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CHAPTER ONE
 
Before You Conceive: Preparing for Pregnancy Emotionally, Financially, Physically, and Medically
 
Having a baby is one of the most important decisions in your life, and, as with all key decisions, you should plan for your pregnancy. You can give your baby the best chance of arriving healthy if you take the time to prepare for her or his arrival. This way you can identify and correct any areas that could cause problems during your pregnancy. You (and your partner, if you have one) can best begin the planning process by examining the areas of your life that will be involved with pregnancy and raising a child.
 
DETERMINING YOUR EMOTIONAL FITNESS: ARE YOU READY FOR A BABY?
 
Before you get pregnant (or if you’re already pregnant and struggling with whether or not to keep the baby), it’s important to assess your emotional fitness. Ask yourself the following questions about giving birth:
 
Who is it that really wants to have a baby? Be sure the answer is you—that you’re making the decision for yourself (and together with your mate, if you’re in a relationship). Too often, our society makes women feel as though we’re not “real women” if we don’t have children. But not everyone is “mother material.” Take a realistic look at your situation and make sure you’re not being pressured by a man, relatives, friends, or society’s expectations.
 
Is it a baby that you’re looking for? Sometimes women decide to get pregnant thinking that a baby is the answer to all their problems. You need to make sure you’re not getting pregnant solely because you don’t feel loved and you want to create a dependent little person who will love you unconditionally. If you don’t love yourself, it will be difficult to be a loving mother.
 
If you’re in a relationship, how will a child affect it? Be sure you’re on solid footing with your mate before you make the decision to get pregnant. Don’t have a baby to hold on to him or to fix a relationship that’s not working. The changes that come with a child can be very stressful, so both of you need to be ready.
 
If you’re not in a relationship, are you prepared to raise a baby alone? Raising a baby by yourself can be extremely stressful. If you’re planning to be a single mother, make sure you have a support network in place—friends, family, loved ones, and baby-care facilities that will help you care for your child.
 
How will a baby affect your future? If you’re in the middle of your education, perhaps now isn’t the best time to become a mother. Or, if your career is on a roll, you may want to put off childbearing if possible. If you don’t have a job, can you handle the financial expenses that come with having and raising a child? If you really feel that now is the time for you, find ways to structure job or educational pursuits to make room for a baby in your life.
 
LOOKING AT WHETHER YOU CAN COVER THE EXPENSES OF HAVING A BABY
 
It’s never too early to take a realistic look at your financial situation—especially if you’re worried about money—and it may be a deciding factor in whether or not you’re ready to conceive.
 
If you don’t have health insurance. In most states, you’ll find you are automatically eligible for Medicaid if you meet the financial criteria. Contact your local Medicaid office to find out the specifics. In addition, if you don’t have insurance but earn too much money to meet Medicaid’s financial guidelines, check with different hospitals and birthing centers about the different ways you can arrange to cover your costs.
 
If you do have insurance, having a baby can be very expensive, depending on your policy. You could be responsible for prenatal office visits, lab work and tests, and hospital or birthing center fees, as well as tests, checkups, and possibly nursery charges for your baby. These expenses are substantial, even when you have an uneventful pregnancy with a normal labor and vaginal delivery. And if you have any complications or emergencies, the expenses will skyrocket.
 
Check with your insurance company or your employer’s benefits department to find out what expenses are covered. If you’re married or in a relationship and you don’t have your own coverage, make sure you’re covered under the father’s policy. (In some workplaces, unmarried partners are covered.) Pay special attention to any gaps in your coverage. Some employers allow you to select from a menu of benefits, and you may be able to rearrange your benefits to get more health coverage. If you hold a job, this is also a good time to find out what type of maternity leave you can arrange and what you can expect when you return to work. Use the checklist below to review your health insurance coverage.
 
ASSESSING YOUR HEALTH: GETTING PREPREGNANCY COUNSELING
 
If you’re planning to have a baby, it’s critical that you seek prepregnancy counseling from a health care provider to assess your overall health and provide you with a plan for achieving the best possible health before you get pregnant. During the visit you will have a physical examination, gynecological checkup, and blood and urine tests. Also be prepared to discuss your medical and reproductive history, your family’s health history, and your diet, exercise regimen, and other lifestyle habits.
 
Where to find prepregnancy counseling: You should go to a family practice physician, an obstetrician gynecologist (OB/GYN), an OB/GYN nurse-practitioner, or a certified nurse-midwife (CNM). The checkup can take place anytime before you become pregnant. Some women find that their regular gynecological exam is a good time to discuss future pregnancy. Be sure to let your health care practitioner know that you want to discuss planning for a baby when you make the appointment so that she or he can be prepared with the tests and information you’ll need. If you’re in a relationship, schedule the visit when it’s possible for your partner to be there since part of the evaluation involves him, too.
 
Preparing for your prepregnancy visit: You (and your partner, if applicable) should review your medical history and that of your family. Use the following checklist to help organize your information. If possible, bring your health records or surgical reports from previous surgeries to the office. This is especially important if you have a medical condition that is being treated by another physician. Write down the names and dosage of any medication that you’re currently taking. Also write down any questions you’d like to ask, and be prepared to take notes during your consultation.
 
HOW YOUR MEDICAL CONDITIONS AFFECT YOUR CHANCES OF CONCEPTION AND A HEALTHY PREGNANCY
 
A number of serious illnesses are more likely to affect African American women than our white counterparts. Nonetheless, you can have a successful pregnancy and a healthy baby even if you have a medical disorder or disease, as long as you prepare your body before attempting to conceive.
 
If you’re taking drugs to control your condition, your health care practitioner should review them to make sure they are safe to use during preconception and pregnancy. You’ll also need to ask your practitioner to explain to you how your disease may affect your pregnancy, as well as how your pregnancy may affect the progress of your disease. If you have more than one health care provider, make sure that your preconception practitioner coordinates her or his findings with your primary care doctor so you don’t receive conflicting advice.
 
Diseases That More Often Affect Black Women and What You Should Know If You’re Trying to Conceive
 
ASTHMA
You should inform your doctor of your pregnancy plans. When attempting to conceive you’ll need to keep your asthma under control by using the least amount of medication that is effective in controlling your asthma, but do not change the amount of medication unless your doctor tells you otherwise. Try to avoid situations that you know trigger your asthma. Most common asthma medications are safe during preconception and pregnancy, including theophylline, aminophylline, prednisone, steroid inhalers, and terbutaline. However, some over-the-counter asthma medications may contain iodine, which is safe for you but can cause thyroid problems for your baby.
 
DIABETES
It’s critical that you control your glucose. Good diabetic control before conception lessens the risks of birth defects and miscarriage. And, since the incidence of neural tube defects such as spina bifida is higher in diabetic women, taking folic acid before conception is critical
 
Keeping diabetes under control during pregnancy also lowers the risk of complications like preeclampsia, hypertension, very large babies, and preterm labor. If you’re taking oral medication, you will be switched to insulin therapy before pregnancy. Plan to meet with a certified diabetes educator who will prescribe for you a diet, exercise regimen, and schedule of daily blood glucose tests and insulin injections. If you had gestational diabetes in a previous pregnancy, chances are increased that you’ll develop it again. (Obese women especially have high rates of gestational diabetes.) Pregnancy could be dangerous—potentially life-threatening—if you have heart or kidney disease in addition to diabetes. In such an instance, your practitioner may advise against trying to conceive.
 
FIBROIDS
Most women with fibroids have no problems conceiving or carrying a pregnancy to term, but you will need to determine the number, size, and location of your fibroid tumors. Unless your fibroids are causing infertility, you should try to conceive with the fibroids rather than have them removed surgically. Sometimes, however, when the fibroids are very large, when they have grown so large or so fast that they have begun to liquefy, or when they fill the space inside your uterus (endometrial cavity), surgery is necessary in order to have a successful pregnancy. If you do need to have them removed, abdominal myomectomy (which removes the fibroids while leaving the uterus intact) is probably better than the newer laparoscopic surgery. Studies have shown that laparoscopic surgery may not be as effective in removing all of the fibroids, may cause more adhesions to form, and may carry more risks to future pregnancies. But always get a second opinion before deciding on surgery.