Planning for the stork

by Barbra Williams Cosentino, R.N.,C.S.W.

Health care providers agree that preconceptional planning - preparing yourself physically, emotionally and financially for parenthood even before pregnancy has occurred - is an important way to start your baby off right.

Three years after their wedding, Jane and Jonathon decided that it was time to start the family they had always wanted. Jane stopped smoking, began a healthy eating and exercise program, and explored the possibility of starting a part-time home-based business. The couple spent some time babysitting for their two-year-old nephew and sharing their ideas about child rearing, breastfeeding, and ways they would discipline a toddler. Finally, Jane tucked her birth control pills into the back of the drawer. Three months later, she greeted Jonathon with the words he had waited to hear: "Hey, honey, you're going to be a father!"

Merry-K. Moos, RN, FNP, MPH, is a nationally recognized expert in the area of preconceptional health promotion and author of Preconceptional Health Care: A Practical Guide. She says that 36% of all pregnancies that occur within marriage are unplanned, meaning that a large number of women are not even aware they are pregnant during the first three to four weeks, when critical development of the nervous system including the brain takes place. Moos encourages all women of child-bearing age to "make a deliberate decision about when you're ready to have a child, to develop healthy habits that will last for a lifetime not just for the duration of a pregnancy and to begin prenatal health care when you first are a candidate for conception." Louise Ragin, RN, MA, a Public Health Consultant in Nursing for the Division of Family Health of the New Jersey Department of Health and Senior Services concurs, stating that preconceptional health care can significantly help to reduce infant mortality by preventing low birth weight, congenital abnormalities and other factors that contribute to a less than ideal pregnancy outcome.

Meeting with a physician, nurse midwife or other healthcare practitioner when your baby is "just a gleam in your eye" allows for early identification of risk factors such as hypertension, diabetes, phenylketonuria, HIV/AIDS, other chronic medical conditions, or a history of repeated spontaneous abortions or previous low-birthweight infants. Other preconception risk factors include poor nutrition status, vitamin deficiencies, smoking, and abuse of alcohol and illegal drugs.

Kristin Stehle, R.N., N.P.C., a women's health care nurse practitioner at the Elizabeth Seton Childbearing Center in New York City, explains that because your health before you conceive can affect your ability to conceive and maintain a pregnancy, it is important to undergo an physical exam before you conceive. A preconceptional health care visit will include an assessment of family, reproductive, medical and nutrition status, as well as a thorough physical and gynecological examination.

Women currently taking birth control pills may be advised to discontinue usage and to use a barrier method of contraception for several months before becoming pregnant. You may be encouraged to begin charting your menstrual cycle, since this can aid in planning a pregnancy and increases the accuracy of gestational age dating once conception has occurred. Your provider will encourage you to attain a healthy weight before conceiving since severe under- or overweight can lead to complications during pregnancy such as high blood pressure or gestational diabetes.

Folic acid supplementation (400 mcg/day) beginning at least one month prior to conception and continuing through the first trimester will be recommended. Folic acid also found in orange juice, leafy green vegetables, legumes and grains has been found to lower the risk of neural tube defects such as spina bifida. Although prenatal vitamins may also be prescribed at this time, the dangers of vitamin over-supplementation and the importance of avoiding use of most herbal remedies and essential oils during pregnancy should also be discussed. Increasing your consumption of omega-3 fatty acids, found in oily fish such as mackerel, salmon and sardines, is important since these substances are critical for fetal brain development.

Your healthcare practitioner will probably encourage you to continue a moderate exercise program, since studies show that exercising before and during pregnancy is helpful in increasing cardiovascular fitness and facilitating the birth process and recovery period. According to Washington C. Hill, MD, FACOG, of the Department of Maternal-Fetal Medicine at the Perinatal Center of Sarasota Memorial Hospital, it's important to treat and stabilize certain medical conditions such as diabetes, lupus or epilepsy before conception takes place. Other conditions, such as urinary tract infections, thyroid disease, anemia or heart disease should be fully evaluated and the risks during pregnancy discussed.

Preconceptional health care should also examine your use of tobacco, alcohol, prescription and recreational drugs, with information provided on ways to improve unhealthy behaviors. Workplace and home environmental hazards should also be examined since exposure to teratogenic substances such as radiation, certain chemicals and second-hand smoke should be limited. Screening can be done for genetic disorders such as Tay Sachs, sickle cell or Cooley's Anemia, with referrals for genetic counseling as needed. The presence of hepatitis antibodies and Rh factor will be determined. Rubella titers can be drawn, and tests revealing your HIV status or the presence of other sexually transmitted diseases can be evaluated. In addition, viral testing for the TORCH diseases (toxoplasmosis, rubella, Cytomegalovirus and herpes) will help you to find out if you already have protective antibodies, or if extra steps are needed to protect your unborn child.

Psychological preparation is an important aspect of preconceptional planning. Experts point out that having a baby will create many changes in your life. While some of these changes will be for the better, others may cause relationships to crack and strain. Along with sleepless nights and endless loads of laundry, there may be financial pressures and perhaps the need for a larger living space. Open and loving communication with your partner, both before and after the baby is born, will help as you negotiate the many decisions to be made about returning to work, childcare, discipline and parenting styles. Pregnancy and the birth of a child are major events in a woman's life. Preconceptional health care enables the soon-to-be expectant mom to be well prepared and knowledgeable, paving the way for a healthy pregnancy, a safe delivery, and a sense of security once your newborn has finally entered the world.