Still, not every woman living with rheumatic disease with this desire does follow through, in some cases because of unfounded concerns about the safety of medicines they may be taking, says study coauthor Megan Clowse, MD, director of the Duke Autoimmunity in Pregnancy Clinic and associate professor of medicine at Duke University in Durham, North Carolina. “The good news is we found quite high levels of women desiring to breastfeed, and high numbers of those successfully doing so,” Dr. Clowse says. The 265 women in the study were part of a pregnancy registry Clowse set up for her practice a decade ago. “There are a lot of women with rheumatic diseases who want to breastfeed, but there was very little data about this. When I set up the registry, I made sure we asked about breastfeeding,” she says.
Some Women Didn’t Follow Through and Nurse Babies
Before they delivered, 79 percent of the pregnant women indicated their desire to nurse. By the time of their postpartum visit an average of 7.5 weeks after delivering, three-quarters of these women were in fact doing so. This means 25 percent of the women who had hoped to breastfeed were not. Some had tried but stopped, in some cases because they couldn’t develop a milk supply or because their baby had health issues. Other women said they gave up breastfeeding because they worried that the medicines they were taking might possibly pass through to the baby. This mindset echoes the results of a survey conducted among members of the arthritis community CreakyJoints, presented at the American College of Rheumatology meeting in September 2017. In that survey, 86 percent of women said they had either avoided taking medicines while breastfeeding, or they stopped nursing prematurely in order to resume the drugs needed to avoid postpartum flares.
Most Rheumatoid Arthritis Medicines Are Safe to Take While Breastfeeding
But for almost all rheumatoid arthritis medication, this concern is unfounded, Clowse says. New mothers can safely nurse on nearly all RA drugs in use today, she says. That’s because medicines like Enbrel (etanercept) and Remicade (infliximab) don’t readily pass to a baby through mother’s milk, and any that do get through, especially with full-term infants, are not well absorbed by their gut, according to Mother to Baby, a website created by experts on birth defect risks. Clowse even tells patients they can nurse while taking methotrexate, a medicine that women must avoid while pregnant. “Breastfeeding is a different biology from pregnancy. There is very minimal transfer in breast milk,” she says. The one type of medicine Clowse does restrict from nursing mothers is small-molecule Janus kinase (JAK) inhibitors, such as Xeljanz (tofacitinib), primarily because they are so new that there is not enough data on its nursing safety.
Not All Doctors Support Nursing for Moms With Rheumatic Diseases
Clowse admits that she is especially enthusiastic about allowing patients to breastfeed, because she knows first hand that it can be an important part of a mother’s experience. Plus, breast milk is so healthy. According to the American College of Obstetricians and Gynecologists (ACOG), breast milk contains antibodies that protect infants from ear infections, diarrhea, respiratory illnesses, and allergies. It also can make it easier for moms to lose pregnancy weight, and it may reduce her risks of breast cancer and ovarian cancer. This is why ACOG recommends exclusive breastfeeding for the first 6 months of life, or longer if it is mutually desired by the mother and baby. Clowse knows that her encouragement is likely more pronounced than that of other rheumatologists, and likely explains the high numbers she found in her study, she says. In this research, women who exclusively formula-fed babies were likely to be younger and have less education and lower incomes than nursing mothers. Although black women in her study were less likely to nurse than whites, Clowse says that was related more to the education levels of the women in her registry than their race.
Get Your Doctor On Board With Breastfeeding
If your doctor erroneously tells you that you cannot nurse on any of the medicines you are taking, you can show them the information from Mother to Baby. “There’s actual data, so you don’t have to base the decision on myth,” Clowse says. “The reality is you can breastfeed on almost all RA medication. You don’t have to pick between taking care of your disease and breastfeeding your baby,” she asserts.
Use Supportive Devices to Ease Pressure on Joints
Aimee Matsumoto, a public relations professional in Pasadena, California, who blogs about her experience having RA, is a new mom who is determined to nurse her infant. Matsumoto is not on any medicines, having had bad reactions to those she has previously tried. Matsumoto was fortunate to go into remission during her pregnancy, but since her baby was born 9 months ago, her pain has come back with a vengeance. When her joints flare, it can be hard to breastfeed because of the challenges of holding the baby in a nursing position, she says. Matsumoto overcomes this by using a nursing pillow, such as My Brest Friend, to take the weight off her hands. Other time she feeds her baby while both are lying down.
Find Lactation Support to Help You Breastfeed
A lactation consultant is the best person to help you figure out ways you can nurse that protect your joints. You can find one near you on the website of the International Lactation Consultant Association.
