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As a person living with a chronic condition such as arthritis, you are likely well-practised at planning ahead. As you no doubt know already, giving time to planning means you can be sure of what you want and need, prioritise and spread out activities, build in rest times and ask for help and understanding in advance if you need it. It’s actually a great approach for anyone, regardless of any health needs.
When it comes to starting a family, planning ahead can be just as beneficial, if not more so, for the same reasons. If having a family is the life choice you’ve made (and of course it may not be), it will be a magical and demanding time, sometimes in equal measure. Raising a child can be equal parts rewarding as it is exhausting.
In this article, we’ve thought about how you might prepare yourself emotionally and physically before you begin trying to conceive, with the goal of giving you that extra boost of strength for the pregnancy and early months of caring for your baby.
We asked mums in our Facebook community group, Arthur’s Place Social, about their experiences and women who would like to be mums in future about their concerns and questions. Based on this, we asked clinical psychologist Dr. Emily Taylor and Cambridge-based physiotherapist Amanda Savage what support they might give.
Chat about this in our Facebook group
We asked Dr Taylor lots of questions, including how to manage common worries such as if coping with a newborn will be too much, what to do with any guilty feelings that might arise about not being able to do all the things you’d like to, as well as how to stay emotionally strong in the first few months with a newborn.
We asked Amanda for her top tips, and her answers cover topics such as exercise, healthy habits and finding out about available support and resources in advance.
We hope you find their thoughtful responses, in the sections below, truly helpful on your journey. Above all, don’t forget that you’re amazing, and you already show great strength of body and mind on a daily basis just living with your condition. You got this!
Dr Emily Taylor is a clinical psychologist in NHS Lothian, and Programme Director for the post-graduate programmes for Young People’s Mental Health and Psychological Practices at the University of Edinburgh.
Q: Why might it be helpful for a woman with arthritis to feel emotionally ready to have a child, in the context of already having a chronic condition?
Dr Taylor says: Any prospective parent benefits from noticing and taking care of their emotional wellbeing. Trying for a child, pregnancy, and being a parent are all emotionally demanding. Having a chronic condition adds another layer to this, physically and mentally, but some of that emotional layer will be positive – resilience, acceptance and tolerance are all essential qualities for being able to raise a child. We have limited control over if and when we fall pregnant after we start trying, what will happen during the pregnancy, or indeed raising a child, so while there may be less than optimal times to get pregnant, I wouldn’t encourage people to wait until the ‘perfect’ time.
Q: What questions might she wish to ask herself before starting out, to help work out if she feels emotionally ready?
Dr Taylor says: First of all, do you want a child? What will having a child mean to you, and what would not having a child mean? Society encourages us to think that all women should want to be mothers, but this isn’t true. Lots of women make the decision not to start a family and are very happy with this decision.
Here are some questions to consider:
1. If you woke up tomorrow and discovered you were pregnant, how would you feel?
2. What would you gain, and what would you lose?
3. What changes would happen in your life over the next five years and how would you feel about those changes?
As you will be raising a child for approximately 20 years, consider the impact over the next two decades (it’s difficult – most of us cannot possibly know how our lives will look that far into the future!). Notice the different emotions that you experience as you think about this. Try writing some of it down.
If your thoughts seem to constantly swing backwards and forwards between feeling ready or not, this could be a sign that you are quite unsure about being a parent. Perhaps you are not ready, or you are thinking realistically about what being a parent will entail and can see problems. Many women will feel certain about wanting a child, but if you are uncertain, listen to that uncertainty and try to understand what it means.
Q: What questions might she wish to ask others?
Dr Taylor says: If you become a parent, who will be your support team? Have you and your partner had an open and full conversation about what you both expect from yourselves and each other? It is important that you both fully understand and accept each other’s position, and that those positions match.
Who else will be around? (Grand)parents, siblings, friends who live locally are all valuable supports. What role do they imagine having and what would be their limits? Are grandparents or other family members willing to help with practical day-to-day parenting, and not just treats?
Speaking to close friends about your hopes and fears can be helpful and asking people who have become parents about their experience can give you more insight into the day-to-day demands and pleasures. However, you are entering an area in which people tend to hold strong views about what others should and should not do in relation to parenting, so you have to trust your own instincts and be prepared to ignore the views of others!
Ask other people with the same medical condition, and who have children who are a bit older (i.e. not in the first flush of parenthood when they are swathed in a fug of newborn love), what their experiences have been. If they could do it all again, what would they have done differently? What has challenged them? What has been easier than they expected?
Q: What might she consider doing in advance to prepare herself emotionally?
Dr Taylor says: There are things that anybody preparing themselves for parenthood can do:
Identify the things in your life that cause you anxiety, stress or upset and try to find ways to resolve them. You probably can’t make your life perfect, but you can do practical things that help you to feel ready, such as organising finances, getting into a routine of healthy eating and exercise, stabilising your job situation. Research shows that daily hassles may have a worse effect on our mental health in the long term than major life events, so doing some housework on your life could pay off for your emotional wellbeing.
Look after your mental health. If you have a history of mental health problems of any sort, it is a good idea to talk with your doctor before falling pregnant. You can discuss how to manage any medication you take (some psychiatric drugs are safe to take during pregnancy and breastfeeding, whilst others are not), and agree on what kind of emotional supports you might need to have in place. Pregnancy hormones can have unpredictable effects on our emotions and having a back-up plan can help you relax and enjoy pregnancy.
Recognise that pregnancy might not happen straight away, or even at all, despite what film and television would have us believe. Monthly disappointment can drain emotional resources and leave you feeling a failure. In general, we aren’t very good at acknowledging how miserable it can be to not fall pregnant, despite it being very common. A small group of confidantes can help reduce those feelings – pick people who are more invested in your wellbeing than in you having a baby, so you don’t need to manage their disappointment as well as your own.
Check that your partner (if there is one) is feeling prepared as well. If you are planning parenthood to improve or save the relationship this should be a warning flag for you. Also, don’t assume that a partner who isn’t keen at the moment will feel differently once the baby arrives. It’s important that you are both feeling prepared emotionally.
Q: What can she do in the first months after the birth to stay emotionally strong?
Dr Taylor says: Social support and sleep are the key survival strategies during the first few months.
Having a newborn baby is an amazing experience and lots of fun. However, your freedom is constrained by their sleeping and eating patterns, they are short on conversation and you will be exhausted.
It might seem easier to move into your pyjamas on a semi-permanent basis and resign yourself to never going out. But becoming isolated from others will be bad for you – we all need to speak to other people sometimes.
You will be introduced to mother-and-baby groups through antenatal classes and they are easy to find in your local community. But, keeping in touch with pre-baby friends means you can step out of the baby bubble sometimes and reconnect with yourself.
Your sleep will be disrupted, and if fatigue is a problem for you anyway, you could become very tired. Prolonged exhaustion can be bad for mental health and might seem unavoidable in the first few months.
Try to share night feeds and get some ear plugs so that when it isn’t your turn you can sleep. Ask friends or family to look after baby for a few hours during the day so that you can get a nap. Bring other people into the parenting circle early on – friends and family members who can get to know your baby and their needs. This will help you to relax about handing them over for a few hours.
Q: What might be the positive emotional impacts of pregnancy and new motherhood, in the context of living with a chronic condition?
Dr Taylor says: How you feel about your body might change. For all the aches and pains, especially later on in pregnancy, your body is doing an amazing thing all on its own, and the feeling of a new life growing inside can be very special.
Your hormones will be all over the place, but your chemistry is gearing up for an outpouring of love that will ensure you keep your baby safe and give them the nurture they need. It’s pure biology, and it feels great (and a little overwhelming!).
Growing a baby inside you and caring for them after they are born is an important job that requires lots of skills that you didn’t necessarily know you had. In this context, having a chronic condition might recede into the background – it is always there but it might not seem so important in comparison to the task of raising your child.
Living with a chronic condition might have affected you in terms of how you view yourself, the world and others, giving you more empathy and compassion, resilience, patience and ability to compromise and problem-solve. All these qualities will also help you be a loving and responsive parent.
It might also have made you feel self-doubt or dented your confidence. All parents live in a world of not knowing and this goes on for most of your child’s life, so try not to worry too much about doubts creeping in – they are normal.
Q: What might you say to a woman who tells you “I feel frightened of what might happen”?
Dr Taylor says: This suggests you have a realistic sense of how parenthood might unfold! Ask yourself what this fear relates to. If your medical condition does not feel under control or you have concerns about the physical effects of pregnancy and childbirth, including what will happen if you have to stop taking medication for a while, talk with your doctor about this in advance. Together, your worries can be addressed and a plan of support put in place.
But, if your fear is about something less concrete, try to identify what the fear relates to. Are you worried about your own abilities? Remember that lacking self-confidence is not the same as lacking competence. Are you worried about the support that others will provide? Speak to them about this. These feelings are ones that must mums, with or without a condition, will feel at times.
Q: What might you say to a woman who tells you “I’m worried that I won’t be able to cope”?
Dr Taylor says: Just like any mum, at some point, you will almost certainly feel that you cannot cope, and this will be completely normal. If this worry feels unusual for you and is overwhelming perhaps you don’t feel ready or sure about having a child. This might not be the right time to start planning a family, and you shouldn’t feel pressured (by yourself or others) to go ahead with pregnancy planning. If you know you want to be a mother, but are prone to worry or have low self-confidence, this shouldn’t stop you having a baby. You are not alone in feeling this way, and you might surprise yourself.
Q: What might you say to a woman who tells you “I feel guilty bringing a child into the world, in case I can’t look after it properly or I pass on my arthritis”?
Dr Taylor says: Whilst you need to be realistic about your capabilities and honest about your motives for having children, no child is born into perfect circumstances.
Also, what does ‘looking after properly’ mean? The key elements of being a parent are providing love and nurture, security, physical care, boundaries and opportunities. Does your arthritis prevent you from doing these things altogether or does it mean you might have to ‘outsource’ some specific activities – enrolling your child in a sports club rather than running around with them yourself for instance?
You can discuss with your doctor the heritability of your arthritic condition. However, treatments are improving all the time, the risk generally in the case of arthritis is small, and hopefully you feel your own life is worthwhile despite having a chronic condition.
Q: Is it possible to be totally emotionally ready for pregnancy and motherhood?
Dr Taylor says: Categorically, no!
Amanda Savage has supported women through physiotherapy since 1993, working in the NHS at St. George’s Hospital in London and Addenbrooke’s Hospital in Cambridge. She also has relevant qualifications and full membership of the Professional Network of Pelvic, Obstetric & Gynaecological Physiotherapy.
Amanda writes:
Aim for cardio and strength training
Before you become pregnant try to get your exercise regime at its best so that you can go into a pregnancy at your optimum health. Focus on cardiovascular fitness and joint and muscle strength.
Smoking, alcohol and healthy eating
Important areas for all women to consider before conception are stopping smoking, reducing alcohol intake and aiming to be the right weight for your height. The NHS has a useful information page about this here.
Get the support of your medical team
The NHS also recommends that if you have a chronic condition planning a pregnancy should be with the support of your medical team. This is particularly important with arthritic conditions as some of the drugs which manage the condition cannot be used when pregnant and /or breastfeeding.
It would be advisable to ask for a review with your physiotherapy and/or occupational therapy team before you became pregnant so that you can be on their radar to support you right from when you may need to change your medications.
Find out what exercise classes might be available to you
You could also find out about local antenatal exercise classes, like yoga, pilates or aqua-natal classes, and discuss them with your medical team before you get pregnant to make sure they are suitable.
Make contact with the class instructors and keep the time slots free in your diary so that you can be ready to join the class or classes as soon as they allow, usually after your 12-week scan. Exercising in water is lovely when you are pregnant as the water supports your body weight.
Find out what the physical demands of motherhood might be
Take some time to look around at friends with small babies, toddlers and young children. This will give you an idea of the physical things that you will need to be able to do to care for a new addition.
There will be help out there to cope with the physical strain of motherhood; for example, occupational therapists work with people to adapt and modify equipment and will know lots of tips and tricks to reduce the physical burden of caring for small children.
If you do go on to start a family, allow yourself lots of time to look at equipment like prams, slings, car seats, cots and changing stations to best suit your situation. Many baby equipment stores have great customer service, letting you try out all the levers, buttons and fiddly straps until you find the ones you like best.
If you are working, find out in advance about your maternity leave
Maternity leave in the UK is very generous. Many people forget that it is designed to reduce the need for heavily pregnant women to go out to work and that you are eligible to take several weeks leave before the birth not just after! Many women find it useful to use outstanding annual leave to first reduce their working day, or their working week, or number of days commuting, before starting their official maternity leave.
It could be helpful to know in advance of any pregnancy what your maternity leave options would be, or in other words, what pressure you may or may not be under to recover and get back to work. Likewise, if the baby’s father is involved, find out about paternity leave too.
Finish the DIY before conception!
Before pregnancy is also a pragmatic time to try to finish any of the more physical projects you may be helping with at home – such as decorating, DIY and garden projects – or warn your partner that they could be doing them on their own once you are pregnant!
