
Getting Pregnant

Important Factors before Conceiving

Are you ready?

Pregnancy is one of the biggest physical changes your body will ever undergo, so before you start trying, make sure you're in the best possible condition. Dads-to-be may have some work to do, too: What you eat, drink, and otherwise ingest can affect the quality of your sperm. Take our quiz to see if you're both physically ready for baby-making.

Trying to conceive? Five changes to make to your diet now

Improve your diet	The sooner you start eating well, the more likely you are to get pregnant. For both men and women, food and fertility are linked. You need to stick to a balanced diet to boost your chances of conceiving and of having a healthy baby. Eat several servings of fruit, vegetables, grains such as whole wheat bread, and calcium-rich foods such as yogurt, cheese, and milk every day. Certain vitamins and nutrients — such as vitamins C and E, zinc, and folic acid — are important for making healthy sperm. Not getting enough nutrients can affect your periods, making it difficult to predict when you ovulate. And you may not ovulate at all if you've lost a drastic amount of weight or are obese.
What to avoid	If your eating habits leave something to be desired — and many people's do — you'll have to make some adjustments. Some solid advice: Cut out or only occasionally drink alcohol. Stop using recreational drugs and, if you smoke, quit. All of these substances and habits can harm a developing fetus. You may also want to cut back on caffeine. The research on whether caffeine can affect fertility is mixed. Experts generally agree that low to moderate caffeine consumption, less than 300 mg a day or about the equivalent of three cups of coffee, won't affect your fertility, but your doctor may recommend that you cut caffeine out entirely to play it safe. Although fish is generally very healthy, certain types are high in mercury, which can be dangerous to your unborn baby. Because mercury can accumulate in your body and linger there for more than a year, it's best to avoid high-mercury fish such as shark, swordfish, king mackerel, and tilefish while you're trying to conceive. Instead, eat lower-mercury fish such as salmon and canned light tuna once or twice a week. Processed meats should be consumed in small amounts, and smoked or raw meats should be avoided entirely during the pregnancy. Even hot dogs or deli meats should be heated until they are steaming before you eat them if you are pregnant.
Take a vitamin-mineral supplement.	Although you can meet almost all of your nutritional needs through a balanced diet, many experts believe that even the healthiest eaters can use extra help. You may find it particularly hard to eat well when you're at work or parenting other children, so taking a prenatal vitamin ensures that you're getting enough folic acid and other nutrients to boost your chances of conceiving. Remember that a supplement is a safeguard, not a substitute for a sound diet. And since regular over-the-counter multivitamins may contain megadoses of vitamins and minerals that could be harmful to a developing baby, it's smart to switch to a pill formulated specifically for pregnant women. Those who consume a vegetarian diet may also need Vitamin D and B12 supplements in addition to extra protein. Talk with your doctor about the right prenatal supplement for you.
Get lots of folic acid -- at least 400 micrograms a day	This vitamin has been proven to reduce a baby's risk of neural-tube birth defects such as spina bifida, and it is linked to a lower incidence of heart attacks, strokes, cancer, and diabetes. Most women of child-bearing age should get 400 micrograms (mcg) daily, the equivalent of 0.4 milligrams (mg), according to the U.S. Public Health Service (USPHS). If you have a family history of neural-tube birth defects or take medication for seizures, your doctor may suggest that you boost your daily intake to 4,000 mcg, or 4 mg, starting at least a month before you conceive and continuing throughout your first trimester. A good over-the-counter prenatal vitamin should contain more than the minimum recommendation of folic acid, between 600 and 800 mcg — what you'll need during pregnancy. In addition, you can eat folate-rich foods, such as dark green leafy vegetables like spinach or kale, citrus fruits, nuts, legumes, whole grains, and fortified breads and cereals. Folic acid is a water-soluble vitamin, so your body will flush out the excess if you consume too much. But there's a downside to being water-soluble, too. You can lose a lot of this vitamin in cooking water, so steam or cook vegetables in a small amount of water to preserve the folate. For some women, there's an exception to this rule: Getting too much folate may hide a B-12 deficiency, which is sometimes a problem for vegetarians. Ask your doctor or midwife if you think you may be at risk.

Find your ideal body weight.

Also, overweight women have more pregnancy and birth complications, and underweight women are more likely to have a low-birth-weight baby.

Giving up birth control

What you need to know about giving up birth control

You've probably spent most of your adult life trying to make sure that you don't get pregnant. Now that you're ready to start trying, you may need to know a few things about giving up your chosen method of birth control. You need to start taking folic acid at least a month before you start trying to conceive.)

Here's what you need to know about getting pregnant after having used various types of contraception:

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Barrier methods

Barrier methods, such as male condoms, female condoms, the sponge, the diaphragm, and the cervical cap, don't affect your fertility — so if you're using one of these methods and you want to start trying to get pregnant, just stop using it. And don't worry: Spermicides used with barrier methods can't harm a pregnancy. Even if you accidentally conceive while using a spermicide, it won't hurt your baby.

Natural birth control

To get pregnant after using a natural birth control method, such as withdrawal or a "fertility awareness" method (including the calendar method and checking basal body temperature and cervical mucus), all you have to do is stop not trying and go for it. If you've been using fertility awareness methods, you're in especially good shape to start trying.

If you have regular menstrual cycles, the information you've gleaned from charting your cycles can help you estimate when you're most likely to conceive. And if you've become familiar with changes in your cervical mucus during your fertile period, you'll have a valuable tool for identifying when you're about to ovulate.

Combined hormonal methods: The Pill, patch, and vaginal ring

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. In any case, you'll most likely get your period within a few days once you do stop.

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 if 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.

Progestin-only pills (the "minipill")

Progestin-only pills contain a very low dose of synthetic progesterone, which is rapidly eliminated from your body. The contraceptive effects don't last much more than 24 hours after your last pill (that's why minipill users have to be so careful about taking them at nearly the same time every day). So you should consider yourself fertile the day after you stop taking the pills.

Depo-Provera

With Depo-Provera — a shot of synthetic progesterone given every 12 weeks to prevent pregnancy — you may be fertile just 13 weeks after your last shot, or it may take a year or more for you to start ovulating again. On average, fertility returns about ten months after a woman gets her last shot.

If you still haven't had a period a year after your last injection, see your practitioner. Experts don't know why it takes longer for some women to become fertile again, but it's not related to how long you were getting the shots, and using Depo-Provera doesn't affect your fertility in the long run.

Implants

Progestin implants (such as Norplant) areno longer available in the United States, but there may be a new version on the market here soon. The contraceptive effect of the implants ends when they're removed.

Intrauterine device (IUD)

An IUD can be taken out at any time during your cycle, and you can start trying to get pregnant right away. Typically, your fertility will be the same as it was before the device was put in.

What if my partner or I have been sterilized?

Surgical sterilization techniques such as tubal ligation and vasectomy are considered permanent methods of birth control, and are intended for those who are sure they won't want to get pregnant or father a child in the future. But people do sometimes change their mind about such things.

Here's what you need to know if you or your partner is hoping to reverse a sterilization procedure. In both cases, reversal is expensive and complicated, with no guarantee of success, and is unlikely to be covered by insurance.

Your chances of getting pregnant after a tubal ligation reversal range from 43 to 88 percent, depending on how it was done, and you'll be at higher risk for an ectopic pregnancy if you do conceive. If the sterilization damaged much of the fallopian tubes, a reversal may not be possible at all.

A reversal is considered major surgery and requires a stay in the hospital. An alternative for women who've had a tubal ligation is to use assisted reproductive technology, such as in vitro fertilization, to try to get pregnant.

Male sterilization, or vasectomy, is also hard to reverse. Between 30 and 75 percent of men who reverse a vasectomy go on to be successful at getting a woman pregnant. Many factors are involved, but the longer it's been since the surgery, the less likely it is that the reversal will succeed. Vasectomy reversal is a serious procedure — you'll be out of commission for a week and may be barred from heavy physical activity for up to a month. If the attempt at reversal fails, you can have sperm removed and try in vitro fertilization.

Female fertility worksheet

Since fertility problems are a shared concern, you and your partner should go to the first appointment together. Bring copies of your health records to your visit and have copies sent to your doctor ahead of time to avoid the hassle and expense of duplicating medical tests. Expect to be asked about your sexual history, when you first menstruated, whether you've ever had any sexually transmitted infections, miscarriages, or abortions, how often you make love, whether you use lubricants, and more. Not much about your private life will be private anymore, so you'll want to feel comfortable with your doctor.

How many months have you been actively trying to get pregnant? (Women under 35 should try for about a year before seeking help — women over 35, or those who have a chronic medical condition or a known condition that may affect fertility, should seek help after six months.

Have you tried charting your basal body temperature, ovulation cycle, and cervical mucus? In addition to signaling when you're most fertile, charting can tell you if you're ovulating regularly.

MENSTRUAL HISTORY:

Do you have an irregular menstrual cycle? For example, do you have your period more or less often than once a month? (An irregular cycle could simply mean you don't ovulate regularly. But it can also indicate a thyroid problem, a prolactin problem, polycystic ovaries, or, if you're over 40, early menopause. If you're irregular, seek help right away because waiting to conceive naturally may be a waste of your time.)

Do you have exceptionally light or heavy periods? (It's normal for bleeding to vary from month to month, but if your flow is consistently unpredictable, you may have an ovulation problem. And sudden heavy bleeding could mean a fibroid in the uterine lining.)

How many days long is your menstrual cycle? (To determine your cycle length, count from the first day of one period to the start of the next. A cycle of 24 to 35 days is normal.)

Do you spot between periods? Or have any unexplained bleeding?

During menstruation, do you have severe pelvic pain or cramping? (Most women feel some discomfort during their period, but severe pain could be a sign of endometriosis or pelvic adhesions

.)

Did you get your first period after age 18? (This could indicate a hormonal imbalance or a reproductive endocrine disorder.)

MEDICAL HISTORY:

Do you have a feeling of heaviness in your pelvis? (This can be a symptom of fibroids.)

Have you been diagnosed with endometriosis? (This can cause fertility problems in women.)

Have you been diagnosed with polycystic ovarian syndrome? (This is an ovulation disorder.)

Have you had any pelvic or abdominal surgery, such as an appendectomy? (Surgical procedures can sometimes cause scarring that affects fertility.)

Do you have a history of abnormal Pap smears? (These can lead to diagnostic procedures, such as cryotherapy or cone biopsies, that can affect your cervical mucus.)

Have you had your tubes tied (tubal ligation)? Have you had a reversal? (Reversing a sterilization procedure isn't foolproof. Scar tissue can still prevent pregnancy or increase the chances of an ectopic pregnancy.)

Do you have a chronic illness such as diabetes, thyroid disease, or hypertension?(C chronic conditions, and some of their treatments, have been linked to fertility problems and high-risk pregnancies.)

Do you take any medications? (Steroids and other medications — including herbal medications — can affect your fertility.)

Have you ever been pregnant or given birth and had complications? (A previous pregnancy can, in rare cases, cause scarring or exacerbate a condition that can affect your fertility.)

Have you had any miscarriages? How many have you had, and did you and your doctor come to any conclusions about the cause? Did they occur in the first 12 weeks or in the second 12 weeks of pregnancy? (Repeated miscarriages are a form of fertility problem — and may mean your body needs special help carrying a pregnancy to term.)

SEXUAL HISTORY:

Have you ever used an intrauterine device (IUD) as birth control? (IUDs can increase your chances of having pelvic inflammatory disease.)

Have you ever tested positive for a sexually transmitted infection? Which one? (Chlamydia and gonorrhea, for instance, have been linked to fallopian tube problems and pelvic inflammatory disease.)

Do you have pain during sex? (This can be a sign of endometriosis or pelvic adhesions due to pelvic inflammatory disease.)

Do you spot after intercourse? (Bleeding after intercourse can mean many things — from a sexually transmitted infection to uterine or cervical problems such as cervicitis, polyps, or dysplasia.)

PREGNANCY

Important Factors when Starting your Pregnancy

Prenatal tests: An overview

First trimester tests

Prenatal tests are one of the many ways your healthcare practitioner can check on your well-being and that of your growing baby. At your first prenatal visit, your practitioner will give you a thorough physical, including a pelvic exam. She'll do a Pap smear (unless you've had one recently) to check for abnormal cells, including cervical cancer. She may also do a culture to check for chlamydia and gonorrhea.

Next, she'll order routine blood tests to identify your blood type and Rh status, and a blood count to check for anemia. She'll also have the lab test your blood for syphilis, hepatitis B, and immunity to German measles (rubella), and offer to test for HIV. (If your practitioner doesn't offer you an HIV test, be sure to ask about it. Being treated for HIV during pregnancy can dramatically reduce your chances of passing the infection to your baby.) In addition to taking blood, she'll ask for a urine sample to test for urinary tract infections and other conditions.

If you're at high risk for gestational diabetes, a glucose challenge test might be done at your first visit. In some cases, your provider will also do a skin test to see if you've been exposed to tuberculosis. And if you're not sure whether you've even had chicken pox (or been vaccinated against the virus), she'll order a blood test to check for immunity.

In addition, your caregiver may offer you genetic screening, such as a nuchal translucency screening (an ultrasound done at 10 to 12 weeks) or a first-trimester combined screening (an ultrasound and a blood test). These screening tests can give you some information about your baby's risk of having certain chromosomal problems and other birth defects. If you'll be 35 or older on your due date or are otherwise at high risk for having a baby with genetic problems, you may opt to have a CVS, a prenatal genetic diagnostic test done between 10 and 13 weeks. Finally, depending on your ethnic background and medical history, you may have a blood test to see if your baby is at risk for sickle cell disease, Tay-Sachs disease, cystic fibrosis, thalassemia, and certain other genetic disorders.

Second trimester tests

During each of your second trimester prenatal visits, your practitioner will ask for a urine sample to screen for signs of preeclampsia, urinary tract infections, and other conditions.
Most practitioners routinely order an ultrasound between 16 and 20 weeks to check for physical abnormalities and to verify your baby's due date. You'll also be offered a multiple marker screening (a blood test done between 15 and 20 weeks that can give you some information about your baby's risk of having certain chromosomal problems and other birth defects). And if you're going to be 35 or older on your due date or have other risk factors for genetic problems, your practitioner will offer you an amniocentesis, a test that can diagnose chromosomal abnormalities and many other types of genetic disorders.

Between 24 and 28 weeks, you'll be given a glucose screening test to check for gestational diabetes, and possibly another blood test to check for anemia. If you're Rh-negative (but your baby's father isn't, or you don't know whether he is), an extra tube of blood may be drawn to check for Rh antibodies before you're given an injection of Rh immune globulin at 28 weeks.

Third trimester tests

During your third trimester prenatal visits, your practitioner will continue to ask for a urine sample at each visit to check for signs of preeclampsia, urinary tract infections, and other conditions. Also, between 35 and 37 weeks, you'll be tested for a common infection called group B strep. If your test is positive, you'll be given antibiotics during labor to help keep you from passing it on to your baby. (If you've had a group B strep urinary tract infection during this pregnancy or a previous baby infected with group B strep, you won't need testing because you'll automatically be treated during labor.

Here are some other tests you may be in for this trimester:

• If your blood glucose level was elevated when you took your glucose challenge test, you'll have a glucose tolerance test to determine whether you have gestational diabetes.

• Your blood may be checked again for anemia, particularly if it wasn't retested late in the second trimester or if you were anemic earlier in your pregnancy.

• If you're at risk for STIs, you'll be tested again for syphilis, chlamydia, gonorrhea, and HIV.

• If you were found to have placenta previa or a low-lying placenta during an earlier ultrasound, you'll have another ultrasound to check the location of your placenta.

If your pregnancy is high risk or your practitioner becomes concerned about certain problems, she'll order tests such as a biophysical profile or a nonstress test to make sure your baby's thriving. When and how often you go for these tests will depend on the reason for the testing. If your practitioner's concerned about your baby's growth, she'll order periodic ultrasounds to measure him and check your amniotic fluid level.

If your pregnancy is normal but you go past your due date, you'll need testing to make sure your baby's still doing well. Between 40 and 41 weeks, you may get a full biophysical profile or a modified one, which includes a nonstress test to assess your baby's heart rate and an ultrasound to check your amniotic fluid level. These tests are usually performed twice a week to help your practitioner decide whether it's safe to continue waiting for your labor to start on its own

Prenatal Health

Pregnancy symptoms: Top ten signs you might be pregnant

Could you be pregnant? Most likely you won't notice any symptoms until about the time you've missed a period — or a week or two later.

If you're not keeping track of your menstrual cycle or if it varies widely from one month to the next, you may not be sure when to expect your period. But if you start to experience some of the symptoms below — not all women get them all — and you haven't had a period for a while, you may very well be pregnant. Take a home pregnancy test to find out for sure!

1. The proof: A positive home pregnancy test	In spite of what you might read on the box, many home pregnancy tests are not sensitive enough to detect most pregnancies until about a week after a missed period. So if you decide to take one earlier than that and get a negative result, try again in a few days. Once you've gotten a positive result, make an appointment with your practitioner. Now head over to our pregnancy area. Also, don't forget to update your profile and sign up for our "My Baby This Week" newsletter. Congratulations!
2. Your basal body temperature stays high	If you've been charting your basal body temperature and you see that your temperature has stayed elevated for 18 days in a row, you're probably pregnant.
3. A missed period	If you're usually pretty regular and your period doesn't arrive on time, you'll probably take a pregnancy test long before you notice any of the above symptoms. But if you're not regular or you're not keeping track of your cycle, nausea and breast tenderness and extra trips to the bathroom may signal pregnancy before you realize you didn't get your period.
4. Frequent urination	Shortly after you become pregnant, you may find yourself hurrying to the bathroom all the time. Why? Mostly because during pregnancy the amount of blood and other fluids in your body increases, which leads to extra fluid being processed by your kidneys and ending up in your bladder. This symptom may start as early as six weeks into your first trimester and continue or worsen as your pregnancy progresses and your growing baby exerts more pressure on your bladder.
5. Abdominal bloating	Hormonal changes in early pregnancy may leave you feeling bloated, similar to the feeling some women have just before their period arrives. That's why your clothes may feel snugger than usual at the waistline, even early on when your uterus is still quite small.
6. Increased sensitivity to odors	If you're newly pregnant, it's not uncommon to feel repelled by the smell of a bologna sandwich or cup of coffee and for certain aromas to trigger your gag reflex. Though no one knows for sure, this may be a side effect of rapidly increasing amounts of estrogen in your system. You may also find that certain foods you used to enjoy are suddenly completely repulsive to you.
7. Nausea or vomiting	If you're like most women, morning sickness won't hit until about a month after conception. (A lucky few escape it altogether.) But some women do start to feel queasy a bit earlier. And not just in the morning, either — pregnancy-related nausea and vomiting can be a problem morning, noon, or night. About half of women with nausea feel complete relief by the beginning of the second trimester. For most others it takes another month or so for the queasiness to ease up.
8. Implantation bleeding	Some women have a small amount of vaginal bleeding around 11 or 12 days after conception (close to the time you might notice a missed period). The bleeding may be caused by the fertilized egg burrowing into the blood-rich lining of your uterus — a process that starts just six days after fertilization — but no one knows for sure. The bleeding is very light (appearing as red spotting or pink or reddish-brown staining) and lasts only a day or two. (Let your practitioner know if you notice any bleeding or spotting, particularly if it's accompanied by pain, since this can be a sign of an ectopic pregnancy.)
9. Fatigue	Feeling tired all of a sudden? No, make that exhausted. No one knows for sure what causes early pregnancy fatigue, but it's possible that rapidly increasing levels of the hormone progesterone are contributing to your sleepiness. You should start to feel more energetic once you hit your second trimester, although fatigue usually returns late in pregnancy when you're carrying around a lot more weight and some of the common discomforts of pregnancy make it more difficult to get a good night's sleep.
10. Tender, swollen breasts	One of the early signs of pregnancy is sensitive, sore breasts caused by increasing levels of hormones. The soreness may feel like an exaggerated version of how your breasts feel before your period. Your discomfort should diminish significantly after the first trimester, as your body adjusts to the hormonal changes.

What to expect at your first prenatal visit

When should I have my first prenatal visit?	As soon as you suspect you're pregnant, schedule an appointment with your doctor or midwife. (If you haven't chosen a healthcare practitioner yet, this is the time to find one!) Even if you've confirmed your pregnancy with a home test, it's wise to follow up with a professional physical examination so you can begin getting prenatal care. Most practitioners won't schedule a visit until you're about eight weeks pregnant, unless you have a medical condition, have had problems with a pregnancy in the past, or are having problems now such as vaginal bleeding, abdominal pain, or severe nausea and vomiting. Also, if you're taking any medications or think you may have been exposed to hazardous substances, ask to speak to the doctor or midwife as soon as possible. Your first visit will probably be the longest one you have with your caregiver, unless you encounter problems along the way. For all your prenatal checkups, be prepared with questions regarding anything you might be wondering about. Here's what you can expect your doctor or midwife to do this time:
Take your health history	She'll want to know the day your last period started, so she can determine your due date; any symptoms or problems you've had since then; whether your menstrual cycles are regular and how long they usually last; and details about any gynecological problems (including sexually transmitted infections) you or your partner have now or had in the past. She'll also want details about any previous pregnancies.
Do a genetic and birth defect history	She'll ask if you, the baby's father, or anyone else in either family has a chromosomal or genetic disorder or developmental delays, or was born with a structural birth defect. She'll want to know about any medications and nutritional supplements you've taken since your last period, about any exposures to potential toxins (bring a list of possible "suspects," especially if you live or work near toxic materials), including alcohol and drugs, and whether you've recently had any rashes, or viruses or other infections. If you're going to be 35 or older on your due date or you have other risk factors for genetic problems, your practitioner will talk to you about genetic counseling and genetic testing
Explain your options for prenatal genetic testing	Your practitioner will offer you genetic screening tests that can give you some information about your baby's risk of having certain chromosomal problems and other birth defects. During your first trimester, you may be offered a nuchal translucency screening (done by ultrasound at 11 to 13 weeks) or a first-trimester combined screening (the nuchal translucency screening and a blood test). Or you may decide to wait and have a multiple marker screening, a blood test done between 15 and 20 weeks. Some practitioners offer "integrated screening," which is a combination of first- and second-trimester tests. If you'll be 35 or older on your due date or are otherwise at high risk for having a baby with genetic problems, you'll be offered genetic diagnostic tests that can tell you for sure if your baby has Down syndrome or other problems. These include chronic villus sampling, generally done at 11 to 12 weeks, and amniocentesis, usually done at 15 to 18 weeks. Finally, depending on your ethnic background and medical history, you may have a blood test to see if your baby is at risk for sickle cell disease, Tay-Sachs disease, cystic fibrosis, thalassemia, and certain other genetic disorders.
Check you out and run some tests	Your practitioner will give you a thorough physical, including a pelvic exam. She'll do a Pap smear (unless you've had one recently) to check for abnormal cells, including cervical cancer. She may also do a culture to check for chlamydia and gonorrhea. Next, she'll order routine blood tests to identify your blood type and Rh status, and a blood count to check for anemia. She'll also have the lab test your blood for syphilis, hepatitis B, and immunity to German measles (rubella). The U.S. Public Health Service and a host of other organizations now recommend that all pregnant women be tested for HIV at their first prenatal visit. If your practitioner doesn't offer you an HIV test, be sure to ask about it. Being treated for HIV during pregnancy can dramatically reduce your chances of passing the infection to your baby. In addition to taking blood, your practitioner will ask for a urine sample to test for urinary tract infections and other conditions. If you're at high risk for gestational diabetes, a glucose challenge test might be done at your first visit. In some cases, your practitioner will also do a skin test to see if you've been exposed to tuberculosis. And if you're not sure whether you've had chicken pox (or been vaccinated against the virus), she'll order a blood test to check for immunity.
Counsel you and let you know what's coming	Your caregiver should give you advice about eating well, foods to avoid, and what kind of weight gain to expect. She'll describe the common discomforts of early pregnancy and warn you about symptoms that require immediate attention. Your emotional health is very important. If you're feeling depressed or overly anxious, your caregiver can refer you to a psychologist or psychiatrist. She'll also talk to you about the dangers of smoking, drinking alcohol, using drugs, and taking certain medications. If you need help quitting smoking or any other addiction, ask her for a referral to a program or counselor. Finally, she'll go over some do's and don'ts of exercise, travel, and sex during pregnancy; discuss environmental and occupational hazards that can affect your baby; and explain how to avoid certain infections, such as toxoplasmosis. If it's flu season (or flu season is near), she should talk to you about getting a flu shot

Which type of doctor or midwife is right for you?

Here are some tips.

How can I decide what kind of practitioner should deliver my baby?
As soon as you decide to start trying to conceive, you should start looking for a practitioner to care for you during your pregnancy. Whether you choose an obstetrician-gynecologist (ob-gyn), a family physician, a certified nurse-midwife (CNM), or a direct-entry midwife will depend on a number of factors, including what kind of birth experience you want, where you plan to deliver your baby, whether your pregnancy is normal or high risk, and what your insurance will pay for.

Here are the primary considerations:

Do you have a serious chronic medical condition?
If you have a medical condition such as high blood pressure, epilepsy, heart disease, or diabetes, or had certain serious complications in a previous pregnancy, your pregnancy will probably be considered high risk. In this case, you'll need to see an obstetrician, or possibly a perinatologist (a physician who specializes in high-risk pregnancies).

If you're having twins or higher multiples, or if certain problems develop during your pregnancy, you'll need to see an ob-gyn or a perinatologist. In some situations, you may be able to see a midwife and a doctor.

Do you already see a practitioner you trust and feel comfortable with?
If you already have a good relationship with an ob-gyn or family practitioner who provides prenatal care and delivers babies, or you see a certified nurse-midwife you like for routine gynecological care, you may want to stay right where you are. This is especially true if your practitioner cares about you, respects your preferences, and takes time to answer your questions. But if you have any doubts about her or about giving birth at the hospital where she has privileges, or you're curious about other options, this is the time to look around for another doctor or midwife.

How important to you is a more individual, less routine approach?
If you're looking for a practitioner who tends to have more time to answer all your questions, is more likely to take a holistic approach to your care, and is less likely to perform routine interventions, you may prefer a midwife.

A midwife will encourage you to learn about the physical and emotional changes you experience throughout pregnancy and to think carefully about what kind of birth experience you want — and she'll support you in your decision. For example, a midwife will guide you through a nonmedicated labor if that's what you choose, but an epidural will still be an option if you're giving birth in a hospital. CNMs have obstetricians available for consultation and backup if needed.

What kind of setting do you want for your delivery?
If you have no health problems or pregnancy complications and you have your heart set on giving birth in a birth center or at home, you'll want to find a midwife who practices in these settings. Birthing centers are usually staffed by CNMs. They're known for being supportive environments for having a natural birth without routine interventions and for welcoming anyone you'd like to have there with you, including family, friends, and siblings.

If you want to give birth at home, you can choose either a certified nurse-midwife or a direct-entry midwife to attend you. On the other hand, if you want the option of getting an epidural, or you're very anxious about something going wrong during labor and delivery and don't want to chance having to transfer to a hospital, you'll want to be in a hospital from the get-go. For a hospital birth, you can choose an ob-gyn, a family physician, or a certified nurse-midwife as your primary caregiver.

WHEN TO CALL THE DOCTOR

Pregnancy symptoms you should never ignore

How do you know whether that sudden ache is normal or warrants a 2 a.m. call to your doctor or midwife? Here's a rundown of symptoms that should set off your warning bells. But even if you don't see your symptom on this list, it's better to err on the side of caution and make that call than to agonize for hours, wondering whether you've pulled a ligament or gone into preterm labor.

Note that some of these symptoms may be more or less urgent depending on your particular situation or health history and on how far along you are in your pregnancy. Ask your practitioner to review with you which signs warrant an urgent call at various points in your pregnancy.

• Your baby is moving or kicking less than usual (once he begins moving regularly). Ask your caregiver if you should monitor your baby's activity by doing daily "kick counts." She can give you specific instructions on how to count and when to call.	• Any swelling in your face or puffiness around your eyes, anything more than a little swelling in your hands, severe and sudden swelling of your feet or ankles, or a rapid weight gain (more than 4 pounds in a week).
• Severe or persistent abdominal pain or tenderness	• A persistent or severe leg cramp or calf pain that doesn't ease up when you flex your ankle and point your toes toward your nose or when you walk around, or one leg being significantly more swollen than the other.
• Vaginal bleeding or spotting.	• Trauma to the abdomen.
• An increase in vaginal discharge or a change in the type of discharge — that is, if it becomes watery, mucousy, or bloody (even if it's only pink or blood-tinged). Note: After 37 weeks, an increase in mucus discharge is normal and may indicate that you'll be going into labor soon.	• Fainting, frequent dizziness, a rapid heartbeat, or heart palpitations.
• Pelvic pressure (a feeling that your baby is pushing down), lower back pain (especially if it's a new problem for you), menstrual-like cramping or abdominal pain, or more than four contractions in an hour (even if they don't hurt) before 37 weeks.	• Difficulty breathing, coughing up blood, or chest pain
• Severe or persistent vomiting, or any vomiting accompanied by pain or fever.	• Severe constipation accompanied by abdominal pain or severe diarrhea that lasts more than 24 hours.
• Chills or fever of 100 degrees Fahrenheit or higher.	• Persistent intense itching of your torso, arms, legs, palms, or soles, or a feeling of itchiness all over your body.
• Visual disturbances such as double vision, blurring, dimming, flashing lights, or "floaters" (spots in your field of vision).	• Any health problem that you'd ordinarily call your practitioner about even if it's not pregnancy related (like worsening asthma or a cold that gets worse rather than better). Just call a little sooner than you would normally.
• Persistent or severe headache, or any headache accompanied by blurred vision, slurred speech, or numbness.	• Painful or burning urination, or little or no urination.

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Medical Dislaimer

The information contained on this site is provided for your general information only. Its author does not give medical advice or engage in the practice of medicine. The author under no circumstances recommends particular treatment for specific individuals and in all cases recommends that you consult your physician or local treatment center before pursuing any course of treatment

If you're not sure whether a symptom is serious, you don't feel like yourself, or you're uneasy, trust your instincts and call your healthcare provider. Your practitioner expects such calls. If there's a problem, you'll get help right away. If nothing's wrong, you'll be reassured.

Your body is changing so rapidly that it's hard to know whether what you're experiencing is "normal." Do yourself and your baby a favor and get any unusual symptoms checked out.

Finally, if you're near your due date, check out the signs of labor so you'll know what to look for and when to call your caregiver

Emotional Health

16 pregnancy sanity-savers

Pregnancy is a time of intense physical and emotional changes, but of course the rest of the world doesn't stop when you're expecting. There's work to show up for, meals to cook, and errands to do — as well as a new baby to get ready for!

These tips from moms and moms-to-be will make your life easier during pregnancy. We hope they'll reduce stress, save you time and money, and help you stay in touch with the joy of being pregnant.

Shower at night. "Taking showers in the evening and sleeping an extra 45 minutes in the morning has helped a lot. You wouldn't think this would make much of a difference, but I really feel like I get enough sleep this way." - Amber	Invest in a good body pillow. "I slept much better in the last trimester after I bought a body pillow. I could curl up on my side, letting the pillow support my back. It also helped to have a stack of pillows for propping myself up when I got night heartburn." — Midge
Do errands at lunch. "I work full time and do a lot of errands at lunch before I get too tired. When I get home I have less to do and can relax or spend time with my toddler." -Jordan	Get help with the nursery. "We invited friends over to help us set up the nursery. We got pizza and beer (and soda for me) and made a party out of it. They helped paint and assemble furniture — and even had a good time doing it!" — Mary
Exercise for energy. "A little bit of exercise increases my energy more than any nap I've ever taken." — Jennifer	Borrow maternity clothes. "Take all the used pregnancy clothes friends offer. It's silly to spend a ton of money on clothes you won't wear for long. Sharing clothes is a nice introduction to the camaraderie of motherhood." — Greta
Keep good communication with your boss. "I check in often with my manager. I work on my feet, and as the months pass, I've slowed down a lot. Taking small breaks helps a lot. She understands this, and doesn't seem to mind." — Jennie	Have home picnics. "At the beginning of my third trimester, I started stocking up on paper plates, cups, and disposable cutlery. On days when I'm wiped out, we have 'picnics' at the dining room table. This saves time and energy that would normally be spent at the sink or emptying the dishwasher. This will be useful when the baby comes, too." — Angela
Nap during lunchtime. "I used lunch breaks at work to cat nap. Fortunately my office had a quiet lounge with a couch where I would curl up and snooze — even 20 minutes worked wonders. Co-workers didn't mind leaving me alone. In fact, it became the pregnancy couch for a string of pregnant women." — Kaitlin To Get To This Page in the Future, Type In A Search Box 33ycnangerp "pregancy33" spelled backwards. Or bookmark this page.	Shop for pre-prepared foods. "Frozen entrees and food from the deli department at your local supermarket are wonderful. You can have a quick, relatively healthy meal with minimal clean up. Pre-made salads and roasted chickens are especially convenient." — Heidi
Learn your workplace rights. "It helps to know your rights. I had horrible, debilitating morning sickness with both my pregnancies and was so relieved to learn I could take disability leave for the worst stretches and return to work for the last trimester." — Zizi	Take notes. "During my first pregnancy, I felt like the biggest idiot on earth due to what I called 'pregnancy dementia.' I learned to carry a note pad with me at all times to write down even the smallest things. It really did help." — Paige
Be good to yourself. "Pamper yourself with fresh nail polish, lovely bath oils, or even a professional facial. These can go a long way in nurturing your spirit." — Sara	Share the ups and downs. "Get together with other expectant moms or people with young kids — it's incredible how sharing the ups and downs of pregnancy and new parenthood can keep your sanity intact." — Allison
Pamper your belly. "Rub natural massage oil on your tummy every day after your shower. It might be an old wives' tale that this prevents stretch marks, but it sure feels nice and luxurious." — Bobbie	Let it out. "Don't be afraid to show the wacky side of pregnancy emotions. A good cry or belly laugh does the soul good." — Marla

Morning Sickness

Morning sickness: Causes, concerns, treatments

Why do they call it morning sickness when I feel nauseated all day long?
"Morning sickness" is really a misnomer. (In fact, the technical medical term is "nausea and vomiting of pregnancy.") For some pregnant women, the symptoms are worst in the morning and ease up over the course of the day, but they can strike at any time and last all day long.

About three quarters of pregnant women experience nausea and sometimes vomiting during their first trimester. The nausea usually starts around six weeks of pregnancy, but it can begin as early as four weeks. It tends to get worse over the next month or so.

About half of the women who get it feel complete relief by about 14 weeks. For most of the rest, it takes another month or so for the queasiness to ease up, though it may return later and come and go throughout pregnancy.

What causes nausea and vomiting during pregnancy?
No one knows for sure what causes nausea during pregnancy, but it's probably some combination of the many physical changes taking place in your body. Some possible causes include:

• Rapidly increasing levels of the hormone human chorionic gonadotropin (hCG) during early pregnancy. No one knows how hCG contributes to nausea, but the timing is right: Nausea tends to peak around the same time as levels of hCG.

Estrogen, another hormone that rises rapidly in early pregnancy, is also considered a prime suspect, and it's possible that other hormones may play a role as well.

• An enhanced sense of smell and sensitivity to odors. It's not uncommon for a newly pregnant woman to find that she's overwhelmed by the smell of a bologna sandwich from four cubicles away, for example, and that certain aromas instantly trigger her gag reflex. This may be a result of higher levels of estrogen.

• A tricky stomach. Some women's gastrointestinal tracts are simply more sensitive to the changes of early pregnancy.

You may have heard that morning sickness can be caused by a vitamin B deficiency. While taking a vitamin B6 supplement does seem to help ease nausea in many pregnant women, this doesn't mean they have a vitamin deficiency. In fact, at least one study has shown no significant differences in the levels of B6 in women with morning sickness and those without.

No one knows why B6 is helpful. There's also some evidence that taking a multivitamin at the time of conception and in early pregnancy helps prevent severe morning sickness, but again, no one knows why.

Some researchers have proposed that certain women are psychologically predisposed to having nausea and vomiting during pregnancy as an abnormal response to stress. However, there's no good evidence to support this theory. (Of course, if you're constantly nauseated or vomiting a lot, you certainly may begin to feel more stressed!)

Are some pregnant women more likely than others to feel nauseated?
You're more likely to have nausea or vomiting during your pregnancy if any of the following apply:

• You're pregnant with twins or higher multiples. This may be from the higher levels of hCG, estrogen, or other hormones in your system. You're also more likely to have a more severe case than average. On the other hand, it's not a definite thing — some women carrying twins have little or no nausea.

• You had nausea and vomiting in a previous pregnancy.

• You have a history of nausea or vomiting as a side effect of taking birth control pills. This is probably related to your body's response to estrogen.

• You have a history of motion sickness.

• You have a genetic predisposition to nausea during pregnancy. If your mother or sisters had severe morning sickness, there's a higher chance you will, too.

• You have a history of migraine headaches.

• You're carrying a girl. One study found that women with severe nausea and vomiting were 50 percent more likely to be carrying a girl.

Will my nausea affect my baby?
The mild to moderate nausea and occasional vomiting commonly associated with morning sickness won't threaten your baby's well-being. If you don't gain any weight in the first trimester, it's generally not a problem as long as you're able to stay hydrated and aren't starving yourself. In most cases, your appetite will return soon enough and you'll begin gaining weight.

If nausea keeps you from eating a balanced diet, be sure to take a prenatal vitamin to make certain you're getting the nutrients you need. (Choose one with a low dose of iron or no iron if that mineral makes your nausea worse.)

Severe and prolonged vomiting has been linked to a greater risk of preterm birth, low birth weight, and newborns who are small for their gestational age. However, a recent study of women who were hospitalized with severe vomiting found that those who were able to gain at least 15.4 pounds (7 kilograms) during their pregnancy had no worse outcomes than other women.

If I don't have morning sickness, does that mean I'm more likely to have a miscarriage?
Not necessarily. It's true that a number of studies have shown that women who have miscarriages are less likely to have had nausea. (If your baby or your placenta were not developing properly, you'd have lower levels of pregnancy hormones in your system, so it follows that you'd have little or no nausea.)

But there are plenty of women with perfectly normal pregnancies who manage to escape nausea during their first trimester. Count yourself lucky and don't obsess about it if you're not suffering!

What about anti-nausea medications?
If the measures above don't provide you with enough relief, let your provider know so you can get the help you need. If your nausea and vomiting is getting worse, waiting too long to take appropriate medication may make it more difficult to treat.

Your provider will likely suggest that you try taking vitamin B6. No one knows why B6 eases nausea in some expectant mothers, but research indicates that it works for some women and it's consistently been shown to be safe when taken in commonly recommended doses.

The usual dose for treating morning sickness is between 10 and 25 milligrams three times a day, but check with your provider before taking anything. She can tell you how much to take and whether the amount in your prenatal vitamin should count as one of the doses. (The amount of vitamin B6 in prenatal supplements varies by brand.)

Don't take more vitamin B6 than your caregiver recommends. Too much can cause numbness and nerve damage and may not be safe for your developing baby.

If vitamin B6 isn't enough to do the job, there are other anti-nausea medications that are considered safe and effective during pregnancy.

What can I do to get relief?
If you have a mild case of nausea and vomiting, some relatively simple measures may be enough to help. (If not, there are safe and effective medications you can take.) Not all of the following suggestions are supported by hard evidence, but obstetricians and midwives commonly recommend them, and many women swear by them.

• Try to avoid foods and smells that trigger your nausea. If that seems like almost everything, it's okay to eat the few things that do appeal to you for this part of your pregnancy, even if they don't add up to a balanced diet. It might also help to stick to bland foods. Try to eat food cold or at room temperature, when it tends to have less of an aroma than when it's hot.	• Give yourself time to relax and take naps if you can. Watching a movie (preferably not one about food!) or visiting with a friend can help relieve stress and take your mind off your discomfort. Or try hypnosis — while there's no definitive evidence that it helps with morning sickness, it has been shown to be effective in combating nausea during chemotherapy.
• Keep simple snacks, such as crackers, by your bed. When you first wake up, nibble a few crackers and then rest for 20 to 30 minutes before getting up. Snacking on crackers may also help you feel better if you wake up nauseated in the middle of the night.	• Try taking your prenatal vitamins with food or just before bed. You might also want to ask your healthcare provider whether you can switch to a prenatal vitamin with a low dose of iron or no iron for the first trimester, since this mineral can be hard on your digestive system.
• Eat small, frequent meals and snacks throughout the day so that your stomach is never empty. Some women find that carbohydrates are most appealing when they feel nauseated, but one small study found that high-protein foods were more likely to ease symptoms.	• Try ginger, an alternative remedy thought to settle the stomach and help quell queasiness. See if you can find ginger ale made with real ginger. (Most supermarket ginger ales aren't.) Grate some fresh ginger into hot water to make ginger tea, or see if ginger candies help. A few studies found that taking powdered ginger root in capsules provided some relief, but be sure to talk to your provider before taking ginger supplements. There's no way to be sure how much of the active ingredient you're getting in these supplements, so some experts think it's best not to use them. (As with many other things that are helpful in small amounts, the effects of megadoses are unknown.)
• Avoid fatty foods, which take longer to digest. Also steer clear of rich, spicy, acidic, and fried foods, which can irritate your digestive system.	• Try an acupressure band, a soft cotton wristband that's sold at drugstores. You strap it on so that the plastic button pushes against an acupressure point on the underside of your wrist. This simple and inexpensive device, designed to ward off seasickness, has helped some pregnant women through morning sickness — although research suggests that it may be largely a placebo effect.
• Try drinking fluids primarily between meals. And don't drink so much at one time that your stomach feels full, as that will make you less hungry for food. A good strategy is to sip fluids frequently throughout the day. Aim to drink about a quart and a half altogether. If you've been vomiting a lot, try a sports drink that contains glucose, salt, and potassium to replace lost electrolytes.	• Ask your provider about a device that stimulates the underside of your wrist with a mild electric current. This "acustimulation" device costs about $75 and is available by prescription only. It's safe, and research has shown that this technique works well for some women.

The usual dose for treating morning sickness is between 10 and 25 milligrams three times a day, but check with your provider before taking anything. She can tell you how much to take and whether the amount in your prenatal vitamin should count as one of the doses. (The amount of vitamin B6 in prenatal supplements varies by brand.)

Don't take more vitamin B6 than your caregiver recommends. Too much can cause numbness and nerve damage and may not be safe for your developing baby.

If vitamin B6 isn't enough to do the job, there are other anti-nausea medications that are considered safe and effective during pregnancy.

What if I just can't keep anything down?
Call your provider if you haven't been able to keep anything — including fluids — down for 24 hours. (If you're newly pregnant and don't yet have a doctor or midwife, go to the emergency room.)

You may have a condition called hyperemesis gravidarum — literally, "excessive vomiting in pregnancy." This condition can be difficult to manage, but the sooner you're diagnosed and begin treatment, the more likely you'll be able to avoid severe symptoms.

Your caregiver will probably want to give you some intravenous fluids right away, since you'll most likely be seriously dehydrated. Then she'll need to do some tests to check your electrolyte levels and make sure no underlying illness is causing your constant vomiting. Depending on your condition, you may need to be hospitalized for a few days so that you can continue to receive IV fluids and medication.

Many women feel much better after they're rehydrated and are able to control their symptoms with anti-nausea medication. In rare cases, you'll need to continue to receive intravenous therapy on and off either in the hospital or at home.

Nutrition

Caffeine: Does it affect your fertility?

Does caffeine affect fertility?
That depends on how much you're getting. Consuming moderate amounts of caffeine — less than 300 milligrams (mg) a day, or what you'd get from drinking two or three cups of coffee — doesn't appear to affect a woman's fertility. (That's according to a 2003 report from the Center for the Evaluation of Risks to Human Reproduction at the National Institutes of Health.) On the other hand, at least one large study recently found that women who consumed 300 mg of caffeine or more a day took longer to conceive than those who got less or none.

To be safe, it's probably wise to limit your caffeine intake. Your doctor or midwife may even advise you to cut it out completely. Caffeine has no nutritional value and can even cause your bones to lose some calcium, an important nutrient for a healthy pregnancy. There's also some evidence that getting more than 300 mg a day can raise your risk of miscarriage.

If you decide to give up caffeine, ease off slowly to avoid withdrawal symptoms such as fatigue and headaches. You might want to start by switching to a half decaf, half caffeinated drink. If you're a real java junkie, try cutting back to a cup a day — most experts think that amount is safe.

Once you've acclimated to life with little or no caffeine, you may find steamed milk with a shot of flavored syrup to be a nice coffee substitute — and the calcium will do your body good.

How much caffeine is in my favorite foods and beverages?
Caffeine is in all the usual suspects (coffee, tea, and cola) as well as in chocolate, other soft drinks (including some orange sodas and root beers), and energy drinks. Believe it or not, there's even some caffeine in most decaffeinated beverages. It's also in a variety of over-the-counter drugs, including some headache, cold, and allergy remedies.

The amount of caffeine in coffee and tea varies widely, depending on whether they're brewed or instant, weak or strong.

Check the chart below for caffeine amounts in some common foods and beverages. Remember to look at the portion size you're getting as well. The chart lists the amount of caffeine in an 8-ounce cup of coffee, but the smallest serving at some coffee shops is 12 ounces.

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Item	Amount	Caffeine
Brewed coffee	8 ounces	75 to 135 mg
Instant coffee	8 ounces	95 mg
Espresso	2 ounces	30 to 50 mg
Cappuccino	2 ounces	40 to 70 mg
Decaffeinated coffee	8 ounces	3 to 5 mg
Brewed tea	8 ounces	35 to 175 mg
Green tea	8 ounces	25 to 40 mg
Instant tea	8 ounces	40 to 80 mg
Iced tea	12 ounces	22 to 36 mg
Coffee ice cream or frozen yogurt	1 cup	8 to 85 mg
Energy drinks	8-ounce can	80 mg
Soft drink	12-ounce can	30 to 60 mg
Hot cocoa	8 ounces	3 to 30 mg
Chocolate milk	8 ounces	2 to 7 mg
Milk chocolate	1 ounce	3 to 6 mg
Dark or semisweet chocolate	1 ounce	5 to 35 mg
Baker's chocolate	1 ounce	26 mg
Chocolate syrup	1 ounce	4 mg

Can some foods increase our chances of conceiving?

Beliefs about the wondrous powers of so-called fertility foods such as shark's fin, camel's hump, ginseng, pine nuts, prunes, or even chocolate date to early civilizations. Unfortunately, most are pure fiction. Many are based on the simplistic notion that eating foods that look like sexual organs, such as figs or eggs, will help those organs function better. Also, no evidence proves the theory that eating spicy foods can increase sexual potency by raising your blood pressure and pulse rate.

There's some scientific proof that eating oysters can boost fertility. Oysters are packed with zinc, which plays a role in semen and testosterone production in men, and in ovulation and fertility in women. That doesn't mean you should down a plate of oysters on the half shell at every meal. Maintaining the recommended dietary allowance of zinc (9 mg a day) can help keep your reproductive system working properly, but excessive amounts of zinc (or any nutrient for that matter) will not turn either of you into a babymaking machine. In fact, super-high doses of vitamins and minerals may actually reduce your fertility.

Trying to conceive? Five changes to make to your diet now

Improve your diet

The sooner you start eating well, the more likely you are to get pregnant. For both men and women, food and fertility are linked. You need to stick to a balanced diet to boost your chances of conceiving and of having a healthy baby.

Eat several servings of fruit, vegetables, grains such as whole wheat bread, and calcium-rich foods such as yogurt, cheese, and milk every day. Certain vitamins and nutrients — such as vitamins C and E, zinc, and folic acid — are important for making healthy sperm. Not getting enough nutrients can affect your periods, making it difficult to predict when you ovulate. And you may not ovulate at all if you've lost a drastic amount of weight or are obese.

What to avoid

If your eating habits leave something to be desired — and many people's do — you'll have to make some adjustments. Some solid advice: Cut out or only occasionally drink alcohol. (For non-alcoholic alternatives, see our list of the best virgin drinks). Stop using recreational drugs and, if you smoke, quit. All of these substances and habits can harm a developing fetus.

You may also want to cut back on caffeine. The research on whether caffeine can affect fertility is mixed. Experts generally agree that low to moderate caffeine consumption, less than 300 mg a day or about the equivalent of three cups of coffee, won't affect your fertility, but your doctor may recommend that you cut caffeine out entirely to play it safe. Learn more about caffeine and fertility.

Although fish is generally very healthy, certain types are high in mercury, which can be dangerous to your unborn baby. Because mercury can accumulate in your body and linger there for more than a year, it's best to avoid high-mercury fish such as shark, swordfish, king mackerel, and tilefish while you're trying to conceive. Instead, eat lower-mercury fish such as salmon and canned light tuna once or twice a week.

Processed meats should be consumed in small amounts, and smoked or raw meats should be avoided entirely during pregnancy. Even hot dogs or deli meats should be heated until they are steaming before you eat them if you are pregnant.

Take a vitamin-mineral supplement.

Although you can meet almost all of your nutritional needs through a balanced diet, many experts believe that even the healthiest eaters can use extra help. You may find it particularly hard to eat well when you're at work or parenting other children, so taking a prenatal vitamin ensures that you're getting enough folic acid and other nutrients to boost your chances of conceiving.

Remember that a supplement is a safeguard, not a substitute for a sound diet. And since regular over-the-counter multivitamins may contain megadoses of vitamins and minerals that could be harmful to a developing baby, it's smart to switch to a pill formulated specifically for pregnant women. Those who consume a vegetarian diet may also need Vitamin D and B12 supplements in addition to extra protein. Talk with your doctor about the right prenatal supplement for you.

Get lots of folic acid -- at least 400 micrograms a day.

This vitamin has been proven to reduce a baby's risk of neural-tube birth defects such as spina bifida, and it is linked to a lower incidence of heart attacks, strokes, cancer, and diabetes.

Most women of child-bearing age should get 400 micrograms (mcg) daily, the equivalent of 0.4 milligrams (mg), according to the U.S. Public Health Service (USPHS). If you have a family history of neural-tube birth defects or take medication for seizures, your doctor may suggest that you boost your daily intake to 4,000 mcg, or 4 mg, starting at least a month before you conceive and continuing throughout your first trimester.

A good over-the-counter prenatal vitamin should contain more than the minimum recommendation of folic acid, between 600 and 800 mcg — what you'll need during pregnancy. In addition, you can eat folate-rich foods, such as dark green leafy vegetables like spinach or kale, citrus fruits, nuts, legumes, whole grains, and fortified breads and cereals. Folic acid is a water-soluble vitamin, so your body will flush out the excess if you consume too much. But there's a downside to being water-soluble, too. You can lose a lot of this vitamin in cooking water, so steam or cook vegetables in a small amount of water to preserve the folate.

For some women, there's an exception to this rule: Getting too much folate may hide a B-12 deficiency, which is sometimes a problem for vegetarians. Ask your doctor or midwife if you think you may be at risk.

Find your ideal body weight.

Shedding some pounds, or gaining a few if you're underweight, while you're attempting to get pregnant is a good idea, since you want to be as close as possible to your recommended weight when you conceive. Being over- or underweight can make it harder to get pregnant. Also, overweight women have more pregnancy and birth complications, and underweight women are more likely to have a low-birth-weight baby.

While you're following a smart eating plan with low-fat, high-fiber foods, start or increase an exercise routine. If you're overweight, aim to lose one to two pounds a week, a safe rate of weight loss. Extreme weight loss from crash dieting can deplete your body's nutritional stores, which isn't a good way to start a pregnancy.

Family Finances

Choosing insurance

Thinking about life insurance isn't easy: It forces you to face your own mortality and the thought of leaving loved ones behind. But difficult as it is, it's crucial to make time for a heart-to-heart with your spouse, especially with a new baby in the picture. By planning for the unspeakable, you can ensure that in the case of your death or disability, your family will continue to live in the manner to which they're accustomed — and be able to pay the mortgage, the health bills, other debts and, of course, college tuition.

How much do I need?

The rule of thumb is six to ten times your annual salary, but everyone's situation is different. How much insurance you'll need depends on various factors:

• How much your family spends annually on items like housing, food, and clothing;

• How much your family will need to cover large one-time expenses, such as your children's college educations;

• How much your spouse earns (and hence how much of your family's expenses that can cover);

• How much your investments and other assets are worth (and hence how much they can cover your family's expenses)

What's term insurance?
This simple insurance policy works like car- or home-owners' coverage: If you die while the policy is active, your family gets the money for which you're insured. If you don't, the policy expires, and the insurance company keeps the money (still better than the alternative!). Some term insurance policies give you the right to renew at the same rate for multiple years, while others do not. The former are generally a bit more expensive.

Term life insurance makes sense for most young, middle-income families with children because it covers a set period, with affordable premiums. A typical insurance premium for $250,000 coverage might be $150-$200 a year for a 30-year-old nonsmoker. Rates are fixed when you buy, and increase as you age.

Do I need disability insurance?
If you're between age 35 and 65, you're more likely to become disabled — and unable to work — than you are to die. Disability insurance insures your earning potential, and it makes sense. Standard recommendation: Insure yourself for two-thirds of your income.

What's whole life insurance?
This more complicated option, also called cash-value insurance, offers both an insurance policy and an investment account. The premiums are larger than those for term insurance, but a portion of those funds go into a tax-deferred savings account. The rates are fixed: You'll pay the same premium at 30 as you will at 60. Upon your death, your spouse or family will collect the death benefit. But you can also choose to cash out the policy when you're older or retired and net the tax-deferred savings.

What about mortgage insurance?
This policy insures that your entire mortgage will be paid off upon your death, leaving your heirs a paid-for house. But you should probably skip this type of insurance, even though it sounds so attractive. Term life insurance can do the same thing for a much cheaper price, and it allows your heirs the option of keeping the house, paying off the mortgage, or investing the insurance proceeds.

Family finances overview

How will baby's arrival affect our tax status?	You can claim a new dependent on your income tax form. (It's best to get your baby a Social Security as soon as possible after birth.) What's more, you'll be eligible for a child credit and possibly a childcare credit.
Will my health insurance needs change?	You'll need to add your baby to your employer's health insurance, if you're insured through work. Most health insurance companies have special rules and policies for babies. Ask your carrier to send you specific details on which of your baby's medical expenses they'll cover and which ones they won't.
Can we afford childcare?	Childcare can be very expensive. Shop around and consider the costs of different types of care — centers, home providers, and nannies are the big three. But money isn't the only issue. You'll need to weigh financial costs against your daycare needs and philosophy before deciding whether you can afford it. Many families find the expense of childcare and the time away from their children isn't worth it. The only way to know for sure is to look long and hard at your family's income and expenses and weigh them against the average cost of childcare in your area. As you consider your expenses, think about savings you might enjoy by not going to work — such as lunches, commuting costs, dry cleaning, etc. Get more help deciding whether you can afford to stay home.

How will we afford a child?

Children are expensive, but most families find a way to make their finances work. One plus: as a new parent you'll be spending more time at home and that can cut your expenses considerably. For more information, see:

Nine easy ways to start saving

Log your spending habits for one month	There's no miracle to saving money. It's as simple (and as difficult) as figuring out how to spend less than you earn. But before you can cut your spending, you need to know what it is you're spending your money on. So, for the next month, keep a log of all your daily, weekly, and monthly expenditures (use a little pocket journal to jot down notes as you go, just as if you were on a business trip keeping track of your expenses). Prepare yourself for some sticker shock. That harmless morning latte on the way to work can add up to a tidy $60 a month, or $720 a year, or $7,200 in ten years — a nice chunk of savings. And those impulse baby clothes purchases you put on your credit card really cost 20 percent more than it says on the price tag (because of interest charges) unless you pay the bill in full each month. No one is suggesting you go without caffeine or your baby go without adorable outfits — just be smart about it. If you can't afford Starbucks, keep a stash of ground espresso at work, and make your own pseudo-lattes (microwave ovens do a respectable job of steaming milk). Or if your budget is tight, wait for those baby clothes sales to go on sale when you shop, and give yourself a cash limit.
Pay yourself first	It may seem counterintuitive, but the secret to getting into the savings habit is to put yourself first. That doesn't mean buying every CD or kitchen gadget that catches your eye — it means including yourself among the regular creditors you pay every month. Set some realistic long-term goals and then "pay" yourself by putting money aside in a savings or investment account on a regular basis. If you wait until the end of the month to see what's left over after paying for essentials and shelling out a few extra dollars here and there for impulse purchases, you'll probably find, like most people, that there isn't much left. Don't give yourself a choice. Set up your retirement, emergency savings account, and college fund with automatic monthly transfers — no matter how small— from your paycheck or bank account. Like nightly tooth flossing, regular saving is a healthy habit that accrues over time and becomes a routine you can't live without. And at the end of each month you'll have the immediate gratification of knowing you socked something away in the bank.
Stagger your savings due dates	Most IRAs, college accounts, and other savings options allow you to pick your own date for automatic withdrawals from your checking account or paycheck. Stagger these dates to make sure all the money isn't transferred out of your account on the same day. If you're paid biweekly, tie one withdrawal to each payday. If you're self-employed and money comes in throughout the month, pick a couple of dates in the middle of the month at a time when you're not paying other bills.
Pay down debt	You've heard it before, but it still may seem hard to believe: Paying off your debt is one of the best ways to save money. This is because the interest you pay on most loans (particularly credit cards) is much higher than the interest you get with most savings options. So get rid of as much credit card, student loan, auto loan, and other personal debt as you can (a home mortgage loan should be your one big debt), and then start saving.
Be your own loan officer	When you finish paying off a car loan or other type of loan, keep making the monthly payments — to yourself. Put them into a savings account or, better yet, set up an automatic withdrawal for the same amount into a higher yield investment account.
Motivate yourself with a big-ticket goal	Pinpoint what you really want (a new sofa, a DVD player, a vacation) and what it will cost, and set a realistic goal, such as giving yourself six months to save for it. Cut out pictures of your goal and put them on your bulletin board at work, your refrigerator at home, and in your wallet. Every time you think about buying new shoes or towels, ask yourself if you want or need them as much as what you're saving for.
Open a savings account you can't touch	Save for even bigger purchases, such as the down payment on a house or car, by putting chunks of saved-up money into certificates of deposit (CDs). These accounts offer virtually no risk, they earn higher dividends than plain old savings accounts, and the money must stay in the account for a predetermined period of time — so you can't get at it whenever temptation strikes.
Start a loose change jar	Put a jar — preferably a large one with a narrow mouth, so you can't get your hand into it — in a prominent place, and empty your pocket or wallet change into it at the end of the day. If you can't stand the thought of coin rolls, use the change-counting machines available at some supermarkets when the jar is full. At the end of the year, this found cash can add up to enough money to pay for a weekend getaway, a Christmas gift, or a health club membership.
Sock away surprises	Any time you get an unexpected windfall — a tax rebate, holiday bonus, or cash gift — put it into your savings account. You weren't counting on this money as part of your regular income, so don't spend it as such. Think of this as your Europe or new car account. Or, if you haven't gotten out of debt yet, use it to pay down credit cards and loans or make an extra mortgage payment toward the principal (which reduces the interest you pay over the life of the loan). To Get To This Page in the Future, Type In A Search Box 33ycnangerp "pregancy33" spelled backwards. Or bookmark this page.

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