The Decision to Start a Family

Preparing for pregnancy...

Thinking about becoming a parent is a joyous occasion in a couple’s life filled with wonderful expectations and anticipation. Traditionally, women have focused on the pregnancy alone as a nine-month event with the optimal outcome of a healthy newborn. However, the best time to start preparing for pregnancy is before you become pregnant. In fact, taking care of yourself now can reduce certain health risks to your baby, particularly in the crucial early weeks after conception. Take some time to think about the following aspects of your life. Learn the steps you can take now to help ensure a happy, healthy pregnancy and future for your baby.

Proper Nutrition
Proper nutrition is a basic component of good health and has a powerful impact on the growth and development of your unborn baby. One of the most essential ideas focuses on knowing what to eat, thus striving for the “Ideal Diet.” Becoming familiar with the food pyramid can be an excellent tool to obtain a balanced diet utilizing the five major food groups. The five food groups can assist in obtaining adequate amounts of iron, calcium, and other vitamins and minerals.

Daily servings should include:
6-11 Breads and Grains
3-5 Vegetables
2-4 Fruits
2-3 Milk & Dairy Products
2-3 Meat and Meat Alternatives

• Eat in moderation-a serving size is approximately the size of your palm
• Consider the quality of food and quantity of calories
• Grain products will provide energy, vitamins, and minerals. Try to choose whole grain products when possible. Avoid muffins, cookies, doughnuts, etc. that contain a large amount of fat.
• Fresh vegetables are the best, although canned and frozen vegetables are also fine. Vegetables contain a large variety of vitamins and minerals. Avoid fried vegetables like French fires that contain a large amount of fat.
• Milk and milk products contain calcium for strong bones and teeth. Try to limit whole and 2% milk, choose skim and lower fat varieties instead. If you are lactose intolerant, talk with your health care professional for possible alternatives.
• Meat and meat products contain protein that helps to build strong muscles and healthy blood. Avoid meats high in fat, such as hot dogs and bacon, and other processed meats. Poultry, fish, beans, nuts, tofu, peanut butter, and eggs are also good sources of protein.
• Avoid junk foods (those high in sugar and fats)—they are empty (non-nutritious) calories.
• Fresh fruits are the best when possible because of the large amount of vitamins and mineral. Avoid fruit juices that contain a large amount of added sugar.
• Avoid caffeine or significantly reduce the amount you consume. Caffeine can be found in coffee, tea, soft drinks, and chocolate. Studies have shown conflicting results, but it could cause infertility, spontaneous abortion, fetal death, or premature delivery (Perry, 1997). Try to switch to decaffeinated sodas, teas, or coffee instead of regular. Caffeine can also interfere with the absorption of iron.
• Drink plenty of fluids. Try to consume at least 6-8 glasses of water each day.

Folic Acid: The good word
Folic acid is critical in defending your baby’s future. Folic acid is a B vitamin that helps protect against birth defects of the spine and brain, such as spina bifida (also known as neural tube defects). Folic acid is extremely crucial in the weeks prior to pregnancy and the early weeks of pregnancy. It is recommended you take at least 400 micrograms of folic acid daily, beginning at least one month prior to pregnancy. Foods that contain folic acid include green leafy vegetables, beans, asparagus, citrus fruit, whole grains, and liver.

• Don’t eat raw or undercooked fish, eggs, meat, or poultry
• Wash raw vegetables and fruit thoroughly
• Avoid any unpasteurized milk or milk products, including soft cheeses such as blue cheese or Brie.
• Cook leftover foods and ready to eat foods until steaming hot.

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Body Weight/Exercise
An optimal way to prepare yourself for pregnancy is to reach your ideal weight prior to becoming pregnant. Being overweight or underweight has been shown to be dangerous for both mother and baby. Being underweight can cause premature delivery, small babies, or anemia. Overweight women have increased problems with overly large babies, high blood pressure and diabetes. It is not a good idea to try and loose weight and diet during pregnancy, thus it is better prior to conception. You should talk to your health care provider on proper nutrition and exercise when trying to reach your ideal weight and appropriate BMI.

Exercise can be a key part in obtaining your desired weight and maintaining that weight. Exercise also is beneficial to build flexibility, reduce stress, maintain muscle tone, strength, and endurance, and also protect against back pain in pregnancy. It has been shown that women also have an easier time pushing and returning back to the pre-pregnant state when they exercised prior to conception. Women report feeling better and more energized with regular exercise. If you are already exercising, continue to do so! Wonderful! If you are not, now would be an optimal time to start. You should allow at least three months of routine exercise prior to pregnancy for your body to adjust.

There are no one-size fits most with exercising. You have to find a program that works for you, as well as a safe program. Safety depends on your health and current activity level. It is important that you don’t hurt yourself or exercise to the point it feels painful. If you have any questions, always contact your health care professional. When you develop a routine (at least three times a week for at least 20 minutes) program, it should include three types of activities:

• Flexibility Training-stretching exercises can help you maintain flexibility.
• Strength Training-exercises that help build muscle tone will make carrying the baby easier, such activities include lifting weights and resistance training
• Aerobic conditioning-these are exercises that strengthen the heart and lungs by completing vigorous activities for 20 minutes, three to five times a week. Some wonderful choices for before, during, and after pregnancy include:
     • Walking
     • Swimming
     • Water aerobics
     • Cycling

Some tips:

• Choose more than one exercise activity, which will help prevent you from getting bored as well as providing a more rounded program.
• Choose activities that you can complete throughout the pregnancy. Low-impact activities tend to be the safest, as listed above. High-impact activities like horseback riding, scuba diving, or skiing are not recommended.
• Choose activities that you enjoy, so you do them because you like them rather then because you “should.” You are much more likely to stick with them.
• Consult your health care professional before you begin any activities if you are pregnant, have any health problems, or over the age of 35.
• If you are pregnant, keep your heart rate below 140 beats per minute while exercising.
• Avoid getting overheated when exercising and drink plenty of water.

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General Health/Medical History
Most women who want to become pregnant are young and healthy. Chances are you will have a normal pregnancy. However, if you diabetes, seizures, high blood pressure, asthma, thyroid problems and other medical conditions consult your health care professional prior to conception to improve pregnancy outcomes. Chronic diseases should be well controlled prior to conception. If you are taking medications for a medical condition prior to pregnancy, ask your health care professional if this is safe. Make sure to tell your health care provider that you are trying to conceive. Remember, over-the-counter medications also may be harmful during pregnancy.

Age
Women who become pregnant after the age of 35 are becoming more common. Advanced maternal age has been associated with complications during pregnancy and birth such as gestational diabetes, hypertension, placental abruption, placenta previa, cesarean delivery, cerebral palsy, and other genetic disorders. Teen mothers, those younger than 15 years old, have had complications including low birth weight babies and preterm deliveries.

Infertility
Infertility is defined as the inability to conceive after 1 year of unprotected intercourse occurring at the time or preceding ovulation (considered 6 months if you are over 35). In the United States, approximately 40% of infertility cases are related to the woman, approximately 30-40% are related to the male, 10% are in both, and in 10%, no cause is found (Hobbins, 2001).

Immunization Status
Have you been vaccinated against rubella (German measles)? If not, you should receive the vaccine at least three months prior to conception. Immunizations should not be given during pregnancy. MMR, oral polio, and varicella vaccine are live viruses and could cause birth defects.

Lifestyle Hazards
Alcohol
Alcohol use during pregnancy is not recommended in any amount and can significantly affect your baby’s development. If you drink alcohol, abstinence should begin during the preconception period. Otherwise, alcohol can cause fetal alcohol syndrome, stillbirths, low birth weight babies, and spontaneous abortions.
Smoking
Smoking is the most preventable cause of low birth weight babies. Other risks associated with smoking include spontaneous abortion, preterm labor, placental problems, increased incidence of respiratory infections in infants, and sudden infant death syndrome (SIDS). Women who smoke are 50-70% more likely to have a child with a cleft lip and palate then non-smokers (Hobbins, 2001).
Recreational Drugs
All recreational drugs have a negative affect upon an unborn baby, and couples should discontinue use immediately, especially if considering pregnancy. These drugs are passed to the baby through the placenta and adversely affect the baby’s development. Continued use can cause a baby to be addicted upon birth and can result in death.
Medications
Couples should discuss any prescription or over-the-counter medication they are taking with a health care provider to determine if the medication may be harmful to the unborn baby. It is important for the health care provider to determine the risks versus the benefits of the medication.

Environmental Hazards at Home and at Work
Substances within the work and home environment may be toxic and harmful during the pregnancy and/or throughout childhood. Avoid exposure to organic solvents, heavy metals (lead, mercury) and radiation (including X-rays).

Family History/Genetics
In preparation for pregnancy, you and your husband’s family medical history should be discussed with your health care professional. Genetic screening and counseling prior to pregnancy can help identify any risk factors for inherited diseases. Couples may need additional counseling if one member has a family history of sickle cell disease, Tay-Sachs, hemophilia, thalassemia, cystic fibrosis, and phenylketonuria (PKU) or if the woman is over 35 years old.

Paternal Issues
Occupational/chemical exposures
Avoid nicotine and toxic chemicals. The father’s exposure to vinyl chloride, chloroprene, benzene, lead or chemical agents such as chemotherapeutic drugs or radiation have been associated with spontaneous abortion, stillbirth, preterm delivery and small-for-gestational age babies (MCN, 1997).
Smoking
Smoking can lead to erectile dysfunction for the male and may affect the woman’s ability to conceive. Once pregnancy occurs, it could lead to a low birth weight baby.
Sexually transmitted diseases
Paternal lifestyle issues also can be a significant for a woman and her child such as exposure to sexually transmitted disease or other viruses including HIV or Hepatitis B.
Age
Advanced paternal age (greater than 37 years of age) has been associated with some genetic diseases.

Social Issues
A supportive, safe environment is important during the preconception period. Abuse during pregnancy can affect the growing baby by causing placental problems, bleeding, fractures, or preterm delivery. If you fear or are suspicious about a possible abusive relationship, contact someone you can trust, your health care professional, Mercy’s Behavioral Care at 712-274-4200, the Council on Sexual Assault and Domestic Violence at 712-277-3575, or Women Aware at 712-258-4174.

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Financial Concerns
Pregnancy and childbirth are most often the first major medical expenses a couple will face. Often these costs are underestimated. It is important to follow-up with your health care insurance company on your coverage. Here for some important questions to consider when reviewing you maternity benefits.

Does it cover prenatal care?
What prenatal tests are covered?
Does it cover your health care provider?
Does it cover a pre-pregnancy planning visit?
What delivery options are covered?
Does it cover hospital costs for the baby?
Is there a co-payment? How much?
Is there a deductible? How much?
Are anesthesia and emergency cesarean sections covered?
Are sick and well-baby visits covered?
Are immunizations covered?

Obtained from “Are you ready? A guide to planning a healthy, happy pregnancy?” (2000). March of Dimes Birth Defects Foundation. p, 20.

The time for financial planning begins immediately. Issues such as lost wages, health care costs, and increased household costs should be evaluated. Depending on your decision to continue to work, childcare costs should be assessed.

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Stress
Stress is a part of everyday life. All men and women should attempt to reduce stress in their lives, particularly in the preconception period and during pregnancy. Too much stress can have a negative effect on a person’s physical and emotional well-being and can increase the risk of preterm labor, low birth weight, and possible miscarriage. Learning how to manage stress can occur by identifying what triggers stress and eliminating or avoiding those issues. Some suggestions for reducing stress include regular exercise, relaxation techniques, communication, asking for help, developing a support system, and humor.

With this information you will be able to make informed decisions and identify risks involved if a pregnancy occurred. Following the steps listed does not guarantee optimal outcomes, but minimizes risks.

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Now, the joint decision - choosing to start a family.

Pregnancy is a joint decision that needs to be made between you and your partner. Through communication, you can decide if you are ready for parenthood and the major impact it will have on your lives—not to mention all the newfound joys, roles, and responsibilities. Talking about your feelings, expectations, and thoughts can help make the planning process easier. Topics of conversation should include personal, relationship, financial, and career. Problems should be discussed openly and honestly. It is very common to feel excitement as well as some anxiety and doubt.
Thoughts of parenthood include different expectations, but couples with a strong, firm foundation can be positively impacted when starting a family. Find a time for you and your partner to share quietly, like a romantic dinner, a walk, or watching the sunset. Answer and discuss the following questions about parenthood:

• Why do you want to have a baby? Do you want to have a baby or is your partner, parent, or someone else pressuring you?
• How will a child affect your relationship with your partner? Are you both ready to become parents?
• If you’re not in a relationship, are you prepared to raise a child alone? Who will help support you?
• How will a baby affect your future educational or career plans?
• Do you and your partner have religious or ethnic differences? Have you discussed how you will handle these and how they might affect you child?
• What will you do for child care? Will one or both of you return to work?
• Are you prepared to parent a child who is sick or has special needs?
• Are you ready to give up sleeping in on Sunday mornings? Finding child care every time you want to go out without your baby?
• Do you enjoy spending time with children? Can you see yourself as a parent?
• What did you like about your childhood? What didn’t you like? What do you want for your child?

Obtained from “Are you ready? A guide to planning a healthy, happy pregnancy.” (2000). March of Dimes Birth Defects Foundation. p. 18.

It is important that you agree on most of the main issues and begin discussing your differences before you conceive. Remember, only the two of you can decide if you are ready, emotionally, to have a baby.

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How Pregnancy Begins
After carefully deciding to become pregnant, you decide it is time to start trying. So, how does pregnancy happen? An egg is released from a woman’s ovaries during ovulation, which occurs 14 days before the first day of her menstrual cycle each month. When sexual intercourse occurs around the time of ovulation, a sperm can meet and penetrate the woman’s egg. This fertilization is termed conception. This fertilized egg, now called an embryo, travels to the woman’s uterus and embeds into the lining of the uterus for growth.

The egg is fertile for 12 to 24 hours after it is released. A man’s sperm can live up to 72 hours after release into the woman’s vagina. Thus, the best time to have intercourse for pregnancy is within the six days prior to and the day of ovulation. The closer intercourse is to ovulation, the more likely it is you will get pregnant, as well as the more often you have intercourse. There is no correlation to the time of intercourse and the sex of the child.

You can talk with your physician about methods to determine your ovulation cycle including the temperature method, cervical mucus method, and the ovulation prediction kit.

If you don’t get pregnant right away, don’t worry. Ninety percent of couples get pregnant within one year of trying. If it has been more than one year (6 months if you are over 35 years old), consult your health care professional.

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Early Signs of Pregnancy
The signs of pregnancy can differ for each person. Some of the symptoms you MAY feel include:
• A missed period or two
• The need to use the restroom more frequently
• Certain foods or smells may make you feel sick or cause you to throw up
• You crave odd foods
• Your breasts feel tender or are more swollen than usual
• You feel very tired
• You become more emotional
• You become constipated
• You have an increase in vaginal discharge

Do not be concerned if you think you may be pregnant and do not experience any of these symptoms.

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Confirming your Pregnancy
If you have missed a period, you may purchase a home pregnancy test kits for urine that measures the amount of a hormone called “hCG.” This hormone can detect pregnancies about 12-15 days after conception and the results are ready in a few minutes. Home pregnancy tests are very accurate and are available at supermarkets, pharmacies, and some department stores. Otherwise, you may call your health care provider and they may order a pregnancy test, which is very similar to home tests. Blood tests are more sensitive than urine tests and can detect pregnancy as early as one week after conception.

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Choosing a Practitioner
If you haven’t already, now is the time to decide who your health care professional will be. It also is a good time to begin prenatal vitamins if you aren’t already taking them, which a health care professional can recommend.
Obstetricians
Obstetricians are medical doctors who specialize in the care of women in pregnancy, delivery, and postpartum and have the ability to perform surgery.
Family Practice Physicians
Family Practice physicians are medical doctors with training in all aspects of health care for all ages. A family practice doctor can be your health care provider during the pregnancy, delivery, and postpartum, as well as your baby’s doctor.

Some questions for you to ask yourself when considering you health care provider:

• What is the reputation of the health care provider?
• Does the health care provider seem interested in making you comfortable, listen to your questions, and take time with you when needed?
• Is the office staff helpful and friendly?
• Is the clinic located conveniently with a workable schedule?
• Does your insurance cover that provider?

In addition to choosing a health care provider, you should consider where you would like your baby to be born.

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