Blog 6: What I want my daughter to know before becoming pregnant or in early pregnancy.

Let me begin with a disclaimer: I don’t have any daughters (I am blessed with 3 wonderful sons). However, as a childbirth educator of more than 30 years, I usually only meet pregnant women in their third trimester as they’re starting to prepare for birth. I often wish that I could have met them even before they became pregnant.

So I am writing this blog post with, what I believe, are a few important points to consider when planning a pregnancy or in early pregnancy. I know this is a vast topic and it’s not possible to cover everything, so I will include some links for those who want to research the topics further. Consider this the most basic information that you might not have thought about in order to have a healthy pregnancy.

There is SO much information on the internet and, coupled with specialized pages on Facebook and advice from girlfriends who have already made the transition to motherhood with a wide range of opinions (remember – they are opinions!!), we may feel daunted by all the things we might be made to feel we need to do, otherwise we might be harming our baby. That leads to guilt and stress – will that affect the developing fetus (more stress!!)? So – relax and enjoy your pregnancy. Look at the population of the world – women have done this before!!! Having said that, our world IS much more toxic than it was even when we were fetuses, so a little awareness of how to improve our health can benefit ourselves, our future children and our families.

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Firstly, and most importantly, you need to visit a doctor before starting to try to become pregnant.  it’s important to discuss with him/her at what point to stop using birth control and how long (if at all) you need to wait after stopping before trying to get pregnant. Stopping the pill a few months before starting to try to get pregnant will help you determine your cycle (do you have a 27 day or a 32 day cycle?) This will help you figure out when you ovulate and when you are most fertile. If you’ve been taking the pill for a while, your cycle could be different from the way it was before you started.

http://www.parenting.com/article/how-birth-control-could-affect-your-fertility?socsrc=ptgfb1509202

Depending on your ethnic background and medical history, your doctor may suggest testing for genetic disorders such as sickle-cell anemia or Tay-Sachs disease. He/she should also know about any genetic conditions in your family, such as a family history of Down’s syndrome, thalassemia or cystic fibrosis, to name just a few. If you do test positive as a carrier for any genetic condition, a genetic counsellor can help you determine how to increase your chances of having a healthy baby. This would include a blood test of you and your partner and, if a genetic disorder is present in either of you, options such as IVF may help to prevent a child from having this disorder.

Your doctor should know about any existing health conditions you may have, such as diabetes, asthma, high blood pressure, a history of depression, being overweight or underweight (or anything else that is relevant) and will be able to advise you regarding prescription or over-the-counter medication you are taking that might be contra-indicated during the pregnancy or in trying to conceive. For example, it is not safe to take some medications for acne when you’re pregnant. Even non-prescription drugs such as ibuprofen are best avoided in early pregnancy.

The concern is that taking certain medication might be teratogenic. A teratogen is an agent that causes birth defects and can include radiation, maternal infections, chemicals, and drugs. This can be a source of great stress to a woman, but there are, in most western countries, organizations that can help you determine if a particular agent is harmful during pregnancy.  Here is the link for women in Israel: http://www.health.gov.il/English/Topics/Pregnancy/health_centers/Pages/Tartology.aspx . For the US, consult: http://www.mothertobaby.org/  . If you live elsewhere, google your country’s resource.

Everything the mother ingests, puts on her skin or breathes passes through her system to the baby’s system. Although the baby is developing and growing during the entire period of gestation, the first three months are the most critical as this is when the baby’s body, including the organs, are formed. This is the period during which the woman should be most aware of what goes into her body. As she might not know that she is pregnant for the first few weeks, this caution is true also for women who are trying to get pregnant.

You may be given a blood test if your doctor thinks you might be anemic and to check whether or not you have antibodies for rubella. If not, you may be offered the vaccination for rubella, in which case your doctor will advise you how long to wait after being immunized before trying to conceive.

It’s also important for your husband/partner to get a check-up before you conceive to ensure that he doesn’t have any chronic illness or is taking any medication that might affect his sperm count or fertility.

Visit your dentist to make sure your teeth and gums are healthy. Current research links oral health to a healthy pregnancy. http://www.mouthhealthy.org/en/pregnancy/concerns?source=Morning_Huddle

Getting your body ready to grow a baby is important and may entail lifestyle changes. As I’ve said before, we live in a much more toxic world nowadays and this is an excellent time to develop awareness for healthy living for yourself and your partner as you prepare to transition to parenthood.

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Healthy Babies Bright Futures is an alliance of scientists and nonprofit organizations working to reduce exposures to neurotoxic chemicals in a developing baby. For more information, see https://www.hbbf.org/product-finder

While there are many articles about how to have an eco-friendly pregnancy, this might be a good place to start: http://www.mindbodygreen.com/0-15391/14-tips-to-minimize-toxins-if-youre-pregnant-or-want-to-be.html While following all of the recommendations listed in the link might be difficult or impossible, do the best you can to increase awareness and don’t drive yourself crazy.

Just because something is natural, it doesn’t mean that it’s safe. That includes herbs (also herbal teas) and supplements. For example, taking vitamins A and E in high doses can cause birth defects and you should not exceed the recommended daily allowance of these vitamins.

Folates are very important for the developing baby, particularly for preventing birth defects such as spina bifida and anencephaly, as well as other conditions such as autism. However, folate and folic acid are terms that are often used interchangeably, even though they are very different. For a detailed explanation on folate, including information on foods high in folate: https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/

Another issue with folic acid supplementation is that as many as half of all pregnant women may not even be able to adequately absorb synthetic folic acid because of a common mutation of the MTHFR gene. In addition, while research has shown conclusively that folic acid is essential for the developing fetus, there is a possibility of a woman having too much folate: http://www.webmd.com/baby/news/20160511/too-much-folic-acid-in-pregnancy-tied-to-raised-autism-risk-in-study

I’m not trying to confuse you, just to raise awareness. It is most important to have enough folate in the early weeks of pregnancy, when you may not even realize you’re pregnant. Remember – the early weeks are when your unborn baby’s body and organs are developing. You should read these excellent articles: http://avivaromm.com/protect-your-babys-health-even-before-birth-5-important-tips-from-a-midwife-md and   http://avivaromm.com/nutritional-supplements-for-women  and discuss all these issues at your pre-pregnancy check-up with your doctor.

Certain foods may contain harmful bacteria, such as unpasteurized milk products, raw meat, undercooked eggs, deli meat and certain soft cheeses. In addition, contact with cat litter should be avoided. http://www.cdc.gov/parasites/toxoplasmosis/gen_info/pregnant.html

While studies on whether caffeine increases the risk of miscarriage have been inconclusive, most experts state that consuming fewer than 200 mg of caffeine (one cup of coffee) a day during pregnancy is probably safe.  As with all the topics in this post, do your own research to decide what’s best for you and your baby.

Caffeine, being a diuretic, interferes with the hydration and pH levels in the body and can create a level of acidity in the vagina that is not compatible with sperm. While some medical professionals indicate that one cup of coffee a day is ok, if a couple is having difficulty getting pregnant, then the pH balance may be relevant, in which case it may be helpful to cut out caffeine completely. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Moderate-Caffeine-Consumption-During-Pregnancy

Alcohol, drugs, cigarettes (including secondhand smoke) should also be avoided. While we don’t yet conclusively know the effect of cellphone use on a developing fetus, it may be prudent to cut down on cellphone usage and certainly never talk on a cellphone while it is charging. In addition, sleeping in an area where electric devices are plugged in or charging outside of a radius of 2 meters, is recommended.

Yet another thing to avoid is overheating, especially in hot tubs, saunas or hot baths. This is particularly important in very early pregnancy, as overheating has been linked to certain birth defects, particularly spina bifida. As the neural tube closes between 21 and 28 days of pregnancy, a time when you might not even know that you are pregnant, it is best to avoid overheating once you start trying to conceive. Even after you become pregnant and in later months, the baby depends entirely on you to dissipate heat (through your perspiration and respiration), so overheating should be avoided throughout the pregnancy. As exercise also raises the body’s temperature, it’s important for pregnant women to refrain from exercising in hot and humid conditions which would prevent the body’s system from dissipating heat.

The subject of nutrition is so vast, but so very important, if we abide by the dictum that ‘we are what we eat’. When it comes to fertility and conception, nutrition is of the utmost importance. As the man’s sperm is 50% of the genetic makeup of the baby, it is equally important for the man to be aware of what goes into his body.

During pregnancy, your body needs 300 more calories per day than it needed before pregnancy. It’s important to eat a balanced diet that includes lots of fresh fruits and vegetables, whole grains, lean sources of protein and to avoid unprocessed foods. It’s also important to drink plenty of water to stay hydrated and to avoid high sugar or artificially sweetened drinks.

Most pregnancy books include information on what foods NOT to eat during pregnancy, like raw fish, undercooked eggs, deli meats, etc. It’s important to check that out when starting to try to get pregnant. Here is a helpful guide to nutrition or what TO eat during pregnancy: https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000584.htm If you want to invest in a comprehensive book on healthy eating (and many other facts) during pregnancy, try this: http://avivaromm.com/books/the-natural-pregnancy-book

Exercise during pregnancy is important for both you and your baby. It can prevent excessive weight gain during pregnancy and can prevent or manage (together with nutrition) gestational diabetes. Exercising during pregnancy has also been linked to preventing hypertension, preeclampsia and preterm birth. It is also an excellent means of controlling stress, particularly as it releases feel-good endorphins. Check with your doctor before beginning any exercise routine once you are pregnant. You can continue whatever you were doing prior to getting pregnant, provided that you listen to your body’s signs. If you wish to begin exercising once you are pregnant, start slowly and increase intensity gradually, depending on how you feel.

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Swimming, yoga, walking and aerobics are all appropriate forms of exercise – provided that you feel good during and after exercising. Here are the current guidelines for exercising during pregnancy:

http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Physical-Activity-and-Exercise-During-Pregnancy-and-the-Postpartum-Period

While you may wish to stay with the Ob/Gyn you have been with since you started using birth control, his/her style of care may not be compatible with yours. If you are healthy and don’t have any medical issues, you may wish to see your family doctor or a midwife. In some places, midwives do routine prenatal care for low-risk, healthy pregnant women throughout the pregnancy. It’s important to know that your doctor’s philosophy of pregnancy will determine how many and which tests you have. Some women are happy to have every test suggested and others may want to have the minimum number, after determining that the pregnancy is normal.

Countless women ask me, towards the end of their pregnancy during the childbirth course I am teaching, why they needed to have so many ultrasounds during the pregnancy – in some cases, one at every prenatal check-up. When it comes to prenatal tests and ultrasounds, you actually do have a choice as to what you consent to during the pregnancy.  It’s really up to each woman to decide if she wants to have every prenatal test offered and to go to a doctor who does an ultrasound at every prenatal visit, or if she wants to choose which tests she does and do the early and late ultrasound scans (or none at all). She may decide to do only the non-invasive tests such as blood tests and to proceed according to the results (acknowledging that there are many false positives with certain tests). I’m not recommending any particular path to take – I’m merely raising awareness that each pregnant woman can choose her prenatal care according to what feels right for her and her partner.

Ultrasounds can be a useful diagnostic tool if a specific problem is suspected at any stage of pregnancy and is commonly used as a routine scan at around 18 – 20 weeks. If there is bleeding at any point in the pregnancy, a breech baby or twins are suspected, ultrasound can be useful for the woman and her doctor/midwife to make decisions as to her care.

Remember that the baby’s body and organs are developing in early pregnancy. As mentioned in the excellent link below, use the B.R.A.I.N. method to determine what is right for you. B = benefits, R = risks, A = alternatives, I = intuition, N = not now/never. http://sarahbuckley.com/blog/ultrasound-scans-in-pregnancy-your-questions-answered

A big incentive for writing this blog post is to help women find resources to deal with stress. All change, by its very nature, has the potential to cause stress, as it implies moving into unknown territory. Pregnancy is certainly such a time, as the article in this link demonstrates: http://europe.newsweek.com/how-calm-your-anxiety-during-pregnancy-315242?rm=eu . It’s too much information (including in this very blog post) that gets pregnant women all stressed out.

It is, however, important to know that it is only very significant levels of stress that really affect the baby long-term. That’s not usually what pregnant women experience, even if they are stressed about having a healthy baby, financial worries or tension at work.

It is, of course, not helpful to stress over how your stress might be affecting your baby. It can be very helpful, rather, to come up with techniques to cope with stress, even before you get pregnant. This is true for both you and your partner. Take a good look at what aspects of your life make you stressed. Can you take short ‘power breaks’ during your work? Can you and your partner work out household chores so you don’t feel exhausted?

It’s important to communicate your feelings to your partner. Share with him your fears and frustrations and see if he can help you deal with your stresses. Think about what you can do to help you unwind, whether it be exercising, practicing yoga, being in nature, reading, listening to music or taking a bath. Talking to your friends who have already had babies can be helpful before becoming pregnant and, once you are pregnant, connecting with other pregnant women can be help you realize that you are not the only one who might be feeling stressed.

Without trying to deny any of these feelings, mindfulness meditation can help you recognize your thoughts and emotions as passing ‘events in the mind’ and that ‘I am not my thoughts’. Starting a mindfulness meditation practice before or in early pregnancy can significantly help you deal with the stress of pregnancy. It can help you develop skills that can be very useful in childbirth as well as for parenting.

Some helpful resources for mindfulness meditation during pregnancy are: Mindful Birthing CD and App: http://www.mindfulbirthing.org/products/#cd

I can’t recommend these highly enough. I have trained with Nancy Bardacke and I, too, teach Mindfulness-Based Childbirth and Parenting courses. While I use my own CDs in my courses, Nancy’s are available commercially and are excellent and easy to use.

Here is another resource: http://www.givingbirthwithconfidence.org/blog/the-tool-thats-missing-in-prenatal-care

In order to give your baby the best start in life, it’s important that you do what you can to improve your own health and lifestyle even before you become pregnant. Once you become pregnant, find a good book on pregnancy and childbirth (though you probably won’t be interested to read the childbirth chapters for a while) and sign up to the Lamaze free e-letter with informative, evidence-based information for your pregnancy: http://www.lamaze.org/YourPregnancyWeekByWeek

Enjoy these unique moments as you prepare to create a new life in the world. It truly is an extraordinary time. And when you do become pregnant, savor each special moment as a new life grows within you.

 

Bio:

Rachelle Oseran (BA) became a Lamaze Certified Childbirth Educator in 1984 through the UCLA School of Nursing and has prepared more than 3000 couples for normal birth over the past 30 years. She is also a qualified MBCP (Mindfulness Based Childbirth and Parenting) instructor, a Birth Doula, certified by DONA International, a Fitness Professional certified by ACE (the American Council on Exercise), specializing in Prenatal and Postnatal Fitness and a Certified Yoga and Pilates Instructor.

She teaches a Lamaze-Accredited Childbirth Educator training course. Rachelle also co-founded and co-directed Great Shape/YMCA, the group exercise department of the Jerusalem International YMCA for 23 years and lectures in Israel and internationally on prenatal and postnatal exercise.

Rachelle was recently inducted as an FACCE (Fellow of the Academy of Certified Childbirth Educators) in recognition of her significant contribution in the field of childbirth education. She lives in Jerusalem, Israel, with her husband and 3 sons.

For more information, visit her websites at www.childbirtheducation.co.il and www.mindfulbirthing-israel.com, her Facebook page at Fit, Birth and Beyond – Rachelle Oseran or e-mail her at rachelleoseran@gmail.com

 

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