What can I do to prepare for the birth?
Antenatal classes provided by the NHS or other organisations such as the National Childbirth Trust are a great way to learn more about the options available during labour and delivery. They are also an ideal opportunity to meet other expectant mums and find out about local health services and support such as mother and baby groups.
Many women choose to make a birth plan which records where you would like to give birth, who you would like to have with you, preferences for pain relief and how you feel about interventions such as forceps delivery.
If you have MS this can be even more important. Not all the health professionals that might see you during labour will be familiar with MS, so it will help if your birth plan documents that certain procedures, such as epidural anaesthesia, are safe for mums with MS. If at all possible, request a meeting with your whole team including midwife, MS nurse and anaesthetist to draw up your birth plan and don’t be afraid to ask for what you want!
Will MS affect my labour or delivery?
MS does not usually affect labour or delivery. The frequency of complications during labour in women with MS does not generally differ from that of women without MS.
Birthing positions, techniques for coping with fatigue or spasticity during labour can be discussed with a midwife in advance and recorded in your birth plan. Some women with MS have recommended a water birth, for both the extra support and the cooling that the water provides.
At delivery, safety of mother and child is paramount and there may be medical reasons for an assisted delivery – eg a forceps or vacuum delivery – or delivery by caesarean section. A caesarean delivery may be recommended if your MS symptoms would affect your ability to push effectively during labour, but should not be advised solely on the grounds of MS, as recovery afterwards takes longer than from a vaginal birth.
What pain relief is available?
Women with MS can generally use most types of pain relief during labour, such as pethidine, entonox (gas and air) and epidural anaesthesia. No adverse effects on delivery or course of MS have been associated with epidural anaesthesia.
TENS machines can be helpful with pain relief in the early stages of labour. However, some women with MS have reported that TENS machines can trigger leg spasm during labour, so it might be worth discussing this with your MS team and midwife in advance.
What can my birth partner do to help?
The most important thing that your birth partner can do is just be with you, providing emotional and physical support. If they’ve accompanied you to antenatal classes and have helped you draw up your birth plan, they’ll have a good idea of what you would prefer. They can help pass the time during the early stages, help you change positions, massage your back and shoulders, comfort and reassure you as labour progresses, help you with relaxation and breathing techniques, support your decisions such as the pain relief you have chosen, and help explain what you want to the midwife or doctor and help you understand what the midwife or doctor need you to do.
Life with your new baby
Will I be able to manage?
Coping with a new baby can be demanding for any new mum, so make the most of offers of help. If possible, try discussing in advance the type of help that you would most welcome. This could be help with housework, restocking the fridge/freezer, night feeding, looking after the baby for a while to allow you to catch up on sleep or just having a bit of time to yourself. If you can’t get help from friends and relatives, it might be possible to have help arranged through social services or your health visitor.
It’s easy to feel isolated when caring for a small baby, so it’s worth making time to get out and meet other new mums in a similar situation. Your midwife and health visitor will know of mother and baby groups in your area and organisations such as the National Childbirth Trust run local groups. Chatting to other parents at baby clinics can help you cope with the ups and downs.
My health visitor recommended some mums groups. I wasn’t sure at first but I’ve made some great friends.
Will I have a relapse?
There is an increased risk of having a relapse during the first three months after your baby is born, so it’s worth making contingency plans with family and friends, just in case. However, one of the larger studies which monitored relapses before, during and after pregnancy reported that, despite the increased risk for the first three months, two-thirds of the mums did not experience a relapse during this period. Women whose MS had been more active in the year before pregnancy, and those who had a relapse during pregnancy, were more likely to experience a relapse after having a baby.
Can I breastfeed?
MS cannot be passed on through breast milk and research has shown that breastfeeding is best for the health of the newborn baby. However, how you feed your baby is a person choice. Some new mums with MS will have understandable concerns about fatigue and may prefer to bottle feed, since this can be shared with others. On the other hand, once established, breastfeeding is quicker and more convenient than bottle feeding. You have to weigh up the pros and cons for your own situation.
My MS nurse was great at helping me work out a feeding routine that worked for me.
Can I take medicines after the birth?
Disease modifying treatments can be present in breast milk. Since the effects of these drugs on the baby are unknown, mums are advised to delay starting treatment while breastfeeding or to stop breastfeeding in order to start treatment. The decision will be influenced by your previous history of relapses.
Steroids can also be present in breast milk and there has been very little research into the potential effects on the baby of the high doses used to treat MS relapses. You can express as much milk as possible before starting the course of steroids and store this for use while taking steroids. You can express and discard milk during your treatment period (usually 3–5 days) and resume breastfeeding 1–2 days after the end of treatment. Your MS nurse and neurologist will agree timings with you.
Other drugs taken to treat MS symptoms such as nerve pain or spasticity may not be recommended during breastfeeding but there may be safer alternatives. Talk to your MS team, midwife or GP for advice.