Breastfeeding Mothers Who Have Lupus
Lupus is an autoimmune disease of the connective tissues that affects mainly young women of childbearing age. It is a chronic illness with symptoms that can be made worse by stress, hormonal changes, and other factors. Lactation does not appear to affect the symptoms positively or negatively.
Until recently, women with lupus rarely had an opportunity to breastfeed because the disease was associated with very high rates of infertility, miscarriage, prematurity, and stillbirth. Advances in monitoring both this disease and high risk pregnancies in general have markedly increased the chances that women with lupus can give birth to healthy babies without devastating effects on their own health. Can these new mothers breastfeed without ill effects?
It is not uncommon for lupus to be first diagnosed during pregnancy, either because the pregnancy worsens symptoms of an underlying disease or because careful health monitoring during pregnancy reveals the disease for the first time. Whether the diagnosis is recent or the mother has been aware of the disease for some time, the knowledge that she has a potentially life-threatening chronic illness may be deeply disturbing to the mother at a time when she is making an emotional investment in the future through her dreams for her baby.
Any mother with a chronic disease will benefit from a good working relationship with her doctors. Careful, open dialogue with her internist, obstetrician, and her baby's pediatrician will help ensure that the mother's needs and those of the baby are met. A mother with a chronic illness often needs a doctor for her baby who is willing to "go the extra mile," to consider her family's special needs, and to do extra reading and research. Many women with lupus find it difficult to have a traditional prenatal interview with a pediatrician because they are on bedrest at home or in the hospital. A doctor who is willing to chat by phone or drop by her hospital room while there to see other patients may be one who exhibits the flexibility that this mother needs.
Many lupus patients are maintained on medications that can pass into the mother's milk. Specific information about these medications and about the advantages of breastfeeding can help a mother assess the risks and benefits for her baby. Neonatologists caring for premature babies may have more concerns about medications in human milk than doctors caring for full-term healthy newborns.
The most common drugs prescribed for lupus are designated by the American Academy of Pediatrics as compatible with breastfeeding (Briggs, Freeman, and Yaffe). However, there are cautions with respect to each drug which the mother needs to consider in discussion with her doctors.
Breastfeeding a Premature Baby
Women with lupus experience a high rate of premature births. This means that many of these new mothers will face the challenges inherent in nursing a premature baby. It's important for them to know how much premature babies benefit from receiving human milk. In many instances these women can prepare for the possibility of a preterm birth and the challenges of pumping during the baby's hospitalization.
Because lupus may affect placental function, women with lupus are more likely to have babies that are small-forgestational age (SGA). In general, SGA babies are slow gainers, whether breast or bottle-fed. Learning as much as possible about breastfeeding management can help a mother overcome this challenging situation.
According to Dr. Bryan Arling (a Washington DC internist in private practice), breastfeeding is particularly desirable for women with lupus because the contraceptive effects of breastfeeding are especially important to these women. Avoiding repeated, closely spaced pregnancies is a high priority for the long-term health of a woman with lupus. However, hormonal contraceptives can make lupus symptoms worse. In addition, women on certain medication regimens experience inexplicably high pregnancy rates while using IUDs. (See Briggs, Freeman and Yaffe.) Therefore, the amenorrheal effects of total breastfeeding are especially important to women with lupus. A mother can learn more about using breastfeeding for fertility control from Sheila Kippley's book, Breastfeeding and Natural Child Spacing and LLLI's information sheet No. 87, "Breastfeeding and Fertility."
Managing the Household
Lupus, like many chronic illnesses, can result in fatigue and an increased need for rest. In our culture many people, including some doctors, view breastfeeding as "tiring" or "draining" to the new mother. A mother needs to understand that having a new baby in the house disturbs sleep, whether the baby is breastfed or bottle-fed. The sleepy feeling a mother may experience as she nurses is a result of relaxation associated with the release of prolactin. This helps her relax and rest more fully, rather than tiring her.
Like other mothers with compromised physical abilities, women with lupus may need help with childcare and household work to prevent fatigue. For these mothers breastfeeding provides a unique connection to their infants. Although others may dress, diaper, wash, walk, and play with her baby, the breastfeeding mother retains a close bond with her baby and an irreplaceable role in the baby's life. In addition, women who choose artificial feeding add to the household work for others. The mother should consider what types of assistance other than infant feeding she can request to conserve her strength. Help with meals and with cleaning can significantly reduce the mother's burden without interfering with the breastfeeding relationship.
Often women who tire easily are particularly concerned about night feedings. These mothers often believe that they will be able to sleep through the night if only their husbands get up to give the baby a bottle. However, mothers whose husbands give nighttime bottles usually find that their sleep is still interrupted when the baby awakens. The mother can minimize the disruption to her sleep by enlisting her husband's help in bringing her the baby, as well as burping and diapering the baby after he is fed. If she nurses her baby in bed with her she can go back to sleep quickly. These night feedings play an important role in regulating supply in the early months and in fertility control.
In some cases the mother may believe she absolutely cannot breastfeed if she must continue to wake and feed the baby at night. Even so, this mother can still continue to breastfeed during the day.
Since lupus does not directly affect breastfeeding, there is little information available that specifically addresses the topic of breastfeeding for the mother with lupus. Contact with La Leche League can help. A local Leader can share information about drugs and fertility control and help the mother dialogue with her doctor, breastfeed a premature baby, and find ways to minimize housework. A La Leche League Group can also provide the basic breastfeeding information that is crucial to any mother's breastfeeding experience.
Lockshin, Michael D. Pregnancy associated with systemic lupus erythematosus. Sem Perinatol 1990; 14:130-38.
Out, H. J. et al. Systemic lupus erythematosus and pregnancy. Obstetr Gynecol Surv 1989; 44:585-91.
Sala, D. Jean and Lentz, Judith R. Pregnant women with systemic lupus erythematosus. MCN 1986; 11:382-87.
Ramsey-Goldman, Rosaline. Pregnancy in systemic lupus erythematosus. Rheum Dis Clin N Am 1988; 14:169-85.
OTHER HELPFUL RESOURCES
Briggs, Freeman, and Yaffe. Drugs in Pregnancy and Lactation.
Kippley, Sheila Breastfeeding and Natural Child Spacing.
LLLI information sheets: "Breastfeeding Your Premature Baby," No. 26.
"Medication for the Nursing Mother," No. 21.
"Breastfeeding and Fertility," No. 87.
"A Mother's Guide to Milk Expression and Breast Pumps", No. 30.
"Breastfeeding Does Make a Difference," No. 64.
THE BREASTFEEDING ANSWER BOOK -- drug questions, breastfeeding premie, pumping for hospitalized baby.
THE WOMANLY ART OF BREASTFEEDING -- household management and nighttime parenting, as well as breastfeeding management.
La Leche League International, Inc.
By Judith R. Gelman