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Pregnancy For Dummies®, 3rd Australian and New Zealand Edition

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Table of Contents

Pregnancy For Dummies®, 3rd Australian & New Zealand Edition

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About the Authors

Jane Palmer is a highly respected, privately practising midwife in Sydney. She manages her company Pregnancy, Birth and Beyond and provides midwifery, childbirth education and lactation services. For over 20 years, she has supported women and their families from preconception to the year following birth. As one of the first Medicare-eligible midwives in Australia, she provides midwifery care in collaboration with the group practice Midwives @ Sydney and Beyond, caring for women planning to give birth at home, hospital or in a birth centre. Being passionate about breastfeeding, she became an International Board Certified Lactation Consultant in 2008. She actively campaigns for the improvement in maternity care and maintains the popular website www.pregnancy.com.au.

Jane is the mother of three children — Joshua, Jarred and Lia — and is grandmother to Dakota. She enjoys family life, writing and travelling.

Joanne Stone, MD, is a full-time faculty member in the internationally renowned Division of Maternal-Fetal Medicine at The Mount Sinai Medical Centre in New York City. She is the director of the Division of Maternal-Fetal Medicine and also cares for patients with problem pregnancies. She has lectured throughout the country, is widely published in medical journals, and has been interviewed frequently for television and magazines on topics related to pregnancy, with a special emphasis on the management of multiple pregnancies. Away from the hospital she loves to spend time with her husband, George, and her two little girls, Chloe and Sabrina.

Keith Eddleman, MD, works with Joanne at Mount Sinai. He is a professor in the medical school and the Director of Obstetrics at the hospital. He teaches medical students, residents and fellows, lectures throughout the world, and appears often on television to discuss issues concerning the care of pregnant women. His areas of special expertise are ultrasound and reproductive genetics. His free time, when he has any, is split between spending time with his family at their apartment in Manhattan or at their country house in upstate New York.

Mary Duenwald is a writer and editor who has for many years specialised in medicine and science journalism. She has written for The New York Times, Discover, Smithsonian, and Departures. She has been executive editor of Harper’s Bazaar, Women’s Sports & Fitness, and The Sciences magazines and a senior editor for Vogue. She is a contributing editor for GQ. She is also the mother of twins, Nick and Claire Murray.

Authors’ Acknowledgements

Writing this book was truly a labour of love. We would like to thank everyone who played a part in the ‘birth’ of this book, specifically the following.

From Jane: So many people contributed to this third edition and I’m forever grateful. My colleagues Robyn Dempsey and Melanie Jackson provided many suggestions from a midwifery perspective. Yvette Barton and Anna Russell took the time to review the book extensively from a non-medical perspective. Rebecca Crisp, Charlotte Duff and Hannah Bennett (and the rest of the Wiley Publishing Australia team) were wonderfully supportive (and understanding when certain deadlines weren’t met). Some amazing technical reviewers volunteered their time to look at sections in their area of expertise. Technical reviewers include Catherine Harding, Marion Gevers and Karen Willetts (from the Australian Multiple Birth Association), Jacinda Jaensch (acupuncturist and traditional Chinese medicine practitioner), Sandra Venables (aromatherapist and homeopath), Sue Watson (from Trauma and Birth Stress — TABS), Christine Carroll (from SANDS Australia National Council), Sharon Franklin (osteopath), Dr Sarah MacNeil (chiropractor) and Peter Jackson (CalmBirth practitioner). All of whom provided such valuable input to make this great book even better.

From Joanne, Keith and Mary: Tami Booth, Jennifer Ehrlich, Christy Beck, Elizabeth Kuball, Paula Lowell and the other folks at Wiley Publishing, Inc. who conceived this idea. Sophia Seidner and Carolyn Krupp and the folks at International Management Group and Dr Jill Fishbane-Mayer for establishing the initial connection. Drs Lynn Friedman, Mary D’Alton, Richard Berkowitz and Ramona Slupik for excellent comments and suggestions and Dr Ian Holzman for nurturing us through the newborn chapter. Kathryn Born and Judith Morgan for taking our scrap art and turning it into terrific illustrations. And to all our patients over the years whose inquisitive minds and need for accurate information inspired us to write this book.

Dedication

From Jane: To my husband, Frank, the biggest thank you. Without your ongoing support I would never have finished this book. To the wonderful midwives at Midwives @ Sydney and Beyond, thank you for your expertise and just being there when I needed you most. And to my friend Anna Russell for your support and practical help.

From Joanne, Keith and Mary: To George, Chloe, Sabrina, Regina, Phillip, Frank, Melba, Jack, Nick and Claire for all their love and support

Publisher’s Acknowledgments

We’re proud of this book; please send us your comments at . For other comments, please contact our Customer Care Department within the U.S. at 877-762-2974, outside the U.S. at 317-572-3993, or fax 317-572-4002.

Some of the people who helped bring this book to market include the following:

Acquisitions, Editorial, and Vertical Websites

Senior Project Editor: Charlotte Duff

Acquisitions Editor: Rebecca Crisp

Editorial Manager: Hannah Bennett

Production

Graphics: diacriTech

Proofreader: Catherine Spedding

Indexer: Don Jordan, Antipodes Indexing

Special Art: Kathryn Born, Judith Morgan and Glenn Lumsden

Every effort has been made to trace the ownership of copyright material. Information that enables the publisher to rectify any error or omission in subsequent editions is welcome. In such cases, please contact the Permissions Section of John Wiley & Sons Australia, Ltd.

Introduction

Welcome to the third Australian & New Zealand edition of Pregnancy For Dummies. This book presents a comprehensive, research-based guide to what’s one of the most memorable experiences in anyone’s life — pregnancy. The For Dummies books are known for being accurate and informative, yet easy to read. This format is the perfect medium to present a no-nonsense, light-hearted, user-friendly and, at times, humorous guide to pregnancy.

When you’re pregnant, you find that everyone has advice — health professionals, friends, family and even strangers. Some of the information can be conflicting, based on personal opinion, out of date or just plain incorrect, and can cause unnecessary anxiety. Having access to the facts, based on the latest research, enables you to put things into perspective. This focus is one of the guiding principles of Pregnancy For Dummies and information provided is aimed at helping you enjoy pregnancy and not worry needlessly. If you have any concerns, keep in mind that you can consult a midwife or doctor. So, enjoy the miraculous process of having a baby.

About This Book

Many women are curious about what lies ahead each step of the way during their pregnancy. The information in this book is written in such a way that you can take things one trimester at a time, if you like, using Pregnancy For Dummies gradually, as you enter into each stage of pregnancy. You can also consult the book as needed if you run into some particular question or problem.

Some expectant parents want to read everything they possibly can about all aspects of pregnancy, find out all there is to know about the latest advances in care, and read up on every possible option open to them. Others want to read only the information relevant to them and avoid reading about any potential problems. For this reason, we give you information on complications and unusual situations at the end of the chapters and in Part V.

Keep in mind that research advances fairly quickly. A great effort is made to ensure that all the information in this book is accurate and up to the minute at the time of publication. But, as you can well imagine, in a very short period of time further advances are made and information on pregnancy expands.

We trust that you use this book as a companion to regular care received from a health-care professional. Some of the information may lead you to ask questions that you may not have thought to ask. Because no one answer or even a right answer to every question can be given, you may find that your midwife or your doctor holds a different viewpoint to some of the information presented in Pregnancy For Dummies. A difference of opinion isn’t uncommon between health-care professionals. So, while this book provides a lot of factual information, as with most information sources, the information shouldn’t be regarded as ‘gospel’. Remember also that many topics presented on pregnancy are for general readership; your situation is unique and certain aspects might warrant extra consideration and attention.

Conventions Used in This Book

We use a couple of conventions in this book:

check.png The terms partners and expectant parents are used. While traditional male–female couples account for the majority of expectant parents, babies are born into many different circumstances. These circumstances may involve single parents, same-sex couples, adoptive parents, or pregnancies that involve surrogacy. In this book, the terms partners and expectant parents cover all situations.

check.png Three main types of health-care professionals provide care to pregnant women: Midwives, general practitioners and obstetricians. (We explore the roles and philosophies of each of these caregivers in detail in Chapter 2.) As a convention for this book, we choose to use the term midwife or doctor to refer to the pregnancy professional. In some situations, we do specify ‘doctor’ — for example, in circumstances that clearly call for the services of a doctor.

Foolish Assumptions

As health professionals, we know from experience that many prospective parents, whether expecting their first child or their fifth, are very keen to find out everything they can about pregnancy, birth and caring for a newborn.

We assume you want answers to all these questions and more:

check.png How will I know when I’m in labour?

check.png Is it safe to have sex during pregnancy?

check.png What prenatal testing is available and why?

check.png What are my options of pregnancy and birth care?

check.png When is the baby’s heart formed?

With the multitude of available sources of information on the subject — books, magazines, newspapers, television and the internet — sorting through and finding what you’re looking for can be difficult. Pregnancy For Dummies does this for you.

How This Book Is Organised

The organisation of the parts and chapters of this book represents a logical flow of information about the pregnancy process. The following sections provide a more detailed overview of each of the six parts.

Part I: In the Beginning

For many women, pregnancy is unplanned; for others, it’s a conscious choice. Planning ahead is a good idea — including seeing a caregiver before you conceive. Even if planning that far ahead is already too late, this part of the book fills you in on what’s happening to your body during the first days and weeks of pregnancy. In this part, you can also find out what happens at a prenatal visit. And you can find out the general scope of what your life is going to be like for the next nine months.

Part II: The Pregnancy Trilogy: A Masterpiece in Progress

Like all good narratives, pregnancy has a beginning, middle and an end. The stages are called trimesters. The way you feel and the kind of care you need vary with each stage. In this part, you get an idea of how each trimester unfolds.

Part III: The Big Event: Labour, Birth and Beyond

After you put in your nine months, it’s time for labour — that important event that results in the birth of your baby. At this point, a lot is going on in a short time. Your experience depends heavily on the support you receive both during pregnancy and labour, and what kind of birth you have. This part covers the basic scenario of labour, birth and the early days after birth — plus a number of different variations on the theme.

Part IV: Pregnancy and the Modern Woman

This part covers contemporary issues facing expectant parents. Today, most women choose to work through pregnancy and want to know their rights as well as how pregnancy can affect them at work. The use of complementary and alternative therapies is increasing and we look at the different treatments available. The average age of a woman having her first baby is increasing and family structures are changing. We explore these and other issues in detail.

Part V: Special Situations

This part is where to look for information about all kinds of special situations that may arise during pregnancy. If you’re having any kind of difficulty, from the mundane to the serious, this part is the one to consult.

In a way, it would be nice if we didn’t have to have a section about some of the challenges that come up during pregnancy. In an ideal world, every woman’s experience would be perfectly trouble-free. On the other hand, many of the difficulties that can arise needn’t develop into full-blown problems if they’re taken care of properly. The information we provide may help you explore your options should any special needs arise.

Part VI: The Part of Tens

The Part of Tens is standard in all For Dummies books. This part is a great place to put aspects of pregnancy in a nutshell. Here, we dispel some common myths. We also explain how you can find out more about getting the best from your midwife or doctor.

Icons Used in This Book

Like other For Dummies books, this one has little icons in the margins to guide you through the information and zero in on that special information. The following paragraphs describe the icons and what they mean.

missing image filePregnancy brings about all kinds of changes in your body — for example, certain hormones flow more freely. We use this icon to point out the physical changes you can anticipate.

missing image fileMany things you may feel or notice while you’re pregnant can beg the question, ‘Is this important enough for my midwife or doctor to know about?’ When the answer is yes, you see this icon.

missing image fileThis book avoids being alarmist, but some situations and actions may come up that a pregnant woman clearly needs to avoid. When this is the case, you see the Caution icon.

missing image fileThe internet is a wonderful place to access information on pregnancy and birth. This icon highlights some great sites for you to check out.

missing image fileWorrying to some degree is normal during pregnancy. This icon highlights issues that cause some women to worry, but which are considered normal or not harmful.

missing image filePartners experience a lot through pregnancy (though, let’s face it, not nearly to the degree that pregnant women do). And partners can do, or should know about, certain things along the way. This icon points out the things that are particularly for them.

missing image fileLots of myths and misconceptions surround pregnancy and birth. This icon highlights some of the major myths.

missing image fileWe flag certain pieces of information with this icon to let you know when something is particularly worth keeping in mind.

missing image fileThis icon signals that we’re going to delve a little deeper than usual into a technical explanation. We don’t mean to suggest the information is too difficult to understand — just a little extra detailed.

missing image fileThis icon marks bits of advice we can give you about handling some situations that may arise during pregnancy, birth or beyond.

Where to Go from Here

Ideally, you’re reading this book before you get pregnant. If so, you can take advantage of the information on how to prepare for pregnancy in Chapter 1; for example, by making sure you’re healthy and in reasonably good shape, by taking folic acid ahead of time and by scheduling a preconception appointment with your caregiver. We expect, though, that the majority of expectant parents start reading about pregnancy after they’ve conceived. Chapters 2 to 20 cover what happens after conception occurs.

Pregnancy For Dummies is written in a logical sequence so you can follow your pregnancy as it progresses. If you’re at the start of your pregnancy and want to find out more about diet and exercise, you can check out Chapter 4. If you’re in your third trimester, no problem — just drop in to Chapter 7 and you’re on your way.

You can read the book from cover to cover if you wish or use it as a reference (the book has a great index). Bookmark the pages that are especially interesting or relevant to you. Write little notes in the margins. And we want to hear from you on how you find Pregnancy For Dummies. Most of all, have fun and enjoy your pregnancy!

Part I

In the Beginning

Glenn Lumsden
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In this part . . .

I’m not sure I’m ready for parenthood’ is a normal reaction to finding out that you’re pregnant, no matter how long you’ve been thinking about having a baby and no matter how long you’ve been trying to conceive. Suddenly, you’re faced with the reality that your body is about to undergo some profound changes; a baby is going to take shape inside you and you’re going to be a parent. Ambivalent feelings about pregnancy are very normal.

You can take positive steps to help prepare yourself for pregnancy ahead of time. One step is to visit a health-care practitioner who has an interest in preconception care four months before you plan to conceive. Even if you’re not that far ahead of the game, this part can help you explore some of the many ways you can prepare yourself physically and emotionally for the very important, very interesting next nine months.

Chapter 1

From Here to Maternity

In This Chapter

arrow Discovering the importance of preconception care

arrow Exploring the questions you can expect at a preconception visit

arrow Improving chances of conception

Congratulations! If you’re already pregnant, you’re about to embark on one of the most exciting adventures of your life. The next year or so is going to be filled with tremendous change and, chances are, unbelievable happiness. If you’re thinking about getting pregnant but aren’t yet pregnant, you’re probably keen to find out all you can to help ensure a healthy pregnancy and baby.

In this chapter, we explore ways in which you can get ready for pregnancy. You can visit a caregiver who has an interest in preconception care, investigate your family and personal health history and take some simple steps to optimise the likelihood of having a healthy, uncomplicated pregnancy. You may also like to gain or lose weight, enhance your diet, quit smoking, review medications and avoid contact with potential hazards. We also provide you with some basic information on ways to improve chances of conceiving a baby, and we touch on the topic of infertility.

Before You Get Pregnant

Preparation for pregnancy, or preconception care, ensures optimal health of both parents before conception, maximising the potential of your future baby’s health and wellbeing. Scheduling and attending a preconception visit with a health-care practitioner can help ensure your body is tuned up and ready to go. Caregivers who specialise in preconception care include naturopaths, doctors and midwives. Preconception visits vary depending on the philosophy of the person you see. Typically though, a preconception visit includes taking a detailed health history, and a urine and blood test. The caregiver educates you on ways to improve your health and your partner’s health before conception and may suggest dietary changes, lifestyle changes, relaxation techniques, natural medicines and/or menstrual cycle charting.

missing image fileIf you’re already pregnant and haven’t had a preconception visit, don’t worry. The important focus now is on maintaining a healthy lifestyle and seeking appropriate health care. Your body prioritises the health of your baby.

missing image filePartners often enjoy going along to the preconception visit. Being involved from the beginning has the added advantage of potentially bringing you closer together. Attending the preconception visit is very helpful, because part of the process is to go over the health background of both biological parents (including sperm or egg donors). In addition, you gain understanding of what lies ahead for both of you.

Exploring your family history

Reviewing your family’s medical history alerts both you and your caregiver to conditions that may complicate your pregnancy or be passed on to the developing baby. You can take positive steps before conception to reduce disorders such as neural tube defects (spina bifida, for example); this is important particularly if you’ve a family history (see the sidebar ‘Why the hype about folic acid?’, later in this chapter). In Chapter 5, we discuss in more detail different genetic conditions and ways of testing for them.

Looking at your ancestral history

Your preconception visit involves questions about your parents’ and grandparents’ ancestry — not because your caregiver is nosy, but because some inheritable problems are concentrated in certain populations. Again, the advantage of finding out about these problems before you get pregnant is that if you and your partner are potential carriers of a genetic disorder, you’ve more time to become informed and to check out all of your options (see Chapter 5).

Past pregnancies and yourgynaecological history

Information about previous pregnancies helps you and your caregiver make decisions on your future pregnancies. You need to discuss any prior pregnancies, miscarriages, premature births, stillbirths or twins — anything that could happen again. Your gynaecological history is equally important because things like prior surgery on your uterus or cervix or a history of irregular periods also may influence your pregnancy.

Considering your personal health

Most women contemplating pregnancy are perfectly healthy and don’t have problems that affect pregnancy. Even so, a preconception visit is very useful to help you plan your pregnancy and to learn more about how to optimise your chances of having a healthy and uncomplicated pregnancy. You can find out more about good nutrition, getting started on a safe exercise program (see Chapter 4), reducing contact with potential hazards, and what vitamin and mineral supplements are recommended.

Some women do have medical disorders that can affect the pregnancy. So, expect your caregiver to ask whether you’ve any one of a list of conditions. For example, if you have diabetes, stabilising your blood sugar levels before you get pregnant and watching those levels during your pregnancy are important. If you’re prone to high blood pressure (hypertension), your doctor or health practitioner wants to get that condition under control before you get pregnant. The reason is that controlling hypertension can be time-consuming and can involve changing medications more than once. If you have other problems — epilepsy, for example — checking your medications and making sure your condition is under good control are important. (See Chapter 17 for more on medical conditions that can affect, and be affected by, pregnancy.)

Caregivers usually ask questions about whether you smoke, drink alcohol or use any recreational/illicit drugs. Questions on lifestyle issues aren’t meant as an interrogation; your caregiver is trying to assess factors that may affect pregnancy, to be able to provide you with appropriate support. The point is that these habits can be harmful to a pregnancy and dropping them before you get pregnant is best. Your caregiver can advise you on ways to do so or refer you to help or support groups. (See Chapter 3 for more information.)

missing image fileFor further information on preconception care, visit the websites Foresight, The Association for the Promotion of Preconception Care () and OHbaby ().

Commonly Asked Questions

Your preconception visit is a time for you to ask your caregiver questions. In the following sections, we answer some of the most common questions about body weight, medications and quitting birth control.

Checking your weight

The last thing most women need is another reason to be concerned about weight control, but this one is important — pregnancy goes more smoothly for women who are neither too heavy nor too thin. Overweight women find it more difficult than normal to conceive a baby, and have a higher-than-normal risk of developing complications during pregnancy. Underweight women risk having too-small (low birth weight) babies.

missing image fileTry to reach a healthy, normal weight before you get pregnant. Trying to lose weight after you conceive isn’t advisable, even if you’re overweight. And if you’re underweight to begin with, catching up on kilograms when the baby is growing may be difficult. (Read more about weight and weight gain in Chapter 4.)

Reviewing your medications

Many medications are known to adversely affect pregnancy and many more have unknown effects. Some medications are teratogenic, which means they cause the baby to develop abnormally. Because of the potential impact of some medications, you’re well advised to have all medications carefully scrutinised, including medications prescribed by your doctor and medications you can buy from a pharmacy or local supermarket. Headache and cold preparations, antacids, laxatives and even humble vitamin tablets all need to be reviewed. Your caregiver can guide you on appropriate medications before and during pregnancy. If you’re taking medication, you may be able to switch to a safer preparation before trying to fall pregnant.

The following are some of the common medications that women ask about before they get pregnant:

check.png Aspirin (Aspro, Cardiprin 100, Disprin): Avoid aspirin in pregnancy, particularly in the later stages. Aspirin interferes with the clotting process in both the mother and the baby. Aspirin can also potentially cause problems during the birth for the mother and haemorrhage in the baby. Please note that some doctors prescribe low-dose aspirin for certain medical conditions in pregnancy. Low-dose aspirin is taken under strict medical guidance only.

check.png Herbal preparations: Seek advice if contemplating the use of herbal preparations in pregnancy. If a herbal remedy is recommended to you, check with the prescriber about the safety of the preparation for you and your baby. Many herbal preparations haven’t been tested to determine their safety during pregnancy.

check.png Injectable contraceptives: Your menstrual cycle may take several months to return to normal after discontinuing injectable contraceptives. Most women find ovulation returns within three to six months. Some women, however, find their cycle doesn’t return for 12 to 18 months. Long-term use of injected contraceptives can decrease bone density, so taking daily calcium and vitamin D supplements may be advisable — but consult your health care practitioner before taking either calcium or vitamin D supplements.

check.png Oral contraceptive pill: The oral contraceptive pill can lower blood levels of zinc and interferes with the way the body metabolises vitamin A, making levels too high or too low. The oral contraceptive pill also affects folate, B complex vitamins and vitamin C levels. For this reason, stop the pill for at least three months before trying to fall pregnant; although if you fall pregnant sooner, the effect is minimal. In the meantime, use alternative forms of contraception like condoms or a diaphragm.

check.png Vitamin A: High levels of vitamin A can cause miscarriage and birth defects. Vitamin A can remain in your body for several months, complicating the situation further. Stop any medications that contain vitamin A derivatives — the most common is the anti-acne drug Accutane — at least one month before trying to fall pregnant. Just a note of caution: Some anti-wrinkle creams, such as Retin-A and Renova, contain vitamin A derivatives, the effects of which are unknown.

The recommended amount of vitamin A from all sources is 2,500 international units (IU) per day. Taking high-dose vitamin A supplements in pregnancy isn’t recommended, except under supervision of your midwife or doctor. Check any vitamin supplements you’re taking to see if they contain vitamin A. Vitamin supplements formulated for pregnancy generally contain quite low doses of vitamin A, whereas general multivitamins may not. Note that you actually need more than three times the recommended daily intake of vitamin A to reach the ‘danger zone’.

missing image fileIf you’re worried that your diet plus your vitamin supplement may put you into that ‘danger zone’ of 8,000 IU per day, rest assured that getting that much vitamin A in your diet is extremely difficult.

Knowledge of the effects of medications, supplements and herbal preparations on the baby is far from complete, particularly the long-term effects. Your caregiver can carefully guide you about any medications you require, minimising any potential side effects.

Vaccinations and immunity

People are immune to all kinds of infections, either because they contracted the disease in the past (for example, most of us are immune to chickenpox because we had it when we were kids, causing our immune systems to make antibodies to the chickenpox virus), or because they’ve been vaccinated (that is, given a shot of something that causes your body to develop antibodies — immune system agents that help protect you against infections).

Rubella is a common example. Your caregiver checks to see whether you’re immune to rubella (also known as German measles) by drawing a sample of blood and checking to see that it contains antibodies to the rubella virus. These days, the recommendation is that you have a vaccination against rubella at least three months before becoming pregnant (if you’re not immune), but if you get pregnant before the three months is up, it’s highly unlikely to be a problem. The fact is that no known cases have been reported of babies born with problems due to the mother having received the rubella vaccine in early pregnancy.

Most people are immune to measles, mumps, poliomyelitis and diphtheria, and your caregiver is unlikely to check your immunity to all of these illnesses. Besides, these illnesses aren’t usually associated with significant adverse effects for the baby. Chickenpox, on the other hand, does carry a small risk of the baby contracting the infection from the mother. If you know you haven’t had chickenpox, let your caregiver know and discuss the option of having a vaccination before you get pregnant.

Being vaccinated against an illness in pregnancy generally isn’t advisable. Some vaccines during pregnancy pose a possible risk to the baby. Limited evidence has been gathered to date on the effects of vaccines on pregnant women. On the other hand, Australia’s National Health and Medical Research Council states that no convincing evidence exists for vaccines being harmful to the baby (though more research is necessary). Vaccination may be recommended when the risk of the disease is greater than the theoretical risk of the vaccine to the baby. (See Table 1-1 for safe and unsafe vaccines during pregnancy.)

/Table 1-1a

/Table 1-1b

Quitting birth control

How soon you can get pregnant after you stop using birth control depends on what kind of birth control you use. The barrier methods — such as condoms, diaphragms and spermicides — work only as long as you use them; as soon as you stop, you’re fertile. Hormone-based medicines — including the Pill and Depo-Provera — take longer to ‘get out of your system’. You may ovulate very shortly after stopping the Pill (weeks or days, even). On the other hand, resuming regular ovulatory cycles after stopping Depo-Provera can take three months to one year.

No hard-and-fast rules exist about how long you should wait after stopping birth control before you start to try to conceive. You may choose to wait three or even four months after stopping the oral contraceptive pill, due to its effects on your body’s vitamin and mineral balance. But if you want to, you can start to try to conceive right away. If you’re very fertile, you may get pregnant on the first try. But keep in mind that if you haven’t resumed regular cycles, you may not be ovulating each month and timing your intercourse to achieve conception may be more difficult. (At least you can have a good time trying!) If you get pregnant while your cycles are irregular, working out exactly what day you conceived and, therefore, knowing your due date, may be more difficult. (For more information about calculating your due date, see Chapter 2.)

If you use an intrauterine contraceptive device (IUCD), you can get pregnant as soon as you have it removed. Sometimes a woman conceives with her IUCD in place. If getting pregnant with your IUCD in place happens to you, your doctor may choose to remove the device because the device left in place puts you at risk of miscarriage, or giving birth prematurely. Your doctor also checks that the pregnancy isn’t ectopic, which is a pregnancy that gets stuck in the fallopian tube and never makes it to the uterus. (See Chapter 5 for more on ectopic pregnancies.)

missing image fileGetting pregnant with an IUCD in place doesn’t put the baby at increased risk of birth defects.

Increasing Your Chancesof Getting Pregnant

The title of this book notwithstanding, we’re going to assume that you know the basics of how to get pregnant. What many people don’t know, though, is how to make the process more efficient, so that you give yourself the best chance of getting pregnant as soon as you want to. To do this, you need to think a little about ovulation — the releasing of an egg from your ovary — which happens once each cycle (usually once per month).

After leaving the ovary, the egg spends several days travelling down the fallopian tube, until it reaches the uterus (also known as the womb), as shown in Figure 1-1. Most often, pregnancy occurs when the egg is fertilised within 24 hours from its release from the ovary, during its passage through the tube, and the budding embryo then completes its journey down the tube and implants in the lining of the uterus. (See Chapter 5 for an overview of what happens after fertilisation.) In order to get pregnant, you need to get the sperm to meet up with the egg as soon as possible (ideally, within 12 to 24 hours) after ovulation. And the best way for this to happen is for the sperm to be in the tube already waiting for ovulation.

So when does ovulation happen? It was once thought that ovulation occurred about 14 days before you got your period, which is, if your menstrual cycles are 28 days long, 14 days after the first day of your previous period. However, new research indicates that you can ovulate anywhere from day six in your cycle to around day 21. (Each cycle begins on the first day of a period.)

Figure 1-1: An overview of the female reproductive system.

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Some women find that they can pinpoint the time of ovulation more easily if they keep track of their temperature, which rises close to the time of ovulation. To do this, you take your temperature (orally) each morning before you get out of bed. It typically reaches its lowest point right before your pituitary gland releases luteinising hormone (LH), which triggers ovulation. (Two days after the LH surge, your temperature rises significantly — about a half to one degree above baseline — and stays elevated until you get your period. If you get pregnant, your temperature remains high.) You may want to invest in a special ‘basal body temperature’ thermometer (sold in most pharmacies) because this type of thermometer has larger gradations and is easier to read.

When checking your temperature to determine ovulation, keep in mind the following:

check.png A rise in your basal body temperature indicates that ovulation has already occurred. This measure doesn’t predict when you ovulate, but it does confirm that you’re ovulating, and gives you a rough idea when ovulation occurs in your cycle.

check.png Reading the signals can sometimes be hard because not all women follow the same pattern. Some women never see a distinct drop in temperature, and some never see a clear rise.

Other options for working out whether you’re ovulating are available, including the following:

check.png Home ovulation predictor kit: This monitors the LH surge by testing the amount of LH in urine. As opposed to basal body temperatures mentioned earlier, the LH surge is useful in predicting when ovulation occurs during any given cycle. A positive test for any cycle tells you that you’re ovulating. In general, these kits are very accurate and effective. The main drawback is the expense. At around $8 to $50 per kit, they’re more expensive than taking your temperature.

check.png Salivary ovulation predictor kit: These kits detect increasing levels of salt in your saliva (which occurs as your oestrogen levels rise as you near ovulation) using a pocket-sized portable microscope. When salt dries, it crystallises into a fern-like pattern. You can help identify your fertile window by the ferning that occurs in the days leading up to ovulation. At around $70, these kits aren’t a cheap option.

check.png Observing your mucous secretions: The amount and type of mucus produced by the cervix changes during your menstrual cycle. Typically, infertile mucus is absent, thick or sticky. Fertile mucus is wet and slippery, sometimes described as egg white in appearance. Having sex when your mucus is in the fertile phase increases the chance of conceiving a baby. The ovulation method, or Billings Method, can be easily learnt both for conception or contraception. Some caregivers teach this method and you can find it described in some books in detail.

missing image fileFor websites exploring the Billings Method visit WOOMB International () and FertilityFriend.com ().

missing image fileTo make sure that you get the sperm in the right place at the right time, have sex several times around the time of ovulation, starting five days before you expect to ovulate and continuing for two to three days afterward. How often? Once every two days is probably adequate. (If the sperm count is down, waiting a couple of days between sexual intercourse increases the chances of conception.) If your partner has a normal sperm count, have sex as often as you like. Sperm can last in the cervix, uterus and tubes for up to five days.

It was once thought that having sex daily would result in a lower sperm count and reduce fertility. However, later medical studies found that this is true only in men who have a lower-than-normal sperm count to start with.

To achieve a pregnancy, the absolute prime time to have sex is 12 hours before ovulation. The sperm are then in place as soon as the egg comes out. Sperm are thought to live inside a woman’s body for 24 to 48 hours, although some have been known to fertilise eggs when they’re as much as seven days old.

No couple should count on getting pregnant on the first try. On average, you’ve a 15 to 25 per cent chance each month. Studies show that roughly half of all couples trying to get pregnant conceive within four months. By six months, three-quarters of couples achieve conception; by a year, 85 per cent do; by two years, the success rate is up to 93 per cent. If you’ve been trying unsuccessfully to conceive for a year or more, consult a caregiver.

missing image fileYou can take a few steps to improve your chances of conceiving, including the following:

check.png Avoid contact with chemicals: Use common sense when using cleaning agents and chemicals around the home. If you’ve any concerns regarding your work environment, speak to your caregiver. (For more on checking your work environment once you’re pregnant, see Chapter 13.)

check.png Avoid eating fish known to accumulate high levels of mercury (see Chapter 4 for details).

check.png Find out when you’re ovulating: If you succeed in doing this, you can plan your sexual encounters at the most opportune time.

check.png Improve your nutrition: Take nutritional supplements if recommended.

check.png Quit smoking cigarettes or marijuana: If you smoke, don’t. (Call the Quitline for help — 13 78 48 in Australia and 0800 778 778 in New Zealand.)

check.png Reduce or eliminate alcoholic drinks: Alcohol can decrease the chances of becoming pregnant. Research has found that five or more drinks each week reduce the chance of conception by around 50 per cent (more on alcohol in Chapter 3).

check.png Reduce or eliminate caffeine intake: Caffeine is found in coffee, tea, cola drinks and chocolate. In large amounts, caffeine has been shown to inhibit ovulation.

check.png Use safe lubricants during sex: Many over-the-counter lubricants contain spermicide, resulting in rapid loss of sperm and decreasing remaining sperm’s motility (ability to move). Choose one of the fertility-friendly lubricants on the market.

missing image fileIn most cases, you’re well advised to just relax and enjoy the process of trying to conceive. Don’t get too anxious if it doesn’t happen right away. Remember that by one year after trying to conceive a baby, 85 per cent of couples have success.