Leaven: La Leche League’s International Journal for Leaders

Arthritis, Fibromyalgia and Breastfeeding

Family Research Laboratory, University of New Hampshire

Mothers with arthritis may face special challenges. People who are unfamiliar with arthritis may think of it as an "old person's" disease and wonder what it has to do with breastfeeding. While osteoarthritis (OA), is more common in older people, inflammatory arthritis and fibromyalgia are much more likely to affect young women. Indeed, having a baby may actually trigger a flare of symptoms . Here are issues mothers may face, and what you can do help.

You can assist mothers with arthritis by helping them anticipate adaptations they may need to make when caring for their babies. Some concerns related to arthritis are as follows.

Pain in the Upper Extremities

Proper positioning is important for all breastfeeding mothers, but it is even more so for mothers with arthritis or fibromyalgia. These mothers need to position their babies in a way that does not stress the joints of their upper body. The use of pillows and other supports will be necessary so that she does not stress her, hands, wrists, elbows, shoulders, or neck. Carrying the baby may also stress these joints. A front-pack that causes the mother to lean forward will not be useful for long. A baby sling is helpful until the baby gets too heavy, then she will have to shift to a carrier that takes most of the weight in her hips.

Mothers will also need to give special consideration to the "stuff" that they carry with them when they go out with their babies. A baby car seat with a carrying handle may be very difficult to use. You might need to brainstorm with mothers about adaptations they can make in how they carry their babies, and how to bring less baby stuff along on outings (of course, the breastfeeding mom is at an advantage here). If mothers have not already done so, this might be a good time for them to get their physical therapists involved to help with exercises and stretches to counter some of the strain of caring for their babies.

Yeast Infections

Mothers with arthritis can be susceptible to yeast infections. Sometimes, this increased susceptibility is due to medication use. Steroids, in particular, can make mothers vulnerable to yeast infections. If the mother has had serious episodes of her illness in the past, she may have been given IV steroids during labor or immediately after, to keep the immune system in check. Or she can be on low-dose steroids as a general regimen. If this mother develops cracked or bleeding nipples, thrush should certainly be considered.

Raynaud's Phenomenon

Raynaud's Phenomenon is another co-occurring symptom of fibromyalgia and many forms of arthritis. It can also occur by itself (known as "primary Raynaud's"). Raynaud’s phenomenon involves constriction of the veins in the hands and feet so that they blanche or turn blue. They may also become red and hot as the blood rushes back into the area. The most commonly affected areas are the hands and feet, but other extremities can be affected including the nose, ears and mouth. There are even some anecdotal accounts of Raynaud's affecting the nipples. If this happens, it could inhibit let down. Both stress and cold can trigger Raynaud's. If you suspect this might be occurring, suggest some strategies to help the mother relax and stay warm as she breastfeeds.

Fatigue and Sleep Deprivation

Fatigue and sleep deprivation can be considered "occupational hazards" of being a new mom. But for the mother with arthritis, it is of special concern. Lack of sleep can cause her symptoms to flare, and she may experience a substantial increase in pain. Depending on the severity of her symptoms, she may not be able to participate in night time feedings. You may need to help her come up with alternative feeding arrangements that will keep her illness in check. It is also important that she have help during the day, particularly in the early weeks. Doing too much during the day can also lead to a flare of symptoms.

Depression

There are many physical illnesses that have depression as a symptom including several types of arthritis (e.g., fibromyalgia, rheumatoid arthritis and lupus). Mothers with arthritis may be at increased risk for postpartum depression. They may more vulnerable to the depressive effects of lack of sleep. Their pregnancies may have been considered "high risk," and may have had more interventions than they would have liked. Further, mothers you work with may have had a history of miscarriage prior to the birth of this baby. Some of the autoimmune conditions can cause pregnancy loss. The birth of this baby may trigger a grief reaction for the other babies that she has lost.

Medications

Mothers with arthritis or fibromyalgia are likely to be on one or more medications. They may need information on whether these medications are safe to use while breastfeeding. Medications can become a major battle ground for women and their doctors. Several mothers I have worked with had been told to wean their babies so that they could take their medications. Each of these mothers were actively resisting their doctors advice and refusing to take their medications. Unfortunately, rheumatologists (the specialists who work with arthritis patients) often do not have access to accurate information on breastfeeding and medications. You can help mothers and doctors work together constructively by providing them with this information.

Below I have listed five basic types of medications that mothers might be on.

Non-steroidal Anti-Inflammatory Drugs (NSAIDs)

These include such medications as over-the-counter drugs such as ibuprofen, or ones that are available by prescription only (such as "Daypro"). The are used to help control inflammation and pain.

Anti-Malarial Drugs

For reasons no one completely understands, anti-malarial drugs can help control symptoms of rheumatoid arthritis and lupus. The most common of these is Plaquenil (hydroxychloroquine), which the AAP has approved for use in breastfeeding mothers.

Steroids

Steroids are used to control inflammation, and suppress an over-active immune system. The most common of these is prednisone. Large doses may be used during life-threatening episodes. Steroids can be used while breastfeeding, but if a mother is on large doses, she may be too ill.

Immunosuppressants/Cytotoxic Medications

These medications are used in cases of life-threatening illness, and include cyclophosphamide and methotrexate. Both of these are contraindicated for breastfeeding mothers. A third medication, Imuran, is not contraindicated, but caution is advised.

Antidepressants

Interestingly, antidepressants are also often used not only for depression, but to control pain and help regulate sleep. For example, low-doses of the tricyclic amitriptyline (Elavil) is a commonly prescribed drug for fibromyalgia because of its sedating quality. Some anti-depressants are better than others with regard to breastfeeding. You may need to provide information on several so that mothers and their doctors can make informed decisions.

In conclusion, mothers with arthritis may want to breastfeed but may have inaccurate information. You can help by providing information on medications and breastfeeding, and by helping mothers anticipate and solve some of the issues that might make breastfeeding difficult for them.

Table 1

Types of Arthritis

Osteoarthritis: Osteoarthritis is the most common form. It is known colloquially as "wear and tear" arthritis and is more likely to occur among the elderly, and/or at the site of a previous injury.

Inflammatory arthritis: Inflammatory arthritis is a category that covers over 120 different diseases. These diseases not only affect the joints, but other organs in the body. These types of arthritis include rheumatoid arthritis, lupus and systemic sclerosis, and are most likely to strike women of child-bearing age. These types can range in severity from mild to life-threatening.

Fibromyalgia: Fibromyalgia is a chronic pain syndrome characterized by diffuse soft tissue pain (sometimes called "arthritis of the muscles"). It can occur in conjunction with inflammatory arthritis or by itself. One hallmark symptom of fibromyalgia is sleep disturbance, where alpha waves intrude on delta sleep. This is thought to cause pain, as the muscles need this deep sleep in order to repair the microtraumas that occur during the day. Not surprisingly, another characteristic symptom is fatigue. While not a fatal disease, it can be disabling.

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