Pregnancy is possibly one of the biggest changes a woman’s body will encounter, before and after the baby is born. For that reason, it is important that you take care of yourself in order to, by extension, take care of your baby.

It’s a good idea to make an appointment with your doctor to discuss getting pregnant and pregnancy before you even begin trying. Look at any existing health conditions and how they may affect getting pregnant, pregnancy and delivery. If you’re on birth control, you may wish to ask about how this affects the length of time it might take you to get pregnant. It has been known to take a woman’s body up to three months before she can get pregnant after being on birth control for a substantial length of time. It also allows you to track exactly how many days your cycle is and when you’ll be ovulating. As always, every woman is different, so your doctor can best advise you about this.

Talk about starting an exercise routine so that your body is in good shape to handle the delivery. If you start an exercise program before you get pregnant, you’re more likely to continue on with it (with some modifications) during your pregnancy and after the baby is born. Look at cutting back on caffeine, alcohol consumption (excess alcohol intake has been shown to interfere with your fertility and can also lower sperm count in men) and cigarettes; try to quit if you can. Now is also the time to shed any extra pounds if necessary. Go over any changes in your diet that might be required so your body can handle the pregnancy in tip top condition. Now, rather than later, is the time to find your surefire stress buster; it might be funny movies, playing cards with friends, long walks in nature, or soothing music and a good book. You’ll also want to put support systems in place before the baby is born so that, if you need assistance or just a shoulder to lean on, you’ll know exactly where to go when the time comes.

There is also your family to consider; how is the pregnancy and new baby going to affect any children you already have, any adjustments your husband will have to make, and any concerns regarding extended family or pets. There’s also other, but just as important, things to consider as well, such as making sure you have a camera that’s handy and in good working order (makes a great shower gift!), painting the nursery (do it before you get pregnant), knowing the policies about maternity leave from work, having a “parenting talk” with your spouse or partner about who handles what and how, and visiting your dentist to have any necessary dental work taken care of. You might even want to book a getaway with your husband/partner or girlfriends before your life becomes centered around the baby. There are many more things you’ll want to consider before getting pregnant so let’s take a look at them now.

Preconception Health
The word “prenatal”, also known as “antenatal” in some countries, literally means “occurring or existing before birth”. When viewed in the context of “before birth”, the health of the mother should be considered even before she becomes pregnant. This is called preconception health. Going into a pregnancy with an already healthy body benefits both the mother and the child, including during the birth and afterward. With this in mind, you should be in the very best shape you’ve ever been in, in your life, before becoming pregnant. Look at it this way; you wouldn’t run a marathon without preparation so it just makes sense to prepare your body for pregnancy before it occurs. Being in the best shape you’ve ever been in before you get pregnant means:

• Your body will be able to give the baby all it needs before the birth
• Your body will have an easier time of the birth if your muscles are strong and healthy
• You’ll have more stamina for the birth (if you need it)
• You’ll have more stamina for after the birth so you can take care of your baby without feeling worn out
• You’ll sleep better (when you do sleep)
• Your body can make better use of the nutrients you’re giving it (and, by extension, giving to your baby if you breastfeed)

Preparation for pregnancy should begin at least 6-12 months before becoming pregnant and might include the following:

1. A complete physical to rule out any pre-existing conditions, shed light on any risk factors, and ensure existing conditions are under control.
2. Ensuring your vaccinations are up to date.
3. Stop smoking and reduce your use of alcohol and caffeine if necessary.
4. Reorganizing your diet to include the healthiest choices possible every day.
5. Preparing your body for the rigors of carrying a child, childbirth, and looking after your baby by being physically active and in good shape, at an appropriate weight, and are feeling mentally fit.
6. Setting up support systems (friends, family and professionals) so they’re at the ready when you might need them.
7. Educating yourself about what your body will experience during a pregnancy (remember, no two are alike) and afterward.

Prenatal Care – What’s Involved?

Prenatal Care – What’s Involved?
Once you’ve received the news that you are pregnant, you’ll want to begin seeing your doctor on a regular basis so that your pregnancy can be monitored and any problems can be spotted and/or prevented early on.

You may also wish to discuss the best way to quit smoking and begin limiting alcohol consumption if you haven’t done so already. You’ll be advised about which toxic substances or materials to avoid before, during, and after your pregnancy; some household chemicals and cat or rodent feces are prime examples of this.

After you become pregnant, expect to see your primary health care provider and/or midwife about once a month for the first six months, twice a month in the seventh and eighth month, and weekly in your ninth month unless otherwise advised. If pre-existing conditions are present which must be managed, such as diabetes or high blood pressure, they will probably want to see you more often. During these prenatal visits, your primary health care provider will advise you on topics such as birthing choices and classes, nutrition, supplements, rest, and exercise.

Supplements – During your first prenatal visit with your primary health care provider, be sure to talk about any supplements, herbals, and over-the-counter medications you’re currently taking. Your doctor may want you to alter your supplement regimen to include a prenatal supplement. These are commonly recommended for pregnant women and help ensure your body has the base elements it needs to support your health, and the baby’s, throughout the pregnancy. If you’re already taking a multivitamin (or combination thereof), you won’t want to overload your system and may just revert to taking the prenatal supplement, depending on what your doctor’s recommendations are. There are many prenatal vitamin formulas available today and your doctor will be able to recommend one that’s right for you. If you haven’t already, this is the time to add nutrients like folic acid to your diet.

Prenatal Care – Folic Acid
Prenatal Care – Nutrition & Exercise

Folic Acid
One very important vitamin is folic acid (aka folate, folacin, or pteroylglutamic acid or PGA). Folic acid is very important in pregnancy as it helps to regulate embryonic and fetal nerve cell formation, which is vital for normal development. Studies have shown that a daily intake of 400 micrograms in early pregnancy may prevent the vast majority of neural tube defects, such as spina bifida and anencephaly. It may also help to prevent premature birth. To be effective, this regimen must begin before conception and continue for at least the first three months of pregnancy; if a woman waits until she knows she is pregnant, it may be too late, because critical events in fetal development occur during the first six weeks of pregnancy – before many women know that they have conceived. 1 When you see your primary health care provider for prenatal care, he/she can advise you about which specific supplements you should be taking and their proper dosage.

Once you’re pregnant you truly are eating for two but you don’t have to take that literally. Weight becomes a concern when you begin to accumulate too much. Your doctor will advise you of exactly how much weight you can expect (or should) put on during the pregnancy. Remember, what you put on now has to come off later.

Eating for two means getting the most out of the calories you consume during the day. Choosing nutrient-dense foods over sugary, fat-saturated foods will only benefit you and your baby now and in the coming months. If you have trouble deciding on a diet that’s right for you, you can either consult with your doctor or a dietician to create a plan. And remember, the word “diet” simply refers to the foods you are consuming. Now is not the time to cut back but to move forward with healthy, nutritious choices that include fruits, vegetables, whole grains, water, nuts, seeds, healthy fats (olive oil, avocados) and low-fat dairy and lean meat choices. Remember to include foods rich in iron such as eggs, almonds, avocados, dates, kidney beans, lentils, peaches, pears, raisins, wheat bran, and soybeans. Getting enough iron prevents you from becoming anemic. Anemia is linked to preterm birth and low birth weight. Wash your fruits and vegetables thoroughly before consuming them, cook your meats to temperature, and store food properly to avoid food-bourne illnesses such as toxoplasmosis and listeria. Fish such as swordfish, king mackerel, shark and tilefish are particularly high in mercury so they are best avoided altogether.

Prenatal Care – Birthing Choices

Your doctor will either give you the green light to continue, or counsel you to refine your exercise program, once your pregnancy has been confirmed. There are plenty of gentle exercises you can continue with, providing you have your doctor’s okay first. Choose from water exercises for expectant moms, gentle yoga classes, Tai Chi, or even just walking every day but you’ll want to refrain from sports such as basketball, skiing, long-distance running, scuba diving, and things of that nature for obvious reasons.

Birthing Choices
This is something you’ll want to discuss with your partner and your doctor at the beginning of your pregnancy. The choices you have will depend on a few different factors, including:

• Where your doctor has practise privileges
• Your financial situation
• Availability of facilities and practitioners in your area (midwives, birthing centers)
• Your health history
• Home birth, if this is an option open to you

No matter where you live, you should be able to access prenatal classes. These classes come in many different shapes and sizes but all are geared toward one thing; to help prepare you and your partner for labour, delivery, and the aspects of early parenthood. You’ll want to consider classes run at a hospital, clinic, or local birthing center by either a doctor, a nurse, a midwife, or a properly trained individual. Don’t be shy about asking for credentials before the class begins and, if you hear anything during a class which you’re not sure about, always run it by your doctor or OBGYN for clarification before you act on it.

Stress and Rest

A good prenatal class begins at about 34 weeks and will either be advertised as a “women only” (some women are less comfortable with men in the room), “couples”, or “refresher” format and educate you on the following:

• The process of labour and childbirth
• Choices you may have to make during labour and delivery
• Details about medical procedures and interventions
• Relaxation, massage and breathing techniques during labour
• Birthing positions
• Pain relief choices
• Feeding options and breastfeeding workshops
• Care of your back during pregnancy, labour and delivery

A growing number of studies are confirming what used to be considered just an old wives’ tale – that stress really isn’t good for pregnant women. It not only increases the risk of pre-term labour, but possibly a host of other problems for babies after birth.2 Dr. Pathik Wadhwa, assistant professor of behavioral science, obstetrics and gynecology at the University of Kentucky College of Medicine states, “At each stage of development, the organism uses cues from its environment to decide how best to construct itself within the parameters of its genes.” Translation…a fetus does not simply need the right blueprint and nutrients to develop into a healthy baby. Dr. Wadhwa also advises that, “When the mother is stressed, several biological changes occur, including elevation of stress hormones and increased likelihood of intrauterine infection…the fetus builds itself permanently to deal with this kind of high-stress environment, and once it is born, may be at great risk for a whole bunch of stress-related pathologies.” Some studies even suggest that stress in the womb can affect a baby’s temperament and neurobehavioral development.

Postnatal Care
Rest for the New Mother

Postnatal care is the care of mother and child and begins the moment the baby is born and continues for the weeks and months after delivery. Postnatal care encompasses more than just the physical health of the mother and child. A comprehensive postnatal care program will also address the psychological and day-to-day needs of the whole family. During the weeks after delivery, a postnatal care program will monitor the development of the baby, provide education and support for the mother so that she may ease confidently into her new role, and ensure that dad and the rest of the family are supported while adapting to their roles within the new framework of their family. During this important period, it is essential to keep up with your regular visits to your primary health care provider so that mother and baby’s health can be monitored and anything that comes up can be dealt with right away.

The most important thing for the new mother is to get as much rest as possible as the physical exertion of the delivery and caring for a newborn can be exhausting work. A popular piece of advice that just makes good sense states that you should, “rest when the baby rests”, although many new mothers use this time to catch up on things like housework that could, and should, quite easily be handled by others. Wherever and whenever possible during the first few weeks, enlist the help of family and friends to pick up the slack on the more mundane necessities of keeping your household running (cooking, cleaning, laundry, paying bills, running the kids to school). When the new mother feels able, she should allow herself to participate in light activities around the house, resting whenever she feels the need arise. These light activities also help the new mother’s circulation, as the movement of the legs and feet can assist in preventing blood clots from developing. On the whole, a new mother should be able to return to her pre-pregnancy lifestyle within six to eight weeks, barring unforeseen complications. This can be confirmed during your visits with your doctor after the baby is born.

Postnatal Diet and Exercise

Nutrition is an important concern for a new mother, especially if she is breastfeeding. Now is not the time to begin restricting calories in an attempt to return to your pre-pregnancy weight. Breastfeeding mothers need to keep their fluid and caloric intake fairly high, and of best quality, to ensure optimum quality and quantity of breast milk. The word to pay attention to here is “quality”; choose nutrient-dense foods and stay away from processed foods, high sugar content foods, saturated fats, and empty calories.

However, if you are not breastfeeding, now is the time to revisit and review your pre-pregnancy diet and make the necessary changes. Your body still needs all the nutritional assistance it can get while resetting itself to pre-pregnancy functionality. Your nutritional intake should include protein-rich foods, milk products, whole grains, nuts and seeds, healthy fats (olive oil, avocado, walnuts), fresh fruits and vegetables (raw where possible for the fiber and nutrients), with a view to restricting saturated fats and foods with no redeeming nutritional value. Also, at the very least, include a daily multi-vitamin to ensure you’re meeting the recommended daily vitamin and mineral requirements. Your primary health care provider can assist you with this.

When your primary health care provider gives you the nod, you can return to an exercise program to help the muscles that were involved in carrying and delivering your baby to return to normal. Regular exercise also helps you increase the quality of your sleep which, in turn, helps you stay calm and feel energized.

Today’s new moms are lucky in that there are so many choices for “moms and tots” exercise classes where either the child actually becomes part of the class or childcare is provided right in the room where mom is exercising. Regular exercise can be something as simple as taking the baby out for a daily walk, weather permitting. If you can walk with others, so much the better, as this lets you multi-task; you’re not only benefiting from the exercise you get but also from the social contact you have.

As important as nutrition and exercise are, social contact is just as important as it keeps you from feeling isolated in your new role and helps put perspective on daily activities. If getting out of the house to exercise isn’t a possibility and you have the space, you might consider exercise DVD’s or hosting a mother/baby exercise class in your home.

Specific Vitamins and Minerals for New Mothers

Specific Vitamins and Minerals for New Mothers
As always, your primary health care provider will tell you what you need based on your medical records. However, for interests sake, the following are guidelines for new mothers to consider when evaluating their vitamin and mineral needs.

FOLATE – (aka folic acid) is involved in numerous chemical reactions in the body and is essential for normal growth of all cells. Pregnancy and childbirth can lower your body’s stores of this vitamin. Eating a well-rounded diet should give you the recommended daily intake (RDI) of folate.

VITAMIN B12 – is essential during pregnancy and while breast feeding for healthy development of your baby’s nervous system and red blood cells. It also helps prevent anemia, assists folic acid in the utilization of iron, and is required for proper digestion and the metabolism of carbohydrates and fats.

CALCIUM – is important to keep your bones strong, to maintain a regular heartbeat and the transmission of nerve impulses, and for the prevention of muscle cramps. It is especially important during lactation.

VITAMIN D – is in particularly low supply in human breast milk. You may also want to check your formula for the addition of vitamin D. Vitamin D is important for your baby as it is necessary for normal growth and development of bones and teeth, and lowers the risk of softened, deformed bones known as rickets. For mom, it’s important for the utilization and absorption of calcium and for normal blood clotting. Where and when possible and/or plausible, take your baby out for limited exposure to sunlight to encourage their own stores of vitamin D to develop and grow.

Iron Deficiency after Delivery
On a special note, if you experienced significant blood loss during or after delivery, you may feel especially weak and tired, short of breath, and you may have a poor appetite. Talk with your primary health provider about this. It is possible that the loss of blood has depleted the iron in your body. To rebalance the equation, consider including iron-rich foods in your diet such as meats, fish, poultry, eggs, green leafy vegetables, and prepared foods enriched with iron such as breads and cereals. You can read all about iron if you click here.

Breastfeeding

To breastfeed or not is a very personal choice and depends on a lot of factors, some of which you may not be able to control. If breastfeeding is not an option for you, there is no reason to feel less than adequate nor should you let anyone make you feel you’re doing less than everything that you possibly can for your baby. Whether you breastfeed or not, feeding your baby can be a joyful, bonding, restful experience between mother and child. Your doctor is the best person to discuss breastfeeding with and he/she can point you in the direction of the best formula to use for your baby should you decide not to breastfeed.

Early breast milk, known as colostrum is very rich in nutrients and antibodies which is passed on from the mother to the child at each feeding. Colostrum eventually changes over to “mature milk” by the fifth day after birth, is thinner than colostrum, and contains just the right amount of fats, sugar, water and protein necessary for the newborn to flourish and grow.

Breastfeeding can be good for the new mother’s health as well. Over and above the relaxation aspect during feeding time, breastfeeding has been linked to a lower risk of Type 2 diabetes, breast cancer, ovarian cancer and postpartum depression.3 There are no bottles or nipples to sterilize, it’s less expensive, you can express your milk for later use, and you can feed your baby on demand whenever and wherever necessary.

Sometimes, as much as a new mother wants to, circumstances prevent her from breastfeeding. A few examples might include producing a low supply of breast milk, medicial conditions or serious illness/infections, taking medications that might be passed on to the baby, drug/alcohol addiction, or conditions such as mastitis. Occasionally, it might not be the mother but a condition of the baby that rules out breastfeeding; for example, if the baby is born with choanal atresia (a narrowing or blockage of the nasal airway). If you can’t breathe through your nose, you can’t nurse. Severe cholic and/or bowel conditions may also make it necessary for the baby to be put on a formula that is better for their condition.

Postpartum Depression

Postpartum depression is a discussion which is as necessary to have between doctors, pregnant women and their partners, as talking about what happens during labor and delivery. The more education and discussion around this topic, the less mystique and fear it holds for women and their families.

According to Womenshealth.gov, a division of the Department of Health and Human Services, USA, “about 13% of…new mothers have depression.” When you are pregnant or after you have a baby, you may be depressed and not know it. Some normal changes during and after pregnancy can cause symptoms similar to those of depression. But if you have any of the following symptoms of depression for more than 2 weeks, call your doctor:

• Feeling restless or moody
• Feeling sad, hopeless, and overwhelmed
• Crying a lot
• Having no energy or motivation
• Eating too little or too much
• Sleeping too little or too much
• Having trouble focusing or making decisions
• Having memory problems
• Feeling worthless and guilty
• Losing interest or pleasure in activities you used to enjoy
• Withdrawing from friends and family
• Having headaches, aches and pains, or stomach problems that don’t go away

Hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of estrogen and progesterone increase greatly. In the first 24 hours after childbirth, hormone levels quickly return to normal. Researchers think the big change in hormone levels may lead to depression.4

There is a difference between what is referred to as the “baby blues” and postpartum depression. The baby blues most often resolve themselves within a few days or a week whereas postpartum depression symptoms last longer and are more severe. Postpartum depression can begin anytime within the first year after the baby is born. Care from family members after childbirth needs to include the psychological state of the mother, remembering that it is normal for a new mother to experience some extent of confusion, baby blues, fatigue, sleeplessness, and changes in appetite. However, if a new mother begins to have thoughts of hurting the baby, herself, or loses interest in the baby altogether for an extended period of time, it is necessary to talk to a health care professional about these concerns. It becomes urgent to consult with a health care professional if the symptoms of depression become more and more intense and if thoughts of causing harm arise.

If you are meeting with your doctor on a regular basis, tell him/her about the feelings/emotions/thoughts you are having and how they might be affecting your ability to function on a daily basis. If your doctor thinks there is any reason for concern, he/she will discuss this further with you, get you the help you need, and/or reassure you about the feelings you’ve been having after the birth of your child.

Physical and Emotional Wellbeing

In this modern day and age, women who decide to have children are very lucky indeed. Advances in medical science now allow for greater care to be given in the prenatal period as well as after the baby is born. And more is understood about what a woman goes through, physically as well as mentally, during and after the pregnancy. There are childbirth classes and support networks set up in every community that all families can take advantage of and there are birthing options now which allow the family to choose exactly the experience of childbirth that’s right for them. If you are considering getting pregnant, so much is available to you that you should never feel alone or isolated during or after your pregnancy.

In some communities and cultures, it is still felt that a woman is at her most beautiful when she is pregnant and, to a certain extent, this is true. However, make no mistake; pregnancy is hard on a woman’s body and mindset for nine months and these conditions can continue even after the child is born. Don’t think you need to bear this all on your own. If you feel you need to, don’t hesitate to reach out to others, keep in touch with your doctor, take care of yourself, and ask for assistance. Pregnancy and childbirth should be a time that is enjoyed, cherished, and shared by everyone nearest and dearest to a woman while she is beginning this new chapter of her life.

 Pregnancy: 1st Trimester, Questions to Discuss with Your Doctor – Harvard Medical School
 Prenatal care: 1st Trimester Visits – Mayo Clinic Printable Fact Sheet
 Pregnancy and Healthy Weight, National Institute of Child Health & Human Development
 Glossary of Maternal and Fetal Medicine Terms, Children’s Hospital of Philadelphia
 An Expectant Dad’s Guide to Pregnancy, WebMD
 New Dad’s Survival Guide – a cute, witty website for expectant and new Dads
 Pregnancy, Birth and Beyond for Dads and Partners

References:

1. Prescription for Nutritional Health, Fourth Edition, Phyllis A. Balch, CNC

2. Fetus to Mom: You’re Stressing Me Out!

3. Breastfeeding

4. Depression During and After Pregnancy