Preparing for Pregnancy
What you should know before, during and after
By Kate Morgan

Starting a family – or even just thinking maybe you want to start a family – can bring on an onslaught of questions, concerns and outright fears. Take a look at everything you should consider on your way to bringing home that first baby.

What to expect…

When you’re beginning the fertility process

Women under 35 who have been trying to get pregnant for a year or more should consider visiting a fertility specialist, advises nurse practitioner Amanda Berger of Delaware Valley Institute of Fertility & Genetics. But don’t think the appointment is just for you – your partner needs to be there as much as you do.

“A lot of female patients expect to come in and be evaluated as a single unit,” Berger says. “I think it takes a lot of couples by surprise when our office requires one or sometimes two semen analyses, but about 30 percent of infertility issues are male-related. Another 30 percent have something to do with both partners.”

Berger also says women being evaluated for fertility issues should plan to be in the office regularly. Initially, physicians will often track the ovulation cycle and hormone patterns for a month or more.

“I don’t think patients expect to see us so frequently,” Berger says. “But we do about three ultrasounds over the course of a month to monitor things like the egg releasing. In the first month or so, they’ll come in about four separate times, and then at the end of that process we’ll meet again to go over what we found.”

Berger says she sees a number of women who weren’t aware their cycle of ovulation might be abnormal until they began trying to get pregnant.

“We see patients who went on birth control when they were younger to normalize their cycle,” she says. “They feel like they’ve had a normal cycle for years and years, but that’s only as a result of the birth control. What’s happening under that may not be so regular. That’s something even young women who don’t want children yet should really keep in mind.”


When you’re undergoing fertility treatment

While you may be familiar with the various forms of fertility treatments, one thing you shouldn’t expect – even though it was customary in years past – is that in-vitro fertilization (IVF) will result in twins or triplets.

Doctors tailor fertility treatment plans to each individual couple. Louis Manara, DO, medical director at The Center for Fertility and Reproductive Medicine in Voorhees, says there are a number of myths surrounding the various treatments.

“There’s a misconception out there today, which is that IVF leads to a lot of multiple births. That’s really not the case anymore,” says Manara. During IVF, an embryo created in a laboratory is implanted in the uterus. “The quality of the embryos produced in labs now is really high. Most of our patients can have a single-embryo transfer, which has really become the responsible thing for practitioners to do.”

The chance of a woman becoming pregnant with multiple babies increases, however, when a woman is undergoing other courses of treatment, such as using injectable hormone medications. Manara says the chance of a multiple pregnancy in that case is about 20 percent. With a multiple pregnancy, a number of risk factors increase – in some cases rather drastically.

“The complication rate with twins compared to singletons is about six times greater,” Manara says. “That applies to preterm birth, preeclampsia, diabetes, placental accidents; you name a complication, and if you’re pregnant with twins your chances of having that happen are much higher. We also see a much higher rate of cesarean section, hypertension, toxemia and low-birth weight babies. This is because really, humans are meant to carry just one baby. We get by with twins – we know how to handle it and what to do, and we have good outcomes most of the time, but these complications do happen with greater frequency.”

Most women who do become pregnant with twins, Manara says, should expect to see their doctors often. In addition to regular appointments with their OB/GYN, they will also need to see a maternal fetal medicine specialist.

“They’ll need a substantial number of additional ultrasounds to monitor growth, symmetry of growth and position of the babies,” Manara says. “They’ll certainly be spending more time in the doctor’s office.”


When you’re a (slightly) older mom

While “35 is the new 25” according to fertility specialist Peter Van Deerlin, MD, of South Jersey Fertility Center, women in their mid- to late-30s may be surprised to hear that 35 is considered an advanced age, at least when it comes to fertility.

“Patients will see a diagnosis that says ‘advanced maternal age’ and sometimes be alarmed,” Van Deerlin says. “That’s just a medical term for a woman who will be 35 years of age or older at her due date. The term is an old one. It used to be that after 35 you wouldn’t do the amniotic fluid test, because at that age the chance of the test causing Down syndrome or another problem was 1 in 200. Nowadays the risk is lower – about 1 in 1000 – but they’ve kept 35 as the line for ‘advanced maternal age.’”

Today, Van Deerlin notes, 35 is a perfectly normal age to have a child. He does, however, say risk factors rise considerably after 40.

“For someone 40 years of age, the risk of damage from an amniocentesis jumps to 1 in 40 or roughly 2 percent,” he says. “Keep in mind that means 98 percent of the time, it’ll be fine, but it is a big jump.”

Women over 40 are also at greater risk of miscarrying. Pregnancies that do go to term carry increased risks of high blood pressure and gestational diabetes.

“A woman is born with all the eggs she’ll ever have,” Van Deerlin says. “So they’ve been around for 40 years by the time she’s ovulating that egg out. We find the better eggs tend to be ovulated earlier in the reproductive life, so the proportion of good eggs gets smaller, and the chances of having a chromosomal anomaly – one that will result in a miscarriage – get higher.”

Despite the risks, Van Deerlin says “older” moms should not be deterred from trying to conceive. By maintaining a healthy lifestyle, he says, a woman can greatly increase her chances of having a healthy pregnancy into her early 40s.

“We see lots and lots of moms have successful pregnancies at 40 or 41,” he says. “Time is of the essence, for sure, but the risks are not so great that anyone should be deterred from trying to become a mom. They can improve their chances by staying physically fit and getting to an ideal body weight. That tends to make blood pressure more normal, lowers the risk of diabetes, makes it easier to withstand the rigors of nine months of pregnancy and makes it easier to push that baby out.”

When you’re preparing to give birth

As your due date approaches, it’s time to consider what you want your birth experience to look like. That includes determining who will be in the room and what friends, family and medical professionals will make up your “birth team.” Eric Grossman, MD, co-founder of Advocare Premiere OB/GYN of South Jersey, often recommends his patients consider adding a doula to that team.

“We have patients who want a ‘natural’ delivery,” he says, “but what they really want is a safe delivery of a healthy baby in an environment where they feel in control. A doula can provide the constant encouragement and emotional support that makes the labor feel like a natural process. Because I have other patients and surgeries and phone calls, I can’t be there for 100 percent of your labor, but your doula can.”

Grossman frequently refers patients to Jodi Green, a certified doula since 2002. “I didn’t know what a doula was when I had my first child,” Green says. “I had a great doctor, but my experience was very scary. When I was expecting my second child I started looking around for what would make it a better experience. Having a doula changed everything. It was a profound, life-changing experience.”

Green says that while a doula in no way replaces the medical team, she can serve as a go-between between doctors and family members, presenting options and helping the family make medical decisions if necessary.

“We’re the ones who suggest position changes and offer comfort measures to make labor easier,” Green says. “If something does come up, the doula is the person who explains to the family what their options are and supports them in deciding what’s best for them at that time with the reality at hand.”

Green says that while she’s there to provide constant support to the laboring mother, she also provides a helping hand to her partner or other family members. “I’m always reassuring both mom and her partner that everything they’re seeing is normal,” Green says. “There is so much that happens during birth that, under any other circumstance, definitely would not be normal. It makes a huge difference to have someone there who is fluent in birth and can say, ‘This looks good and totally normal, and you’re doing great.’”


When you’re the mom of a newborn

Once you’ve entered the world of parenting, it’s normal to have plenty of questions, so don’t be afraid to speak up and ask your doctor, says Wendy Martinez, MD, founder of Advocare The Women’s Group for OB/GYN.

“One of the biggest things women often don’t expect or realize is that while they’re breastfeeding, most won’t get a period,” Martinez says. “Because of that, they feel they can’t get pregnant, which is a total misconception. You can get pregnant, and you need to use birth control.”

Martinez says many women assume most birth control options are off-limits to breastfeeding moms, but they can safely take progesterone-only birth control, or use an IUD or condoms.

As for “getting your body back” after giving birth, Martinez says, most of the extra weight will come off naturally, and a woman can often return to her pre-pregnancy weight through a moderate program of exercise.

“Most women will drop 20 pounds by their six-week checkup,” she says. “After that, you do need to do some work. Some kind of aerobic activity for 20 minutes, five days a week will not only get your body back into shape, but will make you feel so much better. You don’t have to be real vigorous, but you want to be sweating. If you can talk, you’re not doing it fast enough.”

When it comes to certain postpartum problems, Martinez says new moms are sometimes reluctant to discuss the issues they’re having. She urges her patients to be extremely open. Often, what they’re experiencing is common for postpartum women.

“A lot of women have problems with their bladder, a little bit of leakage, and they don’t tell anybody,” Martinez says. “I try to tell them, ‘For nine months you’ve had this big heavy baby resting on top of your bladder, of course you’re having leakage!’ That can go on for up to 8 months, and I tell them to do some Kegel exercises to strengthen those pelvic muscles.”

New moms are also reluctant to discuss experiencing anxiety or depression, which is normal after delivery. Martinez says these feelings are entirely treatable if moms are willing to talk to their doctors.

“Women’s hormones are still very much in flux after giving birth,” she says. “That’s why some people experience postpartum depression or anxiety. People who have a history of those things are more at risk, but some women who have no history will also get depressed and may need medication. If a new mom feels like she can’t cope, she needs to contact her doctor immediately. They also need to understand it does not mean she is a bad mother – she just needs a little help, like we all do from time to time.”

April 2016
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