Breastfeeding & Rheumatoid Arthritis

Amalah,

First of all, I love your advice column – and so does my husband! You were the one who convinced us BOTH that cloth diapers were not actually so scary. And pretty much whenever we have an issue we are trying to figure out my husband asks “what does Alphamom have to say about it?” So we’re both hoping you’ll have something to say about this.

I have rheumatoid arthritis (RA), which is an autoimmune disease that causes extreme joint pain and fatigue. RA has made my path to motherhood a rocky one. I had to stop taking all the medications that were controlling the disease for six months before it was even safe to try to conceive. Then we had to “try” while I was also dealing with totally untreated RA (Every joint in my body hurts! Yay! Let’s get busy!) I was lucky enough to experience some remission during my second trimester, but during my third (which we already know is SO COMFORTABLE) I had major joint pain in my knees, hips, and hands. But it was all totally worth it because now we have a beautiful baby boy who is six weeks old.

Six weeks looks like it is also going to be about the end of my birth-induced remission, because that familiar joint pain is starting to return to my toes, fingers, and wrists. I know that eventually (soon?) I’m going to reach a point where all the wrist braces and Epsom salt soaks in the world are not going to be enough, and I won’t physically be able to care for my baby without medicine – medicine that is, unfortunately, not compatible with breastfeeding.

I am extremely grateful that my son and I have already had six very successful (and wonderful) weeks of breastfeeding. I am really, really hoping that we will be able to manage a few more, but I’ve known all along that we would eventually reach a point where it would be better for both of us to stop. I’ve been preparing by pumping and freezing as much extra milk as possible so that when the time comes I will know that I have done everything in my power to provide the maximum amount of breast milk to my son.

But what I find I’m not prepared for is the emotional impact this transition is going to have on me. The other day we did a couple of bottle feelings so that daddy could participate (and, let’s not lie, so that mommy could have a cocktail) and I was surprised to find that I actually missed nursing him and was anxious to get him back on the boob – not only for him but also for ME. If I had such a strong reaction to skipping a couple of feedings I can’t imagine how I will manage when I have to stop all together. I know that eventually my pain will progress to the point where it is the right decision, but I’m just not ready!! (And even though I know I’m doing everything I can and formula is fine and blah blah blah but I must admit to a little bit of mama guilt over having to stop before either of us are actually ready).

Any advice on how to deal with this? Or maybe you (or your commenters) might have some parenting tips that would make it easier to manage baby care with chronic pain so I can put off the inevitable just a little bit longer?

~RA Mama~

First all, and I hope you know this, but you are a Grade A Rockstar Badass, m’lady.

Second of all, it’s hard…nay, downright impossible to define being “ready” to wean. Some women absolutely have a set timeline in their head (I will breastfeed for X number of months/years) and manage to make to that goal and remain completely, utterly fine with saying “all done” and stopping. A LOT of us, though, have a squishier time with it. I always wanted to nurse until a year. I only managed to last that long with my third baby, who I then planned to wean this month (thanks to travel, crappy supply, his growing disinterest)…only to freak the EFF OUT once push came to shove because *I* wasn’t ready. (In other words: I came home from the trip, woke him up from a nap and shoved my boobs at him. So we are still nursing.)

So I completely, totally feel you. You can logic the whole thing out in your head — formula is fine, my health is just as important, happy mama makes a happy baby, etc. — and still basically feel like crap about it. About the unfairness of it. Especially if you feel like it’s your body that is somehow “letting you down.” (Either for a chronic condition, supply/growth issues or some other crappy medical issue that precludes breastfeeding.) Even though your body just got done doing something mind-blowingly amazing by conceiving, carrying and birthing a human being. It still doesn’t feel like “enough” if there’s still something you were hoping it would be able to do postpartum. (And if there’s anything women seem to be especially great at, it’s not accepting our bodies and/or their limitations without turning it into a degree of “failure.”)

This isn’t really advice, obviously. Just more of a nice back rub while I nod and sympathize because yeah. What you’re going through sucks and what you’re feeling is NORMAL. So normal that even those of us who aren’t in your exact situation can still probably find something in our own breastfeeding adventures that feels (at least emotionally) similar.

The best advice I can give is to take nursing one day at a time. When I was nursing Noah and things were a disaster, I set very tiny mental milestones for myself. I will nurse him tomorrow. I will nurse him until the end of this week. I will make it to four weeks. Then six. This might not be possible for you due to the unpredictability of your flare-ups, but it might help to set super-short, possibly achievable goals for yourself rather than looking longingly and wistfully forward at six months or a year or other possibly not-doable lengths of time.

Try as hard as you can to not view every day of nursing as potentially “one of the last,” but as a major, awesome accomplishment. Don’t let the inevitable weaning dominate your thoughts and keep you from enjoying the days you have. Because weaning will happen when it has to happen. Weaning will ALWAYS happen when it has to happen, for every mom and every baby, be it two weeks or two years. And it can be hard and emotionally/hormonally challenging at either of those points, so be kind to your body AND your brain. It’s okay to stop. It’s okay to be sad.

As for continuing to nurse while managing RA symptoms, well, jeez, there’s a pathetic dearth of solid information out there, as I’m sure you’ve already researched. Everything I found basically says the same basic thing: That there’s a pathetic dearth of solid information. I found a first-person account of a mom who nursed for four-and-a-half months, albeit with a lot of pain. The National Rheumatoid Arthritis Society in the U.K seems to have the most thorough briefing on breastfeeding with RA that I could find. (Though note it hasn’t been reviewed or updated since 2009, however I’m not seeing evidence of any major breakthroughs or studies on RA meds and breastmilk since then either.) And now I’m thoroughly stepping too close to the “do not ask ME, ask your doctor” zone, since beyond a few weeks post-C-section doped up on breastfeeding-safe Percocet and Ibuprofen, I’ve just never had to deal with anything like what you’re going through.

If you have to stop breastfeeding, you know it’s okay to stop breastfeeding. There may not be a magic breastmilk-safe bullet for your physical pain; there may also not be one for the emotional sadness you feel when you stop nursing. Besides, probably, the passing of time and the realization that there is SO. MUCH. MORE. to motherhood than nursing. Including feeling good and healthy enough to chase your toddler around and pick him up for hugs and push him on the swings and take him to the zoo and tickle fights and pillow fights and dancing in the kitchen and on and on it goes.

You’ll be able to do ALL OF THOSE THINGS when you’re taking care of yourself and taking your necessary meds. And once again, your superhero cape is looking quite impressive, Mama.

Photo source: Hemera/ Thinkstock