Pregnancy, birth & caring for a small baby whilst coping with RA

05/09/06: Helen Arnold

Taken from NRAS magazine, Autumn 2006

The steroids worked well at controlling my arthritis and my partner and I threw precaution to the wind and hoped that nature would take its course! It didn’t. One year later and starting to get worried, I visited my GP who immediately referred me to the local Assisted Conception Unit at the hospital. After countless stressful and invasive tests, no specific cause for my infertility could be found, but we started treatment pretty quickly and had three attempts at IUI (intra-uterine-insemination), a process which is less invasive and intensive than IVF and with only a 10% success rate. It didn’t work and by now it was late 2003. I started to wonder if I would ever get pregnant. My RA Specialist reassured me that if I had a flare-up there was other medication I could take, that would be safe to take while trying to conceive. I was on the maximum dose of steroids that it was considered to be safe whilst pregnant.

I had my first IVF treatment in February 2004, which resulted in a traumatic ectopic pregnancy, and then in October 2004 my second treatment was successful. I couldn’t believe I was finally pregnant after two and a half years of trying!!! My next thoughts turned to how my RA would react to me being pregnant. Trawling the internet, most information seemed to suggest that a period of remission was usual in pregnancy and I hoped that I would be able to decrease the dose of steroids I was taking. This didn’t prove to be the case; every time I tried to lower the dose, my RA would stubbornly protest and my wrists, hands, feet and neck would become painful. My Obstetrician advised me that it was perfectly okay to continue with the steroid dose I was taking and I relaxed.

My pregnancy continued to full term, uncomplicated and normal. I started thinking more about how I would cope with the baby if my RA flared once the baby was born. I worried how I would hold my baby during night-time feeds if my hands became bad (night-times and mornings are always the worst). I put an armchair close to the cot and bought a breastfeeding support pillow and a baby support sling for the bath. I worried how I would be able to breastfeed with the medication I was taking, but was told that it would be fine. My hospital notes indicated that I was taking steroids and that as a result I should be given adrenalin while in labour. I believe that taking steroids inhibits the body’s ability to produce adrenalin, which is necessary while you are in labour.

Baby Spike was born very quickly on 14th July 2005 after an uncomplicated six hour labour with two co-proxamol for pain relief! Born at 9.40am and weighing 7lb 9oz, he was perfect. I had been warned that RA often kicks back in with a flare up soon after birth, but I was so emotionally and physically drained that I didn’t think about this. However, holding the back of Spike’s head and neck while breastfeeding for long periods was very painful and my wrists ached so. Feeding him I was like The Princess and The Pea, surrounded by cushions and pillows! I looked jealously at other women in the ward holding their tiny babies’ heads with one hand as they fed, while I sat tense and uncomfortable with aching wrists and neck while the midwives berated me, "If you aren’t relaxed your baby won’t feed properly!"

My wrists ached because of damage already done by the RA. I didn’t have a notable flare-up after Spike was born until I stopped breastfeeding at around four months, when I suddenly became very sore. I have to admit, bottle feeding Spike at this point was much easier, although I don’t regret the effort I made to give him a good start by breastfeeding. Sleeping with Spike in bed with me during the early months seemed natural and saved having to bend down to lift him out of his cot when I was in pain. I also fed him sometimes while we were both lying on our side, with no resulting wrist pain. I know that co-sleeping is against current medical advice, but it certainly worked for us.

SpikeSpike is now ten months old and I am back taking methotrexate and continue to lower my dose of steroids, before I soon stop taking them altogether. What had initially been a "just for a few weeks until I get pregnant" decision has ended up with me taking them for nearly four years! Although my arthritis is well controlled, I find that carrying Spike around on my hip is difficult - I have a special sling which helps me. I am sometimes unable to bath him and my partner helps out. I feel the bones in my wrists grinding painfully when I lift Spike. However, when you are a mother to a small baby, you learn to find quick solutions (slings, pillows, lifting techniques etc), get on with it, forget the pain and enjoy the time you have with them. My arthritis is very well at the moment and I take Spike swimming every weekend! I have even been known to jog with the pram to drop him off at nursery when I’m late for work in the mornings!

I count my blessings every day, that I have a condition which is treatable and that I have a beautiful baby I never thought I would be able to have.