Can You Determine the Sex of Your Baby?

You’re trying to get pregnant and you’re wondering if there’s any way you can get that little girl or boy that you so desire. Admit it, someone told you if you eat a certain food or have sex in a certain position, you can control the sex of your baby and part of you thought, "why not?" In the case of most of these old wives tales, it can’t hurt to try, but are some of them dangerous? And remember, for all of the women who claim that one or more of these tricks worked for them, there are just as many who will tell you that they didn’t work at all!

Cultural Beliefs
The ancient Mayans believed that you could determine the sex of a baby by looking at the mother’s age at conception and the year of conception. If both numbers are even or both are odd, then the baby will be a girl. If one number is even and the other is odd, the baby is a boy. Some people will tell you that this absolutely works, but we figure the odds are about 50/50.

The Chinese also have a method for predicting the sex of a baby. The belief is that if you compare the mother’s age at conception and the month of conception you can accuratly predict the sex of the baby using a chart. A quick office poll reveals that the Chinese method has about the same rate of success as the Mayans – 50%.

Don’t feel like putting all of your faith in the Chinese or Mayan methods? Here are a few other methods that some people claim will work:

If You Want a Girl:

• Eat lots of chocolate and other sweets If you’re not diabetic or pre-diabetic, go for it – but in moderation! We all know that too many sweets are bad for blood sugar, waist-lines and teeth.
• Both of you should eat lots of fish and veggies It may not get you a girl, but eating healthy is never a bad idea.
• If the woman orgasms first, you’ll have a girl/
• The missionary position will produce girls
• If the woman is on top you’ll have a girl

If you Want a Boy:

• Eat lots of salty foods We’re not so sure that this is a good idea. Too much salt can cause hypertension and in some cases, stomach cancer. If you already have high-blood pressure, definitely don’t try this.
• Eat lots of red meat
  There are a lot of vegetarians who will tell you that you can have a boy without eating any meat. While moderate intake of red meat is fine, too much does carry some health risks; consumption of too much red meat has been linked to colon cancer and heart disease. If you want to try this, consider choosing organic meat. Meat from cattle that have been fed grass contains more omega three and six fatty acids (the good fats), and less saturated fat.
• Let the man initiate love making
• Make love standing up
• Lie down for a while after sex
• Have sex while on all-fours

Other Pearls of Wisdom A common claim is that more boys are conceived on odd numbered days and more girls on even numbered days. If you want a girl, try to conceive when the moon is a quarter full and for a boy try when the moon is full. Some people claim that the time of day can affect the baby’s gender too – girls are conceived in the afternoon and boys at night.

What Doctors Say Sorry to say, the scientific community doesn’t put any stock in any pregnancy folklore. Probably because all of these methods produce no more than a 50/50 chance of conceiving a child of the sex you prefer. Of course, there are some scientific theories about how to choose the sex of your baby. The most popular one involves keeping track of your ovulation cycles and mucous production.

Another scientific method of gender selection is called Percoll density gradient centrifugation procedure, also known as "sperm spinning". The sperm is placed in a centrifuge and spun. The Y (male-producing) sperm rises to the top of the centrifuge and the X (girl-producing) sperm goes to the bottom. This method has about a 77% success rate, however it is expensive and time consuming and requires undergoing in-vitro fertilization. In other words – it’s not a try at home method.

Sexual Positon and Baby Making

Best Sexual Positions for Baby Making

Obviously, if the time is right a woman may conceive regardless of sexual position. All of us likely could cite a case where actual intercourse did not take place but pregnancy occurred! Still, if you want to optimize your odds consider these suggestions. All are speculative by scientific standards, but considered successful by parents worldwide.

Upping the Odds with Effective Positions

Missionary Position (a.k.a. Man on top): Overwhelmingly, experts and parents alike agree that having the man positioned on top offers the greatest possibility of conception. The degree of penetration combined with the prone position of the woman allows the sperm to be deposited near the cervical opening. Additional "pluses" for this position allow both partners to communicate through sensual looks, intimate kisses, touch and oral stimulation of breasts and nipples (for both partners!), and movement.

From Behind (a.k.a. "doggy style"): The woman kneels before the man, facing away. Penetration is then from behind, enabling the man to enter with deeper thrusts and deposit the sperm close to the cervix. Due to the control this offers the man, his orgasms may be more intense as well.

Want to have even more fun with this position? The man can reach around and fondle his partner's breast or clitoris during intercourse and perhaps even following his own orgasm for additional stimulation. The woman may find she can pleasure her partner by reaching between, "tickling" his testicles gently as he moves and/or stroking the base of his penis. The resulting orgasms may surprise you both!

Spooning: The woman lays with her back to her partner and he cuddles her from behind. Penetration will not be as deep, but both partners are often quite relaxed which can also lead to achieving conception. The woman is able to move against her partner, inviting stimulation and allowing him to enter her from behind. The man is able to manually stimulate the woman's breasts and clitoris. Gentle kisses and communication between the two of you may ignite more pleasure. Something to try? The woman may want to help guide her partner's touch. She may also be able to reach and stroke him as he enters.

"Living on the Edge": Take this one literally! The woman lays on the edge of the bed or couch. The man can then enter from the front from either a standing or kneeling position. Like the missionary position, this allows the man to enjoy a good penetration. The unusual position may excite you both. Again, manual stimulation of both partners can add even more pleasure and intensity. Gravity, ladies, remains on your side helping the sperm meet their goal!

"Scissors": No, this is not your average "rock, paper, scissors" game! This position is one of the more unique used -- but may be just outside of the ordinary enough for you both to increase your enjoyment and result in achieving pregnancy. There are a few variations of this but the basics involve the woman lying on her side; bottom leg is between your partner's legs; top leg may be lifted up or straddled over his side. Men, lay perpendicular to your partner; bottom leg under hers; top leg between hers so the two of you are like "scissors" with the your view being your partner's back. Be certain to adjust either the angle or proximity if needed for comfort. Penetration from this position can and should be sensual for both partners.

Trying for a Certain Gender?

Whether you want a precious baby girl or a bouncing baby boy, positioning actually may play a role (along with timing and other factors.) Male sperm (Y-chromosome) are known for being faster swimmers than their female (X-chromosome) counterparts. They also tend to die off quicker while the female sperm live longer.

Those wishing for a boy may find it best to settle on "doggy style" position. This allows the penetration to be deeper, shortening the distance the sperm carrying the Y-chromosome must travel. According to what is known as the Shettles™ method, the optimal time to conceive a male child is close to ovulation -- generally by having sexual intercourse within the window 24 hours prior to ovulation to 12 hours after. Male sperm also supposedly prefer a more alkaline environment for swimming so ladies, avoid dairy and up the sodium intake. Men, drinking caffeine before sex (NOT alcohol!) can boost the speed of your Y’s!

Dreaming of a girl? Opt for a position with shallow penetration, such as spooning. A greater window of opportunity allows the slower, but much more resilient "female sperm" to take their time in reaching their destination. These sperm typically survive three to five days, and in some (rare) cases up to seven! Female (X-chromosome) sperm tend to prefer a more acidic environment. Increasing dairy products and sweets (don't forget those more natural, healthy sources such as fruits) may provide an additional aid.

How Important is Orgasm?

What about the O-factor? Obviously, for the male's role, achieving orgasm certainly aids in distributing sperm to its intended destination. Don't forget though that female orgasm can be as equally important, particularly after the man has climaxed! The reasoning? Achieving female orgasm can improve the environment for the sperm to swim and survive. The resulting contractions help draw the sperm up and into the cervix -- ready to meet that egg and "make" a baby!

The most important dynamic is to relax and enjoy being intimate with your partner. While certainly increasing your personal knowledge and understanding of your fertility is important, you will likely find that leaving that outside the bedroom will allow you both to focus on your love and desire to pleasure one another versus feeling as if being intimate is now yet another chore on your to-do list.

For those that have been trying for a year or more may wish to seek out medical advice regarding their and/or their partner's fertility.

SEXUAL INTERCOURSE, OVULATION AND CONCEPTION

Many women who are trying to conceive want to learn when ovulation and implantation occur and what are usual miscarriage or pregnancy loss rates. Quite often the numbers women are given are based on averages, theoretical numbers and sometimes just plain guesses because it is such a difficult topic to scientifically investigate. New data comes available periodically but it is not always promptly and widely disseminated even on the Net.

When does implantation take place?

One such relatively recent study tells us that implantation does not always take place on day 7 after ovulation. In fact it very rarely does. This study by AJ Wilcox accurately determined the day of implantation by very sensitive pregnancy test (HCG) measurement compared to ovulation.

HCG hormone starts being produced when the pregnancy implants into the uterine lining. The findings in normal women trying to conceive included:

• first appearance of HCG (implantation) occurred 6-12 days after ovulation
• 84% of the pregnancies implanted on days 8-10 after ovulation
• early pregnancy loss increased with later implantation -
  implantation early pregnancy loss rate
  • 13% by day 9
  • 26% on day 10
  • 52% on day 11
  • 86% on day 12 or more

Overall the total pregnancy loss up to 6 weeks was 25%. Now that seems very high to most people but keep in mind many of these pregnancy losses occurred so early that women often were not aware they were even pregnant. The normal early pregnancy loss rate that most women know about is 15-18% of clinically recognized pregnancies so almost 40% of all pregnancy loss is unrecognized.

When is the best time to have intercourse in order to get pregnant?

Wilcox had also performed previous work in 1995 (2) which demonstrated that pregnancy only occurs if intercourse occurs within the 6 days prior to and including ovulation. Intercourse after the day of ovulation does not result in pregnancy. The probability of conception ranged from 10% when intercourse occurred five days before ovulation to 33% when it occurred on the day of ovulation itself.

This is the data that suggests the best timing of intercourse in order to conceive is day 10, 12, 14 and 16 (in case of late ovulation) of a 28 day cycle or days -4, -2, 0, +2 in relation to expected ovulation in the case of cycles different than 28 days.

When should I begin testing with home urine tests?

Most home pregnancy tests that check urine beta-HCG are sensitive to 20-25 mIU/ml of HCG. The general rule-of thumb is to test at the time when you are a day late for your menses or about 15 days after ovulation. The test can be positive anywhere from about 2-3 days prior to a missed menses to 4-5 days after.

Testing really does depend upon how regular your menses are or in other words how regular ovulation occurs. If you tend to be late (longer than 28 days) with your periods or the timing of menses varies by several days each cycle, then it is better not to waste pregnancy tests by testing at day 28-29 after the last period starts.

Are ovulation prediction tests worth doing?

Pelvic ultrasound looking at the ovaries is considered the gold standard in ovulation prediction in a research setting but obviously in a practical application of a woman trying to conceive, ultrasound is not used. Urinary LH testing has been shown to have a 100% correlation with ultrasound as far as predicting the timing of ovulation. In that same study, they looked at cervical mucous changes, basal body temperatur (BBT) charts and salivary ferning. Cervical mucous changes only had a correlation of 48%, salivary ferning correlated 37% and BBT has a 30% correlation.

For the home tests that measure LH surge that immediately precedes ovulation, detection of LH occurs at above 30 mIU/ml. This means that women with polycyctic ovarian syndrome who have slightly higher resting LH values are still not falsely detected as ovulating. The urinary LH spike occurs about 24-36 hours prior to ovulation so it is very useful for women trying to conceive because it gives them a window of warning. The test will show positive for one or two days and rarely 3 days if you catch a spike right at the beginning and it is a large release of LH.

What Should You Do After Intercourse To Increase Your Chances Of Getting Pregnant?

What should you do after intercourse to increase your chances of getting pregnant? Well, ask your grandma! There are a lot of tips and tricks that suggest that you can increase your odds of getting pregnant, even after intercourse, by following certain routines. These may work with some women and might not work with the rest. Though not completely scientific, they have shown marked results in some women who swear by them. Douching for example was once a popular method to increase your chances of getting pregnant, but today it has been shrugged off as a myth.

Will having intercourse in the morning help?

Some studies claim that a man’s sperm count may be higher in the morning as compared to other times of the day. But other studies also show that the differences in sperm count are so minimal that it does not matter much in terms of getting pregnant. For example, assume that your sperm count goes from 87 million in the evening to 88 million in the morning. This may sound significant in numbers. But understand that it doesn’t change much if you are talking about a tough conception history. That’s so because, after all, it only takes one sperm to do the job.

One of the surest ways is to have intercourse as often as you can! So stop worrying about the clock and have sex whenever the mood strikes you — day or night.

Will timing intercourse during the monthly cycles help?

Yes, definitely. If you really want to swing the odds of getting pregnant in your favor, you should try and start timing sex sessions as close to ovulation as you can. For most women that’s about halfway between periods and the most fertile period in the month. Our article on ovulation will help you better understand the process and give you an idea of when you’ll ovulate.

It also helps to keep in mind that while it’s important to understand your cycle and the changing patterns of cervical mucus and basal temperature, it’s equally important to try to relax, enjoy sex and the warm feeling of being parents soon. Believe it or not, the more relaxed you are, the better your chances of conceiving.

What can we do after intercourse to increase our odds?

For most healthy couples, getting pregnant isn’t difficult, and no special arrangements need to be made beyond depositing the man’s semen into the woman’s vagina. Generally, the sperm reach the cervix within seconds of ejaculation. But if you have been trying hard and long enough, here’s a secret. Lie flat after intercourse and raise your legs to 30 degrees. This helps the cervical and vaginal muscles to relax and facilitates the movement of cervical mucus. If your man has enough sperm count and you have the right consistency of cervical mucus, this method will greatly help to increase your chances of getting pregnant.

Even doctors recommend that a woman should lie down with her legs slightly raised after intercourse to increase her chances of conception. This greatly helps in women who are trying to get pregnant because the sperm doesn’t have to fight gravity as they make their way to the egg. There is no scientific evidence of this improving the chances of getting pregnant, but many people have tried it to aid conception. It is a harmless technique and worth a shot.

Even after trying various techniques and therapies, if you still encounter trouble in conceiving, you must consult a doctor for advice on how to proceed.

NUTRITION and PREGNANCY

A balanced diet is a basic part of good health at all times in your life. During pregnancy, your diet is even more important. The foods you eat are the main source of nutrients for your baby. As your baby grows, you will need more of most nutrients. This pamphlet will help you learn more about:

Good food choices for you and your baby Nutrients you will need Healthy weight gain

Eating right during your pregnancy is one of the best things you can do for yourself and your baby.

Before You Become Pregnant

The best time to begin eating a healthy diet is before you become pregnant. This will help you and your baby start out with the nutrients you both need.

If you are planning to become pregnant, visit your doctor. Getting good health care before you are pregnant will help you throughout your pregnancy. As part of your visit, you will be asked about your family life, work, and lifestyle, including your diet. You and your doctor will discuss how to eat right before and during your pregnancy and which nutrients are especially important, such as folic acid.

A Healthy Diet

The first step toward healthy eating is to look at the foods in your daily diet. Early in pregnancy, morning sickness can affect your eating habits. You may crave certain foods or not feel like eating. If this happens, you still should try to eat a variety of foods each day to help ensure you are getting the right amount of nutrients.

Having healthy snacks that you can eat during the day is a good way to get the nutrients and extra calories you need. You may find it easier to eat snacks and small meals throughout the day rather than three big meals a day. This also may help you avoid nausea and heartburn.

Healthy eating also means avoiding things that may be harmful. This includes alcohol (beer, wine, or mixed drinks) and illegal drugs, which may cause birth defects and other problems for the baby. Smoking cigarettes is especially harmful to a pregnant woman and her baby.

You also may want to avoid or limit your caffeine intake during pregnancy. Although some studies suggest drinking three or more cups of coffee per day may increase the risk of miscarriage, there is no proof that caffeine causes miscarriage.

Meal Planning

Planning meals in advance can help ensure you and your family eat a balanced diet. The food pyramid developed by the U.S. Department of Agriculture can help you choose what to eat (www.mypyramid.gov) (see Table 1). It takes into account your age, sex, and your amount of daily physical activity and shows the number of servings you should have each day from each of the six food groups:

1. Grains
2. Vegetables
3. Fruit
4. Oils
5. Milk
6. Meat and beans

Basic Nutrients

Every diet should include proteins, carbohydrates, fats, vitamins, and minerals. To be sure your diet provides you with the right amount of nutrients, you should know which foods are good sources of each.

The RDA—recommended daily allowance—on food labels shows the levels of nutrients you need every day. During pregnancy, the RDAs are higher for most nutrients. Table 2 shows the key nutrients you and your baby will need during your pregnancy.

Extra Nutrients

Pregnant women need extra iron and folic acid, and these are usually prescribed in pill form as supplements. Sometimes a prenatal supplement that contains these two nutrients plus vitamins and minerals is recommended. Ask your doctor or nurse how your needs can be best met.

Women should take 400 micrograms of folic acid daily, in addition to a well balanced diet, for at least 1 month before pregnancy and during the first 3 months of pregnancy. This can help prevent neural tube defects, which affect the spine and skull of the fetus.

Women who have had a child with a neural tube defect are more likely to have another child with this problem. These women need much higher doses of folic acid—4 milligrams daily. It should be taken for at least 1 month before pregnancy and during the first 3 months of pregnancy. Women who need 4 milligrams should take folic acid as a separate supplement, not as part of a multivitamin.

Check with your doctor before taking any vitamins, herbs, or other supplements that are not prescribed for you. They might be harmful during pregnancy. Just because a product is natural does not mean it is safe to use during pregnancy.

Weight Gain

When you are pregnant, you need to eat more to help the growth and development of your baby, as well as for the changes in your own body that promote a healthy pregnancy. During at least the last 6 months of pregnancy, you need to eat or drink about 100 more calories per day than you did before you were pregnant.

How much weight you gain during pregnancy depends on your weight before pregnancy (see box). A healthy gain for most women is between 25 and 35 pounds. If you are overweight, you should gain less, but some weight gain is normal. If you are underweight, you should gain more. Talk with your doctor about the amount of weight you can expect to gain. This may vary if you are pregnant with more than one baby.

Special Concerns

Vegetarian Diets

If you are a vegetarian, you can continue your diet during your pregnancy. However, you will need to plan your meals with care to ensure you get the nutrients you and your baby need. Be sure you are getting enough protein and that it is the correct type. You will probably need to take supplements, especially iron, vitamin B12, and vitamin D.

Lactose Intolerance

Milk and other dairy products are the best sources of calcium in your diet. Some women have symptoms such as bloating, diarrhea, gas, and indigestion after drinking milk or eating dairy products. This is known as lactose intolerance.

During pregnancy, these symptoms often improve. But if you still have problems after eating or drinking dairy products, talk with your doctor or dietitian. He or she may prescribe calcium supplements if you cannot get enough calcium from other foods. Calcium also can be found in cheese, yogurt, sardines, certain types of salmon, spinach, and fortified orange juice.

Mercury

Fish and shellfish are good sources of protein, omega-3 fatty acids, and other nutrients. However, pregnant women should not eat certain kinds of fish because they contain high levels of a form of mercury that can be harmful to the developing fetus.

You should avoid eating shark, swordfish, king mackerel, or tilefish during pregnancy. These large fish contain high levels of mercury. Albacore tuna also is high in mercury so you may want to choose canned chunk light tuna instead. Other types of fish are fine in limited amounts. You can eat up to 12 ounces (about two meals) of other varied fish and shellfish per week.

Check local advisories about fish caught in local rivers and streams. If there is no advice about them, it may be safe to eat up to 6 ounces (one meal) per week of fish from local waters. During that week, do not eat any other fish.

Listeriosis

Listeriosis is an illness caused by bacteria that can occur in unpasteurized milk and soft cheese and prepared and uncooked meats, poultry, and shellfish. It can be particularly harmful to pregnant women and their babies.

Symptoms occur several weeks after you eat the food. They can include fevers, chills, muscle aches, and back pain. In some cases, there may be no symptoms at all. When a pregnant woman is infected, the disease can cause miscarriage or stillbirth.

Because the symptoms of listeriosis are like the flu, it can be difficult to diagnose. If you have a fever or flu-like illness, check with your doctor who may take samples from your vagina, cervix, and blood to be checked. If the bacteria are found, you and your baby can be treated with antibiotics. If there is a chance that a newborn is infected, he or she also can be tested and treated.

To prevent listeriosis, wash all fresh fruits and vegetables before using them. While you are pregnant, do not eat:

• Unpasteurized milk or soft cheeses
• Raw or undercooked meat, poultry, shellfish
• Prepared meats, such as hot dogs or deli meats, unless they are reheated until steaming hot

Always be sure to wash your hands and any utensils, countertops, or cutting boards that have been in contact with uncooked meats.

Pica

During pregnancy, some women feel strong urges to eat non-food items such as clay, ice, laundry starch, or cornstarch. This is called pica. Pica can be harmful to your pregnancy. It can affect your intake of nutrients and can lead to constipation and anemia. Talk with your doctor if you have any of these urges. He or she may be able to suggest other things you can do when you feel the urge to eat non-food items.

Finally...

Eating right during your pregnancy is one of the best things you can do for yourself and your baby. Take a look at the foods in your daily diet. Make sure they provide the nutrients you and your baby need. It is never too late to start eating a healthy diet.

PREGNANCY AFTER 35

What you need to know:
Healthy women from age 35 into their 40s usually have healthy pregnancies. If problems do arise, they can usually be successfully treated.

Women over age 35 have an increased risk of:

• Fertility problems
• High blood pressure
• Diabetes
• Multiple pregnancy (twins or more)
• Miscarriage
• Placenta previa, a condition in which the placenta is in the wrong place and covers the cervix
• Cesarean section
• A baby with a genetic disorder

Because of these increased risks for women over 35, prenatal care is especially important.

What you can do:
No matter what your age, see your health care provider before trying to get pregnant. This is especially important if you:

• Have a chronic medical condition, such as diabetes, a seizure disorder or high blood pressure
• Are on long-term medication

If not under control, some medical conditions can cause risks for you and your baby.

If you are older than 35 and don’t get pregnant after trying for six months, see your health care provider.

A Mommy After 35

Most healthy women from age 35 into their 40s have healthy pregnancies. Most women over 35 are in good health. Good prenatal care and healthy habits can help you reduce certain risks. If problems do arise for women over 35, they can usually be successfully treated.

No matter what your age, see your health care provider before trying to get pregnant if you:

• Have a chronic medical condition, such as diabetes, a seizure disorder or high blood pressure
• Are on long-term medication

If not under control, some medical conditions can cause risks for you and your baby.
If you are older than 35 and don’t get pregnant after trying for six months, see your health care provider. Older women may find it harder to get pregnant than younger women because fertility declines with age. In many cases, infertility can be treated.
Prenatal Care Is Important
Prenatal care is especially important for women over 35 because:

• They’re more likely to get high blood pressure and diabetes for the first time during pregnancy.
• They may choose to have testing for Down syndrome, a combination of mental retardation and physical defects.

Healthy Habits
To help reduce risks during pregnancy:

• Eat healthy foods.
• Gain a healthy amount of weight.
• Exercise, with your health care provider’s guidance.
• Don’t drink alcohol, smoke or take illegal drugs.
• Don’t take any medications or herbal supplements without first checking with your health care provider.

Prenatal Screening Tests
Ask your provider about prenatal screening tests for the baby. For instance, amniocentesis is often recommended for pregnant women 35 or older.
In amniocentesis, the health care provider inserts a thin needle through the woman’s abdomen. A small amount of amniotic fluid (the fluid that surrounds and protects the baby) is removed and tested for chromosomal abnormalities such as Down syndrome or a specific genetic disorder for which the fetus is at risk. Test results are usually available within a week or two. Most women who have prenatal screening tests learn that the baby is healthy and feel reassured by the results.

EMOTIONAL PREPARATION TO BECOME A MOTHER

There are thousands of articles about the physical preparation that a healthy pregnancy requires and very few about the psychological aspects of it. I titled this article “How to emotionally prepare for motherhood” because the psychological changes that start before your become pregnant do not end at birth. Glade B. Curtis, M.D.,OB/GYN & Judith Schuler, M.S. in their book Pregnancy Week by Week, suggests that “pregnancy is not a 9 months deal but should last at least 12 because it takes at least that time for our bodies to adjust and, even longer for our minds to be ready.” It is important to remember that pregnancy is a period of transition. It is a period when we will be laying the foundation for :

1. a healthy child’s development,
2. a healthy mother’s adjustment, and
3. a strong relationship between mother and child.

As important as it is that we take care of our bodies during and even before pregnancy, it is crucial that we take certain steps in order to be at our best psychologically during pregnancy and after child birth. Here some main considerations:

• Redefine yourself to include the role of motherhood in your life. Every person’s identity is formed by the various roles that they perform in the world. Becoming a mother is one more such role and it has psychological implications. What does it mean for you to be a mother? What is the value for you, your family, to society? Is this role more or less important than other roles you currently play in your life? Does it create a conflict within you and/or with others in your life?

• Research shows more and more the importance of the mother-child relationship on the healthy development of a person. It is not a matter of simply providing room and board. Susan Johnson’s, Ph.D., founder of Emotionally Focus Therapy (EFT) for couples, in her latest book (2008) “Hold Me Tight,” explains in detail how the need to connect to another human being (in this case to the caretaker) is innate to all of us; as much as the need to eat and be dressed. Becoming a parent is about being emotionally present and connected to your child. Consider a prenatal class to learn about bonding techniques to enhance the relationship with your baby.

• Assess your partnership. The thought of a baby solving the problems in an old marriage myth that thousands of couples prove false each year. If you and your partner are currently experiencing problems, put your communications skills to work. Develop or maintain a healthy relationship and look to prevent problems in the future. Do not expect the baby to make a miracle. In addition, there will be stressful moments for sure and you both will need to have a solid foundation of trust and communication with each other to make it through successfully.

• Try to maintain a healthy mental state. Remember that you are not sick but your whole self is experiencing a transition so do not wait for things to be exactly as they were before pregnancy. Accept change, and avoid becoming frustrated. Be prepared for things to be different and you will deal with change easier. Remember, a positive attitude will be your best ally.

• Expect mood swings. Nearly all pregnant women are prone to emotional ups and downs due to the rapid production of hormones. Accept that you will feel down from time to time and do not fight it. It is perfectly normal. However, keep you eyes open on inadequate hormone production, especially estrogen (low levels produce more depression, fatigue and lethargy) and progesterone (more irritation, anxiety, and edgy).

• Use all resources around you; do not try to do it alone. Rely on family, friends, your husband and practice stress management techniques. A survey conducted by the baby charity Tommy's in the UK discovered that 9 in every 10 expectant “mums” are stressed, so find ways to reduce it. This is not the time to be a superwoman and if you don’t ask for help you will end up exhausted and overwhelmed. Some people want to help, but are timid to intervene. Let’s be clear about when and how they can help us.

• Prevent mental health complications. Pregnancy is a time when our past comes back to hunt us. Relationships issues, fears, and the way we deal with life and crisis will surface. The relationship with your own mother, confidence in yourself, trust in others to be there for you etc are some of the main issues that pregnant women deal with, regardless of them being aware or not. If you find yourself overly stressed, often depressed, or if you’ve had a history of depression or mental problems, be aware of it and do not hesitate to ask for help. If you suffer(ed) from low self-esteem, eating disorders, or have body image problems, pregnancy can be a very vulnerable time. A new survey in London has revealed that one in every 50 pregnant women develops an eating disorder. Your image of yourself while you are pregnant is very important. Women with a good self-esteem tend to feel good when pregnant and women with low self-esteem may experience complications. Keep in mind that it is ok to consult with a specialist if you need it.

• Learn how to baby-proof your marriage. In other words, how to become a mom without giving up being a wife. Remember that while you are incorporating one more role in your life it is important that you do not drop the others completely. The Journal of Personality and Social Psychology shows that having a baby impacts a marriage in ways new parents never anticipated. Research done by the Bringing Baby Home Program shows that relationship satisfaction decreased up to 67 percent for new parents. Many couples and men complain that after the birth of a baby, the mother has no more time or energy for them or the relationship. Even the most capable man still needs you and your relationship too. Remember that both roles are important and that one the biggest gift you can give to your child is a strong and healthy marriage.

• Plan and balance your new life. Trying to develop a new and balanced lifestyle that takes into consideration all areas of your life. Again remember that even though being a mother is the main priority, especially at the beginning, you will do better if you dedicate some time to take care of your self, your relationship, and come back to the child. Too much of a good thing is not good. So add variety to you, your family and your baby’s life.

Congratulations on your pregnancy! Good luck with the new born!

Reviewed by : Bambang Widjanarko, obstetrician & gynecologist

Juni 2009

IS PARENTHOOD FOR YOU?

Posing the question

For some people this is the world's easiest question — they've always been able to see themselves as parents, they have their life set up the way they want it, and they're ready to go. Others go back and forth on this one for years, or feel the need to do a little serious wobbling before taking the plunge. Some just never get the call.

Wherever you are on the spectrum, even if you know you want to do it, you can make a conscious decision about whether to become a parent. And whether you're having trouble deciding whether you want to have a child, or are just wondering whether you're ready to take on this lifelong project, we hope this article will help you get closer to a decision.

One thing's for sure: No one has to have children. The world's not short on people to populate it, and whether to become a parent is completely up to you and whatever hopes and dreams you have for your life.

The hardship factor

Being a parent is really fun, and satisfying in a way you can't fully imagine when you don't have children. And it's really hard work — more work than you can imagine until you've done it.

It's hard because of the sheer volume of demands on your time and energy, with few breaks to refresh and recharge; it's hard because parents almost never have enough time, money, emotional support, training, or preparation to do the job they want to do; it's hard because it puts your own emotional issues squarely in your face as your children inevitably push every button you have; and it's hard because the mistakes you make — and you'll make some, for sure — affect the ones you love the most: your children.

Having a child is a major life change, and because women everywhere bear the major responsibility for raising children, it's a change that in general affects women's lives more than men's. It means adding the way society treats parents (not well) on top of the way society treats women (ditto).

"Parenting — the vitally important job of raising the next generation — is treated economically almost like a hobby," says Patty Wipfler. "Women already don't get enough pay, support, or recognition for their contributions to society, and becoming a parent kind of squares that."

Men as a whole are more involved as parents today than ever before, but the day-to-day housework, meal-making, emotional counseling, childcare, purchasing, and household details and logistics still tend to fall — unpaid — to the woman of the house

That's not to say it's an easy decision for men. Both men and women face unhappy tradeoffs between work and parenthood in modern society, with women usually having to choose parenting to the detriment of work, and men usually having to choose work to the detriment of parenting.

Men's patterns of workaholism, reinforced by most workplaces today, are fueled by a new sense of responsibility for the family. Long hours of work increase the sense of emotional isolation that most men deal with anyway, and many feel frustrated at not being able to be the kind of father they wish they could be.

A reality check

With all the romanticized images of children and parenthood floating around, hardly anyone gets a realistic idea of what it's like to be a parent before they actually become one.

If you never had to carry a 5-pound sack of flour around for a week in junior high, psychologist Harriet Lerner's book The Mother Dance: How Children Change You can serve as an on-paper preview, or you can always get a real-life glimpse by caring for a friend's or relative's baby overnight. Or try assuming you've made the decision to have a child and then spend a week thinking about how that makes you feel and all the ways your life would change; then assume you've decided not to have one and live with that for a week.

Parenthood isn't for everyone. Maybe you've never wanted children; maybe you have other ambitions for yourself that caring for children would make impossible.

"We are this wonderfully creative species," says Mindy Toomay, a fiction and cooking writer and teacher who is entirely comfortable with her decision not to have children. "But so many people never explore their creative or spiritual potential because family demands get in the way. For me it felt like it would be an impediment — it has been for a lot of people I know, particularly women." And certainly there are instances of people becoming parents and then regretting their decision.

Then again, some people are surprised by how much they like being a parent. "I did catering during high school so I wouldn't have to babysit," says Sally Webb, now the mother of two small boys. "But I found I really love being a mom."

Most people, especially women, are brought up to expect that they'll be parents. From baby dolls to baby showers, girls and women are surrounded by images and expectations from parents, peers, religion, advertising, and the media. But the decision to be a parent is not up to your mother, your father, your friends, your church, or even any expectations you might have grown up with. It's your life, and it's up to you.

Are you ready to have a baby?

The following series of questions, developed by our staff with help from San Francisco psychotherapists Ann Davidman and Denise Carlini, is designed for you to discuss with your partner or a friend, mull over on your own, write about in your journal, take to your therapist — whatever helps you take a good look at them.

If you would be having a child with a partner, show these questions to your partner and see whether you would be comfortable with his or her answers. The questions are meant to be answered by both men and women.

"A lot of our work is helping people to understand their ambivalence so they can move on to the next step of making a decision," says Davidman. "We've found that ambivalence can be a result of emotional issues the person isn't completely aware of, such as unresolved grief."

They suggest you start by asking, "What do you want for you?" – regardless of your current situation, regardless of what you might have to go through to get what you want, such as finding a partner if you want one.

If you think you might want a child, don't even ask yourself at this point how that will come about, whether biologically, through adoption, or whatever. Just concentrate on your personal wishes and desires.

• Do you spend time with children? Do you enjoy it?
• What did you enjoy about being a child? What didn't you enjoy?
• What did you appreciate about the parenting you received? What didn't go well?
• What messages did you get about what a parent is supposed to be?
• How do you feel as you answer these questions?

PRECONCEPTION HEALTH CARE

• Why is a preconception check up important ?
• What does agenetic councelor do ?
• Why should women of childbearung age take a folic acid ?
• What vaccines might a woman need before pregnancy ?
• What maternal illness should be treated before pregnancy ?
• How long should a woman wait between pregnancies ?
• How can preconception care help prevent problem that occurred in past pregnancies ?
• What can a woman do to help stay healthy before pregnacy ?
• Why should a woman try to achieve a healthy weight before pregnancy ?
• References

Preconception health care is care a woman of childbearing age receives before pregnancy or between pregnancies. This type of care looks at biomedical, behavioral and social risk factors that may affect a woman’s health. The goal is to provide information and treatment before pregnancy that can improve a woman’s health and help reduce risks to her future baby.

All women of childbearing age can take steps before they get pregnant to improve their chances of having a healthy, full-term baby. By getting preconception health care, a woman can learn what steps she can take before pregnancy to protect her health and give her baby the best chance to be healthy.

Why is a preconception checkup important?
A preconception checkup can help assure that a woman is as healthy as possible before she conceives. Her provider can identify and often treat health conditions that can pose a risk in pregnancy, such as high blood pressure, diabetes or certain infections. The provider can give her information on things like nutrition, weight, smoking , drinking alcohol and occupational exposures that can pose pregnancy risks. The provider also can make sure a woman’s vaccinations are up to date and that any medications she takes are safe during pregnancy.

The provider can ask a woman about her health history, as well as that of her partner and her family. If the woman or her partner has a history of birth defects or prematurity, or if either has a high risk for a genetic disorder based on family hystory, ethnic background or age, the provider may suggest seeing a genetic concelor.

What does a genetic counselor do?
A genetic counselor discusses the risks for a genetic disease in a couple’s future children. The counselor can arrange blood tests (called carrier tests) that can identify carriers of many genetic diseases. If both parents are carriers of a disease, each child has a 25 percent chance of inheriting the disease. Carrier tests are given for a variety of conditions, including:

• Cystic fibrosis CF), a disease of the lungs and digestive system that is most common in Caucasians, but can affect children from many backgrounds
• Tay – Sachs disease, which causes fatal brain damage and is more common in people of Eastern European Jewish ancestry and in some non-Jewish individuals of French-Canadian and Cajun ancestry
• Sickle cell disease, a blood disorder that mainly affects African-Americans
• Thalassemia, a blood disorder that mainly affects those of Mediterranean, African and South Asian descent

Genetic screening and counseling before pregnancy may reassure a couple that their children are not at increased risk for a specific inherited disease. Genetic counseling also allows carriers the opportunity to understand their risk and discuss options. Women who can benefit from genetic counseling include:

• Women over age 35
• Women who have certain genetic disorders, such as phenylketonuria (PKU)
• Women who have had a child with a neural tube defect (NTDs), a birth defect of the brain and spinal cord

Why should women of childbearing age take folic acid?
Folic acid is a B vitamin that can help prevent birth defects, particularly NTDs. Studies show that if all women consumed the recommended amount of folic acid before and during early pregnancy, up to 70 percent of all NTDs could be prevented ^{(1, 2)}. Studies also suggest that folic acid may help prevent some other birth defects, including cleft lip and palate and some birth defects involving the heart ⁽¹⁾. A recent study also suggests that women who take folic acid for a least 1 year before becoming pregnant may reduce their risk of having a premature baby ⁽⁴⁾.

To prevent NTDs, most clinicians recommends that all women who could become pregnant take a multivitamin containing 400 micrograms of folic acid every day starting before pregnancy, along with eating healthy foods. This advice, based on recommendations from the Institute of Medicine (IOM) ⁽³⁾, assures that a woman gets all the folic acid and other vitamins she needs.

A woman also can get folic acid by eating a serving of folic acid-enriched cereal every day that contains 100 percent of the daily value (DV) of folic acid (400 micrograms). Healthy food choices include foods that are fortified with folic acid and foods that contain folate, the natural form of folic acid found in foods. Many grain products, including flour, rice, pasta, bread and cereals, are fortified with folic acid. Folate-rich foods include green leafy vegetables, dried beans, legumes, oranges and orange juice.

A woman who has had a pregnancy affected by an NTD should take a higher dose of folic acid. Taking a higher dose of folic acid daily (4,000 micrograms or 4 milligrams), beginning at least 1 month before pregnancy and in the first trimester of pregnancy, reduces by about 70 percent the risk of having another affected pregnancy ⁽⁵⁾. Women with diabetes or epilepsy and women who are obese are at increased risk of having a baby with an NTD ⁽¹⁾. Women with these conditions should consult their providers before pregnancy about taking a larger dose of folic acid.

What vaccines might a woman need before pregnancy?
At a preconception visit, the health care provider may do a blood test to see if a woman is immune to rubella (German measles) and chickenpox. Both of these diseases can cause birth defects and other complications if a woman gets them during pregnancy.

If a woman is not immune, she should be vaccinated before pregnancy. She should then wait 1 month after vaccination before attempting to get pregnant.

Women who are at high risk for hepatitis B (such as health care workers) and have not been vaccinated for it should consider getting the hepatitis B vaccine before or during pregnancy. This disease can be passed on to the baby during delivery. A provider also may recommend other vaccines, such as the flu shot.

What maternal illnesses should be treated before pregnancy?

• Diabetes: Women with poorly controlled diabetes that started before pregnancy are about 3 times more likely than women without diabetes to have a baby with a serious birth defect (6). They also are at increased risk for miscarriage and stillbirth and for having a baby that is very large. Controlling blood sugar before pregnancy and during the first few months of pregnancy can help prevent birth defects.
• High blood pressure: Chronic high blood pressure can increase the risk of pregnancy complications, including placental problems (solusio placenta), poor fetal growth and preeclampsia (a pregnancy-related disorder characterized by high blood pressure and protein in the urine).
• Systemic lupus erythematosus (SLE): This autoimmune disorder can cause arthritis-like symptoms, kidney disease, skin rashes and other problems. Affected pregnant women are at increased risk for miscarriage, poor fetal growth, preterm labor and stillbirth ⁽⁷⁾ . However, if symptoms are well controlled before pregnancy, the risk of these complications is reduced.
• Seizures: Some seizure control medications increase the risk of birth defects. During a preconception visit, a provider may adjust a woman’s dose or switch her to a drug that is safer for the fetus. A woman should not stop taking seizure medication without asking her provider, as seizures themselves might harm a fetus.
• PKU: Women with this inherited condition cannot process certain proteins. They must eat a special diet and be carefully monitored before and during pregnancy to prevent mental retardation and birth defects in their offspring ⁽⁶⁾ .
• Kidney disease: Some women with severe kidney disease may suffer additional kidney damage during pregnancy, and their babies may be at increased risk for death, premature delivery or poor growth ⁽⁷⁾ .

How long should a woman wait between pregnancies?
For most women, it’s best to wait at least 18 months before getting pregnant again. This gives a woman’s body enough time to get ready physically for another pregnancy. It also gives her time to adjust to life as a mom. Shorter time intervals between pregnancies may increase the risk of premature birth ⁽⁸⁾ . However, not all women can wait 18 months because of their age or other reasons. A woman should talk to her health care provider to determine the right amount of time for her.

How can preconception care help prevent problems that occurred in past pregnancies?
Even if a woman has not had problems in a previous pregnancy, preconception care can help prevent birth defects or pregnancy complications in a future pregnancy. For example, taking folic acid can help prevent NTDs, and treatment of certain health conditions, such as high blood pressure, can help prevent premature delivery. A 2006 report from the Centers for Disease Control and Prevention (CDC) recommends that all women who have had a previous pregnancy that ended in an adverse outcome receive evaluation and treatment between pregnancies to reduce the risk in future pregnancies ⁽⁶⁾.

Preconception care is important for women who have had a miscarriage, stillbirth or premature delivery. The health care provider can review a woman’s medical record and may recommend tests to help determine the cause of an adverse outcome. The tests may include blood tests and imaging tests, such as ultrasound. If tests show that a health problem in the woman may have contributed to the outcome, treatment between pregnancies often can reduce the risk of the problem recurring in another pregnancy. If a woman had a previous premature delivery, the provider may recommend lifestyle changes, such as quitting smoking, and discuss the possibility of treatment with the hormon progesterone during her next pregnancy to help reduce the risk of another premature delivery.

What can a woman do to help stay healthy before pregnancy?
A woman should:

• Avoid alcohol. Drinking alcohol during pregnancy can cause physical and mental birth defects called fetal alcohol syndrome (FAS). Because no amount of alcohol has been proven safe in pregnancy, pregnant women and women considering becoming pregnant should avoid it entirely.
• Quit smoking. Smoking during pregnancy nearly doubles the risk for having a low-birthweight baby. It also increases the risk for premature delivery, other pregnancy complications and sudden infant death syndrome (SIDS) (9). Smoking also may make it more difficult to conceive ⁽⁹⁾ .
• Stay away from cocaine and other illicit drugs and prescription drugs not prescribed for her. These drugs pose many risks, including premature delivery, low birthweight , birth defects, learning or behavioral problems, and withdrawal symptoms.
• Fully cook all meat and don’t change a cat’s litter box. Undercooked meat and cat feces can contain a parasite that causes an infection called toxoplasmosis, which can cause birth defects. Another way to avoid cat feces is to wear gloves when working in the yard or garden.
• Avoid contact with all rodents, including pet hamsters, mice and guinea pigs. These animals can carry a virus that can harm your baby ⁽¹⁰⁾ .
• Avoid sitting in hot tubs and saunas. These may elevate body temperature and, possibly, increase the risk for NTDs ⁽¹⁾ .
• Avoid hazardous chemicals, such as solvents (substances that dissolve other substances, like paint thinner). Working with solvents may increase a woman’s risk for miscarriage or having a baby with birth defects ⁽¹¹⁾ .
• Avoid eating fish that can be high in mercury. Mercury is a metal that can harm an unborn baby; it often is found in fish. Pregnant women and women considering pregnancy should not eat fish that are high in mercury, like shark, swordfish, king mackerel and tilefish ⁽¹²⁾ . These women can eat up to 12 ounces per week of fish that are low in mercury, including shrimp, salmon, pollock, catfish and canned light tuna. They should eat no more than 6 ounces of albacore (white) tuna per week. Women should always check with their local health department before eating any fish they catch themselves ⁽¹²⁾ .

Why should a woman try to achieve a healthy weight before pregnancy?
Women who begin pregnancy overweight or obese may be at increased risk of having high blood pressure and diabetes, having a baby with certain birth defects, having labor and delivery complications, and having a stillborn baby ^{(6, 7)} . They also may have more difficulties becoming pregnant ⁽¹³⁾ . Women who are underweight may be at increased risk of having a premature or low-birthweight baby ⁽⁷⁾ . A woman can help reduce her risk for these complications by attaining a healthy weight before pregnancy.

References

1. Centers for Disease Control and Prevention (CDC). Folic Acid: Frequently Asked Questions. Updated 1/30/08.
2. Berry, R.J., et al. Prevention of Neural Tube Defects with Folic Acid in China. New England Journal of Medicine, volume 341, number 20, November 11, 1999, pages 1485-1490.
3. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes: Folate, Other B Vitamins, and Choline. Washington, D.C., National Academy Press, April 7, 1998.
4. Bukowski, R., et al. Preconception Folate Prevents Preterm Delivery (abstract). American Journal of Obstetrics and Gynecology, Special Supplement, Society for Maternal and Fetal Medicine 28th Annual Meeting, volume 197, number 6, December 2007.
5. Centers for Disease Control and Prevention (CDC). Folic Acid: PHS Recommendations. Updated 7/26/05.
6. Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR). Preconception Care Work Group and the Select Panel on Preconception Care. Recommendations to Improve Preconception Health and Health Care – United States. Morbidity and Mortality Weekly Reports, volume 55, no. RR-6, April 21, 2006.
7. American College of Obstetricians and Gynecologists (ACOG). Your Pregnancy and Birth, 4th edition. ACOG, Washington, DC, 2005.
8. Conde-Agudelo, A., et al. Birth Spacing and Risk of Adverse Perinatal Outcomes. Journal of the American Medical Association, volume 295, number 15, April 19, 2006, pages 1809-1823.
9. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General – 2004. Office on Smoking and Health, Atlanta, GA..
10. Centers for Disease Control and Prevention (CDC). Lymphocytic Choriomeningitis Virus (LCMV) and Pregnancy: Facts and Prevention. Updated 9/20/06. .
11. Khattak, S., et al. Pregnancy Outcome Following Gestational Exposure to Organic Solvents. Journal of the American Medical Association, March 24/31 1999, volume 281, number 12, pages 1106-1109.
12. U.S. Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA). What You Need to Know About Mercury in Fish and Shellfish. Accessed 5/4/06.
13. American Society for Reproductive Medicine. Patient’s Fact Sheet: Weight and Fertility. Revised 8/01, accessed 5/8/06.

Reviewed by Bambang Widjanarko, 0bstetrician&gynecologist

Juni 2009