Deciding whether or not to have a baby is a big decision and knowing you have to go through pregnancy with arthritis can be daunting. However, the fact is that giving birth with arthritis is now a common and relatively straightforward procedure.

As each pregnancy is different, and the effects of arthritis vary greatly from person to person, you should discuss with your doctor whether you may need to adjust your treatment before you get pregnant. Some drugs such as DMARDs, anti-TNFs, methotrexate, cyclophophamide or leflunomide should not be taken if you are trying to conceive or are planning to breastfeed (for further information see our leaflet on Drugs and Complementary Therapies).

During pregrnancy, some women find that their arthritis remains unchanged or even improves, while others, especially those with osteoarthritis of the hips and knees, may find that it worsens as they gain weight. It is best to try to lose some weight before you get pregnant - this will not only help your joints but will make it easier to become pregnant and make for an easier and less complicated pregnancy.

First Trimester (Weeks 1 - 13)

During the first trimester, the baby's vital organs are forming, and it is during this time that medications and other lifestyle habits (such as smoking, drinking, diet and drug use) can affect that development. If you need medications to help control your disease, your doctor may recommend some that can reduce arthritis inflammation but do not cross the placenta. The first trimester is when many women find the symptoms of their pregnancy are most pronounced e.g. fatigue, morning sickness, heartburn and dizziness. If it's all getting too much for you, remember that you're not superwoman and take some time out to look after you and your baby. If the fatigue is too much for you, talk to your doctor or visit www.arthritisireland.ie for information on managing your arthritis symptoms.

Second Trimester (Weeks 14 - 27)

This is one of the most exciting times of pregnancy - many women share the news of their pregnancy with others, and their bump starts to show. Luckily, some of the more unpleasant symptoms of the first trimester fade and energy levels usually return to normal. In fact, approximately 70% of women with rheumatoid arthritis experience an improvement in arthritis symptoms beginning in the second trimester and lasting until after the baby is born. Unfortunately your arthritis symptoms will usually return once the baby is born.

Third Trimester (Weeks 28 - 40)

The final trimester can prove especially difficult for women with arthritis. During the last 12 weeks, the joints and muscles may be affected and problems with weight-bearing joints (hips, knees, ankles and feet) may become worse due to increased weight. Muscle spasms in the back can occur as the uterus grows and the spine curves slightly to support it, leading to pain, numbness and tingling in the legs.In the last 12 weeks breathing can be difficult, especially if your arthritis affects your lungs or rib joints and you may experience shortness of breath - if this occurs, you should rest whenever you can.

Delivery

The big day has arrived! Many women with arthritis can have a normal labour, and there are many different positions in which you can give birth so if, for example, you have difficulty because you cannot move your legs enough in one position, the midwife will discuss with you some other suitable positions. In some cases, women with arthritis will be advised to deliver their baby by C section, but this is not common. If your arthritis affects your spine, getting an epidural may not be possible. This is a procedure in which pain medication is injected between the vertebrae directly into the outer layer of the spinal canal. In this instance, you should discuss alternative pain relief methods with your doctor before delivery and, if a C-section is necessary, it may need to be done under general anaesthetic.

Pregnancy Forum

Looking for some good advice on the challenges that pregnancy brings when you have arthritis? Why not join the Arthritis Ireland Pregnancy Forum? The forum is run as a secret group on Facebook so your involvement is totally confidential. If you would like to sign up, please send Laura an email at lhickey@arthritisireland.ie.