Even though the symptoms of RA may improve for most women during pregnancy, typically there is a flare of symptoms at some point during the first 8 weeks after delivery. Some doctors will recommend resuming RA treatment just before and during delivery or shortly thereafter to suppress disease activity. To control an RA flare during pregnancy or after delivery, a corticosteroid such as prednisone, given at a low dose, is considered safe. The American Academy of Pediatrics has approved the use of prednisone during lactation, if the health benefit to the mother outweighs any risk.1,2
What to expect after delivery
Pregnancy places a great stress on your body. This is especially true if you have RA and are affected by inflammation in your joints. The added weight of your growing baby, as well as the weight you gain during your pregnancy, will place an increased demand on your joints, bones, muscles, and cartilage. Just imagine having to carry around a 10 to 20 pound bag of groceries all the time. So that you don’t wear yourself out during your pregnancy, make sure that you give yourself ample time and space to relax. This is especially important, because you will need the extra energy for after your delivery.
Taking care of an infant requires an enormous amount of energy, as well as patience and the support and understanding of your friends and family. This is true for mothers (and fathers) who don’t have a chronic condition like RA, so it is especially important for those with RA. To make sure that you have the energy and support you will need, start organizing and planning even before you get pregnant. If you are already pregnant, there is no time like the present to sit with your partner or a friend or family member and start to plan for the challenges that you’ll face.
Practical suggestions that make a difference
Typically, expectant parents spend the months before delivery setting up their house or apartment so that their new baby will have a safe, comfortable, and stimulating environment. You will, no doubt, spend much time and energy selecting items like a crib, bassinet, clothes, baby care items, and other resources that will help you with baby care. As you prepare for your baby, you should also think and plan from the perspective of a person with RA and anticipate what equipment and arrangements will make your job as a new parent easier.
You will want to consider a range of baby care activities including food preparation, nursing (or bottle feeding), changing diapers, bathing, baby transport (car seat, stroller, baby carrier pack), laundry, and house cleaning. Think of each of these from the perspective of your specific challenges as an RA patient.
For instance, set up your baby changing and dressing area at an optimal height, with plenty of accessible storage, to make it easy for you to change and dress your baby. The same is true for planning a bathing area for your newborn. Make sure that you have all your supplies handy (soap, shampoo, lotions, towels, diapers, clothing) and that the height of your bathing station is optimal for your comfort and safe for your baby. Set up your kitchen and kitchen table so that food preparation and clean-up is easy for you. Make sure your baby’s highchair is easy to put baby in and take baby out and easy to keep reasonably clean.
Think of using a high crib, so you don’t have to bend down too much when picking up your baby. Using a diaper service makes it unnecessary to clean diapers yourself. However, many baby care items are made in disposable form (some biodegradable options are available, too). Using disposable items, such as diapers and wipes, is one way to make diaper changes easier and less energy intensive. Most disposable diapers have adhesive strips that make putting diapers on and taking them off very easy, an important feature, especially as your baby becomes more active and less cooperative.
When it comes to baby clothing, think of features that will make dressing and undressing your baby easy and efficient. For instance, avoid garments that have a lot of buttons or shoes that require tying. Many baby clothing items are made with velcro fasteners, which makes dressing and undressing a breeze. You can sometimes add velcro fasteners to garments that don’t already have them.
Assistive technologies
If you have RA, you have probably discovered a number of devices that make common tasks and activities a little easier, such as a roller knife for cutting vegetables or a buttonhook for helping you put on that favorite sweater. These types of devices are often referred to as assistive technologies (sometimes called adaptive technologies) and include a wide range of clever products that make everyday functioning easier. You may find some of these products particularly useful in your new role as a parent, where you will be looking for ways to save energy and do childcare tasks more efficiently.
One useful online source for assistive technologies is the organization AbleData; telephone 1-800-227-0216. Abledata is a source for information and ideas on assistive technologies and has a searchable database of over 29,000 products that you may find useful.