Most important step for childbirth is preparation

May 7, 2012

By Erin Tracy, M.D., M.P.H., and Glenn Markenson, M.D.

Massachusetts Medical Society

Having a baby is an exciting event, and most parents' biggest wish is that mother and child come through the experience without complications and that the baby be born healthy.

As physicians who have delivered our fair share of newborns, we tell patients that the first and most important step for childbirth is preparation — well before becoming pregnant.

A visit to one's health care provider to discuss what might need to be done before becoming pregnant is a wise step for those thinking about having a child. This is particularly important if the mother-to-be has underlying medical problems, such as diabetes or high blood pressure. Those conditions can then be addressed before pregnancy, with the aim of preventing problems that later could affect the baby.

While each patient is different and should follow her own provider's instructions, here are some basic recommendations in four areas — pre-conception, pregnancy/pre-natal, delivery, and post-natal ­— that have proven to be beneficial to having a healthy baby.

Pre-conception

Maintain a healthy lifestyle, with a good diet, regular exercise, weight control, no tobacco, and no excessive use of alcohol.

Healthy living is good for overall well-being, but for a woman who wants to have a baby, it's critical, because the baby's development depends on the health of the mother.

Stay up-to-date on vaccinations. Being immunized against infectious diseases is not only good for you, but also good for the baby.

Declining vaccination rates have been responsible for recent outbreaks of whooping cough, measles, and mumps, some of which have claimed the lives of infants.

Take a multi-vitamin with folic acid, a vitamin known to decrease the incidence of Spina Bifida, a spinal abnormality that is the most common permanently disabling birth defect in the U.S.

Pregnancy/Pre-Natal

Once you think you're pregnant, see your provider early to determine how far along you are, because the care you'll receive from that point on depends on the baby's due date. Visit your provider as often as he or she prescribes for regular check-ups. You'll also discuss options for various screenings, to make sure the baby is growing properly and to look for signs of maternal or fetal complications.

Get an annual flu shot. Pregnant women have a higher risk of getting sick from the flu, and the only protection the baby has is from the mother.

Get regular exercise, appropriate for your condition and medical history. This can help you manage weight, build stamina, and relieve the stress of pregnancy. Avoid things that can harm your baby, like alcohol, cigarettes, and drugs. No amount of alcohol in pregnancy has proven to be safe.

Take childbirth classes, often given at local hospitals. This can be good preparation for the post-delivery period.

Delivery

This, of course, will be a cooperative effort with your provider, but timing is important. Unless complications exist, labor should be allowed to develop spontaneously. While a Caesarean section, or delivery by surgery, may be necessary at times, it's best, if there's no risk, to wait until after 39 weeks to deliver. If you're scheduled for a Cesarean section or labor induction it's also best to wait until 39 weeks of pregnancy. Babies tend to do better after that time.

Post-Natal

Breast feeding, good for both mothers and babies, is encouraged as the preferred method of feeding for newborns and infants. Exclusive breastfeeding is recommended until the infant is six months old.

Be aware of post-partum depression, which is normal and common. After delivery, mothers experience great changes in their bodies that can affect mood and behaviors. Symptoms include feelings of sadness, guilt, doubt and helplessness, anxiety or panic attacks, intense concern about the baby, or thoughts of self-harm. Spouses should watch for signs because the mother may not be able to seek help for herself. Counseling and medications are available, and Massachusetts law now provides for increased screening for and public education on post-partum depression. Be ready for the 'handoff' — when the baby's medical care moves to the pediatrician. While obstetricians or midwives try to communicate with the pediatrician and discuss what occurred during the pregnancy, parents may sometimes have to provide the information directly to the pediatrician.

For more information on pregnancy and healthy babies, visit the Page for Patients at the American Congress of Obstetricians and Gynecologists at www.acog.org. For a video discussion, visit the Massachusetts Medical Society at www.physicianfocus.org/healthybabies.

Erin Tracy, M.D., M.P.H. is a physician at Massachusetts General Hospital and chair of the Massachusetts Section of the American Congress of Obstetrics and Gynecology.

Glenn Markenson, M.D. is chief of Maternal Fetal Medicine at Baystate Medical Center in Springfield.

Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org.

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