Considering motherhood? Here’s what to plan for if you’re nearly ready for the pitter-patter of tiny feet.
Starting a family is a big step, with much for you and your partner to consider. Are you financially prepared? Do you have the space? Are you emotionally ready? Will your fur baby (i.e. dog or cat) accept your new family member? While parents will tell you can never truly be ready for such a big life change, one thing you can take charge of is your health. If you’re contemplating pregnancy for the first time and think you’re ready to have your first baby, then you can start now to ensure the baby has the healthiest start possible. We spoke with SCL Health experts Dana Roper-Cooper, MD, an obstetrician gynecologist, and Erica Gillesby, BSN, RNC, an OB nurse navigator, about what women about 12 to 18 months out from starting a family should know and can do now.
Start with your healthiest self
Having a healthy mom will help give your baby a good start in life. When you’re getting ready to have a baby, concentrate on steps you can take to improve your own health, such as decreasing alcohol intake, quitting smoking and/or any substance use (like marijuana) and taking proactive steps to improve your diet and exercise regimen.
Dr. Roper-Cooper of Essential Women’s Care advises initiating a prenatal vitamin with iron and at least 400 micrograms of folic acid as these are the two most common deficiencies for women who want to get pregnant. Increasing iron intake can be done through a supplement or through good eating habits, such as eating lean red meat no more than twice per week and plenty of green leafy vegetables. Fish oils, which are included in many prenatal vitamins, are good for your heart, and they have also been shown to decrease neurological issues for the developing fetus, as well as rates of preterm labor.
Equally important is maintaining—or doing your best to achieve—a normal weight prior to initiating pregnancy. You’ll want to strive for a normal body mass index (BMI, which for most people is between 18 and 25) through healthy diet and physical activity. Make sure to get aerobic exercise and increase your heart rate for 30 minutes at least three to four times per week. If you aren’t already active, this doesn’t mean you need to take up running or Cross Fit. Dr. Roper-Cooper encourages many of her patients to start with swimming as it is one of the most gentle but effective ways to get a good workout without increased risk for joint injury. The stationary bike and walking are also good options.
“Once you are pregnant, there are heart rate parameters to consider, but prior to pregnancy it’s all about following a healthy exercise regimen,” says Dr. Roper-Cooper.
See your OBGYN
Keep up with your annual exams with your OBGYN to make sure you have a normal Pap smear and no other health issues. Then, about four to six months from the time you desire to get pregnant, schedule a pre-conception counseling visit with your OBGYN. At this point, your doctor will ensure you have a normal Pap history and may recommend thyroid screening tests to look for hypothyroidism or hyperthyroidism, which can cause menstrual irregularity, hypertension and can even increase the risk of behavioral and developmental issues for your baby. You and your partner may also wish to order genetic panels to screen for inheritable disorders like cystic fibrosis or sickle cell anemia at this time.
Make sure you discuss any current medications with your doctor, especially antidepressants, due to risks for cardiac abnormalities or potential behavioral issues for the baby. If you do have depression, you may be able to stay on antidepressants if needed. “While not everyone needs to discontinue antidepressants during pregnancy, we want to ensure all women get the proper counselling about their options,” shares Dr. Roper-Cooper. “If she hasn’t tried to get off of antidepressants and isn’t having any current issues, we may consider attempting to discontinue antidepressants three to four months prior to conceiving.” Though patients often can and do stay on some medications, it’s important to evaluate this on an individual basis.
“The biggest advice I have is to at least have a visit with your physician while you’re thinking about getting pregnant,” says Dr. Roper-Cooper. “This way you have plenty of time to talk about your medical history, medications, any pertinent family history and current health to give you and your baby the healthiest start possible.”
Know your timeline
As we all know, not all pregnancies are planned or happen when you expect them to, but you can prepare for key decisions in the near future. For example, while physicians used to advise ceasing family planning methods several months before wanting to conceive, new data suggest you can stop birth control just one month prior to the date you’d like to get pregnant and start trying immediately.
Most healthy women will conceive within one year of trying, though there are many factors that can determine how quickly a woman will conceive, including the regularity of her menstrual cycle, medical issues like hypertension, obesity or previous history of sexually transmitted infections, the health of her partner, diet and even travel. (Varied sleep schedules, stress, being overly fatigued and decreased mobility, which often come with frequent travel, can all impact a woman’s menstrual cycle and her ability to conceive.) Try not to worry if it takes longer than you expected. “With patients in their 20s and early 30s, we’ll give them a full year to get pregnant before looking into potential complications,” says Dr. Roper-Cooper. “Usually after a patient reaches 35, because the risks for morbidities go up, we will typically look for reasons she might not be conceiving around four to six months after she begins trying. We might look at basic labs, ovarian reserves with labs and/or ultrasound, or a hysterosalpingogram (HSG) test to ensure her tubes are open, so we can get her on a pathway for conceiving earlier,” says Dr. Roper-Cooper.
Finding a hospital
Though you most likely won’t start touring hospitals until you’re at least eight to 12 weeks pregnant, you can start researching online now. Erica Gillesby, an OB nurse navigator with Lutheran Medical Center, advises that proximity to home is a good factor to consider when picking a hospital in case of unanticipated problems or rapid labor. You can also look into the various services and amenities that hospitals offer. She says,
“You’ll want to understand the amenities offered and your various options for controlling pain, like whether the hospital offers nitrous oxide, aromatherapy or TENS units (a machine used in physical therapy that sends small electrical pulses to help control pain) in addition to epidurals.” Some hospitals also offer squat bars, birthing balls and soaking tubs to keep mom comfortable throughout the process. “You want a hospital that offers personalized care unique to you. I’ve seen many a birth plan, and there’s very, very little that Lutheran can’t accommodate. We’re all about family-centered care,” Erica says.
During your research, Erica also advises really understanding if the hospital is in line with best practices as well as your ideals and what you want from your birth experience. “Start thinking about what you’d want now so you’re aware of the options available when it’s time to tour and make your final decision.”
Insurance and costs
With a shifting healthcare environment, many patients are shouldering more of the costs of their healthcare through high deductible plans. Since having a baby is already expensive, talk to your insurance provider about what’s covered, Dr. Roper-Cooper says. “Currently, the Affordable Care Act (ACA) mandates that insurers cover obstetrical care, but I would definitely check with your carrier to ensure you don’t have any restrictions in your policy, such as waiting three to nine months before that care is covered under your policy. Also ensure that the provider you want to see and the hospital you want to deliver at is covered by your plan prior to scheduling any appointments to avoid any unforeseen out-of-network costs.”
There’s a lot to think about when preparing for a baby, and you wouldn’t want to add financial strain to the mix.
Becoming a mom is a big decision for any woman, but by taking proactive steps to keep yourself healthy and find supportive care from a provider and hospital, you’ll be well on your way to being ready for baby—when the perfect time comes.
Don’t have an OBGYN?
Because pre-counseling with your OBGYN is an important part of planning, if you don’t have an OBGYN you see regularly, now is a good time to find one. Since there’s a lot of value in finding a doctor that someone close to you already knows and trusts, Dr. Roper-Cooper recommends asking for personal referrals from family and friends. She also suggests looking for data on who delivers the most babies and their outcomes through reputable websites like Healthgrades.com. Reviewing online profiles is another way to search for an OBGYN who is in line with your ideals to help narrow your list before you start scheduling appointments.
Since some women already have an idea about the hospital they’d like to deliver in, Erica also recommends thinking about where you’d like to give birth before choosing a provider, as not all OBGYNs deliver at the same hospitals. You’ll also want to ask your OBGYN if she or he will be the person to deliver your baby or if the practice shares call amongst the group, in which case you may want to meet all of the providers in the practice.