Parenthood is a roller coaster, and when you add inflammatory arthritis to the mix, there are lots of questions about fertility, pregnancy, birth and raising kids to ask and answer as best you can. There are no perfect solutions and no guarantees, but arming yourself with information goes a long way to feeling good about your decisions.
1. Check in with your health-care team
Before you start trying to conceive, your family doctor or specialist can work with you to both stabilize your arthritis and review your medications, advising which ones, if any, to replace or discontinue. (This includes men with arthritis too.) Check out resources like Mothertobaby.org, LactMed and InfantRisk.com. Frustrating but true: in some cases, there aren’t any for-sure recommendations, so you, your partner and your doctor will have to do some risk assessment to see what’s the best plan for you and your baby. The Canadian Arthritis Patient Alliance is also an excellent resource for information about pregnancy and parenting with arthritis.
2. Consider fertility factors
Some studies show that women with rheumatoid arthritis (RA) may take slightly longer to become pregnant. As well, using NSAID medication may interfere with ovulation, or sex may be painful, making it tougher to hit that window of opportunity for conception. A condition called antiphospholipid syndrome, associated with rheumatic disease, can lead to miscarriage or stillbirth, so ask your doctor about the need for screening.
3. Think specifics with your partner
Now’s the time to talk in more detail about what life as parents could be like and what tasks your partner could take on—lifting a toddler, getting up at night etc. What other supports can you draw on?
4. Consider pregnancy possibilities
How will pregnancy affect your arthritis? Everyone is different of course, but according to the research, psoriatic arthritis (PsA) symptoms may improve or go into remission; ankylosing spondylitis (AS) symptoms stay the same or worsen, and rheumatoid arthritis (RA) symptoms decrease. If you have joint damage in your spine, you may feel additional pressure and pain as your baby grows. If you have lupus or RA, talk to your doctor about the need for screening for certain antibodies that can cross the placenta, and, rarely, cause complications with the baby.
5. Do some labour and delivery planning
Let’s face it: labour hurts, no matter what your situation. If you have arthritis in your spine, hips or lower pelvis (sacroiliac joints), you might have additional pain during labour and delivery, so look into ways to manage pain through positions, medications and working with your doctor, midwife or doula.
6. Be aware of flares
An inflammatory arthritis flare is fairly common within three months of giving birth (50 per cent of juvenile RA pregnancies, 70 per cent of PsA pregnancies and 90 per cent of AS pregnancies), so it’s important to do some mental and physical prep for that possibility. Think about if you want to breastfeed and for how long, when you will restart your medications, and the kind of support you’ll need from loved ones and your health-care team.