What should I do before I become pregnant?

During the year prior to attempting conception, the most important things are to get yourself in good health and stop any destructive behavior which might harm your child such as smoking, excessive consumption of alcohol, or use of recreational drugs. If you take medications regularly, you need to review with your doctor or Ob-Gyn if they are harmful to a developing baby. Being underweight or overweight may cause problems with fertility, poor or excessive fetal growth, diabetes or high blood pressure. Average weights for women are as follows:

Height Weight
5’3″ 120 – 135 lbs.
5’6″ 130 – 145 lbs.
5’9″ 140 – 155 lbs.

Knowing your family’s medical history — particularly with respect to genetic problems, ethnic origin, history of recurrent miscarriages or mental retardation — is very important. The pre-pregnancy time is a great time to collect this information.

A pre-conceptional visit is a good time to review with your physician your family history, your health risks and other factors which could influence the outcome of your pregnancy.

 Risk Factor
Condition  Comments
Northern European Cystic Fibrosis recessive trait, carrier screening
Ashkenazi (European Jewish) Cystic Fibrosis Tay Sacks and 19 others recessive traits, carrier screening
Mediterranean, Middle Eastern, Sephardic Jewish Thalessemia problems with anemias, carrier screeing
Fragile X Mental Retardation family history of autism/mental retardation in males, chromosome testing
All families Spinal Muscle Atrophy
Sex linked Recessive diseases Hemophilia family history of hemophilia
Autosomal Dominant disease Huntington Chorea, early onset Alzheimer’s family history of these types of conditions
West African Sickle Cell, Thalessemia problems with anemia, carrier screening
Cats, rural farm workers Toxoplasmosis outside or barn cats who eat wild game (birds, mice), transmitted from infected feces (litter box issues)
Worker with deaf children CMV virus may cause mental retardation, deafness children with CMV virus deafness may be viral carriers, mother-to-be immune status should be checked prior to pregnacy
Rubella (German measles) status Congenital rubella check immunity and immunize if needed
Cajun, French Canadian, Jews, Irish? Tay Sacks disease recessive traits, carrier screening
Inbreeding many recessive genetic disorders found where there are many marriages in small, isolated communities (Amish…etc.)
HIV HIV blood test for presence of infection
Syphilis Syphilis blood test for presence of infection
Smoking growth retardation, childhood respiratory infections, poor reading scores stop smoking
Alcohol Consumption Fetal Alcohol Syndrome restrict alcohol to one glass of wine, beer, hard liquor daily prior to conception or stop altogether except for special occasions
Obesity Diabetes in pregnancy, large babies, increase risk for birth injury, c/sections stillbirth lose weight
Diabetes Malformations of the spine diabetes should be well controlled before pregnancy to prevent birth defects

Finally, before conceiving (ie: tossing the birth control pills), it is very important to take a multiple vitamin with 400 mcg of folic acid. This will reduce the risk of certain types of birth defects by 70%. There is little benefit to starting these medicines after you know you are pregnant since the damage is already done.

I’m pregnant (I think)… What do I do next?

Find out for sure by buying an over-the-counter home pregnancy test and running the test. Besides missing your period, other signs of pregnancy are passing urine all the time, pelvic heaviness, tiredness, sore breasts, and nausea. These are normal. Pain, especially low on one side or other or bleeding is not normal. If you think you are pregnant, stop smoking, consuming alcohol or using recreational drugs immediately. If you are not taking folic acid supplements or a multiple vitamin daily, start now and make an appointment to see your physician. Buy a book about pregnancy such as What to Expect When You are Expecting or The Girlfriend’s Guide to Pregnancy. Start reading and writing down questions!!

I don’t have any insurance… Help!!!

Many years ago, the United States made it a matter of public policy to protect pregnant women and their babies. Virtually all States’ Medicaid programs have much higher income eligibility for pregnant women than other recipients so it is fairly easy to qualify for medical assistance through Medicaid if you are of moderate or low income. Generally, you need a note verifying your pregnancy and you take this to your local Health Department or Medicaid Office and you will receive a form certifying presumptive eligibility. Most obstetricians in the US accept Medicaid but you will need to call and ask before making an appointment.

How do I choose a physician if I do not have one?

Obstetrical health care providers come in many forms: they are old or young, male or female, physicians or midwives. They have many practice arrangements including solo practice, small and large groups, clinics, midwives alone or working with physicians and than, of course, there is the insurance issue — who is a provider in your “Plan”. Generally, if your provider is Board Certified by the American College of Obstetricians and Gynecologists, they have demonstrated the highest level of competence in Obstetrics. Your physician’s reputation is important but perhaps more important is his or her responsiveness to your needs. Do you share a similar philosophy about your birth experience? Does your physician listen to you and your needs? Does your physician take time to answer your questions and offer important education to you. Another important thing is the hospital they work in and where you will have your baby. Is this hospital equipped to care for a sick newborn? Does the hospital have immediately available anesthesia for emergencies? It is OK to request an interview with a physician before deciding to choose him or her. If they are too busy to chat and meet you, they are probably too busy to meet your needs.

What is a Midwife?

The word Midwife is an ancient term which brings forth the image of the loving grandmother in the village who has attended all the births for decades. In the past, these women were often untrained but were all that was available in rural communities. Because of poor outcomes, traditional midwives got a bad reputation. Today, there are several types of midwife:

  • Untrained birth attendants who do home births and are illegal in many states
  • Licensed midwives who do home births and have demonstrated some training — often as an apprentice. Some are competent and others are not
  • Certified Nurse Midwives (CNM) — these practitioners have a Masters Degree in Nursing and have done two years of advanced training and passed certifying exams. They work in a practice agreement with a physician and are highly qualified to care for healthy pregnant women and do normal births. Most work in hospital or birthing centers. It is important to look at and understand the practice arrangement of your CNM so you are satisfied with and receive good care.

Home births remain very controversial. The risk is being in the wrong place at the wrong time with a poorly trained attendant if something bad happens and there are limited resources to help you. There is good data that suggestions that 25% of women having first babies will require a hospital transfer and 6% of these transfers are urgent, For women who have had a baby, the numbers are about 10% and 2%. If you are thinking about home birth, do not be swept up into the romanticism of the concept. Assess your risks and consequences very carefully.

What if I am not sure I want to be pregnant?

The normal emotional response to any unexpected change in life is often negative. We live in a society today where everything is planned. Unplanned events such as an unplanned pregnancy often cause of life plans to go awry. Studies which were done before there was access to elective pregnancy terminations showed that many women had negative feelings about unplanned pregnancy but as time went on, they came to accept it and in fact were joyful when the child was born. As a newly pregnant mom with mixed feelings, you have to balance not rushing into a decision hastily with making an appropriate decision at an appropriate time. If you choose to terminate your pregnancy, it should be done no later than 8-10 weeks to minimize complications. That allows you about one month from finding out that you are pregnant to work out issues with your family, the father of the baby, and yourself so that you can make whatever decision is appropriate for you. The right to have an elective abortion in the first trimester of pregnancy is a private matter between you and your health care provider. In some states, if you are a minor, you will need either your parent’s permission or, if you feel you cannot obtain that, an order from a judge in your community.

What happens on the first visit?

Different providers conduct the first visit in different ways. The following things may need to be or might be done:

  • A medical history
  • Genetic counseling
  • A physical exam including a pelvic exam
  • Blood testing
  • A vaginal ultrasound to determine if the baby is alive, how many babies are there, and how many weeks along the pregnancy is
  • You may receive a gift bag with educational materials, information about the hospital or practice etc.
  • A prescription for prenatal vitamins — Note: prenatal vitamins contain a lot of iron and may upset the stomach, especially in the early months of pregnancy. Generally, you do not need iron at that time so, if the vitamins upset your stomach, switch back to a multivitamin or just the folic acid pills until the fourth month.

What is prenatal care?

Prenatal care is an organized system for providing preventative health services to pregnant women. It is, for the most part, the same throughout the world. A typical program of prenatal care would include the following:

  • Initial visit — see above
  • 10-12 weeks — Down syndrome screening — NT ultrasound or the new Harmony or Verify blood test or wait to perform this at 16 weeks with blood test
  • 16 weeks — alpha fetoprotein Quad screen for Downs syndrome and neural tube defects (problems with the spine and brain), amniocentesis over age 35 if appropriate
  • 20 weeks — abdominal ultrasound and anatomical scan — time to find out the sex if you are lucky. If you have not has a tetanus-diphtheria-whooping cough (TDAP) vaccine, this is the time to do it. It gives the baby more protection if given during than after pregnancy. Also, your “Flu shot” if you will be pregnant during the influenza season
  • 24 weeks — a simple visit — a good time to bring in your legal pad and ask questions. For first time moms, a good time to learn about and dispel myths about breastfeeding.
  • 28 weeks — time to check your blood count for signs of anemia (this checks your nutrition), for diabetes and its time for a shot of Rhogam if you are Rh negative
  • 32 weeks — it’s time to start discussing your birth experience and to prepare for nursing. A great time to ask questions about these two topics. It’s also time to start La Maze or Bradley classes if you are interested in childbirth preparation.
  • 34 weeks — by now, you should have finished your tours of the hospital and your prenatal classes. It’s time to focus on preparing for your baby. Some hospitals and the Red Cross offer classes in Infant CPR (Cardiopulmonary resuscitation). A good thing to do. It’s also time to meet pediatricians and find who you are comfortable with.
  • 36 weeks — your Group B Strep culture to determine if you are a carrier and require penicillin when you are in labor to protect your baby. Group B Strep is not a sexually transmitted disease. Don’t worry if you are positive.
  • 37, 38, 39 weeks — time to watch for high blood pressure and toxemia or the baby’s growth slowing. Also time to finish with all of your questions about your birth experience. A good time to do an informal “kick chart”. Within four hours of when you wake up, you should experience ten movements. Your baby is fine for the day. Hiccoughs on the part of your baby are even better!!!! It takes a well organized fetal brain to get that organized.

The Big Day!!!! Call your health care provider if:

  • The baby’s movements slow down
  • You rupture your membranes
  • You have a lot of bleeding
  • You have a severe headache or right upper abdominal pain
  • You have contractions every five minutes last 45 seconds which steadily intensify over 1-2 hours. A good contraction should, “take your breathe away” so you have to stop talking as it happens
  • Of course, call if you are not clear what is happening or if you have any questions.

In the meantime, if you are not sure you are in early labor, do the following:

  • Walk, it helps the baby drop into a good position in your pelvis
  • Drink clear fluids with some salt and/or sugar such as juice or broth