Tips for a Tolerable Pregnancy
When I made the decision to become pregnant, one of the chief factors I weighed was how my body would handle the pregnancy. I had long heard about the swollen ankles, hip issues, sciatica, and other discomforts many pregnant women experience. As a person with rheumatoid arthritis, I experience swollen joints and shooting pains on a regular basis, so I worried about whether my discomfort would be exponentially worse than that of women without chronic health conditions. Fortunately, I was able to have two healthy pregnancies, and I did not end up bedridden, as I worried I might. That is far from saying that my pregnancies were always comfortable, and I did run into some issues that required problem solving. However, with some research and conversations with my care providers I was able to find solutions.
As a disclaimer, I want to state that I know I was very fortunate, and that some women with RA experience high levels of pain during their pregnancies in spite of all of their best efforts to decrease their symptoms. Each woman’s pregnancy and disease activity level is different, so each individual’s experience will be unique. Up to 85% of women with RA go into remission during pregnancy, others continue to have mild-moderate disease activity (as I did), and a minority of women experience flares during pregnancy and require medical intervention. This article will not address every woman’s unique issues, but hopefully these tips will be helpful to some.
Sleep support. Many people with rheumatoid arthritis struggle to get a good night’s rest, as the aches and pains it causes can make it difficult to get comfortable enough to sleep. Similarly, many pregnant women struggle to find a position conducive to slumber. So when you are pregnant and have RA, falling asleep can become a major challenge. However, there are a number of products on the market developed to provide comfort to pregnant women, and I ended up investing in a “total body maternity pillow,” which cost about $60. There are many versions on the market, and the one I used is shaped like a large “G.” The long, curved portion runs the full length of your back to provide support to counter all that belly weight, and one end curls under your head while the bottom portion goes between your knees and up under your belly. I always need a pillow between my knees in order to fall asleep, as my hips and knees ache otherwise, so I was happy to find a pillow that provided the support that my body needed for both pregnancy and RA. This pillow ended up being so crucial to my ability to sleep that when we flew to a family reunion I stuffed it in an extra-large vacuum-sealed bag (to shrink it down a bit) and put it in an extra piece of luggage so that I wouldn’t have to go the trip without it.
Movement. Exercise is always an important component of RA self-care, and I found this to be even more the case during pregnancy. One of my greatest arthritis challenges during pregnancy were my hips, which would lock up on me after I was in a seated position for any length of time and would send shooting pains through my body while walking. Pregnancy changes the body’s alignment, and hips have to compensate for all of that belly weight. I discussed this with my midwife, and she suggested that I do large hip circles several times a day to keep my hips loose. At the time I was working a desk job, and I wondered how I could do hip circles without attracting the attention of my coworkers. The solution was that every time I went to the restroom (which was often, as pregnancy causes more frequent runs to the ladies room), I would do 10 large hip circles before exiting the stall. Standing with my feet slightly wider than shoulder-width apart, I placed my hands on my hips and moved them in as large a circle as possible, first clockwise and then counterclockwise. Doing these hip circles on an hourly basis ended up greatly reducing both the pain and immobility in my hips.
Another important way I kept in motion was attending prenatal yoga classes. I began yoga practice a year or two after my diagnosis, and I have found that it is one of the most beneficial exercise routines for my RA. Prenatal yoga incorporates postures that strengthen muscles needed to support a woman’s body during pregnancy and labor, and omits any yoga poses that might be negative for a pregnant body and/or growing baby. Attending weekly prenatal yoga sessions and practicing a few postures on a daily basis were instrumental to both my physical health and emotional well-being.
Alignment. While movement helped me greatly during pregnancy, during the last few weeks when my belly was at its biggest I experienced more and more hip pain. Fortunately, there is a chiropractor in my area that specializes in prenatal care. A woman’s skeletal frame adjusts during pregnancy to compensate for the large belly, and this can put more strain on hips. Through regular sessions my chiropractor was able to improve my body’s alignment, which reduced the pressure on my hips. During the last four weeks of my pregnancies I visited her twice a week, and I found that my pain diminished after each visit.
Pharmaceuticals. Before becoming pregnant, I had conversations with both my rheumatologist and my OB/GYN about what to expect. These are important conversations to have, as doctors’ opinions vary as to what medications are considered safe during pregnancy. My rheumatologist and I discussed the potential risks of the prescriptions I was on, and determined it would be best for me to discontinue my RA treatment during pregnancy. However, my rheumatologist, OB/GYN, and midwife all agreed that it would be safe for me to take prednisone during pregnancy if needed. There are many pros and cons to prednisone, but one of the good things about it is that it is a drug that has been around for a long time and has been studied at length. As all of my care providers were comfortable with me taking prednisone during pregnancy, I did indeed do a few short rounds of prednisone during each pregnancy, and I gave birth to two healthy children.
In addition, my rheumatologist prescribed lidocaine patches for those troublesome hips of mine, and my other care providers approved their use. The lidocaine patches did not make as big of an impact on my pain levels as the prednisone did, but they did diminish the hip pain slightly. I felt more comfortable with topical treatment versus taking pills, so I used the lidocaine patches until the need for prednisone was more pressing.
Deciding to become a mother is one of the biggest decisions a woman ever makes, and this decision is only more complicated when entering rheumatoid arthritis into the equation. However, there are ways to decrease discomfort, and having RA does not necessarily rule out the possibility of a healthy, and even tolerable, pregnancy.
When was your last flare?