Are You Really Ready to Have a Baby?
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How Sure Are You? 
Your pregnancy affects everyone, not just the two of you.  There are many things to consider BEFORE getting pregnant.
MAKING THE DECISION PREGNANCY AND YOUR CAREER
THE COST OF BABY PREGNANCY AFFECTS EVERYONE
PRE-CONCEPTION EVALUATION
including both Family Histories 
and Your Medical History		 AGENTS THAT CAUSE BIRTH DEFECTS
Environmental, social, legal and 
illegal drugs
WHAT ELSE AFFECTS PREGNANCY? LIFESTYLE CHANGES
PREPARING THE WORLD YOUR NUTRITION AND HEALTH
MATERNITY LEAVE PROBLEMS? ADDITIONAL RESOURCES
EXIT THIS PAGE
MAKING THE DECISION
Making the decision to start or add to a family is not a simple or easy one. Pregnancy will involve all aspects of your lives: emotional, physical, financial, career, partnership and all personal relationships.
You and your partner must look at your motivations for wanting to be parents and what it means to you. By answering the following questions, you can begin discussions to honestly make this life-altering decision.
  • Are we a stable couple?
  • Will we share responsibilities of child care, home care?
  • Are we the same religion? If not, does this pose a problem for the child's religious training?
  • Will a child add to our relationship?
  • Do we have similar ideas about education, discipline?
  • How will having a baby affect our careers?
  • Can we afford a baby? (See Cost of Baby above)
  • Can we afford child care?
  • Do we have a support system near us to help, if needed?
  • Do we have an emotional support system, if needed?
  • If we had to support a parent or sibling (emotionally, financially, physically), could we do this with a child?
  • Will our insurance cover maternity and newborn expenses? If not, NOW is the time to change your coverage to include maternity/newborn/well child expenses.
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    You and your partner should honestly discuss these and other questions that may arise, before you get pregnant. You should BOTH agree that the time is right for a pregnancy.
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    PREGNANCY AND YOUR CAREER
    Your pregnancy and post-delivery period WILL affect your career, even if you decide to return to work soon after delivery. The Pregnancy Act of 1979 has helped women during pregnancy and the Family Leave Act of 1993 has helped mom and dad spend time with their child after delivery. However, each employer has individual policies regarding pregnancy and maternity leave. The following is a suggested list of questions to ask your employer/company regarding pregnancy and maternity leave:
    • How long may I work while pregnant?  If prolonged standing is required, can another position be found for me after I can no longer stand for long periods?  When I can no longer travel, can alternative work be found for me?  Can alternative work be found if my doctor wishes me to take it easy?  Can I put in less hours if my doctor suggests it? Do you require the doctor to verify the safety of working during pregnancy?
    • Can I take leave before the baby is born?  How soon?  Do I get paid? 
    • What is the company policy on maternity leave?  Is this separate from vacation/sick leave?
    • What is your husband's company policy on Family Leave?
    • Do I maintain my seniority while on maternity leave?  Do I get paid while on maternity leave? Does the company consider maternity leave a disability?
    • Can I return to the same position?  Is my job protected while I am on leave? For how long?
    • Is the maternity leave policy in writing?  IF SO, GET A COPY. IF NOT, REQUEST IT.
    • How long do I have after birth before I must return? If a C-section is done, is that time extended? Can I take vacation/sick leave to stay home longer?
    These questions need to be answered before you get pregnant. If you are experiencing difficulties getting information or with your maternity leave, please see Additional Resources Below.
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    PREGNANCY AFFECTS EVERYONE
    CHOOSING A CARE GIVER/DELIVERY CENTER
    Know exactly what kind of birth you want, the type of person to deliver your baby, and the method of childbirth preparation you want to use.  Don't be afraid to interview people.  (This is covered elsewhere on this site.)
        Now that you have made the choice to become parents, found your practitioner and chosen your birthing place, it is time to really begin.
        Before we start getting physically healthy to have a baby, we need to look at the emotions involved. Emotions influence our general health, body, weight, relationships with other and all other facets of our lives. Pregnancy is a time of intense emotions for a woman, probably more so than at any other time in her life. Dad also is feeling more intense emotions, perhaps not hormone-helped like Mom, but still present. How will it feel to be parents, perhaps again? What will being pregnant be like? You will receive more advice than you have ever received in your life. Even strangers will come up to you and tell you how to feel. How will your parents, friends, co-workers and children feel about this pregnancy? All of this depends on their past experiences and whether or not they were good or bad. What you need to understand is that YOUR feelings are the important ones. 
        Mom's body will change and become different. How this is perceived and reacted to by Dad and Mom both will affect your interest in the pregnancy and each other. You need to know, before beginning, that pregnancy adds stress to any relationship. You need to trust each other, communicate your feelings, including your fears, and learn to compromise. No one ever said a pregnant woman was not emotional. Hormones have something to do with it, but even more important is the inner feelings Mom has about herself and her partner. Body image can change sexuality and Dad needs to be supportive of these changes. 
        Interest in sex can also be altered during pregnancy. Elizabeth Bing and Libby Coleman in Making Love During Pregnancy found four patterns: (1.) It increased throughout pregnancy  (2.)  It increased in the middle trimester but decreased during the last trimester  (3.) It stayed the same  (4.) It decreased throughout pregnancy. In other words, we don't know until it happens. But with understanding and a supportive relationship, both Mom and Dad will be able to communicate their feelings. 
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    PRE-CONCEPTION EVALUATION
    TIMING YOUR VISIT
    Both Mom and Dad should be present for the pre-conception visit. This should be about three months before you plan to get pregnant. The length of your visit should allow enough time to examine Mom, draw blood for laboratory studies, evaluate both Mom's and Dad's medical and family history, and to ask questions. A follow-up visit should be scheduled approximately one week later to go over the results of all the information gathered. At that time your caregiver will discuss changes that may need to happen begin getting pregnant. Pregnancy Nutrition, Exercise, etc is covered under the Pregnancy Sub-Division. It may be a good idea to check them over now.
    FAMILY HISTORY IS IMPORTANT
    Because each of you contribute half of the chromosomes (genetic material that determines specific features, such as eye color) for your baby, both Mom's and Dad's family history is important. Twins, ethnic background, hemophilia, Down's syndrome, mental retardation, sickle cell disease, muscular dystrophy and cystic fibrosis are all inherited. It is important that your doctor know if there is anyone in the family that has these problems. It is also important to know if there is a history of diabetes and high blood pressure in Mom's family since these could put you at an increased risk to develop this during pregnancy. Please see the evaluation form at the end of the chapter to help in evaluating your family history.
    YOUR MEDICAL HISTORY
    Your past and current medical history is very important. Childhood illnesses and immunizations are essential. Rubella is devastating and is still around. If you need immunizations, no is when to get them. Some immunizations are safe in pregnancy. Dad can bring home measles and other diseases so his immunization history is also important.
        If your are currently taking medications, these may need to be changed before pregnancy so that they do not affect your baby. An example of this is coumadin (a blood thinner medication) which can cause birth defects. Heparin (another blood thinner medication) can be used instead and does not cause problems for your baby.
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    AGENTS THAT CAN CAUSE BIRTH DEFECTS
    TERATOGENS
    A teratogen is any medication, chemical, infectious disease, or environmental agent that might interfere with the normal development of a fetus and result in the loss of a pregnancy, a birth defect, or a pregnancy complication.  This is just a small listing of the most devastating drugs.  A complete listing of all drugs, their classification (how they affect development of the baby), and the affects can be found at Drugs in Pregnancy and Lactation: Complete Listing
    AGENTS AND DRUGS THAT CAUSE BIRTH DEFECTS
    There are over thirty known Absolute Human Teratogens (cause birth defects in developing fetus).  See the common ones below this chart.
    TYPE OF DRUG or AGENT NAME OF DRUG OR CHEMICAL
    ENVIRONMENTAL organic solvents, chemicals, lead, anesthetic gases, organic mercury
    SOCIAL alcohol, cocaine, nicotine
    LEGAL Seizure medications (such as Dilantin, Valproic Acid, Tegretol), Accutane, thalidomide, chemotherapy, lithium, Warfarin, cyclophosphamide
    ILLEGAL Alcohol, Cocaine
    INFECTIOUS DISEASES rubella, cytomegalovirus, genital herpes, toxoplasmosis, Fifth's disease, chicken pox (varicella)
    OTHER diabetes, radiation, hyperthermia (high fever)
    COMMON DRUGS USED AND 
    THEIR EFFECTS ON YOUR BABY
    PRESCRIPTION DRUGS
    Thalidomide
    A tranquilizer, Thalidomide can cause partial to complete ABSENCE both arms and legs.  Thalidomide is now back on the market in the United States.
    Valproic Acid
    Used to treat epilepsy, women who take are twice as likely to have a baby with Spina bifuda (defect of spinal cord or brain). 
    Retinoic Acid
    Used to treat skin disorders such as acne
    There is a 40% chance of having problems during pregnancy or having a baby with birth defects.  Some of the effects of retinoic acid include: small lower jaw; cleft palate; heart and brain malformations; small, malformed ears; acaudia (no end of spine), acrania (no head)
    Cyclophosphamide
    Cyclophosphamide has caused, cardias defects, decreased fertility and other effects in BABIES born to mothers who take the drug while pregnant. There is a 25% chance of birth defects if the drug is taken during the first trimester. 
    SOCIAL DRUGS
    ALCOHOL
    The affects of Mom's alcohol use during pregnancy has long been recognized.  It can cause decreased growth before and after birth, specific facial abnormalities (such as low set ears), and mental retardation of varying severity (including learning disabilities and possibly hyperactivity).  These problems are called the Fetal Alcohol Syndrome (FAS).
        More recent studies have now shown that Dad's alcohol use can also cause problems.  These can include decreased growth before birth, learning disabilities, behavior problems and changes in the babies immune system.  These problems are called Fetal Alcohol Effects (FAE).
        There is no question that the mother's alcohol intake can cause the more severe problems.  But in light of the recent findings about Dad's consumption,  refraining from alcohol should be done by both parents-to-be.
    CIGARETTES (NICOTINE)
    Nicotine causes physiological responses in the fetus, which allows it to be called a toxicant, but smoking is not a major cause of congenital malformations.  If Mom smokes during pregnancy, she may have up to twice the risk of miscarriage.  Decreased growth of the baby before birth has also been seen.  Abruptio placentae ( premature separation of the placenta from the uterus), placenta previa (the placenta covering the opening of the birth canal), premature rupture of the membranes (early breaking of the bag of fluid around the baby) and premature delivery can be caused by cigarette smoking. 
        There may also be an association between Dad's smoking before pregnancy and an increased risk of brain cancer in the baby in later life, especially if the child is a boy.
        Secondary smoke from Dad or others in the household or in the workplace can increase the risk of minor learning disabilities.
        A carcinogenic agent (cancer producing) from second hand smoke can pass through the placenta and can cause bladder, brain and other types of cancers in the babies when they are older.  A recent study bay the American Medical Association has proved beyond doubt that second hand smoke gets to your baby.  If yiou are around someone who smokes, your baby is 'smoking'. 
        Cigarette smoking should definitely be discontinued in the pre-conception period.  Your doctor can prescribe the patch and/or various behavior modification classes that could help with this.
    ILLEGAL DRUGS
    The use of illegal drugs on a recreational and addictive level can be a BIG problem for your child.
    MARIJUANA
    The evidence is still not conclusive on marijuana use either in pregnancy or before.  Because the question still exists of possible problems, the smart thing is not to use it.
    COCAINE
        Cocaine and crack use by Mom during pregnancy has been associated with heart and brain defects, learning disabilities, stillbirth, prematurity and  decreased growth.  Crack use has been shown to cause abruptio placentae and increase in the number of miscarriages.  There is an increase in the number of Crib Deaths when Mom uses cocaine during pregnancy. Even though Crib Death is not a defect, cocaine does have an effect on it. 
        Dad's use of cocaine is now being studied.  There has been an association with learning disabilities in children born to fathers who used cocaine.  Evidence exists that cocaine  may attach itself to sperm and be carried to the egg during fertilization.
    Because the effects can be devastating for your baby, illegal substance use should be stopped before attempting to get pregnant.
    ENVIRONMENTAL AGENTS
    Mercury    
    The following are the forms of mercury that can cause birth defects:
    • mercuric chloride - spontaneous abortion
    • metallic mercury vapor - effects the brain and can cause minor mental retardation
    • methylmercury - the MOST teratogenic form because it is easily absorbed into the GI tract of Mom and crosses the placenta to go into the baby's blood.  It causes cerebral palsy, blindness, speech disorders, tremors, convulsions, abnormal reflexes and mental retardation

    Polychlorinated (brominated) biphenyl  (PCB's)    PCB can cause lower birth rates, skin discoloration, uncoordination, and conjunctivitis.
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    LIFESTYLE CHANGES
    Your doctor may make certain recommendations about your diet, exercise regimen, habits, vitamin use, medication changes, stress and exposure dangers. You will be started on prenatal vitamins.
        She will also inform you of specific test that you may need during pregnancy, such as an amniocentesis (a test that draws fluid from around the baby to determine specific diseases and genetic problems).
        Now may be the time to also take a last fling or vacation as two. Remember, when baby comes you may find it a little more difficult to do mountain climbing for awhile.
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    PREPARING THE WORLD
    Now that you are preparing yourselves for the changes in your life, it is time to prepare the people in your world. If you have children, you may want to begin talking about a new brother or sister. If changes have to be made in your job, now is the time to discuss this and maternity/paternity leave with your employer. You also need to know your rights as a pregnant worker. The time to find out is before you are pregnant.
        Mom and Dad are now healthy and prepared, but when is the best time of the month to get pregnant? Check it out under the Subjects in this Section: Getting Pregnant
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    RESOURCES THAT MAY HELP MATERNITY LEAVE PROBLEMS:
    9to5,
    The National Association of Working Women
    American Civil Liberties Union:
    Women's Rights Projects
    National Organization for Women
    Women's Legal Defense Fund
    ADDITIONAL GENERAL RESOURCES THAT MAY HELP:
    A Check List of What
    You Need to Know
    STOP Trying Not to Get Pregnant
    Pregnancy Preparation
    A Date with Your Doc
    A Tongue in Check Look
    at Preparation for Pregnancy
    ADDITIONAL DRUG AND BIRTH DEFECTS RESOURCES THAT MAY HELP:
    Excellent 'Don't Miss It' Site
    About Drugs and Birth Defects    		 Drugs in Pregnancy and Lactation:
    Complete Listing
    When Can Pregnancy be
    Affected by Drugs?    		 List of Hazards to
    Reproduction by OSHA
    Herbs in Pregnancy to Avoid Teratogen Information System
    Environmental Teratogens Clinical Teratology Web
    Birth Defects Caused by Drugs Search for a Drug
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