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These last fifty years mark the first time in human history that sexually active women have been able to choose whether or not to have a baby. In the past, women’s options were celibacy or motherhood. Of course, it’s liberating and exciting to be able to control our own reproduction, but these benefits come with responsibility: If it’s possible to plan a pregnancy, it’s worth trying to do so.
Even Unplanned Pregnancies Deserve Some Planning
More than 30 percent of babies born in this country are the result of unplanned pregnancies. Because no contraceptive device is 100 percent effective, there are a few things you should think about if you’re a heterosexually active female, regardless of whether you’re trying to get pregnant at this very moment.
First Step: Don’t Panic!
If you are a perfectly healthy, addiction- and medication-free woman under the age of forty, and you do nothing at all about your prenatal health—and by nothing I mean you never see a physician, get tested for anything, or alter your diet or lifestyle—your chances of having a healthy baby at term are still over 90 percent. However, modern medicine has quite a lot to offer the pregnant woman in terms of her well-being and that of her child. To make informed decisions for your baby and yourself, you should know and understand the standard obstetrical process. I’m not saying that you must follow every suggestion offered by prenatal experts to have a healthy and happy pregnancy, but don’t just guess at which guidelines to bend or rules to break. Therefore, if the condom breaks and you are at a place in your life where you would at least consider having a baby, think about cutting back on booze before you get your next period—embryos don’t seem to handle their liquor well. It’s also a good idea to take a multivitamin every day, especially one containing folic acid, which is known to prevent certain birth defects and is relatively easy to incorporate into your life. Smoking isn’t good for anybody, mother or child, so consider dropping that out of your regimen. Talk to your doctor about any medications you might be taking. Some relatively common drugs, like the acne treatment Accutane, unnecessarily raise the risk of birth defects.
The point is that even an unplanned pregnancy should not be a completely haphazard affair. The minute you begin to suspect that you could be pregnant, start avoiding behaviors that could be harmful to the embryo.
Planning to have a child is a deeply personal process that often combines careful planning with soul-searching. For me, deciding to have a baby was at least in part the result of a strong desire to make myself a better person—someone less egocentric.
Not long before we decided to have children, my husband and I went to a dinner party. Our hosts, a professional couple, announced early in the meal that they were voluntarily childless. They were professors, and perhaps they fancied that they had intellectualized themselves out of a biological imperative. Yet during the course of dinner, the wife showed off her husband’s PhD dissertation like a grandma with baby pictures, and the two of them cooed at their pet bird the whole night. Watching this couple dote on their academic accomplishments and their pets left me with a strong urge to have a baby immediately.
There’s arguably a standard progression to the human experience, and those who disagree probably aren’t reading this book. Having a baby should be an expansive experience in more ways than one. Instead of thinking about yourself all the time, you are supposed to think about someone else. If you believe that life is a continuous process of learning, expanding, knowing, loving, and maturing until the day you die, then having a child is one of the best ways to make yourself into a better person. Other good reasons to have a baby are that you want to give life to the world, you have a strong desire to love unconditionally, you have an interest in watching another person grow and mature under your thoughtful guidance, and you have an undeniable urge to carry your genetic dynasty forward.
There are some not-so-good reasons to have a baby, too. From the baby’s side of things, it is nice to be planned and wanted, but just being planned doesn’t necessarily make for a better situation. For example, it’s not so nice to be wanted as an accessory or as a cure for a shaky marriage. It’s also disheartening to see parents of girls try again and again, just hoping for a boy (or vice versa). It may seem obvious, but it bears repeating: All babies are human beings, and the birth of a child—boy or girl—will change your life indelibly and forever.
It’s sad when babies are born for the wrong reasons. Teen mothers have achieved notoriety, perhaps unjustly, for saying, “I wanted someone to love me unconditionally.” However, it is a rude awakening for all parents to learn that babies cannot love you right out of the womb. Instead, they need constant supervision—they need to be nurtured and kept warm and dry. For months, even years, those adorable little eyes will communicate a pretty constant message: “Feed me, love me, hold me, take care of me.” And while they will certainly cling to you, they’re mostly holding onto what is familiar to them. Becoming a good parent means being excited about your role as a giver rather than a receiver of love.
The good news is that it’s a thrill when a four-year-old picks a flower and presents it to you. Or when she goes out to the local drugstore on Mother’s Day and comes back with a five-dollar bottle of perfume. These are moments you don’t forget, largely because you’ve been waiting for them for so long.
The logistics of getting pregnant may not be so important. Women who face their forties without a partner in sight get inseminated. Lesbian couples buy sperm, have a few romantic interludes with a turkey baster, and head into parenting as partners. Women whose marriages are on the rocks accidentally (or not so accidentally) get pregnant all the time. Regardless of how you get there, with the right attitude any pregnancy can have a magnificent outcome.
Of course, when you first decide, with your partner or on your own, that you want to get pregnant, it is the obstetrician’s hope that you will then and there make an appointment for a preconception consultation. The advantage to this approach is that once you are pregnant you don’t have any catching up to do. You won’t have to hear your doctor say, “Wait a minute, let’s think about this medication you’re on. You may have to see a geneticist.” Or “Let’s look at that X-ray you had last week.” The best conception plan starts with just having a plan, although this seldom happens in the real world.
Preexisting Health Conditions
At your preconception consultation, your obstetrician should investigate your underlying health. The vast majority of women who want to get pregnant have very little to talk about. However, if you suffer from any autoimmune disorders such as rheumatoid arthritis, lupus, or scleroderma or you have a significant, chronic medical problem such as high blood pressure, diabetes, kidney disease, epilepsy, multiple sclerosis, or bipolar disorder, you need to address these issues with your physician. If you’ve had any significant surgery or if you were born with a birth defect yourself, especially of your reproductive or urinary tract, your obstetrician must have all of that information. She, possibly in concert with specialists, will try to proactively address how your particular medical situation will affect your pregnancy. There are so many different situations with infinite solutions that we will not attempt to address them all here—especially because less than 1 percent of pregnant women will have to deal with these problems.
Generally, if you are not perfectly healthy when you want to conceive, there are three things to consider:
1. How will your health problems impact the pregnancy? Will becoming pregnant threaten your health? Will your condition hurt the baby?
2. Could the treatment for your illness—medication, radiation, and so forth—affect the pregnancy? Could you switch to a safer therapy or suspend treatment for a year? Are there procedures that you can postpone?
3. Is your condition a genetic problem?
When the obstetrician is uncertain how your medical history might affect your pregnancy, your best resource is a geneticist. A geneticist is a doctor who specializes in counseling, diagnosing, and treating genetic problems. Geneticists rely on a huge body of information that includes every recorded case of illness or problems due to medication in pregnancy. They can recommend specific tests, crunch the numbers, and give you odds. Geneticists also investigate the weaknesses of your particular ethnic background. For example, certain Jewish communities are statistically more likely to suffer cases of Tay-Sachs disease, whereas sickle-cell anemia disproportionately hits African Americans.
Things to Avoid
Of course, when you are pregnant it is ideal to maintain perfect health and steer clear of all medication. In particular, you should strive to avoid:
Actively dividing cells, such as those of an embryo, are most sensitive to radiation, which can dislodge part of a new cell, mutating or killing it. This is why we use radiation to treat cancer (characterized by rapid cell division) and why radiation is so bad for an early pregnancy. Every cell is extra important in a first-trimester fetus—a whole baby is going to grow out of that handful of cells. Radiation at this stage could damage a toenail cell or a brain cell, you never know. Either way, avoiding radiation during pregnancy, especially in the first trimester, is the only way to dodge the risk. The less you get, the less likely it is to damage something important.
Luckily, exposure to radiation is easy to prevent because you know where it is and can therefore make an effort to avoid it. Even in an emergency room, if you inform the hospital staff that you might be pregnant, they will find an alternative way to treat you.
For example, it may be that as few as 0.5 percent of head injuries in the emergency room turn out to include a skull fracture. The overwhelming majority of the time, a bump on the head is effectively treated with ice and Tylenol. But it’s less likely to result in a lawsuit for the doctor to perform two hundred X-rays to detect the one person who has a significant injury. In fact, most of the X-rays you receive in emergent care are defensive, meaning that the doctors are defending themselves against litigation, as opposed to protecting you against harm. However, if you are pregnant, the physician might take the time to follow a less aggressive course of action, saying instead, “I don’t think you have a skull fracture, but if you have trouble staying awake, if you get confused, if headaches persist for forty-eight hours or you have any symptoms whatsoever, come back and we’ll give you an X-ray.” That would save 199 people from unnecessary exposure to radiation, but it requires a brave doctor, a responsible patient, and a less costly legal system.
All X-ray technicians, radiologists, and emergency room personnel are supposed to ask whether you could be pregnant. But many women, especially when they’re under the stress of an injury, quickly say, “Of course not!” Take a minute to think about it—you could be pregnant if you’ve had sex one time between your last period and now, even if you used a condom, the pill, and an intrauterine device (IUD).
The dangers of exposure to radiation during pregnancy start when the egg is fertilized, not beforehand. If you had a mammogram two years ago or a chest X-ray two weeks before you conceived, there’s no reason to be concerned about your pregnancy. An egg still within the ovary is dormant (that is, not dividing) and so is relatively resistant to radiation. The amount of radiation that would be required to affect a dormant egg is a lot higher (such as the radiation level used to treat cancer) than that used to take a standard X-ray, for example.
Unfortunately, radiation is all around us; however, it’s not something to go nuts over. Years ago, there was a big panic about computer monitors and pregnancy. Computer screens, like televisions, emit rays, but you tend to sit a lot closer to your computer than to your TV. Radiation from these screens becomes almost undetectable from more than three feet away, effectively nullifying the risk with televisions. Even so, there is still no evidence that computer use negatively affects fetuses.
Seek easy opportunities to avoid being exposed to radiation. For example, don’t stand near the microwave while you’re waiting for your popcorn. There’s no need to rip your microwave out of the wall and toss it out the window because you’re pregnant; just be a little more cautious.
Radiation is a legitimate, if hypothetical, concern when it comes to air travel. Some studies suggest that women should consider staying on the ground as much as possible during the early stages of pregnancy, though no specific guidelines or risks have been established. A general rule is that the longer the flight and the higher you go, the more radiation there is. A pregnant woman should avoid flights whose route is over the North Pole, where radiation levels are highest. U.S. government health agencies believe that the radiation risk from social traveling, meaning once or twice in the first trimester, is trivial. If you are planning on flying more than that, discuss it with your obstetrician. She might suggest moving a trip to the second trimester when the fetus is fully formed and less susceptible to environmental injury. Flying twice a week or more during the first trimester is considered too much radiation for a young fetus—if you are a flight attendant, consider a desk job for the first twelve weeks of pregnancy.