Questions to ask yourself
Deciding to become pregnant should be a conscious decision for all women. Since it will probably be one of the greatest decisions a woman ever has to make" it is important that she has the information to do so.
If you have arthritis and are pregnant or are thinking about having children you may want to ask yourself these questions if you haven't already:
- Am I ready?
- Will my arthritis go away?
- Will my child inherit arthritis?
- How will arthritis affect my pregnancy?
- How will pregnancy affect my arthritis?
- How can I plan ahead for my pregnancy?
- How can I make it easier to care for myself and my baby after birth?
This information aims to help women with arthritis answer these and other questions. As you review this information list the pros and cons of having a child. Then refer to this list as you and your partner make a decision. Since arthritis and pregnancy affect everyone differently the answers to these questions will be different for everyone.
Any couple who is thinking of having a baby will have certain physical emotional and financial issues to consider before conceiving the child. A woman with arthritis will have particular concerns related to arthritis. The self-test will help evaluate the physical ability of a woman with arthritis to care for a new baby. Following the test are some questions to think about and discuss with others.
Self-test for strength and endurance
This test will give you a good idea of how caring for a baby will affect you physically and what problems you may have to work on before having a baby. Try the activities below and list any problems you have with certain ones. Your therapist doctor or nurse can help you work out the problems. (Note: the weight and structure of a bag of potatoes is used to mimic the motions of carrying and lifting a baby.)
- Can I lift a 10 lb. bag of potatoes from the height of my bed?
- Can I hold a 10 lb. bag of potatoes in one arm while sitting for at least 10 minutes?
- Can I go up and down stairs easily while carrying a 10 lb. bag of potatoes?
- Can I walk around the house carrying the 10 lb. bag of potatoes for up to 10 minutes?
- Do I get more pain in my hips knees and/or feet when I am carrying the 10 lb. bag of potatoes?
- Can I screw on and off the top to a baby bottle?
- Can I push a diaper pin through a thick diaper?
- Can I get through my average day without taking a nap?
- Can I bend my neck (chin to chest) to see the baby if I were holding it close to me?
Other questions for you your family and your doctor to consider
Any major life decision should be made at a time when you are not under stress. You need to be clear about why you wish to get pregnant and when you wish to do so. The why might be very difficult to answer because we're all influenced by previous life experiences current roles and relationships and by our frame of mind. It's not uncommon for instance for some women to choose pregnancy when they are feeling lonely and depressed thinking that a new baby will change things for them. You might want to ask yourself the following questions when thinking about how you feel about having a baby:
- Am I expecting a new baby to fill a void in my life?
- Do I want to get pregnant only to try to relieve some of the pain I'm having from my arthritis?
- Are there people around me who can help me when I'm not feeling well?
- Is this a good time to have a baby personally emotionally and financially?
If you're not sure how you feel about some of these questions discuss your feelings with your family and friends. You might also find it helpful to talk to your doctor or other health team members. These people can also refer you to a counselor or someone specially trained to help with these issues or to other women in similar situations.
Will arthritis go away during pregnancy?
Rheumatoid arthritis may improve at any time during pregnancy. In most women it usually improves by the end of the fourth month. While joint swelling may decrease pregnancy women may still have some joint pain or stiffness due to existing joint damage.
Lupus may stay the same improve or flare (get worse) during pregnancy. To decrease the chances of a flare the lupus should be in remission for six months before you become pregnant. This means not only that you feel well but that blood tests and other tests for the disease are also normal.
Research on scleroderma and other types of arthritis is not as conclusive. Some studies report that scleroderma flares while others report that it improves.
If illness does improve during pregnancy it may flare two to eight weeks after your baby is born. Proper planning and treatment before during and after pregnancy however can help decrease pain and swelling and help improve your ability to function. You and your health care team can work together on ways to do this.
Having an abortion will NOT prevent a flare. Any type of delivery--whether from a spontaneous abortion a therapeutic abortion or a stillbirth--could cause a flare.
Will a child inherit arthritis?
Probably not. While the causes of most forms of arthritis are not known some forms tend to appear in families more often than others. These types of arthritis are called "familial" yet heredity is never the single factor that determines if a person develops arthritis. Other factors such as the environment (exposure to certain viruses or chemicals) also may have an effect.
Scientists have found certain genetic markers that may indicate if some people have a higher risk for getting some types of arthritis. However the relationship between these markers and the actual development of arthritis is still unclear and does not mean you will pass arthritis on to your child. Generally there is no way to tell if your child will ever have arthritis in the future.
How does arthritis affect pregnancy?
The physical changes that normally occur during pregnancy may affect joints and muscles in the following ways.
Controlling the arthritisTo feel your best during your pregnancy and after your baby is born try to get your arthritis under the best possible control before you become pregnant. This means keeping in close touch with your doctors and following your treatment program carefully before during and after pregnancy. Below are some ways to do this.
Health care teamYour health care team must include a doctor (preferably a rheumatologist AND an obstetrician) along with other health professionals as necessary. Work as a partner with your health care team members so you'll stay as healthy as possible.
Follow your treatment plan
You're probably already following a treatment plan for your arthritis. Once you become pregnant you and your doctor may have to change some parts of this plan slightly. As a pregnant woman with arthritis your plan should include:
You've probably wondered whether you should continue taking your arthritis medicines. While it would be ideal to be off all medicines during pregnancy this is not always possible. Talk to your doctors about the medicines you're taking and which ones are safe to take while you're pregnant. Some medicines are used more often than others during pregnancy and your doctor may prescribe medicines other than those listed below. Some medicines just haven't been used enough to know whether or not they'll cause problems to your baby during pregnancy. The most important concern of course is keeping you and your baby as healthy as possible.
Discuss any medicines you use--either prescription or over-the-counter--with your doctor(s). If you must take medicines during your pregnancy your doctor will give you the lowest possible dose and will monitor the effect of the medicine on you and the baby. Do not start or stop taking any prescription or over-the-counter medicines without first contacting your doctor.
Taking medicines while breast-feeding
Any medicines you take may be passed to your baby through breast milk. Here. are some tips to consider if you intend to breast feed.
You probably already have an exercise program to follow for your arthritis. While you'll want to continue exercising to keep your joints in their best condition you'll also want to make sure the exercises don't harm your baby. Discuss your exercise program with your doctors before you begin especially if you have:
If your arthritis improves during your pregnancy you may wish to exercise more than usual.
Good nutrition is very important for your health and for your baby's health. You should eat a balanced diet and practice good eating habits before during and after your pregnancy especially if you are breast-feeding. A dietitian nutritionist or other health care worker can help you plan a balanced diet.
Arthritis may cause eating problems due to:
Also joint pain may make it difficult to prepare meals so you may be less likely to eat a balanced diet. If you're taking prednisone you may need a special diet to help avoid high blood sugar which may be caused by the medication. Discuss these problems with your doctor.
Some possible problems and solutions associated with pregnancy and diet are discussed here.
Problem 1. Weight gain or weight loss
Gaining too much weight will put more stress on your joints. The extra weight of pregnancy can make this problem worse. But if you do not gain enough weight you and your baby may not be getting enough nutrients you both needs to stay healthy.
Most doctors suggest you gain between 20-30 pounds during pregnancy. To do this you must balance diet and exercise. Here are some questions you should consider:
Your obstetrician or dietitian can help you plan a diet that takes these factors into consideration. If your arthritis for instance prevents you from getting as much exercise as you would like then you will not need as many calories as someone who is more physically active. But you still will need to pay close attention to your diet to make sure you get enough vitamins and minerals.
Problem 2. Nausea and vomiting
Nausea and vomiting can lead to problems that could affect you and your baby.
To reduce nausea:
Problem 3. Heartburn
Heartburn usually gets worse as your uterus enlarges and pushes up on your stomach.
Talk to your doctor about this and how your arthritis medicines might be affecting your heartburn.
To reduce heartburn:
Problem 4. Constipation
Bowels may slow down during pregnancy and cause constipation. Some forms of arthritis such as scleroderma also cause bowel changes.
Contact your doctor immediately if you are having bloating gas diarrhea or constipation problems beyond what your doctor thinks is normal for you.
To relieve constipation:
The extra weight of pregnancy may make your joints hurt more. To avoid further damage to your joints it's important to learn ways to protect your joints from extra stress and strain. Here are some ways to do this.
| The following issues may also be of particular concern during pregnancy especially if the pregnant woman has arthritis: sexuality alcohol self-esteem surgery and labor and delivery. |
The fatigue nausea and emotional changes of pregnancy often cause sexual desire and the frequency of intercourse to decrease during your first three months. Desire often increases during the second trimester but may decease again during the third trimester when you may feel uncomfortable and/or unattractive. Fatigue or fear of another pregnancy may decrease sexual desire after your baby is born. The additional pain and fatigue of arthritis may make these problems worse. If these changes are a problem for you talk openly with your partner about them. Often open communication can help solve many of these problems.
AlcoholDo not drink alcohol to control or ease pain. Alcohol may harm your unborn baby.
Asking for help
If joint problems pain or fatigue decrease a woman's ability to care for her baby she may feel that she's an inadequate mother. She may feel this way especially when the arthritis flares. It's important for women with arthritis to remember that they are capable of caring for thier children but that they may need help. Accepting help does not make anyone less of a mother--it simply means they are accepting responsibility for their children's well-being.
If you are troubled by such thoughts it may be helpful to talk to someone who specializes in these problems.
SurgeryIf you need joint surgery it could affect your ability to care for your baby. Consider having the surgery before you become pregnant so that you'll be able to recover before you have to care for your baby.
Labor and delivery
Labor and delivery are not usually particularly difficult for women with arthritis. However you'll want to find a comfortable position during the labor and delivery process. You probably can deliver your baby as most women do: vaginally lying on your back. If this position is uncomfortable you may want to lie on your side or sit in a rocking chair or birthing chair. Even if you have had a hip replacement you may be able to deliver your baby vaginally without complications.
As with any pregnant woman you may need monitoring and certain blood tests during labor and delivery. However the amount of monitoring you may need will depend on how active your disease is. If you have lupus or scleroderma your fetus probably will be monitored throughout labor. In some cases it may be necessary to check the fetus' blood during labor to determine if there are any problems that might require the baby to be born by cesarean section rather than vaginally.
| As mentioned earlier arthritis may flare after giving birth. In many women it often flares two to eight weeks after birth. To prevent as many problems as possible after the baby is born women with arthritis and their health care teams should devise a follow-up plan for post-partum treatment. |
A follow-up plan should include:
Saving energy is important for any mother. After a baby is born a woman with arthritis may feel fatigued more often. Some of this will be due to the arthritis and some due to the loss of sleep and extra energy required to take care of a baby.
Saving energy means performing tasks in ways that require the least amount of energy possible. Women with arthritis can do this by organizing tasks and by planning ahead. Here are some tips to help save energy and time while caring for a baby.
Lifting and carrying:
Always discuss any problems with a doctor and health care team. They can help you work around the problem so you and your baby will be as healthy as possible.
Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK contact the National Helpline: (800) 283-7800.
Adapted from the pamphlet originally prepared for the Arthritis Foundation by Diane M. Erlandson RN MS MPH Patricia A. Fraser M.D. Michael Greene M.D. Martha K. Logigian MS OTR/L Mary Myers OTR MEd and Connie Roberts RD MS. This material is protected by copyright.