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 Pregnancy & Motherhood

July 2009
Planning a Baby
Dr Sohani Verma
 
With the magic of monsoon, gorgeous greenery soaked in raindrops, beautiful breeze and peacocks dancing with joy, it would be no wonder that, the old, hidden, deep desire of having a beautiful baby starts surfacing! And why not? Parenthood is the biggest gift one can hope for! For most women getting pregnant is the ultimate dream of their married life.

So if this intoxicating, superb monsoon weather is making you feel "broody", here are a few health tips to make your journey to parenthood safer and shorter.

Plan your pregnancy
Ideally, a child should be born only when you want her / him and not merely out of accident or inadvertence!

"It is the greatest prayer between man and wife, that is going to bring into the world another soul fraught with tremendous power for the good of society." - Swami Vivekananda.

The above is correct not only spiritually, but also medically.

The most important thing a couple can do for the health of their future child is to plan well ahead. This will help you to get your body in the best condition possible. Only a healthy mother can provide the best and safest environment for her baby to grow in her uterus. Therefore, as soon as you start thinking about trying for a pregnancy, see your doctor / gynaecologist for "pre-pregnancy counseling." During this counseling, your doctor should be able to advise and guide you regarding the following important issues:

  1. Nutritious healthy diet and moderate regular exercises to achieve / maintain ideal body weight.
    • These have a huge impact on fertility, pregnancy and the final outcome. A balanced diet helps to regulate hormones and nourish the reproductive system. Being overweight or underweight – both disrupt your hormones. Maintain your ideal bodyweight for your height and age.
    • Stay physically active and continue moderate regular exercises while you are trying for pregnancy. However, vigorous, intense schedule of exercises when combined with being lean can disrupt your hormone productions, hence refrain from such routines.
    • Avoid foods that are rich in heavily processed carbohydrates and transfats (french fries, potato chips, foods made with refined flour, soft drinks etc).
    • Ensure adequate intake of folate and iron such as lentils, chickpeas, spinach, broccoli, asparagus, oranges, beets, lettuce etc.
    • A daily intake of Folic Acid 400 mcg tablet is advised whenever you plan to start trying and continue this during the first 3 months of your pregnancy. Folic acid is essential to the process of building and replicating DNA during conception and early pregnancy and its deficiency may lead to increased chances of miscarriage and congenital malformations in the baby.
    • Quit smoking, tobacco consumption, alcohol and drugs you may be addicted to. Discuss with your doctor the possible harmful effects of these and how to quit them.
    • Eliminate / minimise caffeine intake.
    • Avoid chronic physical and / or emotional stress and try to feel emotionally balanced.
  2. Get your general health checked
  3. Even if you think you are healthy, you need pre-pregnancy screening to rule out any sub-clinical illness and check your general health. A detailed medical and family history may point towards extra care to be taken to safeguard the pregnancy. A thalassaemia / sickle cell screening test may be advisable to exclude the carrier status, before you plan for a baby.
  4. Necessary immunisation Rubella (german measles), chicken pox, hepatitis A and B are some of the diseases which are known to cause serious harm to the foetus. These unnecessary risks could be avoided if the woman is already vaccinated before starting her pregnancy. Pre-pregnancy counseling is the golden opportunity to discuss and avail these protections.
  5. If you are on any medications for any chronic disorders, these may need a change to safeguard the foetus.
  6. Any previous or family history of inherited diseases should be reviewed and preventive plans can be laid down with the help of a genetic expert.

Understanding natural fertility
Although most women can easily conceive, it would be helpful to know that the average monthly chances of conceiving in normal couples of proven fertility are only 20-25%. The peak rate is 33% in the first month of trying and it then falls quickly in the next three months, settling to about 5% each month. It is essential to appreciate this chance nature of fertility and not raise your anxiety and stress level prematurely, which may only have a negative impact on fertility. If there are no obvious medical problems such as irregular, long cycles etc (and these would be eliminated at the prepregnancy counseling session), then just by waiting for a period of one year will yield natural conception in 80% of the couples. In a normal healthy couple, hence, it is not usually advisable to jump to fertility enhancing medical drugs before trying naturally for one year. Otherwise, the risk of multiple pregnancy and other side effects could be quite high in these fertile couples.

Improving fertility awareness
  • It comes as a surprise to most women, when they are informed that out of the whole month; there is only a "24 hour period' which is their fertile period. This is so because the life of the ova (egg / oocyte) after it is released from the ovary (ovulation) is only 24 hours, during which it can be fertilised by the sperm.
  • This 24 hour period of fertility may vary by 3-4 days either way, from cycle to cycle. Keeping this inter-cycle variability in mind, usually 6-8 days' period in each cycle is described as fertile period. In contrast to the egg's short life of 24 hours, most of the sperm survive up to 48-72 hours inside the woman's body and many would be still alive even 6 days after intercourse.
  • Ovulation usually takes place 14 days (+/- 3-4 days) before your next expected date of start of menstruation.
  • So if your menstrual cycle is of 28 days (interval between first day of one menstruation and the first day of next menstruation) then you are most likely to ovulate on day 14 of the cycle.
  • Hence, you can concentrate on trying for a baby between day 10 and day 18 of your cycle to cover the fertile 24 hours of your cycle. Methods to track ovulation If you are still unable to achieve your goal despite trying for over a minimum period of 3-6 cycles, you may wish to track the exact day of your ovulation to enhance your chances of conception.
  • Changes in the quality of your cervical mucus may indicate the timing of ovulation. It increases in quantity and becomes more slippery and stretchy (like eggwhite), usually 2-3 days before ovulation.
  • The basal-body temperature chart which earlier was very popular, is not considered very practical now-a-days. Also, the temperature chart tells you about the ovulation, only after it has already happened.
  • Hence this method is not often used these days.
  • There are several ovulation predictor kits available in the market these days, which work on the principle of detecting LH surge (luteinizing hormone) which occurs 12-48 hours prior to the ovulation. These are readily available in the market, with full instructions.
  • However, for most healthy couples, these kits are not necessary.
If even after one year of trying, you do not get the desired result, don't lose heart. See an infertility specialist. With the help of modern technology and expertise, most - if not all - couples are able to fulfill their dream of parenthood. So relax and enjoy the beauty of monsoon and your prayers will be granted soon!
Dr Sohani Verma is Senior Consultant Obstetrician Gynecologist and IVF Specialist, In-charge IVF Lab at Indraprastha Apollo Hospitals, New Delhi.

    
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