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Having a baby can be a rollercoaster of a ride whether the pregnancy is planned or a surprise of gargantuan proportions.
If you are living with psoriasis right now, you will know that it can be unpredictable. Some pregnant women find that their psoriasis clears, and others find their skin gets worse. Psoriasis has so many triggers and there are so many changes, both emotionally and physically that we experience in pregnancy. I have had four pregnancies with psoriasis and each has been very different for my skin.
What should I plan?
Even if you have already had one good pregnancy, it’s still worth investing in time to plan so you are prepared. In my first two pregnancies I cleared within the first trimester, and then in my third I developed a strep infection at five weeks and was thrown into an unpredictable and horrific guttate and plaque psoriasis mega flare.
The thing about pregnancy with psoriasis is that there are some restrictions on the medications we can take. If you are planning a pregnancy, I would recommend talking to your GP or dermatologist about your options in pregnancy and beyond, and with the increasing use of video consultations this can fit in easily with your current routine. I had a job where I needed to tie my hair back, so I talked about what I could use safely behind my ears. There is a huge amount of advice on the internet, but I would not take advice from anyone who does not know your medical history. It is not worth the risk. EVER.
Knowing what you will do in preparation for pregnancy may seem overly cautious, for me knowing my medication choices from my doctor in preparation really helped me to reduce the stress. Knowing my options also reduced the stress when my skin started to worsen because I had a plan which could be implemented immediately.
Unexpected sources of stress in pregnancy
Stress is a major trigger for my skin and being pregnant can be stressful - sometimes in unexpected ways. There are the more obvious sources of stress; things like relationship, work, and finances. Pregnancy destroys my diet, which doesn’t help my skin. In my most recent pregnancy I couldn’t eat for a few months, and then I could only eat bland foods with limited nutrition. It was only in the last few weeks of my pregnancy that I started to eat fruit and vegetables again.
Not eating because of severe nausea is incredibly stressful. Unable to work, or even read, the stress of not being myself was hard to manage. Emotional stress is a trigger for me, I have to remind myself that everyone is excited about a new baby and are happy to help.
Make sure that you are not martyring yourself. Tell people what you need to help reduce your mental and physical loads, even if it’s just dropping off a microwave meal.
Making space for bump and you
When pregnant, and especially just after birth, it's easy to forget who you are. This may sound ridiculous, especially if you haven’t yet fallen pregnant, or you love being pregnant, but in my experience, I found having a living thing moving inside my tummy feels weird and disorientating.
I feel that this person I have never met is suddenly dictating my life. What I can and can't eat, and how much energy I do I have to stay up past 7pm (usually none). I felt like I had lost control of my own body - even though I was simultaneously totally and utterly in love with the bump.
It's easy for your babies needs to overtake your own, and to start to feel like time taken for you is selfish or should come second. This is dangerous thinking, I have been there many times. I know now that a happy mamma is the secret to happy babies and a happy family.
What can you do?
Make sure you get your things done first. When you're pregnant make sure you find time to do things you want like sleep and have coffee with friends. After the baby comes - it's even more important. Put your moisturiser on before you get baby ready - even if that means passing your baby onto someone else. You can sit your baby in a rocker so you can have a bath, whatever it takes to help you focus on being you.
I find self-care is more likely to happen if it's done in the morning, I currently have a newborn and three older children. If I can't get my moisturiser on before getting dressed and putting the kids onto the school bus, then it's a priority that I have a relaxing bath (optimistic I know!) and apply the moisturiser afterwards while my baby sits in a bouncy chair next to me on the floor.
It's also easy to overlook appointments - make sure your dermatology and any other self-care appointments are already scheduled in. I had an emergency root canal when my breast-fed baby was only 11 days old. My friend sat with her in a cafe near the dentist so I could see my baby girl immediately after the treatment. Ask for help from those around you. It may not always be easy to ask but it can make a big difference.
Postpartum flaring and the Koebner response
There were a few things I wasn't aware of before my first pregnancy, and postpartum flare ups was one of them. Like so many things I have experienced living with psoriasis, postpartum flaring has been unpredictable too. I remained clear for months after my first three pregnancies, it was glorious. After baby number four, I have flared at all my friction points, which is worst for me up and down my arms, where I pull myself up against my pillows several times a night to feed my baby.
There is also the Koebner response, this is where psoriasis appears in the areas where skin has experienced trauma. With my most recent pregnancy, my psoriasis arose in the areas where my had skin stretched. I had a few patches across my breasts and across the lower part of my abdomen. I have been fortunate enough not to get psoriasis where I had stitches from a vaginal delivery, and I have no experience of dealing with a C-section scar - but it's definitely something that's worth talking to your doctor about while still pregnant, so you know what to do if this happens to you.
Even during my psoriasis mega flare, there were treatment options that could get my psoriasis back until control and that could still be used whilst looking after a baby. Just make sure any treatments are given the thumbs up from your own doctor. And remember, your body is under a lot of strain (even if you are glowing) and you need to give yourself the love, admiration and space for self-reflection that you deserve. Don’t compare yourself to other pregnant women who look like they're doing it all...you don't see the people like me eating biscuits in bed while binge watching anything by Phoebe Waller-Bridge.
You are growing a miracle, put your feet up and get someone to make you a cuppa.
Article developed in partnership with LEO Pharma.
MAT-34774 May 2020