“Get dads more involved!” Photo by Kelly Sikkema on Unsplash
You’ve probably worked out by now that new babies don’t come with an instruction manual. So, it’s totally normal in the early stages of motherhood to feel confused at times about exactly how to take care of your baby, or yourself for that matter.
It’s important to look after you, as hard as that might seem right now, while baby is so dependent. The first year of motherhood is wonderful but it can also be exhausting, both physically and emotionally. With a chronic condition like arthritis in the mix as well, it would be understandable if you felt overwhelmed occasionally.
Friends and family can be a great support, and friends with children will have good advice to share about ways to make this experience a little easier. Sometimes, though, you might want to know what a health professional might advise, particularly with regard to managing your own needs.
In this article we ask health professionals from rheumatology, midwifery, occupational therapy, physiotherapy and psychology services what tips they would share with new mums with arthritis. We hope you find their approach helpful. Remember, too, to involve your own health team as much as possible in this first year, and never be afraid to ask for support if you need it. You will not be alone in how you feel; what you’re going through is totally normal for all mums.
Check your medication options
Some women have flares during pregnancy, and some women have a post-delivery flare, so you need to be prepared for that possibility, both during pregnancy and after the delivery. Make sure you’ve checked whether you can carry on taking all the medication you’re currently taking. Lots of women don’t want to take medication because they want to breastfeed – check with your rheumatologist which drugs you can and can’t use during breastfeeding.
Pain management without medication
There are other methods of pain management – an ice cool pack, for a hot painful joint, and a heat pack for a stiff joint can help. If you are breastfeeding, you need to make sure you get in a good comfortable, supportive position. You may find if the baby has been on the breast for 45 minutes you may be stiff afterwards. TENS machines can offer pain relief for your joints, which is something you may have come across during pregnancy and labour.
Have a back-up plan
Should you have a bad day, what is your back up plan? In the early days there may be parents and in-laws on hand, but as the baby gets bigger you need to have a back-up plan. Who can you call upon if you can’t get the baby out of the cot? You don’t know when a flare is going to occur, so you need to think about each day – who can you call on a Monday? Think if you have a friend who doesn’t work on certain days. Are there days when your husband can come home from work if you are struggling? You may need to think about paying for private services, to find a childminder or a nanny you can call on for bad days. You just need a bit more planning than a mum who doesn’t have arthritis. This isn’t a big problem – you just need a bit more planning and back-up.
Pace yourself and ask for help
If the baby is new, you’re going to be tired anyway, but you may be trying to do too much – cooking dinner, doing the housework. You may have to prioritise what’s important for you and the baby.
Ask your rheumatology nurse if they have a mums’ or dads’ group, or if they can put you in touch with another mum who has arthritis – someone who’s been through it who they can talk to and get tips and ‘cheats’ from.
With thanks to Colin Beevor, Matron and Service Manager, Rheumatology Dept, Queen Alexandra Hospital, Portsmouth for his contribution to this article.
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Babies are born socially interactive
Your baby will most enjoy looking at your face and will watch and follow faces. As the baby’s eyes develop over the first few weeks they will begin to focus more and listen. Babies engage best with their parents when they are in a quiet alert state. Watch your baby to learn their different behaviour states.
Try to notice how your baby likes to be soothed
Does your baby like sucking on their fingers? Gently rocking in the pram? Being held while you walk about? Soft singing? Being close to you in a baby carrier? Does the baby have a favourite cuddling position? How can you make the baby’s favourite position more comfortable for you?
Sensitivity and warmth are crucial
Eye contact, voice tone, pitch and rhythm, facial expression and touch are crucial elements in interacting with your baby. Talk and sing with your baby. It doesn’t matter if you think your singing is terrible! The very best activity for a baby is looking at their parent’s face and listening to their voice.
Babies don’t come with an instruction manual!
Watch; wait and wonder. Watch quietly what your baby is doing, noticing their signals and cues. Wait for him or her to initiate an action or interaction. Wonder about what your baby might be feeling and talk to your baby about what you think your baby may be feeling.
With thanks to the Royal College of Midwives for their contribution to this article.
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Look for light-weight equipment
Choosing light-weight kit is worth the money. When you’re pregnant you don’t realise how much babies are going to weigh – they’re like kettlebells! Prams and car seats can be really heavy too. It’s worth looking at a car seat that can clip onto wheels. You can also get car seats that swivel so you don’t have to lift them out of the car, but they are more expensive.
Think about getting two prams, one that you can load up and go to the park or the shops, and a smaller umbrella pram that you can take in and out of the car more easily. If you are keen to try a sling, find your local sling library so you can try them out.
Post-natal exercises are really important
All post-natal mums are very vulnerable for the first six to eight weeks after their delivery, whether you had a vaginal delivery or a caesarean section, because your body has done such an amazing job during the birth. Postnatal mums should be looking at doing pelvic floor exercises and abdominal exercises as soon as they are ready. There are booklets available about pelvic floor and abdominal exercises on the Pelvic Obstetric and Gynaecological Physiotherapy (POGP) website at https://pogp.csp.org.uk/booklets.
Exercising in water might be particularly good if you have arthritis – a lot of mums might already have discovered that during pregnancy. Aqua-natal exercises can be really good because the water is really supportive – but only after six weeks post-birth because of the risk of infection.
Consider joining a low impact post-natal exercise class
This might be tai chi, yoga or pilates. It might be difficult to find somebody who is an expert in both arthritis and postnatal exercise. But if you find a postnatal class run by a qualified physiotherapist, they will have knowledge of arthritis as well.
Exercise groups are also great because it puts you in contact with other mums and helps prevent isolation. But don’t go to a baby boot camp type class where the emphasis is on jumping and running!
Build your team
All maternity departments have a physiotherapist attached to them, and once you have made contact you can go back to them. You may be able to self-refer to that team in your area. You can contact your own physiotherapist if you feel more comfortable picking one yourself. Many offer different services too which might be more associated to you – for example, you can learn more about dry needling as a method of therapy to help you out.
What skills does your partner have? What are they going to be able to help you with? Find classes that you can both go along to, before birth ideally.
Find an exercise class that you enjoy, and make it a priority to go to that class – you may need to call on a friend or relative to babysit older siblings.
You have to look after yourself. Think of a chicken who needs to look after her eggs. If you’ve got a tired, undernourished chicken, the eggs are going to suffer!
With thanks to Amanda Savage MCSP MSt, PRO for Professional Network of Pelvic, Obstetric and Gynaecological Physiotherapy (POGP), for her contribution to this article.
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Make sure you have the best equipment you can get
There are cots that are height adjustable, and that open at the front rather than slide up and down.
Two-door cars are really difficult with children and car seats – it’s much easier to get the car seat in and out if you have a four-door car.
You can get gadgets to help with oven knobs, key extensions, double-handed or insulated mugs. If you’re cooking for you and/or the baby, lifting pans can be really tricky – you can get cooking baskets, which you pop into the pot and then transport it without having to lift the pot off the stove.
Check out the Disabled Living Foundation – they are an independent charity and are not trying to sell you anything!
Protection is key
You can use soft splints to protect yourself during the day. It’s important to protect your joints so that you’re not twisting too much, which may cause harm. If you have lever taps, it’s a lot better than turning taps, for example.
Use pillows and cushions for breastfeeding, to take the pressure off your shoulders and elbows, for bottle-feeding as well as breastfeeding. The V-shaped pillows give a lot of support.
Ask for the help to which you are entitled
You can get an assessment from your local authority – they will do a free assessment and do small adjustments to your house, such as replacing taps. If parenting is causing a flare-up of your arthritis for any reason, they want to avoid a hospital admission, so it’s in their interests to help you.
With thanks to Roisin Hodgson (BSc), Occupational Therapist, for her contribution to this article.
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There’s no such thing as a perfect mother
There isn’t a perfect mother – every mother comes with her own baggage. The important thing is to get help and support to manage any difficulties you may have. You don’t have to feel that you’re doing it all alone. You aren’t in isolation. Try not to feel overwhelmed. Know that you’re in a community of young parents and whatever your specific issues are, a lot of their issues are the same.
Don’t keep things to yourself
If you’re struggling in some area, with the baby, or with your emotions, then reach out to others and talk about it. Try to hook up with an arthritis support group, and parenting groups. If you are struggling to enjoy motherhood, you are not alone. There is help available, through your GP or health visitor, or through counselling and therapy.
Don’t feel apologetic about your arthritis. If you’re having trouble, just ask for help – just like a small person might ask for help in reaching something from a high shelf.
Because you’re young, and arthritis is not necessarily a condition that people are expecting you to have, there may be an element of embarrassment or stigma. But the more people with these health issues talk about it and say, ‘I’m 25 and I’ve got arthritis’, the better, because people around you will be better informed and able to help.
Set up a supportive environment
Having a baby is a big job, and you need support, to take some of the pressure off you, so that you can focus on creating a positive environment. That might be from a partner, family or friends.
Learn to regulate your own emotions
Babies can’t regulate their own emotions – the mother has to act as the baby’s emotional regulator. So, the more the mother is regulated emotionally, the easier it is on the baby.
Everyone has a ‘window of tolerance’ or ‘green zone’. This is where you may experience a negative emotion, but you are able to stay connected with yourself, and regulate your emotions. When you leave that window of tolerance, you become anxious and stressed, and move into the amber, or red zones. But you can bring yourself back to the green zone, through mindfulness, breathing, calming music, or visualisation. Try to find something that works for you. Classes may be helpful – if you enjoyed yoga during pregnancy, it may be useful after birth too.
Pace yourself
Every person with arthritis will have difficult days, where the pain is worse, and you will know some of the factors that make the pain worse or better. It’s important to pace yourself. The baby doesn’t need lots of stimulation or activities – just for you to be there with them. It’s better to have a quiet day with your baby, in the home, just being together and connecting.
With thanks to Consultant Clinical Psychologists, Emma Citron and Dr Claudia Herbert for their contributions to this article.
