diabetes.
  • Children who were breastfed are less likely to be obese.
  • Breast milk may also reduce the risk of certain childhood cancers like leukemia, and maternal cancers such as uterine, ovarian, and breast cancer.
  • Breastfeeding may also help nursing mothers lower their risk of diabetes and certain cancers. It may also help you lose weight after giving birth because it burns calories.
  • Breastfeeding helps mothers by reducing the risk of postpartum hemorrhage. When you breastfeed, your body produces hormones that cause uterine contractions, encouraging it to return to its normal size. This prevents hemorrhage in the first few days to weeks after childbirth.

There are psychological benefits to breastfeeding too. According to the American Academy of Pediatrics’ “New Mother’s Guide to Breastfeeding: 2nd Edition” published in 2015, the act of breastfeeding—holding your baby close to your body—can make your new baby feel safe and protected. You also release hormones during breastfeeding that nurture your bond with your baby – a “mothering instinct.”

If you choose to bottle-feed your new baby, you can also develop a bond with your baby and nurture it. Don’t stress out over any decision you make or if you decide to stop breastfeeding at any point. Your baby can grow up healthy, loved and well developed no matter how you choose to feed it during infancy.

If you decide to breastfeed, here are some tips to keep in mind as you nurse:

  • Find a comfortable position for breastfeeding. Support your back and neck by sitting in a solid chair or up in bed against a headboard. If you have a chair that lets you lean back a little, this can help you get in the right angle.
  • Rest your feet on something like a pillow, footstool or cushion.
  • Make sure your arms are supported as you hold your baby during feeding. There are lap cushions and other devices that are designed to help you support your baby’s head and body.
  • Some moms choose to breastfeed while lying on their sides, and use a cushion or pillow to support the baby.
  • If your arthritis has damaged your upper body joints, you may need help from another person or nursing device or cushion. Make sure you don’t injure your joints just because you feel that you’re “supposed to” do everything yourself.
  • Soon, you may need or want to nurse your baby outside the house. You will want to go out to run errands, go to your or your baby’s medical appointments, visit friends and family, go out to dinner or shop. To make it easier on you, limit the amount of paraphernalia you carry with you in your diaper bag as much as you can. Or split the items up between you and your partner if you’re both going out together. Breastfeeding does require fewer things to carry, but you may want to take a sling or cushion with you if you need it on the go.

Some new moms have trouble breastfeeding. It happens to moms who don’t have a rheumatic disease too. Your doctor can refer you to a lactation consultant if you need one. These professionals can help you work through issues with breastfeeding.

Formula or “Bottle” Feeding

If you find that you don’t wish to breastfeed, cannot breastfeed or need to stop at some point, there are alternative feeding options. You can, of course, switch to formula to feed your baby. Do not worry that formula feeding will harm your baby. It will not. High-quality formulas are available to feed babies that give them every nutrient they need to grow and develop healthfully. There are also supplements made from human milk that you can add to your baby’s formula that make it even better for your child.

If you cannot or don’t want to breastfeed but don’t feel formula is best for you, there are multiple services where you can purchase breast milk for your baby. There are milk banks in each state with donated breast milk that is checked and processed to ensure it is safe for your baby. You can speak with your pediatrician, ob/gyn, or a lactation consultant about the best way to get information about this process.

As you hold and feed your baby with a bottle, you can bond and connect just as you would while breastfeeding. Your baby will feel safe, nurtured and loved.

The most important thing to remember is to adapt feeding to your needs. If your arthritis affects certain joints like your neck, back, shoulders or upper arms, look for new positions or supportive devices to help you adapt. Some people with RA have severe joint pain or stiffness in their hands that may make holding a baby bottle for a long period of time difficult or impossible. PsA can cause severely swollen, “sausage” fingers or painful nail damage that may make it hard to hold a bottle too.

If you have any trouble holding your baby or their bottle, see if you can find devices to help you. Grippers could ft around a baby bottle to make it easier to grasp. Slings can ft around your upper body to help you hold your baby in place. Or, ask for help. Your partner can and should help you feed the baby. You don’t have to go it alone.

Diapering, Dressing and Other Baby Care Tasks

Taking care of a new baby means no end of things to do: diaper changes, cleaning and bathing, dressing your baby, laundry, changing the crib sheets, locking and carrying the car seat, and a very long list of other tasks. Moms and dads with rheumatic diseases have the same responsibilities as other new parents, but may also have to deal with joint pain, stiffness or damage, limited mobility, or fatigue and flares.

Talk with your rheumatologist quickly if baby care tasks become too difficult for you to do. Don’t allow yourself to feel like you’re letting your baby or partner down. Your doctor may be able to adjust your treatment so you control your disease more effectively and feel better. Your rheumatologist can also refer you to physical or occupational therapy – these healthcare professionals can help you adapt your movements or find assistive devices that make it easier for you to care for your baby.

Here are a few tips for common baby care tasks if your arthritis makes them harder or more painful to do:

  • If your baby moves around a lot when you’re trying to clean or diaper him or her, place a toy nearby for a distraction – or sing a little song and make eye contact.
  • As your baby gets a little older, you may be able to teach him or her to lift up a little during diaper changes. Children who are one month or older may be able to lift their bottoms up a bit, making it easier for you to change the diaper.
  • Make a duplicate diaper bag or set of supplies to keep on hand when you’re on a different floor of your house. This can cut down on the need to transport your baby to another part of the house just for a diaper change or clean-up.
  • When you lift your baby, use your arms, not just your hands. Your hand joints are small and could be weakened by arthritis. You have stronger muscles in your arms and shoulders.
  • If you use any diaper creams or similar products, try to find brands in easy-to-open containers with large lids. These can put less strain on your hands, as well as not causing you to stress out because you can’t open the jar! Baby wipes also come in containers with easy to open lids.
  • Dressing a baby can be frustrating for moms and dads who don’t have arthritis! Try to find baby outfits with easy fasteners like Velcro, zippers, and magnets rather than buttons or snaps. Anything that can be easily changed is best. Also, look for clothes in fabrics that are easy to care for and laundered, and don’t need to be ironed. Your baby will never know that you don’t like to iron!
  • For bathing, check out baby tubs that can be easily filled and drained in the tub or sink. You don’t have to lift these tubs when they’re full of water. Ask for help if you cannot lift your baby into a bath. Sponge baths or wipes are another way to keep your baby clean, or attend to unexpected messes, without a full bath.
  • Look for “baby-shaped” sponges that support your baby while he or she is in the bathtub.
  • When you and your baby are on the go, use lightweight strollers that you can easily transport, collapse and put in the car. Test different strollers in the store before you buy them. Make sure you can easily put the rain cover in place and remove it, lift the stroller, get your baby in and out of the stroller, and other important tasks.

Caring for Your Newborn: Ask for Help!

Don’t wait until you are about to collapse from joint pain, exhausting fatigue, muscle weakness or stiffness, or other severe symptoms. If you are having a flare soon after your delivery, you will need help caring for your baby. Don’t feel ashamed to ask for help from family or friends with even the most basic or minor tasks.

Here are a few tips to keep in mind:

  • Muster the troops: Set up a plan for post-delivery assistance in the final weeks of your pregnancy. See if relatives or friends can stay with you for a little while after you come home with your baby, or be “on call” to come over on short notice if you are struggling with baby care tasks like bathing or feeding. People who love you want to help you.
  • Keep phone numbers handy: Program the contact information for family members, friends, doctors or services into your phone so they are easy to find when you need help.
  • Use assistive devices or modifications: There are tons of tools and gadgets to make caring for your baby easier on your joints. These can be as simple as bathing basins with plugs you can drain right into the sink instead of carrying it full of water, wash mitts so you don’t have to grasp a washcloth or sponge, and dressing your baby in clothes that fasten with Velcro so you don’t have to fuss with buttons or snaps. Check online to find what you need to make these tasks easier. There are also aids to help support your baby while you breastfeed or bottle-feed – babies can be heavy to hold and put a strain on weak joints.
  • Do what you can and then let others take over: Don’t feel guilty if you’re not able to do everything involved in caring for your new baby. It’s OK to let others share tasks like feeding from a bottle, bathing your baby, watching your baby while you take a nap, doing laundry or cleaning up dirty diapers.
  • Explore outside help: If your budget accommodates a hired professional, this can be a huge help for you as you care for your newborn. Nannies, au pairs, home health aides and other assistants can come to your home for short periods of time or stay with you around the clock.

For arthritis specific information, see this resource of helpful tips created by the Canadian Arthritis Patient Alliance.

Post-Partum Depression: Seek Help If You Need It

Many new mothers are susceptible to post-partum depression. This is a serious medical condition that may require treatment, so speak to your physician if you show any signs of depression after you and your baby come home.

Your rheumatic disease could put you at risk for depression after you have a baby. You may have a flare that causes severe pain or lack of mobility, making it hard to care for your new baby. You may worry about your ability to take care of your baby as he or she grows up. Getting little or no sleep could just make you feel more fatigued and moody. You may find that you have so many responsibilities because of caring for a new baby that you feel lost, confused or sad.

If you notice the signs of depression, or if others around you notice something is wrong, speak up. Don’t deal with it alone.

Your doctor can refer you to treatment for depression. You may find that counseling or other therapy can help you cope with your post-partum depression. Your doctors, nurses and therapists can also suggest ways to adapt to your new role as a parent, and help you find ways to balance your responsibilities and your rheumatic disease’s physical challenges.