Minimising the risk of Influenza A (H1N1) Infection from mother to baby

• The spectrum of disease of pandemic influenza A H1N1 09 in newborns is unclear
• Breast feeding should be strongly encouraged

Sensible efforts should be made to reduce the likelihood the baby will be infected, while minimising the effect on the mother-baby relationship. These include:

• treating the mother to reduce the risk of transmission (the mother is considered non-infectious after 72 hours of treatment with antiviral medicine)
• the mother and baby should sleep in separate beds
• when breast feeding, bathing, caring for, cuddling, or otherwise being within 1 metre of the baby, the mother should:
• wash her hands thoroughly with soap and water before interacting with the baby
• always use cough etiquette near the baby.

Although these measures can be ceased when the mother is no longer infectious, continued good hygiene should be encouraged at all times. These measures should apply to any carer or family member with influenza.

• Mothers requiring hospital care should not be prematurely discharged because they have influenza
• If discharged while still infectious, mothers should be provided with a sufficient supply of surgical masks to take home
• Prophylaxis is not recommended for the baby. Should the baby develop symptoms, the baby should be isolated from other babies, assessed urgently by a paediatrician, and if influenza is diagnosed, considered for treatment with antiviral medicine.

Source: The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Prevention from Influenza A (H1N1) for Pregnant Women

To avoid influenza, it is recommended that pregnant women are advised to take sensible precautions including:

• Avoid close contact with people who have symptoms, if possible
• Wash hands with soap and running water or use an alcohol based hand rub after contact with symptomatic people or their secretions e.g. on used tissues
• Get immunised against influenza if they will be at any stage of pregnancy during winter
• Encourage symptomatic people in the household to keep at least 1 metre away and follow cough etiquette and good hand hygiene
• Avoid large, crowded gatherings during the influenza season.
• There is no recommendation for well people to wear surgical masks, or to exclude themselves from regular activities.

Source: The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Preterm birth

Preterm birth is the leading cause of neonatal death in multiples. Although the mere fact that you are carrying multiples puts you at increased risk of experiencing a pre-term birth, there are other factors that add to your risk. You’re at increased risk if

■ you have had abdominal surgery during the current pregnancy (for example, an appendectomy);

■ you have an abnormal uterine structure;

■ you have fibroids (benign uterine tumors);

■ you are experiencing emotional or physical stress;

■ you have high blood pressure;

■ you develop a high fever during pregnancy;

■ you have a kidney infection;

■ you are outside of the optimal age range (that is, if you are under 16 or over 35);

■ you are a DES daughter (your mother took diethylstilbestrol — DES — when she was pregnant with you);

■ you have been diagnosed with placenta pre-via;

■ you have been diagnosed with poly hydramnios;

■ you haven’t gained enough weight;

■ you have previously experienced premature labor or delivery;

■ you have been experiencing unexplained vaginal bleeding;

■ you are a smoker.

Although cerclage (a surgical procedure in which the cervix is stitched shut to prevent it from dilating prematurely) was once considered to be an effective means of preventing premature labor, most doctors no longer agree with its routine use in women carrying multiples. These days, cerclage is performed only on women with weak cervixes — a condition that the medical profession charmingly refers to as cervical incompetence. (As you probably realize, this is just a less-than-diplomatic way of saying that the cervix is unable to withstand the weight of the developing fetus, or fetuses, and opens prematurely.)

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

What causes a multiple birth

Twin pregnancies result from either the fertilization of two separate eggs by two separate sperm (a process that results in dizygotic, or fraternal, twins) or the separation of a single fertilized egg into two fetuses (a process that results in monozygotic, or identical, twins). Higher-order multiple pregnancies involve fraternal twins, identical twins, or a combination of both types of twins.

Here are some basic facts about multiples:

■ Twins occur naturally in 1 out of every 90 births; triplets in 1 out of every 10,000 births; and quadruplets in 1 out of every 650,000 births.

■ Fraternal twins occur more often in certain families and in certain ethnic groups (the rates are 1 in 70 in African Americans and 1 in 300 for women of Chinese descent with whites falling in between). The incidence of fraternal twins also increases with maternal age, weight, height, and parity (that is, the number of pregnancies a woman has had).

■ Identical twins occur in approximately 4 out of every 1,000 births and are unrelated to maternal age, race, or parity.

■ Fraternal twins typically look no more alike than any other pair of siblings. They can be either of the same sex or one of each sex.

■ Identical twins have identical features: hair, eye color, blood type, and so on. If, however, one twin developed more rapidly in uterus than the other one, they may not look identical at birth.

■ Identical twins have similar handprints and footprints, but they do not share the same fingerprints. (This was good news to one family of identical twins who had to rush their babies off to FBI headquarters to get them re-fingerprinted so that they could figure out who was who!)

■ Some identical twins are known as “mirror twins” because one is virtually a mirror image of the other (for example, a birthmark that appears on the left arm of one appears on the right arm of the other, one is left-handed and the other is right-handed, and so on).

■ Identical triplets can also occur, but they are extremely rare.

■ It is possible for fraternal twins to be conceived by two different fathers, a process known as super fecundation.

■ Scientists believe that approximately one in eight natural pregnancies starts out as a twin pregnancy — even though only 1 out of every 90 births results in the birth of twins. This is one reason why many caregivers routinely do ultrasounds to confirm that there are no other viable fetuses left in the uterus when they suspect that a patient is miscarrying.

■ It is possible to miscarry one multiple and go on to carry the others to term. It is also possible to have a combination ectopic and uterine pregnancy (that is, one or more babies implant in the fallopian tubes and the others in the uterus). Fortunately, this is rare.

■ Although most twins are born within minutes of one another, sometimes days — even months — can elapse between the births of twins.

■ Often, it isn’t immediately obvious at birth whether same sex twins are identical or fraternal. If the parents want to know for medical reasons, blood from the umbilical cord is drawn and analyzed for type, Rh factor, and so on. If the results are still inconclusive, parents can choose to opt for DNA testing — highly accurate.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

How a multiple pregnancy is diagnosed

The increased use of ultrasound has made it possible for the vast majority of parents to find out in advance whether there’s more than one baby on the way. This wasn’t the case a decade or two ago, when it wasn’t unusual for as many as 40 percent of multiple pregnancies to be undiagnosed prior to labor and delivery.

Even if you haven’t had an ultrasound, certain red flags may alert you and your caregiver to the possibility that you may be carrying twins. These are the warning signals:

■ Fraternal twins tend to run in your family.

■ You have been taking fertility drugs.

■ You experienced excessive nausea and vomiting during the first trimester.

■ Your uterus is growing more quickly or is larger than what would be expected at a particular point in your pregnancy.

■ You notice more fetal movement in this pregnancy than in previous pregnancies (assuming, of course, that this is your second or subsequent pregnancy).

■ More than one fetal heartbeat is heard.

If your caregiver suspects that you may be carrying multiples, he will likely send you for an ultrasound. Early ultrasound can detect more than 95 percent of multiple pregnancies.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

How to shop for your babies without going broke

Equipping a nursery for one baby is expensive enough. Equipping one for two or more babies can be enough to bankrupt a family — or so you might think. “A lot of parents have to get past the idea that everything has to be new for the babies,” says childbirth educator and mother of twins Joyce MacKenzie. “It’s safety and practicality you’re after, not the most beautiful crib in the store window.”

Although there’s a real temptation to run out and buy your babies matching brand-name gear, there are cheaper ways to acquire what your babies need. Here are some tips from parents who’ve been there:

■ Borrow as much baby gear as you can.

Just make sure that whatever you borrow meets current safety standards.

■ Shop secondhand.

You can find nearly new brand-name baby products at most consignment stores for half their original price or less. Although the better secondhand stores go out of their way to avoid carrying cribs or car seats that don’t comply with current safety standards, mistakes can and do happen. Therefore, the onus is still on you to make sure that the items you’re purchasing are up to snuff.

■ Don’t scrimp on the double (or triple or quadruple) stroller.

It’s the one thing that will keep you mobile. Note to parents expecting quadruplets: You might want to consider purchasing two doubles rather than one quadruple stroller if someone else will always be with you when you’re out with the babies. They’re easier to maneuver and easier to pick up secondhand.

■ Get by with a little help from your friends.

If your friends are planning to have a baby shower for you and they ask what you want, suggest a car seat or other big-ticket item. Your friends can pool their funds and buy you something you really need, rather than a lot of cutesy frilly dresses or sailor suits!

■ Go bargain hunting.

See if a local baby store or department store would be willing to give you a break if you bought all of your baby gear through them. If you’re purchasing two or more cribs, car seats, high chairs, and so on, you represent a lot of purchasing power. Don’t be afraid to bargain a little.

■ See if you can solicit some outright donations.

One family was able to convince the owner of a local pharmacy to let them have every seventh bag of diapers free.

■ Eliminate the frills.

Save money on baby wipes either by making your own (fill a squirt bottle with a mixture of liquid

baby soap and plain water, and then buy some inexpensive washcloths) or by making a box of wipes go further by cutting the wipes in half (one family swears that an electric knife works like magic).

■ Cut corners where you can.

You can save on disposable diapers by using high-quality brand names during the night (when you really want the babies to stay dry!) and lower-quality generic brands during the day. Another good strategy is to start buying diapers when you’re pregnant: one couple expecting triplets had 1,600 diapers stockpiled by the time their babies came home.

■ Don’t look a gift horse in the mouth.

Save items such as used baby bottles, nipples, caps, lids, and acetaminophen samples from the hospital if your children spend some time in the NICU (neonatal intensive care unit). Otherwise, these items are thrown away by hospital staff.

■ Don’t overspend in the clothing department.

As a rule of thumb, twins need 1 1⁄2 times rather than 2 times as much clothing as a single baby.

■ Ask your baby’s doctor for a deal.

See if your children’s pediatrician will reduce the co-pay per visit given that you’re buying his services in bulk! Also, don’t be embarrassed to ask for any free coupons and baby-product samples that he may be able to pass your way.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Coping with grief during pregnancy

Pregnancy is an emotional time, so it’s hardly surprising that it can trigger painful feelings of grief about the deaths of loved ones. If, for example, you recently lost a parent or a grandparent, or your partner died during your pregnancy, you may regret the fact that this special person in your life didn’t live long enough to meet your new baby. And, of course, the breakup of a marriage can trigger waves of grief that are not unlike the grief that many people experience following the death of a loved one. So if you find yourself unexpectedly single midway through your pregnancy, you may find yourself grieving the loss of your marriage and your hopes and dreams of co-parenting along with your ex.

A loved one’s death doesn’t have to be recent to trigger waves of emotion, incidentally. Some women who lost their mothers during childhood or their early teens find that they experience a period of “re-grieving” when they find themselves motherless during pregnancy. “I found myself with so many questions that a woman would normally ask her mother,” says Kelly, a 35-year-old mother of one. “It was the loneliest feeling in the world to realize that I didn’t have a mother to share my own journey to motherhood with.”

If you find that grief is affecting your ability to enjoy your pregnancy, you may want to talk to a friend who has been through a similar loss, find out if there is a grief support group operating in your community, or set up an appointment with a grief counselor who has experience with your particular type of loss.

Regardless of what type of support you line up for yourself, it’s important to find a healthy way to vent your feelings of loss so that you can break free from the tidal wave of grief that may threaten to drag you down and give yourself permission to look forward to the wonderful future that awaits you and your new baby.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Being pregnant and in an abusive relationship

According to a study reported in Obstetrics and Gynecology, one in five pregnant teens and one in six pregnant women can expect to experience physical or sexual abuse during her pregnancy — abuse that puts her at increased risk of experiencing miscarriage or giving birth to a low-birth weight baby.

Some pregnant women report an escalation of abuse during pregnancy, whereas others indicate that they only feel safe while they are carrying a child because they feel confident that their partner wouldn’t do anything to hurt the baby — something that can lead to repeated pregnancies as a way of escaping abuse.

Many women who have been putting up with abuse decide to make the break during pregnancy or shortly after the birth, fearing that the abuser may harm the baby. (Their concern about their baby’s well-being is justified, by the way: studies have shown that more than 50 percent of men who abuse their female partners also abuse their children and many others threaten to abuse their children.)

“It took me nine months after my son was born to finally leave an abusive relationship,” says Janna, a 35-year-old mother of two. “When I realized that my partner would be abusing my son, I realized I’d had enough.”

If you are in an abusive relationship and have made the decision to leave, here are some steps that can help you and your children get out as safely as possible:

■ Pack a suitcase and leave it in the care of a trusted friend or neighbor. Include clothing for yourself and your children, prescription medicines, toiletries, and an extra set of car keys.

■ Set up your own bank account and leave the passbook in the care of a friend.

■ Make sure that all of the important records you might need are in a place where you can find them quickly. These include birth certificates, Social Security cards, your voter registration card, your driver’s license, medical records, financial records, and documents proving ownership of the house and car.

■ Know exactly where you’re going and how to get there. If you will be staying with a friend or family member, make sure that person is prepared for the fact that you could show up at their doorstep at any time.

■ Call the police if you need help leaving or if you wish to press charges against your partner.

■ Arrange for counseling for yourself and any children you may already have. You may need some support in breaking free of the cycle of abuse and preparing for a happier future with your new baby.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

What’s up, doc? Things to talk about with your doctor

Fifteen years ago, women didn’t show up on their doctors’ doorsteps until they had missed their second period and were 99 percent sure they were pregnant. Today, most doctors recommend that their patients come in for a checkup before they start trying to conceive.

The reason for the change in thinking is obvious. Recent studies about the benefits of preconception health have served to hammer home an important message: It’s not enough to quit smoking, improve your eating habits, and start popping prenatal vitamins the moment the pregnancy test comes back positive. To give your baby the best possible start in life, you need to ensure that you are in the best possible health before you start trying to conceive.

Here’s why.

Even though today’s pregnancy tests are highly sensitive and allow women to test for pregnancy sooner than ever before, you probably won’t know for sure that you’re pregnant until at least four weeks after the date of your last menstrual period — perhaps even longer if your cycles are particularly lengthy or irregular. During this time when you’re wondering whether you’re pregnant, your baby’s major organs are being formed — a process that medical science refers to as either organogenesis or embryogenesis. That’s why it’s so important to be as healthy as possible before you start trying to conceive. This means setting up an appointment to see your doctor for a preconception checkup.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Getting ready to get pregnant : Have you been diagnosed with endometriosis?

Endometriosis is the name given to a medical condition in which tissue similar to the tissue that lines the inside of the uterus grows outside the uterus, typically on the surfaces of organs in the pelvic and abdominal regions. Endometriosis is one of the top three causes of female infertility. Approximately 30 percent to 40 percent of women with the condition experience fertility problems.

Researchers are unsure why endometriosis affects fertility, but they think that the condition may interfere with the uterus’s ability to accept an embryo, change the egg in some way, or prevent the fertilized egg from making its way to the uterus in its normal fashion.

Because endometriosis often goes undiagnosed, it’s important to be aware of the key symptoms of this medical condition so that you can seek treatment sooner rather than later if you suspect you may be affected:

■ extremely painful (even disabling) menstrual cramps

■ heavy menstrual periods

■ premenstrual spotting

■ bleeding between periods

■ chronic pelvic pain (including pain in the lower back and pelvic region)

■ pain in the intestinal region

■ painful bowel movements or painful urination during menstruation

■ gastrointestinal symptoms (especially the urge to evacuate or pain with bowel movements)

■ fatigue

■ difficulty becoming pregnant.

Note: In vitro fertilization (IVF) has proven to be quite effective in treating infertility in women with endometriosis.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Getting ready to get pregnant : Are you anemic?

If you are anemic, the hemoglobin in your blood is insufficient to carry the amount of oxygen required to reach all of the cells in your body. This can cause serious problems during pregnancy by reducing the amount of oxygen your baby receives. If your anemia is significant, there is an increased risk for intrauterine growth restriction and also fetal hypoxia during labor. In addition, the mother will be less able to handle the blood loss associated with delivery (vaginal or cesarean) if she’s already significantly short on blood. Also, anemia that hasn’t been adequately evaluated may turn out to be a symptom of a more serious genetic or systemic disease.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Getting ready to get pregnant : Do you have any chronic health conditions?

Women who suffer from serious medical conditions — such as epilepsy, lupus, diabetes, high blood pressure, heart disease, PKU (phenylketonuria), or kidney disease — require special care during pregnancy. Here are some examples of the types of issues that women with these types of conditions must confront during pregnancy:

■ Women with poorly controlled insulin-dependent diabetes are four to six times more likely to give birth to a baby with birth defects than non diabetic women. That’s why it’s so important for diabetic women to ensure that their blood sugar is well controlled both prior to and during pregnancy.

■ Women who are epileptic need to carefully consider the risks of taking anti seizure medications during pregnancy. Although some medications increase the chances of birth defects, seizures can themselves be harmful to the developing fetus.

■ Women with lupus — an autoimmune disorder in which the body attacks its own tissues — are at increased risk of experiencing miscarriage or preterm labor. As a rule of thumb, women who have been symptom free for six months prior to conceiving are likely to have a healthy pregnancy.

■ Women with chronic high blood pressure are at increased risk of developing pregnancy complications, including placental problems and fetal growth restriction. A change in medications may make it possible for a pregnant woman with chronic high blood pressure to manage her condition without harming her baby.

■ Women with heart disease or kidney problems may require a change of medications as well as careful monitoring throughout their pregnancies.

■ Women with phenylketonuria (PKU) — an inherited body-chemistry disorder in which the body is unable to process a particular type of amino acid (a building block of protein) — must follow a special diet in order to prevent mental retardation and birth defects in their babies.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Fifteen Reasons to Quit Smoking Before You Start Trying to Conceive

1. Smoking makes you less fertile.

Women who smoke are 30 percent less fertile than other women.

2. Smoking increases the odds that you will experience a miscarriage.

Smokers are almost twice as likely to miscarry as nonsmokers.

3. Smoking increases the likelihood that your baby will be stillborn.

Babies of smokers are twice as likely to be stillborn as babies of nonsmokers.

4. Smoking causes birth defects.

Smoking 10 cigarettes per day increases the odds that you will give birth to a baby with cleft palate and cleft lip by 50 percent.

5. Smoking disrupts the flow of oxygen to the baby.

Your baby receives less oxygen because nicotine restricts the flow of blood through the blood vessels in the placenta.

6. Smoking can harm the lungs of your developing baby.

Exposure to secondhand smoke while in the womb can leave your baby more susceptible to respiratory disorders and infections during early childhood.

7. Smoking increases the odds that you will give birth prematurely.

Babies who are born prematurely tend to experience more health problems than those who are carried to term.

8. Smoking increases the odds that you will experience certain types of pregnancy-related complications.

Women who smoke during pregnancy are also more likely to experience placental abnormalities and bleeding.

9. Smoking reduces the likelihood that you will eat properly during pregnancy.

Smoking acts as an appetite supressant, and if you’re less hungry, you’re less likely to seek out the nutrient-rich foods that your body needs to grow a healthy baby.

10. Smoking interferes with the absorption of vitamin C.

Because vitamin C plays an important role in iron absorption, smoking can indirectly contribute to iron-deficiency anemia.

11. Smoking can interfere with breastfeeding.

Because smoking can decrease the quantity and quality of breast milk, smoking can lead to early weaning.

12. Smoking is linked to a number of childhood health problems.

Children who are exposed to secondhand smoke are more likely to develop asthma, bronchitis, and ear infections. And, according to some brand-new research, they are also more likely to be obese.

13. Smoking increases the odds that your baby will experience serious, even fatal, health problems during infancy.

Babies who are exposed to secondhand smoke are more likely to die of SIDS and to develop certain types of childhood brain cancers.

14. Smoking is linked to childhood behavioral problems.

A recent study found that the toddlers of mothers who smoked during pregnancy were four times as likely to be diagnosed with behavioral problems as the toddlers of nonsmokers.

15. Smoking increases the odds that your baby will develop lung cancer later in life. Children who are exposed to secondhand smoke are at greater risk of developing lung cancer than children who are not exposed to secondhand smoke.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Getting ready to get pregnant : Do you skip meals regularly?

If you’re in the habit of skipping meals, your body could be missing out on such important nutrients as folic acid, iron, and calcium. It’s particularly important to ensure that your diet contains adequate quantities of folic acid. Studies have shown that women who consume at least 0.4 mg of folic acid each day reduce their chances of giving birth to a child with a neural tube defect (for example, anencephaly or spina bifida) by 50 percent to 70 percent. Other studies have indicated that folic acid may help to reduce the risk of miscarriage as well as the odds that you will develop high blood pressure during pregnancy. There’s even some evidence that, when combined with an adequate intake of iron, folic acid may offer your baby-to-be a measure of protection against childhood leukemia.

To increase your intake of this important nutrient, you should consume foods that are naturally high in folic acid, such as oranges, orange juice, honeydew melon, avocados, dark green vegetables (broccoli, Brussels sprouts, romaine lettuce, spinach), asparagus, bean sprouts, corn, cauliflower, dried beans, nuts, seeds, bran cereals, whole-grain products, wheat germ, and fortified breakfast cereals. You should plan to talk to your doctor or midwife about whether it would be a good idea for you to take a folic acid supplement as well. (Most women find that it is difficult to get enough folic acid through diet alone.)

Because neural tube defects can occur very early on in pregnancy, it’s important to ensure that you have adequate levels of folic acid in your diet before you start trying to conceive. That’s why most doctors recommend that you consume adequate amounts of folic acid throughout your childbearing years. After all, nearly half (49 percent) of pregnancies are unplanned.

It’s also important to ensure that your diet contains sufficient quantities of iron. During pregnancy, a woman’s iron needs double. The extra iron is required to create additional red blood cells that carry oxygen from your lungs to all parts of your body as well as your growing baby.

If you find that you are tired all the time, it could be because you’re low on iron. Try boosting your iron intake by consuming iron-rich foods, such as whole-grain and enriched cereals, lean meats, dried peas and beans, dark green vegetables, and dried fruits. Because vitamin C helps your body absorb iron, consume these iron-rich foods with a glass of orange juice or other foods that are high in vitamin C, such as melons, strawberries, grapefruits, raspberries, kiwi, broccoli, tomatoes, sweet potatoes, and so on Finally, you’ll also want to ensure that your diet contains an adequate amount of calcium. A woman who is calcium-deficient prior to and during pregnancy may end up giving birth prematurely to a calcium-deficient baby. Just don’t go overboard in the calcium department: consuming more than 2,500 mg of calcium per day from supplements and food sources (e.g., milk, yogurt, cheese) puts you at increased risk of developing a urinary tract infection and it can make it more difficult for your body to absorb other important nutrients such as iron, zinc, and magnesium.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Getting ready to get pregnant : Have you been dieting recently?

Going on a crash diet right before you start trying to conceive is just plain bad news. While your objective may be noble — getting to a healthy weight before you embark on a pregnancy — you risk depleting your body of important nutrients at the very time when those nutrients are needed to grow a healthy baby. In fact, if the Fad Diet Du Jour that you’ve been following is overly strict, you may even stop ovulating entirely — your body’s way of switching into self-preservation mode in the face of a perceived “famine.”

Note: If you’re struggling with an eating disorder such as anorexia nervosa or bulimia nervosa, or if you have battled with such an eating disorder in the past, you’ll want to be upfront with your doctor or midwife about the situation. Studies have shown that women with eating disorders face an increased risk of miscarriage, obstetrical complications, of giving birth to a low-birth weight baby, and of developing postpartum depression.

That’s not to say that these problems are unavoidable, of course: you may simply require some added psychological support (and possibly some nutritional counseling as well) during your pregnancy.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Getting ready to get pregnant : Are you at a healthy weight?

It’s always best to try to embark on pregnancy at a healthy weight, if you can manage it. Here’s why:

■ Seriously underweight or overweight women don’t tend to ovulate as often as other women, something that can wreak havoc on a woman’s efforts to conceive.

■ Seriously underweight women are at increased risk of giving birth to a low-birth weight baby (a baby who weighs less than five pounds at birth and who may be at increased risk of experiencing some potentially serious health problems).

■ Seriously overweight women face a higher-than-average risk of experiencing pre-eclampsia, gestational diabetes, of requiring a labor induction and/or a cesarean section, and of giving birth to extremely large babies, babies with neural tube defects, babies with heart defects, or babies who are at increased risk of developing diabetes later in life.

■ If you’re not an ideal weight, you might want to try to lose weight or gain weight so that you reach a healthy range before you start trying to conceive. Just don’t try to lose a ton of weight overnight: that’s not healthy for you or the baby and may throw a wrench in your baby-making plans anyway by disrupting ovulation.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

The Age issue to Having a Baby (part 3)

■ Get the scoop on your family’s reproductive history.

Find out if you have close female relatives who have had difficulty conceiving or who have had trouble with endometriosis, uterine fibroids, early menopause, or uterine abnormalities. Some of these conditions tend to run in families, so you’ll want to know upfront what you may be dealing with so that you can either seek treatment or fast-forward your baby-making schedule if it looks like you may be facing greater-than-average challenges on the reproductive front.

■ Choose your sexual partners with care.

Sexually transmitted disease (STDs) are just plain bad news for the female reproductive system, so take steps to protect yourself and your future baby-to-be. (Some STDs can be harmful — even deadly — to the developing baby, so you can’t be too careful on this front.)

■ Quit smoking.

While you’re no doubt aware of the terrible toll that smoking can take on your heart, lungs, and other organs, you might not realize that it can do a real number on your reproductive system, too. Studies have shown that women who smoke are 30 percent less fertile than other women. And, what’s more, they’re at increased risk of developing pelvic inflammatory disease. So smoking is just plain bad news for you and the baby you hope to have some day

■ Encourage your partner to safeguard his fertility, too.

Future fathers are sometimes guilty of assuming that fertility is “a girl thing” that they, as guys, don’t have to pay much attention to. That kind of thinking is dangerously outdated and could rob a guy of his chance to be a dad. In fact, in recognition of the fact that sperm quality does tend to deteriorate over time, The American Society of Reproductive Medicine is now recommending an age limit of 50 for sperm donors. But, of course, that’s not all a guy needs to think about on the fertility front. A man’s reproductive system can be damaged by sports injuries, exposure to toxic chemicals or radiation, the use of anabolic steroids, the use of certain types of medications that can hamper sperm production and/or reduce sperm counts — even by something as simple as carrying around too much weight. (Men who are significantly overweight tend to have excessively high levels of the female sex hormone estrogen, something that can affect a man’s fertility.)

And any dad who is actively trying to father a child should be laying off the alcohol, drugs, and cigarettes, too: these vices can interfere with a man’s ability to ejaculate and/or affect his overall fertility. (Just tell your guy the true high in life comes from being a dad!)

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

The age issue to Having a Baby (part 2)

If you decide to put your baby-making plans on hold for the foreseeable future, but you’re still hoping to become a mother someday, it’s important that you take steps now to safeguard your future fertility. Here are the key points to keep in mind:

■ Choose a birth control method that is fertility enhancing.

The birth control pill (a.k.a. “the Pill”) gets top marks from fertility experts because it changes the consistency of your cervical mucus, making it more difficult for bacteria to pass through the mucus and into your uterus and tubes. The Pill also serves up some added benefits on the fertility

front: it helps to prevent ovarian cysts, halt the progression of endometriosis (a condition that can lead to fallopian tube scarring), to decrease the incidence of ovarian and uterine cancer, and to restore a normal hormonal balance in women who don’t ovulate. Of course, it doesn’t provide you with protection against sexually transmitted diseases, so that’s something you’ll want to keep in mind if you haven’t quite settled upon Mr. Right yet. A birth control method you might want to steer clear of until your baby-making days are behind you is the intrauterine device (IUD): it has been linked to an increase incidence of pelvic inflammatory disease — a major cause of infertility in women.

■ Pay attention to any gynecological red flags.

If you notice an unusual discharge from your breasts or detect any unusual menstrual bleeding, see your gynecologist sooner rather than later. The sooner you seek treatment for any hormonal imbalances or other gynecological health problems, the less likely these problems are to take a toll on your future fertility.

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Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

The Age issue to Having a Baby (part 1)

While you might be tempted to hold off on starting a family until you have your financial house in order, it might not be the wisest move from a biological standpoint. According to the American College of Obstetricians and Gynecologists, postponing motherhood indefinitely isn’t necessarily in the best interests of mother or baby. Not only do you risk missing out on the experience of motherhood entirely (the biological clock waits for no woman, after all), you face an increased risk of experiencing reproductive or other health problems, or of giving birth to a baby with health problems. Here’s what you need to know in order to be fully informed on the age issue:

■ Older mothers are less fertile than younger mothers.

According to the American Society for Reproductive Medicine, a woman over age 40 has just a 5 percent chance of conceiving during any given cycle as compared to the 20 percent odds enjoyed by a woman in her early 20s.

■ Older mothers face an increased risk of miscarriage.

According to a study reported in the British Medical Journal, by the time a woman reaches age 45, her odds of having a pregnancy end in miscarriage are roughly 75 percent.

■ Older mothers face an increased risk of giving birth to a baby with a chromosomal abnormality.

While a 25-year-old woman faces 1/476 odds of giving birth to a baby with a chromosomal abnormality such as Down syndrome, a 45-year-old woman faces 1/21 odds.

■ Older mothers are more likely to conceive twins or other multiples than younger mothers.

Because complications are more common in multiple pregnancies and multiples are more likely to be born prematurely, the rate of loss in multiple pregnancies tends to be higher than when a

woman is carrying a single baby.

■ Older mothers are more likely to develop complications during their pregnancies. Preeclampsia (extremely high blood pressure), placenta previa (when the placenta blocks the exit to the uterus), placental abruptions (the premature separation of the placenta from the uterine wall), gestational diabetes (a form of diabetes that is triggered during pregnancy), premature birth (birth before the 37th completed week of pregnancy), and intrauterine growth restriction (when the baby ends up being significantly smaller than what would be expected for a baby of a particular gestational age) are all more common in order mothers than in younger mothers. Women over the age of 40 are also more likely to have preexisting health problems such as coronary artery disease that may complicate their pregnancies — yet another reason to keep an eye on the biological clock.

■ Older mothers are more likely to require an operative delivery.

Forceps, vacuum extractions, and inductions are more common among older mothers, and, what’s more, older mothers are more likely to require a cesarean delivery than their younger counterparts. (A study reported in the medical journal Obstetrics and Gynecology noted that mothers over the age of 44 are 7.5 times as likely to require a cesarean delivery as younger mothers.)

Continue…

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

The Pre-baby financial checkup (part 2)

■ Do you have enough life and disability insurance?

You should also plan to review your life and disability insurance coverage to ensure that your coverage is going to be adequate to meet the needs of your growing family. You may be surprised to discover just how much coverage is required to replace your contributions to the family. In addition to replacing any income you generate, your life and disability insurance needs to cover your share of all current and future household expenses, including mortgages, loans, and unpaid debts; the cost of your child’s education; childcare expenses; and — in the case of life insurance — such final expenses as funeral and burial costs, taxes, probate fees, and so on. If you discover that

you don’t have adequate coverage, you’ll want to get in touch with an insurance agent so that you can crank up your coverage sooner rather than later.

■ Is your health coverage adequate?

The basic health coverage that met your needs so well in your pre-baby days may not be quite so ideal as you switch into mother mode, so you’ll want to size up your health coverage as well. Basically, you’ll need to decide whether you’re looking for a health maintenance organization (an HMO is a nonprofit cooperative that provides medical care to individuals for a fixed fee each month provided that you choose a health care provider or healthcare institution from within the

network); a point of service plan (a healthcare plan that provides you with the built-in service guaranteed by an HMO plus the flexibility of seeing a doctor outside the network); a preferred provider plan (a network of doctors that provides discounted care to members of a sponsoring organization such as an employer or a union); or an indemnity plan (crème de la crème health coverage that allows you to choose your own doctor and hospital, but that tends to be prohibitively expensive). Note: You’ll find some tips on sizing up a health insurance plan further on in this chapter.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004