Congratulations on your pregnancy!
I'm a fellow PsA sufferer and first time mum...my dd is now 15 weeks old. I chanced upon your post so thought I'd share my experiences with you!
By the second trimester all my symptoms had totally disappeared! I wasn't taking any meds at all. Amazing! Something to do with the steroids produced by the placenta someone said. My knees were still a little fluid-y but no pain. I decided that I wanted to use a birthing pool for the birth so that I had a bit more freedom over birthing positions...there's no way I could kneel or squat without the water supporting me and I know that lying flat on your back isn't really the ideal position. I spoke to my rheumatologist and obstetrician and there was no way I could 'bagsy' the pool at the hospital so I opted for a home birth. With it being my first baby I have no point of reference but I do feel that the water helped as I was able to find the best position for me without worrying about my joints too much. I should probably say that I did transfer to the hospital for the last half hour or so and birth of the bubs, but not for any serious reason and all was fine...I was just getting pretty tired out and my contractions were slowing down a bit. But being able to do my whole labour at home was great.
I was also aware that my joints were likely to flare up pretty soon after the birth and that I may need to start taking meds again that weren't compatible with breastfeeding (i.e. methotrexate). I spoke about it a lot with my consultants and family and friends in order to mentally prepare myself for it, and I had great support too. It knew that it would be more important for the baby to have a mummy who could actually move and look after her than to breastfeed beyond the first few weeks. I sort of told myself to aim for 6 weeks breastfeeding and not to beat myself up about it. It was important to me to have this sorted in my head beforehand.
And yes, within 2 weeks of the birth I could feel the pain and inflammation creeping back in, particularly in my wrists as they were working overtime with a new baby! I had an appointment with my rheumatologist set up for within 2 weeks of the birth and further discussed my options (again!). She gave me a prescription for prednisolone, which she said was safe to use, but I was really reluctant to take anything at all whilst breastfeeding so put the prescription to one side!
When baby was about 6 weeks old I introduced a bottle of expressed breast milk. It was important that she would take a bottle in case I needed to wean to bottle sooner than I hoped. By this point my joints were getting pretty bad and I decided to start the process of moving her onto the bottle. I first changed the bottle of expressed milk to formula. But then I remembered the pred script and did a bit of research; the data suggests that the amount that passes into my milk is almost none even when the dose is much higher than I'm taking (which is 10mg/day). The recommendation is that if you're taking 50mg or more then wait 4 hours after taking it before nursing. So although I'm taking much less than this, I now take the pred in the evening and I've kept the bedtime bottle of formula so there are a number of hours between me taking the meds and her next feed. Which hopefully means she's getting nothing of it through the milk, and if anything it's a negligible amount which has shown no effects on babies. With the prednisolone I've been able to continue breastfeeding...I'm now up to 15 weeks and counting. I'm hoping to keep taking the pred for a couple of months so that I can keep feeding. I don't think it's something you'd want to take long term but at the moment it's really helping. I'll then be much happier to wean when the time comes!
Sorry for this massively long post! But hopefully you'll find this useful! And please do use this thread if you've got any other questions or concerns that I might be able to help with...sometimes it's just helpful to share with someone who's going through or been through the same thing!
All the best!xx