What to Expect When You're Expecting.

by Heidi Murkoff.

Foreword to the Fourth Edition

By Charles J. Lockwood, MD

The Anita O'Keefe Young Professor of Women's Health and Chair, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine THE OTHER DAY I RECEIVED A wonderful, heartfelt thank-you letter from a patient. Enclosed was a picture of a strapping college hockey player-whom I had delivered 19 years before! I have the best job on earth. I get to share in the most joyful, exciting, and wondrous moment that human beings will ever experience-the birth of their child-only I get to experience it over and over and over. Sure, being an obstetrician has its share of tough moments-some very tiring ones at 3 wonderful, heartfelt thank-you letter from a patient. Enclosed was a picture of a strapping college hockey player-whom I had delivered 19 years before! I have the best job on earth. I get to share in the most joyful, exciting, and wondrous moment that human beings will ever experience-the birth of their child-only I get to experience it over and over and over. Sure, being an obstetrician has its share of tough moments-some very tiring ones at 3 A.M A.M., and some very frustrating ones, when the pace of a patient's labor appears to be glacial. There is the occasional adrenaline rush, the patient with the challenging symptom, and the inevitable flood of complex emotions, but mostly it's just plain fun.

In a way, my job is a lot like your pregnancy will probably be-every day will bring a little adventure, but most of them will be fun. What to Expect When You're Expecting What to Expect When You're Expecting is like having a personal obstetrician to guide you through that adventure. I have been recommending this book for years and thoroughly enjoyed reading the fourth edition-because the best just got better. All new, it's packed with information and useful advice, the kind you would hear from your favorite doctor or midwife-one who is wise but funny, thorough but practical, experienced but enthusiastic, organized but empathetic. is like having a personal obstetrician to guide you through that adventure. I have been recommending this book for years and thoroughly enjoyed reading the fourth edition-because the best just got better. All new, it's packed with information and useful advice, the kind you would hear from your favorite doctor or midwife-one who is wise but funny, thorough but practical, experienced but enthusiastic, organized but empathetic.

The book starts you off before conception with solid recommendations on what to-and what not to-do before you are expecting. It then gently guides you through conception to your first visit to a provider. It explains what changes you'll need to make in your lifestyle, job, and diet. One of the book's best features is a month-by-month-in fact a week-by-week-guide to how your baby is developing and what she or he is doing in your uterus. This is accompanied by a description of how you you are developing-and not just your belly but everywhere, from your hair to your toes-and what you should be feeling. It tells you what your provider will do at each visit, and reviews what tests will be ordered and why. Toward the end, it prepares you for the big day, however you might be delivering-vaginally or by cesarean. You'll learn about birthing plans, how to recognize real labor from false labor, and which laboring positions work. Your questions about back labor, fetal monitoring, episiotomy, pain relief, and anesthesia will be answered, even if you didn't know to ask. Then are developing-and not just your belly but everywhere, from your hair to your toes-and what you should be feeling. It tells you what your provider will do at each visit, and reviews what tests will be ordered and why. Toward the end, it prepares you for the big day, however you might be delivering-vaginally or by cesarean. You'll learn about birthing plans, how to recognize real labor from false labor, and which laboring positions work. Your questions about back labor, fetal monitoring, episiotomy, pain relief, and anesthesia will be answered, even if you didn't know to ask. Then What to Expect What to Expect guides you through all aspects of the incredible process of birth. guides you through all aspects of the incredible process of birth.

The book also covers the postpartum period, providing tips for differentiating the "blues" from depression. In an important chapter, it covers complications that you can read about if they occur, or skip over if they don't. It covers pregnancy in women with common medical conditions, such as asthma, high blood pressure, and diabetes-and how to maximize your chances of a normal pregnancy. It also covers what to do if you experience a pregnancy loss, and does it with a wonderful mix of compassion and practicality. Partners are not forgotten: The book provides a very practical guide to being a great coach. And parents-to-be of multiples are included, too. An entire chapter is devoted to their undoubtedly doubled questions and concerns.

As a maternal-fetal medicine specialist, I am impressed by just how much is covered in this book. As an editor, I am impressed by the clear, cogent, and concise writing. As a husband and father, I am impressed that the authors know just what moms-to-be and their partners need to know. The best judges of this book, however, have been the hundreds of patients who have raved about it to me, my staff, and other patients in the waiting room.

If you are reading these words, it's likely you are either newly pregnant or about to become so. Congratulations! My advice to you is lie back, get comfortable, and read on-you are about to embark on the adventure of a lifetime.

Why This Book Was Born Again, Again

TWENTY-FOUR YEARS AGO, I DELIVERED a daughter and conceived a book within a few hours of each other (it was a busy day). Nurturing both those babies, Emma Bing and a daughter and conceived a book within a few hours of each other (it was a busy day). Nurturing both those babies, Emma Bing and What to Expect When You're Expecting What to Expect When You're Expecting (as well as the next baby, my son, Wyatt-and the other (as well as the next baby, my son, Wyatt-and the other What to Expect What to Expect offspring) as they've grown and evolved over the years has been at once exhilarating and exhausting, fulfilling and frustrating, heartwarming and nerve-racking. And like any parent, I wouldn't trade a day of it. (Though there was that week when Emma was thirteen ... okay, make that a year. Maybe two.) offspring) as they've grown and evolved over the years has been at once exhilarating and exhausting, fulfilling and frustrating, heartwarming and nerve-racking. And like any parent, I wouldn't trade a day of it. (Though there was that week when Emma was thirteen ... okay, make that a year. Maybe two.) And now I'm thrilled to announce yet another delivery. A brand-new book that I couldn't be prouder to start showing off and sharing: The fourth edition of What to Expect When You're Expecting What to Expect When You're Expecting. A cover-to-cover, front-to-back revision that's been completely rewritten from start to finish-a new book for a new generation of expectant parents (you!), featuring a fresh look, a fresh perspective, and a friendlier-than-ever voice.

What's new in the new What to Expect What to Expect? So much that I'm excited about. Week-by-week updates on your little one's transformation from microscopic bundle of cells to cuddly newborn-the incredible development of your baby-to-be that will make all that heartburn, all those trips to the bathroom, all that gas, all those pains, and all the sleep deprivation more than worth it. And (speaking of heartburn and gas), more symptoms and more solutions than ever before-and more of your questions answered (even the ones you didn't know you had yet). There's an expanded section on working during pregnancy (as if being pregnant weren't hard enough work!). And going from the practical to the pampered, a brand-new section on expectant beauty: how to love-or at least cope with-the expectant skin you're in, even when it's blotchy, pimply, rashy, itchy, too oily, and too dry; which skin, hair, nail, and cosmetic regimens you can stick with and which you'll have to ditch until delivery. Lots on your pregnant lifestyle (from sex to travel to exercise to fashion), your pregnancy profile (how your obstetrical, medical, and gynecological backstory may-or may not-affect your pregnancy), your relationships, your emotions. A more realistic than ever chapter on expectant eating that responds to every eating style-from at-the-desk to on-the-run, from vegan to low-carb, caffeine-addicted to junk-food dependent. An expanded section on preconception, a new chapter for all you many moms of multiples. Lots more for that very important (but too often neglected) partner in parenting, the dad-to-be. And, of course, the very latest on all things pregnancy (news you can use, on everything from prenatal diagnosis to labor and delivery and beyond).

And because a cover-to-cover revision wouldn't be complete without a new cover, there's one of those, too. Introducing our new cover mom-off her rocker (okay ... out of that rocking chair, finally), she's embracing her belly and celebrating one of life's most magical experiences (and the fact that pregnant women now get to wear cute clothes). She's thoroughly enjoying her expectant self-and I, for one, couldn't be happier for her. Almost makes me want to run out and get pregnant again (I said almost).

As always, just as important as what's different in this fourth edition is what's the same. When What to Expect When You're Expecting What to Expect When You're Expecting was first conceived, it was with a single mission in mind: to help parents-to-be worry less and enjoy their pregnancies more. That mission has grown, but it hasn't changed. Like the first three editions, this fourth one was written to answer your questions, reassure you, relate to you, empathize with you, and help you get a better night's sleep (at least as good a night's sleep as you can get when you're busy running to the bathroom or fighting off leg cramps and backaches). was first conceived, it was with a single mission in mind: to help parents-to-be worry less and enjoy their pregnancies more. That mission has grown, but it hasn't changed. Like the first three editions, this fourth one was written to answer your questions, reassure you, relate to you, empathize with you, and help you get a better night's sleep (at least as good a night's sleep as you can get when you're busy running to the bathroom or fighting off leg cramps and backaches).

I hope you enjoy my new baby as much as I enjoyed creating it-and that it helps you as you go about creating that new baby of yours. Wishing you the healthiest of pregnancies and a lifetime of happy parenting. May all your greatest expectations come true!

About The What to Expect Foundation

Every parent should know what to expect. That's why we created The What to Expect Foundation, a nonprofit organization that provides vital prenatal health and literacy support to moms in need-so they, too, can expect healthier pregnancies, safer deliveries, and healthy, happy babies. For more information and to find out ways you can help, please visit our website at whattoexpect.org.

PART 1.

First Things First

CHAPTER 1.

Before You Conceive.

SO YOU'VE MADE THE DECISION TO start a family (or to grow that family you've already started). That's a great-and exciting-first step. But before sperm meets egg to create the baby of your dreams, take this preconception opportunity to prepare for the healthiest pregnancy-and baby-possible. The next steps outlined in this chapter will help you (and dad-to-be) get into tip-top baby-making shape, give you a leg up on conception, and get you to the pregnancy starting gate with all systems go. start a family (or to grow that family you've already started). That's a great-and exciting-first step. But before sperm meets egg to create the baby of your dreams, take this preconception opportunity to prepare for the healthiest pregnancy-and baby-possible. The next steps outlined in this chapter will help you (and dad-to-be) get into tip-top baby-making shape, give you a leg up on conception, and get you to the pregnancy starting gate with all systems go.

If you don't get pregnant right away, relax and keep trying (and don't forget to keep having fun while you're trying!). If you're already pregnant-and didn't have a chance to follow these steps before you conceived-not to worry. Conception often sneaks up on a couple, cutting out that preconception period altogether and making those preconception pointers pointless. If your pregnancy test has already given you the good news, simply start this book at Chapter 2 Chapter 2, and make the very best of every day of pregnancy you have ahead of you.

Preconception Prep for Moms Ready to board that cute little passenger on the mother ship? Here are some preconception steps you can take to make sure that ship is in shape.

Get a preconception checkup. You don't have to choose a prenatal practitioner yet (though this is a great time to do so; see facing page), but it would be a good idea to see your regular gynecologist or internist for a thorough physical. An exam will pick up any medical problems that need to be corrected beforehand or that will need to be monitored during pregnancy. Plus, your doctor will be able to steer you away from medications that are pregnancy (or preconception) no-no's, make sure your immunizations are up to date, and talk to you about your weight, your diet, your drinking and other lifestyle habits, and similar preconception issues. You don't have to choose a prenatal practitioner yet (though this is a great time to do so; see facing page), but it would be a good idea to see your regular gynecologist or internist for a thorough physical. An exam will pick up any medical problems that need to be corrected beforehand or that will need to be monitored during pregnancy. Plus, your doctor will be able to steer you away from medications that are pregnancy (or preconception) no-no's, make sure your immunizations are up to date, and talk to you about your weight, your diet, your drinking and other lifestyle habits, and similar preconception issues.

Start looking for a prenatal practitioner. It's easier to start looking for an obstetrician or midwife now, when the pregnancy meter's not already running, than when that first prenatal checkup is hanging over your head. If you're going to stick with your regular ob-gyn, then you've got a head start. Otherwise, ask around, scout around, and take your time in picking the practitioner who's right for you (see It's easier to start looking for an obstetrician or midwife now, when the pregnancy meter's not already running, than when that first prenatal checkup is hanging over your head. If you're going to stick with your regular ob-gyn, then you've got a head start. Otherwise, ask around, scout around, and take your time in picking the practitioner who's right for you (see page 21 page 21 for tips on choosing one). Then schedule an interview and a prepregnancy exam. for tips on choosing one). Then schedule an interview and a prepregnancy exam.

Smile for the dentist. A visit to the dentist before you get pregnant is almost as important as a visit to the doctor. That's because your future pregnancy can affect your mouth-and your mouth can possibly affect your future pregnancy. Pregnancy hormones can actually aggravate gum and tooth problems, making a mess of a mouth that's not well taken care of to begin with. What's more, research shows that gum disease may be associated with some pregnancy complications. So before you get busy making a baby, get busy getting your mouth into shape. Be sure, too, to have any necessary work, including X-rays, fillings, and dental surgery, completed now so that it won't have to be done during pregnancy. A visit to the dentist before you get pregnant is almost as important as a visit to the doctor. That's because your future pregnancy can affect your mouth-and your mouth can possibly affect your future pregnancy. Pregnancy hormones can actually aggravate gum and tooth problems, making a mess of a mouth that's not well taken care of to begin with. What's more, research shows that gum disease may be associated with some pregnancy complications. So before you get busy making a baby, get busy getting your mouth into shape. Be sure, too, to have any necessary work, including X-rays, fillings, and dental surgery, completed now so that it won't have to be done during pregnancy.

Check your family tree. Get the scoop on the health history on both sides of the family tree (yours and your spouse's). It's especially important to find out if there's a history of any medical issues and genetic or chromosomal disorders such as Down syndrome, Tay-Sachs disease, sickle cell anemia, thalassemia, hemophilia, cystic fibrosis, muscular dystrophy, or fragile X syndrome.

Take a look at your pregnancy history. If you've had a previous pregnancy with any complications or one that ended with a premature delivery or late pregnancy loss, or if you've had multiple miscarriages, talk to your practitioner about any measures that can be taken to head off a repeat. If you've had a previous pregnancy with any complications or one that ended with a premature delivery or late pregnancy loss, or if you've had multiple miscarriages, talk to your practitioner about any measures that can be taken to head off a repeat.

Putting It All Together

Does looking at this list of to-do's make you realize there's a lot to do even before sperm meets egg? Having a hard time knowing where to start? For a list of questions to ask when choosing a prenatal practitioner, a complete personal medical and obstetrical health history, a family health history chart, and plenty of other helpful information to help you get organized for your baby-making journey, see The What to Expect Pregnancy Journal and Organizer The What to Expect Pregnancy Journal and Organizer and and whattoexpect.com.

Seek genetic screening, if necessary. Also ask your practitioner about being tested for any genetic disease common to your ethnic background: cystic fibrosis if either of you is Caucasian; Tay-Sachs disease if either of you is of Jewish-European (Ashkenazi), French Canadian, or Louisiana Cajun descent; sickle cell trait if you are of African descent; one of the thalassemias if you are of Greek, Italian, Southeast Asian, or Filipino origin.

Previous obstetrical difficulties (such as two or more miscarriages, a stillbirth, a long period of infertility, or a child with a birth defect) or being married to a cousin or other blood relative are also reasons to seek genetic counseling.

Get tested. While you're seeing all your doctors and checking out all your histories, ask if you can get a head start on some of the tests and health workups every pregnant woman receives. Most are as easy as getting a blood test to look for: While you're seeing all your doctors and checking out all your histories, ask if you can get a head start on some of the tests and health workups every pregnant woman receives. Most are as easy as getting a blood test to look for: [image] Hemoglobin or hematocrit, to test for anemia. Hemoglobin or hematocrit, to test for anemia.[image] Rh factor, to see if you are positive or negative. If you are negative, your partner should be tested to see if he is positive. (If you're both negative, there is no need to give Rh another thought.) Rh factor, to see if you are positive or negative. If you are negative, your partner should be tested to see if he is positive. (If you're both negative, there is no need to give Rh another thought.)[image] Rubella titer, to check for immunity to rubella. Rubella titer, to check for immunity to rubella.[image] Varicella titer, to check for immunity to varicella (chicken pox). Varicella titer, to check for immunity to varicella (chicken pox).[image] Tuberculosis (if you live in a high- incidence area). Tuberculosis (if you live in a high- incidence area).[image] Hepatitis B (if you're in a high-risk category, such as health-care worker, and have not been immunized). Hepatitis B (if you're in a high-risk category, such as health-care worker, and have not been immunized).[image] Cytomegalovirus (CMV) antibodies, to determine whether or not you are immune to CMV (see Cytomegalovirus (CMV) antibodies, to determine whether or not you are immune to CMV (see page 503 page 503). If you have been diagnosed with CMV, it's generally recommended you wait six months before trying to conceive.[image] Toxoplasmosis titer, if you have an outdoor cat, regularly eat raw or rare meat, or garden without gloves. If you turn out to be immune, you don't have to worry about toxoplasmosis now or ever. If you're not, start taking the precautions on Toxoplasmosis titer, if you have an outdoor cat, regularly eat raw or rare meat, or garden without gloves. If you turn out to be immune, you don't have to worry about toxoplasmosis now or ever. If you're not, start taking the precautions on page 80 page 80 now. now.[image] Thyroid function. Thyroid function can affect pregnancy. So if you have or ever had thyroid problems, or if you have a family history of thyroid disease, or if you have symptoms of a thyroid condition (see Thyroid function. Thyroid function can affect pregnancy. So if you have or ever had thyroid problems, or if you have a family history of thyroid disease, or if you have symptoms of a thyroid condition (see pages 174 pages 174 and and 531 531), this is an important test to have.[image] Sexually transmitted diseases (STDs). All pregnant women are routinely tested for all STDs, including syphilis, gonorrhea, chlamydia, herpes, human papilloma virus (HPV), and HIV. Having these tests before conception is even better (or in the case of HPV, getting the vaccine; see next page). Even if you're sure you couldn't have an STD, ask to be tested, just to be on the safe side. Sexually transmitted diseases (STDs). All pregnant women are routinely tested for all STDs, including syphilis, gonorrhea, chlamydia, herpes, human papilloma virus (HPV), and HIV. Having these tests before conception is even better (or in the case of HPV, getting the vaccine; see next page). Even if you're sure you couldn't have an STD, ask to be tested, just to be on the safe side.

Get treated. If any test turns up a condition that requires treatment, make sure you take care of it before trying to conceive. Also consider attending to minor elective surgery and anything else medical-major or minor-that you've been putting off. Now is the time, too, to be treated for any gynecological conditions that might interfere with fertility or pregnancy, including: If any test turns up a condition that requires treatment, make sure you take care of it before trying to conceive. Also consider attending to minor elective surgery and anything else medical-major or minor-that you've been putting off. Now is the time, too, to be treated for any gynecological conditions that might interfere with fertility or pregnancy, including: [image] Uterine polyps, fibroids, cysts, or benign tumors. Uterine polyps, fibroids, cysts, or benign tumors.[image] Endometriosis (when the cells that ordinarily line the uterus spread elsewhere in the body). Endometriosis (when the cells that ordinarily line the uterus spread elsewhere in the body).[image] Pelvic inflammatory disease. Pelvic inflammatory disease.[image] Recurrent urinary tract infections or other infections, such as bacterial vaginosis. Recurrent urinary tract infections or other infections, such as bacterial vaginosis.[image] An STD. An STD.

Update your immunizations. If you haven't had a tetanus-diphtheria-pertussis booster in the past 10 years, have one now. If you know you've never had rubella or been immunized against it, or if testing showed you are not immune to it, get vaccinated now with the measles, mumps, and rubella (MMR) vaccine, and then wait one month before attempting to conceive (but don't worry if you accidentally conceive earlier). If testing shows you've never had chicken pox or are at high risk for hepatitis B, immunization for these diseases is also recommended now, before conception. If you're under 26, also consider getting vaccinated against HPV, but you'd need to get the full series of three before trying to conceive, so plan accordingly. If you haven't had a tetanus-diphtheria-pertussis booster in the past 10 years, have one now. If you know you've never had rubella or been immunized against it, or if testing showed you are not immune to it, get vaccinated now with the measles, mumps, and rubella (MMR) vaccine, and then wait one month before attempting to conceive (but don't worry if you accidentally conceive earlier). If testing shows you've never had chicken pox or are at high risk for hepatitis B, immunization for these diseases is also recommended now, before conception. If you're under 26, also consider getting vaccinated against HPV, but you'd need to get the full series of three before trying to conceive, so plan accordingly.

Get chronic illnesses under control. If you have diabetes, asthma, a heart condition, epilepsy, or any other chronic illness, be sure you have your doctor's okay to become pregnant, your condition is under control before you conceive, and you start taking optimum care of yourself now (if you aren't already). If you were born with phenylketonuria (PKU), begin a strict phenylalanine-free diet before conceiving and continue it through pregnancy. As unappealing as it is, it's essential to your baby-to-be's well-being. If you have diabetes, asthma, a heart condition, epilepsy, or any other chronic illness, be sure you have your doctor's okay to become pregnant, your condition is under control before you conceive, and you start taking optimum care of yourself now (if you aren't already). If you were born with phenylketonuria (PKU), begin a strict phenylalanine-free diet before conceiving and continue it through pregnancy. As unappealing as it is, it's essential to your baby-to-be's well-being.

If you need allergy shots, take care of them now. (If you start allergy desensitization now, you will probably be able to continue once you conceive.) Because depression can interfere with conception-and with a happy, healthy pregnancy-it should also be treated before you begin your big adventure.

Get ready to toss your birth control. Ditch that last package of condoms and throw out your diaphragm (you'll have to be refitted after pregnancy anyway). If you're using birth control pills, the vaginal ring, or the patch, talk your game plan over with your practitioner. Some recommend holding off on baby-making efforts for several months after quitting hormonal birth control, if possible, to allow your reproductive system to go through at least two normal cycles (use condoms while you're waiting). Others say it's okay to start trying as soon as you want. Be aware, though, that it may take a few months or even longer for your cycles to become normal and for you to begin ovulating again. Ditch that last package of condoms and throw out your diaphragm (you'll have to be refitted after pregnancy anyway). If you're using birth control pills, the vaginal ring, or the patch, talk your game plan over with your practitioner. Some recommend holding off on baby-making efforts for several months after quitting hormonal birth control, if possible, to allow your reproductive system to go through at least two normal cycles (use condoms while you're waiting). Others say it's okay to start trying as soon as you want. Be aware, though, that it may take a few months or even longer for your cycles to become normal and for you to begin ovulating again.

If you use an IUD, have it removed before you begin trying. Wait three to six months after stopping Depo-Provera shots to try to conceive (many women aren't fertile for an average of 10 months after stopping Depo, so time accordingly).

Improve your diet. You may not be eating for two yet, but it's never too early to start eating well for the baby you're planning to make. Most important is to make sure you're getting your folic acid. Not only does getting enough folic acid appear to boost fertility, but studies show that adequate intake of this vitamin in a woman's diet before she conceives and early in her pregnancy can dramatically reduce the risk of neural tube defects (such as spina bifida) and preterm birth. sFolic acid is found naturally in whole grains and green leafy vegetables, and by law it is also added to most refined grains. But taking a prenatal supplement containing at least 400 mcg of folic acid is also recommended (see You may not be eating for two yet, but it's never too early to start eating well for the baby you're planning to make. Most important is to make sure you're getting your folic acid. Not only does getting enough folic acid appear to boost fertility, but studies show that adequate intake of this vitamin in a woman's diet before she conceives and early in her pregnancy can dramatically reduce the risk of neural tube defects (such as spina bifida) and preterm birth. sFolic acid is found naturally in whole grains and green leafy vegetables, and by law it is also added to most refined grains. But taking a prenatal supplement containing at least 400 mcg of folic acid is also recommended (see page 103 page 103).

It's also a good idea to start cutting back on junk food and high-fat foods and begin increasing whole grains, fruits, vegetables, and low-fat dairy products (important for bone strength). You can use the Pregnancy Diet (Chapter 5) as a good basic, balanced food plan, but you'll need only two protein servings, three calcium servings, and no more than six whole-grain servings daily until you conceive-plus you won't have to start adding those extra calories (and if you need to lose some weight preconception, you might need to cut some calories out).

Start modifying your fish consumption according to the guidelines for expectant moms (see page 114 page 114). But don't cut out fish, because it's a great source of baby-growing nutrients.

If you have any dietary habits that wouldn't be healthy during pregnancy (such as periodic fasting), suffer or have suffered from an eating disorder (such as anorexia nervosa or bulimia), or are on a special diet (vegan, macrobiotic, diabetic, or any other), tell your practitioner.

It Takes Two, Baby

Sure, you're closer than ever physically now that you're trying to make a baby (that's something baby-making efforts just about guarantee)-but what about your love connection? As you strive to form that perfect union (of sperm and egg), are you neglecting the other significant union in your lives (the two of you)?

When expanding your twosome becomes your number one priority, when sex becomes functional instead of recreational, when it's less about getting it on than getting it done (and when foreplay consists of running to the bathroom to check your cervical mucus), relationships can sometimes show the strain. But yours definitely doesn't have to-in fact, you can keep it healthier than ever. To stay emotionally connected while you're trying to conceive: [image]Get out. Been-there, done-that moms will tell you that Been-there, done-that moms will tell you that now's now's the time for you and your spouse to get out of town-or at least out of the house. Once baby's on board, your days (and nights) of picking up and taking off will be numbered. (Maternity leave? More like maternity the time for you and your spouse to get out of town-or at least out of the house. Once baby's on board, your days (and nights) of picking up and taking off will be numbered. (Maternity leave? More like maternity stay stay!) So take that mini vacation you've been saving up for-or that second honeymoon (you can call it a baby-to-be-moon). No time for a vacation? Try something new on the weekends-preferably something that you won't be able to do once conception cramps your lifestyle (horseback riding or white-water rafting, anyone?). Need something more tame as a twosome? Slip off to a museum on a weekend afternoon, catch a late-night movie (or two) at the multiplex, or just linger over dinner at your favorite restaurant (no babysitters necessary).[image]Rev up the romance. Pee-on-a-stick ovulation tests and the pressure to perform (now!) can make sex seem too much like hard work. So bring fun back into the bedroom. Turn up the heat-and not just your basal temperature-with a sexy little nightie, a steamy movie, a sex toy or two, a round of strip poker or nude twister, a new position (kama sutra will be considerably trickier once that belly gets in the way), a new location (serve yourself up on the dining table), or a new tactic (hot fudge on each other instead of on ice cream). Adventurous isn't in your comfort zone? Ratchet up the romance with a moonlight stroll, dinner by candlelight, cuddling in front of the fireplace. Pee-on-a-stick ovulation tests and the pressure to perform (now!) can make sex seem too much like hard work. So bring fun back into the bedroom. Turn up the heat-and not just your basal temperature-with a sexy little nightie, a steamy movie, a sex toy or two, a round of strip poker or nude twister, a new position (kama sutra will be considerably trickier once that belly gets in the way), a new location (serve yourself up on the dining table), or a new tactic (hot fudge on each other instead of on ice cream). Adventurous isn't in your comfort zone? Ratchet up the romance with a moonlight stroll, dinner by candlelight, cuddling in front of the fireplace.[image]Stay on the same page. Worried that your spouse is more interested in charting the stock market than helping you chart your basal body temperature? Get the feeling that he's blase about baby making? Go easy on him. Just because he might not be obsessing over ovulation or going ga-ga every time he passes a baby boutique doesn't mean he's not as eager as you are to get the baby show on the road. Maybe he's just being a guy (laid-back, instead of worked up). Maybe he's just keeping his tension about conception to himself (so he doesn't stress you out, too). Maybe he's focusing on the business end of baby making (he's working longer hours because he's concerned about providing a nest egg for the nestling you'll be creating). Either way, remember that taking the plunge into parenthood is a huge step for both of you-but that you're taking it as a team. To stay on the same page (even if you're using different words), communicate as you try to procreate. You'll both feel better knowing you're in this together-even if you're approaching it a little differently. Worried that your spouse is more interested in charting the stock market than helping you chart your basal body temperature? Get the feeling that he's blase about baby making? Go easy on him. Just because he might not be obsessing over ovulation or going ga-ga every time he passes a baby boutique doesn't mean he's not as eager as you are to get the baby show on the road. Maybe he's just being a guy (laid-back, instead of worked up). Maybe he's just keeping his tension about conception to himself (so he doesn't stress you out, too). Maybe he's focusing on the business end of baby making (he's working longer hours because he's concerned about providing a nest egg for the nestling you'll be creating). Either way, remember that taking the plunge into parenthood is a huge step for both of you-but that you're taking it as a team. To stay on the same page (even if you're using different words), communicate as you try to procreate. You'll both feel better knowing you're in this together-even if you're approaching it a little differently.

Take a prenatal vitamin. Even if you're eating plenty of foods high in folic acid, it's still recommended that you take a pregnancy supplement containing 400 mcg of the vitamin, preferably beginning two months before you try to conceive. Another good reason to start taking a prenatal supplement preconception: Research indicates that women who take a daily multivitamin containing at least 10 mg of vitamin B Even if you're eating plenty of foods high in folic acid, it's still recommended that you take a pregnancy supplement containing 400 mcg of the vitamin, preferably beginning two months before you try to conceive. Another good reason to start taking a prenatal supplement preconception: Research indicates that women who take a daily multivitamin containing at least 10 mg of vitamin B6 before becoming pregnant or during the first weeks of pregnancy experience fewer episodes of vomiting and nausea during pregnancy. The supplement should also contain 15 mg of zinc, which may improve fertility. Stop taking other nutritional supplements before conceiving, however, since excesses of certain nutrients can be hazardous. before becoming pregnant or during the first weeks of pregnancy experience fewer episodes of vomiting and nausea during pregnancy. The supplement should also contain 15 mg of zinc, which may improve fertility. Stop taking other nutritional supplements before conceiving, however, since excesses of certain nutrients can be hazardous.

Get your weight in check. Being overweight or very underweight not only reduces the chances of conception, but, if you do conceive, weight problems can increase the risk of pregnancy complications. So add or cut calories in the preconception period as needed. If you're trying to lose weight, be sure to do so slowly and sensibly, even if it means putting off conception for another couple of months. Strenuous or nutritionally unbalanced dieting (including low-carbohydrate, high-protein diets) can make conception elusive and can result in a nutritional deficit, which probably isn't the best way to start your pregnancy. If you've been extreme dieting recently, start eating normally and give your body a few months to get back into balance before you try to conceive. Being overweight or very underweight not only reduces the chances of conception, but, if you do conceive, weight problems can increase the risk of pregnancy complications. So add or cut calories in the preconception period as needed. If you're trying to lose weight, be sure to do so slowly and sensibly, even if it means putting off conception for another couple of months. Strenuous or nutritionally unbalanced dieting (including low-carbohydrate, high-protein diets) can make conception elusive and can result in a nutritional deficit, which probably isn't the best way to start your pregnancy. If you've been extreme dieting recently, start eating normally and give your body a few months to get back into balance before you try to conceive.

Shape up, but keep cool. A good exercise program can put you on the right track for conception, plus it will tone and strengthen your muscles in preparation for the challenging tasks of carrying and delivering your baby-to-be. It will also help you take off excess weight. Don't overdo that good thing, though, because excessive exercise (especially if it leads to an extremely lean body) can interfere with ovulation-and if you don't ovulate, you can't conceive. And keep your cool during workouts: Prolonged increases in body temperature can interfere with conception. (Avoid hot tubs, saunas, and direct exposure to heating pads and electric blankets for the same reason.) A good exercise program can put you on the right track for conception, plus it will tone and strengthen your muscles in preparation for the challenging tasks of carrying and delivering your baby-to-be. It will also help you take off excess weight. Don't overdo that good thing, though, because excessive exercise (especially if it leads to an extremely lean body) can interfere with ovulation-and if you don't ovulate, you can't conceive. And keep your cool during workouts: Prolonged increases in body temperature can interfere with conception. (Avoid hot tubs, saunas, and direct exposure to heating pads and electric blankets for the same reason.) Check your medicine cabinet. Some-though far from all-medications are considered unsafe for use during pregnancy. If you're taking any medications now (regularly or once in a while, prescription or over-the-counter), ask your practitioner about their safety during preconception and pregnancy. If you need to switch a regular medication that isn't safe to a substitute that is, now's the time to do it. Some-though far from all-medications are considered unsafe for use during pregnancy. If you're taking any medications now (regularly or once in a while, prescription or over-the-counter), ask your practitioner about their safety during preconception and pregnancy. If you need to switch a regular medication that isn't safe to a substitute that is, now's the time to do it.

Herbal or other alternative medications shouldn't necessarily move front and center in your medicine cabinet, either. Herbs are natural, but natural doesn't automatically signal safe. What's more, some popular herbs-such as echinacea, ginkgo biloba, or St. John's wort-can interfere with conception. Do not take any such products or supplements without the approval of a doctor familiar with herbals and alternative medicines and their potential effect on conception and pregnancy.

Cut back on caffeine. There's no need to drop that latte (or switch to decaf) if you're planning on becoming pregnant or even once you become pregnant. Most experts believe that up to two cups of caffeinated coffee (or the equivalent in other caffeinated beverages) a day is fine. If your habit involves more than that, though, it would be smart to start moderating. Some studies have linked downing too much of the stuff to lowered fertility. There's no need to drop that latte (or switch to decaf) if you're planning on becoming pregnant or even once you become pregnant. Most experts believe that up to two cups of caffeinated coffee (or the equivalent in other caffeinated beverages) a day is fine. If your habit involves more than that, though, it would be smart to start moderating. Some studies have linked downing too much of the stuff to lowered fertility.

Pinpointing Ovulation

Knowing when the Big O (ovulation) occurs is key when doing the Baby Dance (aka trying to conceive). Here are a few ways to help you pin down the big day-and pin each other down for baby-making activities.

Watch the calendar. Ovulation most often occurs halfway through your menstrual cycle. The average cycle lasts 28 days, counting from the first day of one period (day 1) to the first day of the next period. But as with everything pregnancy related, there's a wide range of normal when it comes to menstrual cycles (they can run anywhere from 23 days to 35 days), and your own cycle may vary slightly from month to month. By keeping a menstrual calendar for a few months, you can get an idea of what's normal for you. (And when you become pregnant, this calendar will help give you a better estimate of your baby's due date.) If your periods are irregular, you'll need to be more alert for other signs of ovulation (see below). Ovulation most often occurs halfway through your menstrual cycle. The average cycle lasts 28 days, counting from the first day of one period (day 1) to the first day of the next period. But as with everything pregnancy related, there's a wide range of normal when it comes to menstrual cycles (they can run anywhere from 23 days to 35 days), and your own cycle may vary slightly from month to month. By keeping a menstrual calendar for a few months, you can get an idea of what's normal for you. (And when you become pregnant, this calendar will help give you a better estimate of your baby's due date.) If your periods are irregular, you'll need to be more alert for other signs of ovulation (see below).

Take your temperature. Keeping track of your basal body temperature, or BBT (you'll need a special basal body thermometer to do this), can help you pinpoint ovulation. Your BBT is the baseline reading you get first thing in the morning, after at least three to five hours of sleep and before you get out of bed, talk, or even sit up. Your BBT changes throughout your cycle, reaching its lowest point at ovulation and then rising dramatically (about half a degree) within a day or so after ovulation occurs. Keep in mind that charting your BBT will not enable you to predict the day you ovulate, but rather it gives you evidence of ovulation two to three days after it has occurred. Over a few months, it will help you to see a pattern to your cycles, enabling you to predict when ovulation will occur in future cycles. Keeping track of your basal body temperature, or BBT (you'll need a special basal body thermometer to do this), can help you pinpoint ovulation. Your BBT is the baseline reading you get first thing in the morning, after at least three to five hours of sleep and before you get out of bed, talk, or even sit up. Your BBT changes throughout your cycle, reaching its lowest point at ovulation and then rising dramatically (about half a degree) within a day or so after ovulation occurs. Keep in mind that charting your BBT will not enable you to predict the day you ovulate, but rather it gives you evidence of ovulation two to three days after it has occurred. Over a few months, it will help you to see a pattern to your cycles, enabling you to predict when ovulation will occur in future cycles.

Check your underwear. Another sign you can be alert for is the appearance, increase in quantity, and change in consistency of cervical mucus (the stuff that gets your underwear all sticky). After your period ends, don't expect much, if any, cervical mucus. As the cycle proceeds, you'll notice an increase in the amount of mucus with an often white or cloudy appearance-and if you try to stretch it between your fingers, it'll break apart. As you get closer to ovulation, this mucus becomes even more copious, but now it's thinner, clearer, and has a slippery consistency similar to an egg white. If you try to stretch it between your fingers, you'll be able to pull it into a string a few inches long before it breaks (how's that for fun in the bathroom?). This is yet another sign of impending ovulation, as well as a sign that it's time to get out of the bathroom and get busy in the bedroom. Once ovulation occurs, you may either become dry again or develop a thicker discharge. Combined with cervical position (see below) and BBT on a single chart, cervical mucus can be an extremely useful (if slightly messy) tool in pinpointing the day on which you are most likely to ovulate-and it does so in plenty of time for you to do something about it. Another sign you can be alert for is the appearance, increase in quantity, and change in consistency of cervical mucus (the stuff that gets your underwear all sticky). After your period ends, don't expect much, if any, cervical mucus. As the cycle proceeds, you'll notice an increase in the amount of mucus with an often white or cloudy appearance-and if you try to stretch it between your fingers, it'll break apart. As you get closer to ovulation, this mucus becomes even more copious, but now it's thinner, clearer, and has a slippery consistency similar to an egg white. If you try to stretch it between your fingers, you'll be able to pull it into a string a few inches long before it breaks (how's that for fun in the bathroom?). This is yet another sign of impending ovulation, as well as a sign that it's time to get out of the bathroom and get busy in the bedroom. Once ovulation occurs, you may either become dry again or develop a thicker discharge. Combined with cervical position (see below) and BBT on a single chart, cervical mucus can be an extremely useful (if slightly messy) tool in pinpointing the day on which you are most likely to ovulate-and it does so in plenty of time for you to do something about it.

Get to know your cervix. As your body senses the hormone shifts that indicate an egg is about to be released from the ovary, it begins to ready itself for incoming hordes of sperm to give the egg its best chance of getting fertilized. One detectable sign of oncoming ovulation is the position of the cervix itself. During the beginning of a cycle, your cervix-that necklike passage between your vagina and uterus that has to stretch during birth to accommodate your baby's head-is low, hard, and closed. But as ovulation approaches, it pulls back up, softens a bit, and opens just a little to let the sperm through on their way to their target. Some women can easily feel these changes, others have a tougher time. If you're game to try, check your cervix daily, using one or two fingers, and keep a chart of your observations. As your body senses the hormone shifts that indicate an egg is about to be released from the ovary, it begins to ready itself for incoming hordes of sperm to give the egg its best chance of getting fertilized. One detectable sign of oncoming ovulation is the position of the cervix itself. During the beginning of a cycle, your cervix-that necklike passage between your vagina and uterus that has to stretch during birth to accommodate your baby's head-is low, hard, and closed. But as ovulation approaches, it pulls back up, softens a bit, and opens just a little to let the sperm through on their way to their target. Some women can easily feel these changes, others have a tougher time. If you're game to try, check your cervix daily, using one or two fingers, and keep a chart of your observations.

Stay tuned in. If you're like 20 percent of women, your body will let you know when ovulation is taking place by sending a bulletin in the form of a twinge of pain or a series of cramps in your lower abdominal area (usually localized to one side, the side where you're ovulating). Called mittelschmerz-German for "middle pain"-this monthly reminder of fertility is thought to be the result of the maturation or release of an egg from an ovary.

Pee on a stick. Ovulation predictor kits (OPKs) are able to pinpoint your date of ovulation 12 to 24 hours in advance by measuring levels of luteinizing hormone, or LH, which is the last of the hormones to hit its peak before ovulation actually occurs. All you have to do is pee on a stick and wait for the indicator to tell you whether you're about to ovulate (talk about easy).

Watch your watch. Another option in the ovulation test arsenal is a device you wear on your wrist that detects the numerous salts (chloride, sodium, potassium) in your sweat, which differ during different times of the month. Called the chloride ion surge, this shift happens even before the estrogen and the LH surge, so these chloride ion tests give a woman a four-day window of when she may be ovulating, versus the 12 to 24-hour window that the standard pee-on-a-stick OPKs provide. The key to success in using this latest technology is to make sure to get an accurate baseline of your ion levels (which means you'll need to wear the device on your wrist for at least six continuous hours to get a proper baseline).

Spit a little. Another ovulation predictor is a saliva test, which tests the levels of estrogen in your saliva as ovulation nears. When you're ovulating, a look at your saliva under the test's eyepiece will reveal a microscopic pattern that resembles the leaves of a fern plant or frost on a windowpane. Not all women get a good "fern," but this test, which is reusable, can be cheaper than those pee-on sticks.

Cut down on alcohol. Start thinking before drinking. Although a daily drink will not be harmful in your pregnancy-preparation phase, heavy alcohol consumption can interfere with fertility by disrupting your menstrual cycle. Plus, once you're actively trying to conceive, there's always the possibility that you'll have succeeded-and drinking during pregnancy isn't recommended. Start thinking before drinking. Although a daily drink will not be harmful in your pregnancy-preparation phase, heavy alcohol consumption can interfere with fertility by disrupting your menstrual cycle. Plus, once you're actively trying to conceive, there's always the possibility that you'll have succeeded-and drinking during pregnancy isn't recommended.

Quit smoking. Did you know that smoking can not only interfere with fertility but also cause your eggs to age? That's right-a 30-year-old smoker's eggs act more like 40-year-old eggs, making conception more difficult and miscarriage more likely. Kicking the habit now is not only the best gift you can give your baby-to-be (before and after birth), but it can make it more likely that you'll conceive that baby-to-be. For some practical tips to help you quit, check out Did you know that smoking can not only interfere with fertility but also cause your eggs to age? That's right-a 30-year-old smoker's eggs act more like 40-year-old eggs, making conception more difficult and miscarriage more likely. Kicking the habit now is not only the best gift you can give your baby-to-be (before and after birth), but it can make it more likely that you'll conceive that baby-to-be. For some practical tips to help you quit, check out pages 74 pages 7475.

Conception Misconceptions

You've heard plenty of old wives'-and new Internet-tales about how best to make a baby. Here are a few that are ready to be taken off the circuit: Myth: Having sex every day will decrease sperm count, making conception more elusive. Having sex every day will decrease sperm count, making conception more elusive.

Fact: Though this was once believed to be true, more recent research has shown that having sex every day around the time of ovulation is slightly more likely to end in pregnancy than having sex every other day. More, apparently, is more. Though this was once believed to be true, more recent research has shown that having sex every day around the time of ovulation is slightly more likely to end in pregnancy than having sex every other day. More, apparently, is more.

Myth: Wearing boxer shorts will increase fertility.

Fact: Scientists have yet to rule definitively on the boxers versus briefs debate, but most experts seem to think that the underwear a man favors has little effect on the baby race. Though there is something to be said for keeping the testicles cool and giving them a little breathing room (see Scientists have yet to rule definitively on the boxers versus briefs debate, but most experts seem to think that the underwear a man favors has little effect on the baby race. Though there is something to be said for keeping the testicles cool and giving them a little breathing room (see page 13 page 13).

Myth: Missionary position intercourse is the best way for sperm to reach their target. Missionary position intercourse is the best way for sperm to reach their target.

Fact: The cervical mucus that turns thin and stretchy around the time of ovulation is the perfect medium for sperm, helping those boys swim up the vaginal tract, through the cervix, past the uterus, and up the fallopian tubes to the awaiting egg. Unless sperm have a motility problem, they'll reach their target no matter what position you're in while you're doing it. It doesn't hurt, however, to lie down for a while after intercourse so the sperm don't run out of the vagina before they even get a running start. The cervical mucus that turns thin and stretchy around the time of ovulation is the perfect medium for sperm, helping those boys swim up the vaginal tract, through the cervix, past the uterus, and up the fallopian tubes to the awaiting egg. Unless sperm have a motility problem, they'll reach their target no matter what position you're in while you're doing it. It doesn't hurt, however, to lie down for a while after intercourse so the sperm don't run out of the vagina before they even get a running start.

Myth: Lubricant will help the sperm hitch a ride to Egg Central. Lubricant will help the sperm hitch a ride to Egg Central.

Fact: Actually, the opposite is true. Lubricants can change the pH balance in the vagina, creating an inhospitable environment for the sperm. So lay off the Astroglide until after your conception mission is accomplished. Actually, the opposite is true. Lubricants can change the pH balance in the vagina, creating an inhospitable environment for the sperm. So lay off the Astroglide until after your conception mission is accomplished.

Myth: Daytime sex helps you conceive faster. Daytime sex helps you conceive faster.

Fact: Sperm levels do seem to be higher in the morning, but no clinical evidence supports that making hay while the sun shines will increase your chances of conception. (But don't let that stop you if you'd like to grab a quickie before you grab your lunch-break sandwich!) Sperm levels do seem to be higher in the morning, but no clinical evidence supports that making hay while the sun shines will increase your chances of conception. (But don't let that stop you if you'd like to grab a quickie before you grab your lunch-break sandwich!)