1. Schedule a preconception visit
You don't have to have a doctor or midwife lined up to deliver your baby yet, but call your ob-gyn, midwife, or family practice doctor now for a preconception checkup. Your practitioner will review your personal and family medical history, your present health, and any medications or supplements you're taking. Certain medications and supplements are unsafe during pregnancy, and some may need to be switched before you even try to conceive because they're stored in your body's fat and can linger there.Your practitioner will likely discuss diet, weight, exercise, and any unhealthy habits you may have (such as smoking, drinking, and taking drugs); recommend a multivitamin; make sure you're up to date on your immunizations; test you for immunity to childhood diseases such as chicken pox and rubella; and answer any questions you have. In addition, you may be referred to a specialist if you have certain medical conditions, such as asthma, diabetes, or high blood pressure, that need to be controlled before you get pregnant.
If it's been at least a year since you had a checkup, you can also expect to have a pelvic exam and a Pap smear, and to be tested for sexually transmitted diseases if you're at risk.
2. Consider genetic carrier screening
Depending on your ethnic background and family history, your practitioner may encourage you to get genetic carrier screening before you start trying to conceive to see whether you or your partner is a carrier for serious inherited illnesses such as cystic fibrosis, sickle cell disease, and others. If both you and your partner are carriers, your child will have a 1 in 4 chance of having the disease.You can meet with a genetic counselor who will be able to tell you more about the condition and help you sort out your reproductive choices. This may be the single most important thing you can do to help ensure a healthy baby, and all it requires is a saliva or blood sample from each of you. It's even covered by most health insurance policies.
3. Take folic acid (and watch out for vitamin A)
Taking a folic acid supplement is crucial. By taking 400 micrograms (mcg) of folic acid a day for at least one month before you conceive and during your first trimester, you can cut your chances of having a baby with neural-tube defects such as spina bifida by 50 to 70 percent, according to the Centers for Disease Control and Prevention (CDC). Taking folic acid helps prevent some other birth defects as well.You can buy folic acid supplements at the drugstore, or you can take a prenatal or regular multivitamin. Check the label on multivitamins to make sure they contain the 400 mcg of folic acid you need.
Also check to make sure that your multivitamin doesn't contain more than the recommended daily allowance of 770 mcg RAE (2,565 IU) of vitamin A, unless most of it's in a form called beta-carotene. Getting too much of a different kind of vitamin A can cause birth defects.
If you're unsure about what to take, ask your healthcare provider to recommend a supplement.
4. Give up binge drinking, smoking, and drugs – and get help if you need it
If you smoke or take drugs, now's the time to stop. Many studies have shown that smoking or taking drugs can lead to miscarriage, premature birth, and low-birth-weight babies. Keep in mind that some drugs can stay in your system even after their noticeable effects have worn off.What's more, research suggests that tobacco use can affect your fertility and lower your partner's sperm count. In fact, studies have shown that even secondhand smoke may reduce your ability to get pregnant.
Moderate drinking (that’s one drink a day for women) is considered fine while you’re trying to conceive, but you’ll want to avoid excessive or binge drinking at this time. And once you’re pregnant, experts recommend that you stop drinking altogether since no one knows exactly what potential harmful effects even the smallest amount of alcohol has on a developing baby.
Stopping unhealthy habits can be very difficult. Don't hesitate to talk with your healthcare provider. She can talk with you about tools to help you quit smoking or refer you to a program to help you stop taking drugs, for example. Your local health department may also be able to help by putting you in touch with counselors, group programs, and other assistance.
5. Stock your fridge with healthy foods
You're not eating for two yet, but you should start making nutritious food choices now so your body will be stocked up with the nutrients you need for a healthy pregnancy.Try to get at least 2 cups of fruit and 2 1/2 cups of vegetables every day, as well as plenty of whole grains and foods that are high in calcium – like milk, calcium-fortified orange juice, and yogurt. Eat a variety of protein sources, such as beans, nuts, seeds, soy products, poultry, and meats.
6. Check your caffeine intake
While there's no consensus on exactly how much caffeine is safe during pregnancy, experts agree that pregnant women and those trying to conceive should avoid consuming large amounts. Too much caffeine has been linked to a risk of miscarriage in some (but not all) studies.The March of Dimes advises pregnant women to limit their caffeine consumption to 200 milligrams per day, about the amount in one cup of coffee, depending on the brew. That would be a good goal to aim for as you start trying to conceive.
See a chart showing the amount of caffeine in various coffee brews, other drinks, and select foods, in our article on caffeine during pregnancy.
7. Aim for a healthy weight
You may have an easier time conceiving if you're at a healthy weight. Having a low or high body mass index (BMI) makes it harder for some women to become pregnant.Getting to a healthier weight now can also help you get your pregnancy off on the right foot. Women with a high BMI are more likely to have pregnancy or delivery complications, while women who start with a low BMI and fail to gain enough weight are more likely to deliver underweight babies. Talk to your healthcare provider about the best way to achieve your weight goals.
8. Pay attention to the fish you eat
If you're a big fan of fish, start watching your intake. While fish is an excellent source of omega-3 fatty acids (which are very important for your baby's brain and eye development), protein, vitamin D, and other nutrients, it also contains mercury, which can be harmful.Most experts agree that pregnant women should eat some fish, and that the best approach is to avoid those fish that are highest in mercury and limit your consumption of all fish. The U.S. Food and Drug Administration (FDA) recommends that women of childbearing age not eat shark, swordfish, king mackerel, or tilefish, and eat no more than 6 ounces (one serving) of solid white canned tuna per week. Other experts suggest a longer list of fish to avoid. It's also a good idea to avoid eating fish you've caught in local waters unless you're certain there are no contaminants.
The FDA and Environmental Protection Agency (EPA) recommend that pregnant women eat up to 12 ounces (two servings) a week of fish that are not high in mercury. Good choices include herring, farm-raised rainbow trout, salmon, and sardines.
9. Create and follow an exercise program
Start and stick to a fitness plan now, and you'll be rewarded with a healthy body that's fit for pregnancy. A healthy exercise program includes 30 minutes or more of moderate exercise, such as walking or cycling and weight training, on most days of the week.To increase flexibility, try stretching or yoga, and you'll have a well-rounded fitness program. Once you're pregnant, it's okay – even recommended – to continue exercising. (Unless you have pregnancy complications and have been told not to, of course.)
If exercising hasn't been a priority for you lately, you'll need to ease into an exercise routine. Start with something tame, like walking 10 to 20 minutes a day. Add more activity into your daily routine by taking the stairs instead of the elevator or parking your car a few blocks away from work.
10. See your dentist
When you're preparing for pregnancy, don't forget about your oral health. Hormonal shifts during pregnancy can make you more susceptible to gum disease. Higher progesterone and estrogen levels can cause the gums to react differently to the bacteria in plaque, resulting in swollen, red, tender gums that bleed when you floss or brush.The good news is that women who take care of their periodontal health before they get pregnant cut down on their chances of experiencing gum complications in pregnancy. See your dentist for a checkup and cleaning now if you haven't done so in the past six months.
11. Consider money matters
According to a 2009 report from the U.S. Department of Agriculture, middle-income families will spend $286,050 to raise a child from birth through age 17.For the more immediate future, you'll want to consider the cost of pregnancy and delivery. Without insurance, a typical vaginal delivery can cost about $9,000 and a cesarean section about $15,000. Neonatal intensive care can cost $2,000 to $3,000 a day.
If you have health insurance, give the company a call and find out what kind of prenatal coverage they offer. If you're lucky enough to have a choice of plans, compare coverage and providers. If you have a particular doctor or midwife in mind, find out if she's in your plan or how much it would cost to see her out of network.
Find out what your deductibles are for prenatal visits and delivery, and ask what tests and procedures your insurance covers. (Preconception and prenatal care visits and many prenatal tests should be completely covered thanks to Obama's Affordable Care Act.) If you have a high deductible, try to put a little aside now so you won't be slammed with exorbitant bills when the baby arrives.
If you don’t have health insurance, contact your local health department to see what programs and resources are available in your area to help pregnant women and babies get the medical care and other services they need. Call 800-311-BABY (800-311-2229) for information on prenatal services in your area. (For information in Spanish, call 800-504-7081.)
12. Consider your mental health
Women who suffer from depression are twice as likely to have problems with fertility as women who don't, says Alice Domar, director of the Domar Center for Mind/Body Health at Boston IVF. As she points out, "If someone is clinically depressed, she can barely take care of herself, much less a baby. From an evolutionary point of view, it makes sense that it's hard to get pregnant when you're depressed."Domar suggests that all women, but especially those with a personal or family history of depression, do a mental health check before they get pregnant. If you notice signs of depression, such as a loss of interest and pleasure in things that you used to enjoy, a change in appetite or sleep patterns, a loss of energy, or feelings of hopelessness and worthlessness, ask your practitioner for a referral to a therapist or psychiatrist for a consultation.
The two most effective treatments for depression are psychotherapy and medication, and many patients do best with a combination of both. A psychiatrist can help you find an antidepressant that's safe to take while you're trying to conceive and during your pregnancy. You also may want to try stress management techniques, such as yoga and meditation, which research suggests can help depressed women conceive.
13. Avoid infections
It's important to steer clear of infections when you're trying to get pregnant, especially those that could harm your baby-to-be.You'll want to stay away from certain foods, such as unpasteurized soft cheeses and other dairy products, cold deli meats, and raw and undercooked fish and poultry. These foods can harbor dangerous bacteria that cause listeriosis, a food-borne illness that can lead to miscarriage or stillbirth. You should also avoid unpasteurized juices because they can contain bacteria such as salmonella or E. coli.
Be sure to wash your hands frequently when preparing meals, and make sure your fridge is set between 35 and 40 degrees Fahrenheit (2 and 4 degrees Celsius) and your freezer is at or below 0 degrees F (-18 degrees C) to keep cold foods from going bad.
It's a good idea to wear gloves when digging in the garden or sandbox, and to get someone else to change the litter box to avoid contracting toxoplasmosis, another infection that can be dangerous for a developing baby.
Finally, make sure you get a flu shot, to avoid coming down with the flu when you're pregnant. Get vaccinated as soon as the vaccine for the coming season becomes available. Getting the flu while pregnant can lead to serious complications, such as pneumonia and preterm labor.
14. Reduce environmental risks
You may not be able to entirely eliminate all environmental dangers, but you can do your best to keep as many of them as possible out of your life now. Some jobs can be hazardous to you and your unborn child, for example. If you're routinely exposed to chemicals or radiation, you'll need to make some changes before you conceive.Also, keep in mind that some cleaning products, pesticides, solvents, and lead in drinking water from old pipes can be dangerous for a developing baby. Talk to your doctor or midwife about your daily routine, and see if you can come up with ways to avoid or eliminate hazards in your home and workplace.
15. Think your decision through
Having a child is a lifetime commitment. Before you try to conceive, consider whether you're ready to take on this responsibility. Some key questions:- Have you thought through how you'll handle childcare responsibilities and balancing work and family?
- Are you prepared to parent a special-needs child if you have one?
- If you have a partner, are both of you equally committed to becoming parents?
- If you and your partner have religious differences, have you discussed how they will affect how you raise your child?
16. Figure out when you ovulate
Some women simply stop using birth control when they're ready to get pregnant and let fate decide when they'll conceive. Others take a more calculated approach by charting their periods and tracking symptoms to try to pinpoint their fertile days each month.Use our Ovulation Calculator to get a rough estimate of when you're most fertile. If you want to be more exact, start charting your basal body temperature (BBT) and the changes in your cervical mucus. Tracking these symptoms over several months can help you figure out when you're ovulating during each cycle.
Ovulation predictor kits can also help you figure out when you're ovulating by detecting hormones in your urine, or changes in chloride in the saliva or on the skin, that signal ovulation is about to occur. These kits cost $10 to $50 per pack and are available at drugstores.
17. Toss your birth control
So you're ready to bid adieu to birth control. For some people, ditching contraception is as easy as moving the condoms or diaphragm to the back of the dresser drawer. But going off hormonal contraception can require a bit more planning.All you have to do to reverse the effects of the Pill, the patch, or the ring is to stop using them. You don't even have to wait for the end of a monthly cycle to stop. You'll most likely get your period within a few days.
For many women, fertility returns as soon as they stop using these methods, but some may take a month or so to start ovulating again. You'll know ovulation is back to normal when you're getting your period regularly.
Some healthcare practitioners recommend using a barrier method and waiting until you have a couple of normal periods before trying to conceive, because this can help you establish a more accurate due date. But it's completely safe to start trying right away if you want to. And if you do get pregnant before your periods become regular again, don't worry – you can have an early sonogram to date your pregnancy.
If you're using Depo-Provera, it can take up to a year after your last shot for you to start ovulating again, even if your period returns to normal sooner. Find out what you need to know about quitting other kinds of birth control, including IUDs.
