Mayo Clinic Guide to a Healthy Pregnancy: From Doctors Who Are Parents, Too!

CHAPTER 1. Preparing to become pregnant

So you think you want to be a mom — at least sometime in the near future. How exciting! Having a child is a wonderful experience that will enrich your life forever. But the decision to have a child shouldn’t be taken lightly. Parenthood is a lot of work, and the best way to approach it is by preparing yourself so that you’re as ready as possible for this big event.

When it comes to pregnancy, thinking ahead can give you and your baby the best possible beginning. If you’re reading this book and are still in the planning stages before becoming pregnant, good for you! You’re giving yourself a head start on the exhilarating, sometimes confusing, but always worthwhile path to parenthood.

In this introductory chapter, you’ll find some key concepts and action items that can help make your transition to pregnancy as smooth as possible. If you already know that you’re pregnant, congratulations! You may want to page through this chapter and begin with Chapter 2.

IS THE TIME RIGHT?

When your friends with children tell you to say goodbye to lazy weekends and impromptu nights out, and hello to nighttime feedings and loads of baby laundry, they’re not kidding. Having a baby is life-changing. In most ways it’s wonderful, but life will never be the same. Although there’s probably never a perfect time to have a baby, some phases of your life may be more conducive to pregnancy and new parenthood than others.

Questions to ask Here are some questions you might ask yourself in determining whether the time is right:

 Why do I want to have a baby?

 Does my partner feel the same way I do? Do we share the same ideas about how to raise a child? If not, have we discussed our differences?

 How will having a baby affect my current and future lifestyles or career? Am I ready and willing to make those changes?

 Is there are lot of stress is my life right now that could interfere with my ability to become pregnant or enjoy my pregnancy? What about for my partner? Is stress an issue?

 Emotionally, are we ready to take on parenthood?

 Financially, can we afford to raise a child? If I’m single, do I have the necessary resources to care for a child by myself?

 Does my health insurance plan cover maternity and newborn care?

 If I decide to return to work, do I have access to good child care?

If you haven’t thought about any of these issues so far, it doesn’t mean you’ll have an unhealthy pregnancy or be unable to care for a child. But the sooner you set the stage for a successful outcome, the better your odds. That’s true whether you’re still in the planning stages, are trying to conceive or already have a baby on the way.

IS YOUR BODY READY?

OK, so emotionally and financially, you’re ready to go. Now it’s time to find out if your body is primed for the task at hand. You don’t have to be exceptionally fit to have a child, but if you’re healthy to begin with, your chances of enjoying a healthy pregnancy are greater.

So how do you know if your body is ready for pregnancy? Have your care provider give you the green light. Make a pre-conception appointment with your obstetrician-gynecologist, family physician, nurse-midwife or other care provider who will be guiding you through your pregnancy. A preconception visit gives you and your care provider a chance to identify any potential risks to your pregnancy and establish ways to minimize those risks.

If possible, have your partner attend the preconception visit with you. Your partner’s health and lifestyle — including family medical history and risk factors for infections or birth defects — are important because they, too, can affect you and your baby.

At your appointment, your care provider will likely conduct a complete physical examination, including a pelvic exam and a blood pressure check. Some of the subjects you might talk about during your visit include:

Contraception If you’ve been taking birth control pills, your care provider may recommend a pill-free break before trying to conceive. This will allow your reproductive system to go through several normal cycles before you conceive, which will make it easier to determine when ovulation occurred and establish an expected due date. During the pill-free break, you may want to use condoms or another barrier method of contraception. Your fertility may return to normal two weeks after you stop taking the pill.

If you’ve been using a long-term method of birth control, such as contraceptive injection (Depo-Provera), you can try to conceive as soon as you stop using birth control — but be aware that it could take several months for fertility to return.

Immunizations Infections such as chickenpox (varicella), German measles (rubella) and hepatitis B can be dangerous for an unborn baby. If your immunizations aren’t complete or you’re not sure if you’re immune to certain infections, your preconception care may include one or more vaccines, preferably at least a month before you try to conceive.

Chronic medical conditions If you have a chronic medical condition — such as diabetes, asthma or high blood pressure — you’ll want to make sure the condition is under control before you conceive. In some cases, your care provider may recommend adjusting your medication or other treatments before pregnancy. He or she may also discuss any special care you may need during pregnancy.

Medications and supplements Tell your care provider about any medications, herbs or supplements you’re taking. He or she may recommend changing doses or stopping them altogether before you conceive.

This is also the time to start taking prenatal vitamins. Why so early? A baby’s neural tube, which becomes the brain and spinal cord, develops during the first month of pregnancy, possibly before you even know that you’re pregnant. Taking prenatal vitamins before conception is the best way to help prevent neural tube defects, which can result in spina bifida and other spinal or brain disorders.

PRENATAL VITAMINS

One thing you’ll likely be advised to do right away as you prepare for pregnancy is to start taking prenatal vitamins. If you’re wondering whether this daily routine really matters, rest assured that it does!

Prenatal vitamins help ensure you’re getting enough folic acid, calcium and iron — essential nutrients during pregnancy. It’s best to start taking prenatal vitamins three months before conception.

 Folic acid helps prevent neural tube defects. These defects are serious abnormalities of the brain and spinal cord. The baby’s neural tube, which becomes the brain and spinal cord, develops during the first month of pregnancy. You may not even know you’re pregnant during this critical time in baby’s development.

 Calcium promotes strong bones and teeth for both mother and baby. Calcium also helps your circulatory, muscular and nervous systems operate normally.

 Iron supports the development of blood and muscle cells for both mother and baby. Iron helps prevent anemia, a condition in which blood lacks adequate healthy red blood cells.

 Prenatal vitamins may reduce the risk of low birth weight. Some research suggests that prenatal vitamins decrease the risk of low birth weight.

Prenatal vitamins are available over-the-counter in nearly any pharmacy. Some prenatal vitamins require a prescription, however. Your care provider may recommend a specific brand of prenatal vitamins or leave the choice up to you.

If your prenatal vitamins make you feel queasy, try taking them at night or with a snack. Chewing gum or sucking on hard candy right after may help, too. If they seem to make you constipated, drink plenty of water, and include more fiber in your diet and physical activity in your daily routine. Also, ask your care provider about using a stool softener.

If these tips don’t seem to help, ask about other options. Another type of prenatal vitamin, or taking separate folic acid, calcium and iron supplements, may work better.

ADDITIONAL NUTRIENTS

While prenatal vitamins will take care of most of your nutrient needs, there are a couple of other nutrients you may want more of. Talk with your care provider about these:

 Vitamin D. This vitamin is especially important during the third trimester, when calcium demands increase. Most prenatal vitamins don’t contain optimal amounts of vitamin D. In addition to your prenatal vitamin, drink vitamin D-fortified milk or other calcium-rich foods containing vitamin D. If you don’t drink milk or eat calcium-rich foods, it may be wise to take calcium and vitamin D supplements.

 Omega-3 fatty acids. Standard prenatal vitamins don’t include omega-3 fatty acids. The benefits of omega-3 fatty acids on fetal development are uncertain, but there’s some evidence they may promote fetal brain development. If you’re unable to or choose not to eat fish or other foods high in omega-3 fatty acids, talk to your care provider to see if supplementation with omega-3 fatty acids might be appropriate.

Sexually transmitted infections Sexually transmitted infections can increase the risk of infertility, ectopic pregnancy — when the fertilized egg implants itself outside the uterus, such as in a fallopian tube — and other pregnancy complications. If you’re at risk of a sexually transmitted infection, your care provider may recommend preconception screening and treatment.

Family history Certain medical conditions or birth defects run in families and ethnic populations. If you or your partner has a family history of a genetic disorder or may be at risk, your care provider may refer you to a medical geneticist or a genetic counselor for a preconception assessment (see genetic screening in Chapter 20).

Previous pregnancies If this isn’t your first pregnancy, your care provider may ask about previous pregnancies. Be sure to mention any complications you may have had, such as high blood pressure, gestational diabetes, preterm labor or birth defects. If you had a previous pregnancy that involved a neural tube defect, your care provider may recommend a higher daily dose of folic acid than what’s found in most prenatal vitamins.

If you have any concerns or fears about another pregnancy, share them with your care provider. He or she will help you identify the best ways to boost your chances of a healthy pregnancy.

Lifestyle Healthy lifestyle choices during pregnancy are essential. Your care provider will likely discuss the importance of eating a healthy diet, getting regular exercise and keeping stress under control. Good nutrition and exercise create the ideal environment for creating a healthy baby. If you’re a snack-food junky, you might give up some of the junk food before you become pregnant and replace it with healthy fruits, vegetables and hearty whole grains. If your idea of exercise is a short jaunt from your car to work, make it a point to go for a walk or bike ride each day, or sign up for an aerobics or yoga class. This will help prepare your body for pregnancy.

If you’re underweight or overweight, your care provider may recommend addressing your weight before you conceive. As you prepare for pregnancy, it’s also important that you avoid alcohol, illegal drugs and exposure to toxic substances. If you smoke, ask your care provider about resources to help you quit.

HOW TO GET PREGNANT

Face it, some couples seem to get pregnant simply by talking about it. For others, it takes plenty of patience and a bit of good fortune. If you’re wondering what the best approach is to becoming pregnant, here’s what you need to know, and some tips to help you form that perfect union of egg and sperm.

Conception is based on an intricate series of events. Every month, hormones from your pituitary gland stimulate your ovaries to release an egg (ovulate). Once the egg is released, it travels to the fallopian tube to encounter any sperm that may be present. Your fertile period is the period of time when egg and sperm are most likely to meet. This window of opportunity is governed by two factors:

 The life span of sperm inside the woman’s reproductive tract (no more than five days)

 The even shorter life span of the egg (24 hours)

Your best chance of becoming pregnant is to have intercourse one or two days preceding ovulation. But how can you tell when you’re ovulating?

The simplest solution is to have frequent intercourse. If you consistently have sex two or three times a week, you’re almost certain to hit a fertile period at some point. But if you’d like to know more precisely when your fertile period is, there are ways to do this.

When you’re most fertile Following are some simple measures you can take that may help you predict when you’re fertile. You can use these methods separately or together. For example, some women find that combining the first three methods — tracking cycle days, changes in cervical mucus and basal body temperature — gives them a more accurate prediction of when they’re most fertile.

Calendar tracking Use your day planner or another simple calendar to mark the day your period begins each month. Day 1 is the first day of menstrual bleeding (not spotting). Also track the number of days each period lasts. For most women, ovulation occurs within four days of the midpoint of a cycle.

To determine a general time frame for your fertile period, track your menstrual cycles for several months. Subtract 18 from the number of days in your shortest cycle. When your next period begins, count ahead this many days. The next week is a reasonable guess for your most fertile days.

To increase your chances of becoming pregnant, have intercourse once a day during your fertile period, especially in the early days prior to ovulation.

 Pros. Calendar calculations can be done simply on paper and are fairly easy to remember.

 Cons. Many factors may affect the exact timing of ovulation, including illness, stress and exercise. Counting days is often inaccurate, especially for women who have irregular cycles.

Cervical mucus changes Just before ovulation, you might notice an increase in clear, slippery vaginal secretions, if you look for it. These secretions typically resemble raw egg whites. After ovulation, when the odds of becoming pregnant are slim, the discharge will become cloudy and sticky or disappear entirely.

 Pros. Changes in vaginal secretions are often an accurate sign of impending fertility. Simple observation is all that’s needed.

 Cons. Judging the texture or appearance of vaginal secretions can be fairly subjective.

Body temperature Your basal body temperature is your body’s temperature when you’re fully at rest. Ovulation may cause a slight increase in your basal temperature — typically less than one degree. You should be most fertile during the two to three days before your temperature rises. You can assume ovulation has occurred when this slightly higher temperature remains steady for three days or more.

Use a thermometer to monitor your basal body temperature. You might try a digital one or a type specifically designed to measure basal body temperature. Take your temperature every morning before you get out of bed. Plot the readings on graph paper and look for a pattern to emerge.

 Pros. It’s simple, and the only cost is the thermometer. It can be helpful in determining when you’ve ovulated and identifying if the timing is consistent from month to month.

 Cons. The temperature change may be subtle, and the increase may come after ovulation has already happened — too late for conception. It can be inconvenient to take your temperature at the same time every day, especially if you have irregular sleeping hours.

An ovulation predictor kit Over-the-counter ovulation kits test your urine for the surge in hormones that takes place before ovulation. For the most accurate results, follow the label instructions on how to perform the test.

 Pros. Ovulation kits can identify the most likely time of ovulation or even provide a signal before ovulation actually happens. These kits are available without a prescription in most pharmacies.

 Cons. Ovulation kits often lead to excessively targeted sex, and timing sex so precisely can invite being too late. For some women, the cost of ovulation kits is prohibitive.

HEALTHY SPERM

Male fertility depends on sperm quality and quantity, which can be affected by a variety of factors. Men may not be able to control everything that could improve their fertility, but there are steps that can be taken to maximize fertility and help ensure male sperm are top performers.

 Take a multivitamin. A daily multivitamin can help provide selenium, zinc and folic acid — trace nutrients that are important for optimal sperm production and function.

 Eat plenty of fruits and vegetables. These foods are rich in antioxidants, which may help improve sperm health.

 Reduce stress. Stress might interfere with certain hormones needed to produce sperm. Stress can also decrease sexual function.

 Get regular exercise. Physical activity is good for reproductive health as well as overall health. However, men who exercise to exhaustion show a temporary change in hormone levels and a drop in sperm quality.

 Be weight conscious. Too much or too little body fat may disrupt production of reproductive hormones, which can reduce sperm count and increase the percentage of abnormal sperm. Men at a healthy weight are most likely to produce lots of high-quality sperm.

If you’re having trouble If you’re in your early 30s or younger and you and your partner are in good health, try to conceive on your own for a year before consulting a doctor. You may want to seek help sooner if you’re age 35 or older, or you or your partner know or suspect that fertility issues may be a problem in your efforts to conceive a child.

Infertility affects men and women equally — and treatment is available. Depending on the source of the problem, your gynecologist, your partner’s urologist or your family doctor may be able to help identify the problem and suggest treatment. In some cases, a fertility specialist may offer the best hope.

ARE YOU PREGNANT?

Maybe your period is a day or two late, or maybe it’s just a gut feeling you have, but you think you might be pregnant — and you must know, now!

If you’ve been trying to conceive, how will you know if you’re pregnant? A big clue, obviously, is if you miss your period. But you may experience certain signs and symptoms even before then. In addition, home pregnancy tests are very accurate.

Early symptoms For some women, early signs and symptoms of pregnancy begin in the first few weeks after conception. Don’t get too hung up on early symptoms, though. Some can indicate that you’re getting sick or that your period is about to start. Likewise, you can be pregnant without experiencing any of these symptoms.

Tender, swollen breasts Your breasts may provide one of the first symptoms of pregnancy. As early as two weeks after conception, hormonal changes can make your breasts tender, tingly or sore. They may also feel fuller and heavier.

Fatigue Fatigue also ranks high among early symptoms of pregnancy. During early pregnancy, levels of the hormone progesterone soar. In high enough doses, progesterone can put you to sleep. At the same time, lower blood sugar levels, reduced blood pressure and increased blood production may team up to sap your energy.

Slight bleeding or cramping Sometimes a small amount of spotting or vaginal bleeding is one of the first symptoms of pregnancy. Known as implantation bleeding, it happens when the fertilized egg attaches to the lining of the uterus, usually about 10 to 14 days after fertilization. This type of bleeding is usually a bit earlier, spottier and lighter in color than a normal period and doesn’t last as long. Some women also experience abdominal cramping early in pregnancy that’s similar to menstrual cramping.

Nausea with or without vomiting Morning sickness, which can strike at any time of the day or night, is one of the classic symptoms of pregnancy. For some women, the queasiness begins very early — two to three weeks after conception. Pregnant women also have a heightened sense of smell, so various odors — such as foods cooking, perfume or cigarette smoke — may cause waves of nausea in early pregnancy.

Increased urination You may find yourself urinating more often than normal.

Food aversions or cravings You might find yourself turning up your nose at certain foods, such as coffee or fried foods. Food cravings are common, too. Like most other symptoms of pregnancy, they can be chalked up to hormonal changes.

Headaches and dizziness Increased blood circulation caused by hormonal changes may trigger frequent, mild headaches. In addition, as your blood vessels dilate and your blood pressure drops, you may feel lightheaded or dizzy.

Mood swings The flood of hormones in your body in early pregnancy can make you unusually emotional and weepy. Mood swings also are common.

Raised basal body temperature Your basal body temperature is your temperature when you first wake up in the morning. This temperature increases slightly soon after ovulation and remains at that level until your next period. If you’ve been charting your basal body temperature to determine when you ovulate, its continued elevation for more than two weeks may mean that you’re pregnant.

Home pregnancy tests If this seems like a lot of work, relax. An easier way to find out if you’re pregnant is to take a home pregnancy test. These user-friendly tests are widely available at drugstores and pharmacies. They work by detecting the level of human chorionic gonadotropin (HCG), a hormone associated with pregnancy, in your urine.

Taking the test is pretty simple. It usually involves holding a test stick in your urine stream or dipping the stick into a cup of collected urine. The results window on the stick will show a control line (to indicate the test is working) and the test result. Most test results show up as a line, plus sign or change in color. Check the packaging that’s included.

Home pregnancy tests are generally considered very accurate, but there are a few things to keep in mind to make sure you’re getting the best results:

 Because the amount of HCG increases with time — during early pregnancy HCG levels double every two to three days — wait a week after a missed period to take the test. It will give you a more credible result. If you can’t wait that long, consider taking a second test a week later.

 Test in the morning, when your urine is the least diluted.

 Positive results are more likely to be true than are negative ones.

 Follow the directions supplied with the test exactly.

Blood tests. If you have a positive result on your home pregnancy test, contact your care provider. In some cases, he or she may want to confirm the results with a blood test that’s more sensitive to levels of HCG than is a home pregnancy test. Or your care provider may schedule you for your first prenatal appointment without a blood test. In either case, let the excitement begin!

CHOOSING A CARE PROVIDER

Whether pregnancy is a new venture for you or you’re an old hand at it, finding the right care provider and enjoying the type of childbirth you want can make a big difference in your experience.

Plenty of options are available for obstetrical care, birth locations and birth plans. The challenge sometimes lies in deciding which options to choose. The nature of your pregnancy and your own personal preferences can serve as your guides. Take the time to think carefully about your options. Once you’ve made the decision, you’ll know that you chose your care provider for a reason. Trust his or her abilities to safely guide you and your baby through the birthing process, and allow your provider to give you the best possible care.

There are many people who provide maternity care. Here’s a brief look at each specialty.

Obstetricians-gynecologists Doctors of obstetrics and gynecology are commonly referred to as ob-gyns. They specialize in the care of women during pregnancy and also provide general reproductive care, including care of a woman’s reproductive organs, breasts and sexual function. Ob-gyns generally have advanced surgical training to deal with problems in women that may require surgery. Because of their emphasis on women’s health, ob-gyns are the doctors women most frequently see.

Practice Ob-gyns often work in a group practice consisting of various medical professionals, including nurses, certified nurse-midwives, physician assistants, dietitians and social workers. Ob-gyns may work in a clinic or hospital setting.

Advantages If you already see an ob-gyn that you like for your general health care, he or she may be a natural choice for continuing to provide care during your pregnancy and childbirth. Many women choose an ob-gyn for obstetrical care because if a problem or complication arises during pregnancy, they won’t have to switch care providers.

Issues to consider An ob-gyn can meet all the needs of most pregnant women, except perhaps those with extremely high-risk pregnancies. In such a case, your ob-gyn may refer you to a maternal-fetal medicine specialist.

You might choose an ob-gyn if:

 You have a higher risk pregnancy. You may be high-risk if you’re over age 35 or you develop diabetes (gestational diabetes) or high blood pressure (preeclampsia) during pregnancy.

 You’re carrying twins, triplets or more.

 You have a pre-existing medical condition, such as diabetes, high blood pressure or an autoimmune disorder.

 You want the reassurance that if a problem does arise, you won’t need to be transferred to a different care provider.

Nurse-midwives Nurse-midwives provide preconception, maternity and postpartum care for women at low risk of complications. Throughout much of the world, midwives are the traditional care providers for women during pregnancy. In the United States, the use of midwives is steadily increasing.

In general, midwives follow a philosophy that builds on the view that women have been having babies for millennia, and they don’t always need all of the technological intervention that’s available with today’s health care.

Midwives may not have a medical degree, but most receive formal training in midwifery and in well-woman care. Most midwives in the United States today are certified by the American Midwifery Certification Board.

Practice Midwives may work in a hospital setting, in a birthing center or in your home. They may practice solo, but they’re often are part of a group practice, such as a team of obstetric care providers. Most midwives are associated with an ob-gyn in case problems occur.

Advantages Midwifery care may offer a more natural, less regimented approach to pregnancy and childbirth than does standard care. If your child’s birth is attended by a midwife in a hospital, you’ll still have access to pain relief medications.

A midwife may be able to provide greater individual attention during pregnancy and may be more likely to be present during labor and delivery than is a doctor. Various studies have found no significant differences in outcome between having a midwife attendant who’s integrated with an existing health care system and having a doctor attendant for women with low-risk pregnancies.

Issues to consider When considering a midwife, ask about the person’s training, certification and licensure in your state. Also make sure she or he has a backup arrangement with a hospital so that you can have access to obstetrical skills and equipment in case problems develop.

If you’re not giving birth in a hospital, create an emergency plan with your midwife. Include details such as the name and phone number of your midwife’s backup doctor, the hospital you’ll be taken to, how you’ll get there, and the name and phone numbers of the people who need to be alerted. This can reduce stress later if you need to be transferred during labor.

You might choose a midwife if:

 You’re free of health problems and you expect a low-risk pregnancy.

 You want someone who can spend a significant amount of time discussing your pregnancy with you.

 You prefer a more personalized approach to the birthing process.

 You desire a less regimented birthing process.

 You desire fewer interventions.

Family physicians Family physicians provide care for the whole family through all stages of life, including pregnancy and birth. Some family physicians, however, choose not to handle pregnancies.

Practice Family physicians may work solo, or they may be part of a larger group practice that includes other family physicians, nurses and other medical professionals. Family physicians are usually associated with a hospital where they can perform deliveries.

Advantages If you’ve had the same family doctor for a while, he or she will probably know you well and be familiar with your family and medical history. Thus, a family doctor may view your pregnancy as part of the larger picture of your life. Another advantage of a family doctor is that he or she can continue to treat you and your baby after birth.

Issues to consider Family physicians can cover most obstetrical care, but if you’ve had problems with pregnancy before, your family physician may refer you to a specialist in obstetrics or use a specialist as a backup provider. The same may be true if you have diabetes, high blood pressure or another medical problem that may complicate your pregnancy.

You might choose a family physician for your prenatal care if:

 You and your doctor don’t foresee any problems with your pregnancy.

 You want your doctor to be involved with all members of your family.

 You enjoy the continuity in care from prenatal appointments throughout childhood and beyond.

Maternal-fetal medicine specialists Maternal-fetal medicine specialists are trained in the care of very high-risk pregnancies. They concentrate exclusively on pregnancy and the unborn child, dealing with the most severe complications.

Practice Similar to other doctors, maternal-fetal medicine specialists often work as part of a group practice, and they’re generally associated with a hospital, university or clinic.

Advantages This highly specialized doctor is familiar with the complications of pregnancy and adept at recognizing problems. When women with major medical concerns become pregnant, their physicians often consult with maternal-fetal medicine specialists to optimize care for both the mother and her baby.

Issues to consider Maternal-fetal medicine specialists concentrate solely on the problems that occur with pregnancy. These specialists tend to be less directly involved with their patients than are family physicians, ob-gyns and midwives. However, this isn’t true for all maternal-fetal medicine specialists. Don’t let that concern stop you from seeking out such a physician if you need the type of care he or she can provide.

A maternal-fetal medicine specialist rarely serves as the primary health care provider for a pregnant woman. This specialist is brought in at the request of another care provider. You may choose a maternal-fetal specialist if:

 You have a severe medical condition complicating your pregnancy, such as an infectious disease, heart disease, kidney disease or cancer.

 You’ve previously had severe pregnancy complications or had recurrent pregnancy losses.

 You plan on having prenatal diagnostic or therapeutic procedures, such as comprehensive ultrasound, chorionic villus sampling, amniocentesis, or fetal surgery or treatment.

 You’re a known carrier of a severe genetic condition that may be passed on to your baby.

 Your baby has been diagnosed before birth with a medical condition, such as spina bifida.

How to decide Navigating the health care system to find the right care provider for your pregnancy and childbirth can sometimes be a daunting process. Here are some suggestions that may be useful in your search.

Ask for help Try these approaches:

 Consult with your regular doctor and other medical professionals.

 Ask family and friends whom they would recommend.

 Contact your county medical society for a list of the providers in your area.

 Contact the hospital you prefer and find out who provides maternity care.

 Contact the labor and delivery unit at the hospital you prefer and ask the nurses for a recommendation.

Issues to consider Ask yourself these questions:

 Is the care provider certified by a medical board or the board of nurse-midwifery?

 Is the care provider’s office a convenient distance from home or work?

 Is the care provider going to be able to deliver my baby in the place I want to give birth — at a particular hospital or birthing center, or my home?

 Does the care provider work in a solo or group practice? If it’s a group practice, how often will I see him or her? How often will I see others from the practice?

 Who will replace my care provider if he or she isn’t available in an emergency or when labor begins?

 Is the care provider available to answer questions in between my scheduled appointments?

 Is the care provider covered by my insurance company?

 How much do I want my care provider to be able to treat my entire family?

 Did the individual listen to my concerns and provide answers to my questions?

 Did the individual seem open and caring?

CHOOSING A BIRTHING LOCATION

When deciding on a care provider you might also think about where you want to have your baby. This decision is often closely tied to your choice of a care provider and where he or she practices. Most women in the United States have their babies in a hospital, but there are other choices. Some women choose to give birth at a birthing center or in their own homes.

Hospital Most of today’s hospitals treat childbirth less like a medical procedure and more like a natural process. Many hospitals offer a relaxed setting in which to have your baby, with options such as:

 Birthing rooms. These are suites with a homelike decor, and sometimes a bath, where you can labor and possibly even deliver. The father or labor partner can be an active part of the birthing team. In some cases, you may be able to recover in the same room after having your baby.

 Rooming-in. In this arrangement, the baby stays with you almost all of the time instead of being taken to the nursery. An experienced nurse is available to help you with feeding and caring for the baby.

 Family-centered maternity care. This option combines the advantages of rooming-in and the more traditional nursery. During the day, a nurse cares for you and the baby at the same time and can teach you how to care for a newborn. At night, the nurse can take your baby to the nursery if you wish.

Birthing center Birthing centers can be free-standing facilities or part of a hospital. The goal of a birthing center is to separate routine pregnancy, labor and delivery care from the more intensive care required for high-risk pregnancies and births. In this way, birthing centers can reduce their costs because of the reduced need for personnel and equipment. They also strive to provide a more natural birthing experience and avoid overuse of medical intervention. Most birthing centers are run by certified nurse-midwives or teams of obstetrical care providers. You might consider a birthing center if you’re looking for a homelike experience and if there’s an affiliated medical center nearby. If your pregnancy is high-risk or you’re worried that complications could arise during childbirth, a birthing center may not be the appropriate choice. If complications arise, you’ll likely need to be transferred to a hospital, and that takes time.

Home In the United States, each year about 25,000 women have their babies at home. The trend for home births has been fairly stable and remains somewhat controversial. Midwives are almost always the care providers for home deliveries. Advantages of delivering at home are that you’re in a comfortable and familiar environment, and anyone you wish may be involved in the delivery. The disadvantage is that if problems arise, they may not be recognized early on. In certain situations, delay of care could compromise the health of mom and baby.

DELAYED PREGNANCY AND FERTILITY

Just because you’re a little older doesn’t mean you’ve missed the boat. Many women today put off pregnancy to go to school, start a career, travel, or simply enjoy time to themselves in their younger years. If you’re in your 30s or even 40s, you can still have a healthy pregnancy and a healthy child.

In fact, if you’re in your mid- to late 30s and hoping to become pregnant, you’re in good company. Over the past four decades, the average age of first-time moms in the United States has increased. In 1970, the average first-time mom was 21.4 years old. Today, the average first-time mom is closer to 25 years old. Though the numbers vary quite widely from state to state and for different ethnic groups, this upward trend is widespread, occurring in all ethnic groups and all 50 states. In countries such as Switzerland, Japan and the Netherlands, the average age is even higher, around 29.

During this same time period, the proportion of first births to women age 35 years and older has increased nearly eightfold. With advances in assisted reproductive technologies, some new moms are even in their late 40s or 50s. In 2007, for example, nearly 2,000 American women had their first child between the ages of 45 and 54.

Issues to consider The age of 35 is often viewed as the critical age when it comes to getting pregnant. While the biological clock is a fact of life, there’s nothing magical about the age of 35. It’s simply an age at which certain factors become worthy of discussion. For example:

Pregnancy may take longer You’re born with a limited number of eggs. As you reach your early 30s, your eggs may decline in quality and quantity — you may ovulate less frequently, even if you’re still having regular periods. An older woman’s eggs also aren’t fertilized as easily as a younger woman’s eggs. Does this mean you can’t get pregnant? Of course not. It may simply take longer. If you’re older than age 35 and haven’t been able to conceive for six months, consider asking your care provider for advice.

A multiple pregnancy is more likely The chance of having twins increases with age. The use of assisted reproductive technologies, such as in vitro fertilization, also may play a role. Since these procedures typically enhance ovulation, they’re more likely to result in twins or other multiples.

Risk of gestational diabetes is increased This type of diabetes occurs only during pregnancy, and it’s more common as women get older. Tight control of blood sugar through diet, exercise and other lifestyle measures is essential. Sometimes, medication is needed as well. Left untreated, gestational diabetes can cause a baby to grow too large, which increases the risk of problems during delivery.

Chances of a C-section are increased Older mothers have a higher risk of pregnancy-related complications that may lead to a C-section delivery.

Risk of chromosomal abnormalities is increased Babies born to older mothers have a higher risk of certain chromosome conditions, such as Down syndrome.

Risk of miscarriage is higher Miscarriage risk increases as you get older, perhaps due to the higher likelihood of chromosomal abnormalities.

Making healthy choices Steps toward a healthy pregnancy are the same for women age 35 and older as for younger women. To reduce your risk of complications and help ensure a healthy pregnancy at an older age:

 Seek regular care. See your care provider before you conceive, as well as during your pregnancy.

 Choose a healthy lifestyle. Eat a balanced diet, stay physically active and strive for the right amount of weight gain.

 Avoid risky substances. This includes alcohol, tobacco and illegal drugs.

 Read up on prenatal testing. Ask your care provider’s advice about the benefits and risks of each test. Although most prenatal tests simply confirm that a baby is healthy, their results can alert you to other possibilities.