Guide on Having Baby

Are you anemic?

If you are anemic, the hemoglobin in your blood is insufficient to carry the amount of oxygen required to reach all of the cells in your body. This can cause serious problems during pregnancy by reducing the amount of oxygen your baby receives. If your anemia is significant, there is an increased risk for intrauterine growth restriction and also fetal hypoxia during labor. In addition, the mother will be less able to handle the blood loss associated with delivery (vaginal or cesarean) if she’s already significantly short on blood. Also, anemia that hasn’t been adequately evaluated may turn out to be a symptom of a more serious genetic or systemic disease.

Are you in the habit of douching?

Douching is just plain bad news on the reproductive front. Women who douche are at increased risk of developing pelvic inflammatory disease, acquiring HIV, being diagnosed with cervical cancer, and experiencing a preterm delivery. And, according to a recent study in Obstetrics and Gynecology, women who douche at least twice a month have higher rates of bacterial vaginosis (BV) infections than women who don’t douche (infections that have been linked to preterm labor). So if there’s a baby in your future, you might want to kick this particular habit right now.

Have you ever had problems with your uterus, tubes, or cervix? Have these problems required surgery?

A history of uterine or cervical problems or surgery increases your chances of experiencing a miscarriage or giving birth to a premature baby. Make sure that your doctor is aware of these problems so that he or she can suggest some possible treatments (for example, a cerclage procedure to prevent an incompetent cervix from opening prematurely).

Uterine surgery may increase your likelihood of experiencing a uterine rupture during pregnancy or delivery, and tubal surgery may increase your odds of experiencing an ectopic (tubal) pregnancy — a condition, which is potentially life threatening and should ideally be ruled out as early as possible in the first trimester.

Did your mother take a drug called DES when she was pregnant with you?

Diethylstilbestrol (DES) was a drug given to many pregnant women in the 1950s and 1960s. It has since been found to be linked to breast cancer and cancer of the vagina in the daughters of women who took the drug. What’s more, 90 percent of these so-called DES daughters have experienced abnormalities of the cervix, vagina, and uterus that may make it difficult for them to conceive and carry a pregnancy to term. Approximately 20 percent of these women are infertile, and 20 percent experience repeated miscarriages; but 60 percent of them are able to carry a pregnancy to term.

Just one additional footnote before we move on: The sons of women who took DES also have genital abnormalities, including smaller-than-average testicles and penis, undescended testicles, low sperm counts, poor motility of sperm, cysts, and possibly even testicular and prostate cancer.

Have you had two or more abortions during or after the 14th week of pregnancy?

Although the majority of women who have previously had elective abortions do not have difficulty going on to have children, some women do experience problems. As a rule of thumb, the earlier in your pregnancy the abortion was performed, the better your odds of avoiding future problems. If, however, your abortion was poorly done or you developed a subsequent pelvic infection, you could experience problems conceiving or carrying a subsequent pregnancy to term. Specifically, abortions after the 14th week are more likely to have been associated with cervical trauma and a subsequent increased risk of cervical incompetence (a medical condition in which the cervix opens up very early on in pregnancy, resulting in miscarriage).

Have you had three or more miscarriages?

If you have had a large number of miscarriages, you are at increased risk of experiencing another. What’s less important than how many miscarriages you’ve experienced, however, is the number of miscarriages as compared to the number of live births. Consider the numbers for yourself: Women who have had two or more miscarriages and have never given birth to a child have a 40 percent to 45 percent chance of experiencing another miscarriage. Women who have had as many as four miscarriages and yet have successfully given birth to a live baby have only a 25 percent to 30 percent chance of experiencing another miscarriage.

Have you had five or more pregnancies?

Women who have had five or more pregnancies are at increased risk of developing problems during pregnancy, such as placenta previa (where the placenta partially or fully covers the cervix, sometimes necessitating a cesarean delivery), postpartum hemorrhage (excessive loss of blood after delivery), intrauterine growth restriction (if the pregnancies are closely spaced and nutrition is not optimal), and rapid labor. That’s not to say that it will happen for sure (chances are it won’t, in fact): it’s simply something that you and your doctor or midwife need to keep in mind when you’re making plans for the birth.

Have you given birth within the previous 12 months?

If your pregnancies are spaced too closely together, your body may not have had a chance to replenish its stores since you gave birth to your previous child. This puts your baby at increased risk for stillbirth, low birthweight, prematurity, and sudden infant death syndrome (SIDS) — although these conditions are thought to be more of a problem in economically disadvantaged groups where nutrition and access to appropriate health care are less than ideal.

Have you ever given birth to a baby who was either less than 51/2 pounds or more than 9 pounds at birth?

If you’ve previously given birth to a very small or very large baby, you should see your doctor right away to discuss ways of preventing history from repeating itself. Your doctor will make an attempt to identify the underlying cause of the problem (for example, gestational diabetes) and take steps to try to minimize its effects during subsequent pregnancies.

Have you ever experienced a stillbirth?

If your baby was stillborn because of a problem that was preexisting or you developed during your pregnancy (for example, diabetes), careful prenatal management may increase your odds of delivering a healthy baby the next time around. You may want to consider testing for autoimmune disease, reviewing the records relating to your previous pregnancy and birth (including the autopsy and placental pathology reports), having chromosome testing performed, if warranted, and so on. Note:

Have you ever given birth to a baby who died within the first month of life?

You and your doctor will want to know whether there was a preventable cause of death and, if there was, take action to prevent a repeat of this tragedy.

Have you ever given birth to a baby with a birth defect?

Some birth defects are genetically caused; others result from unknown causes. If the birth defect was genetically caused or you’re not sure what caused it, you may wish to go for genetic counseling before contemplating a subsequent pregnancy.

Have you given birth to a baby who required care in an intensive-care nursery?

Once again, you’ll want to discuss your previous experience with your doctor so that your situation can be reviewed and steps can be taken, if possible, to avoid a similar outcome to this pregnancy. In many cases, your doctor will be able to reassure you that the problems your first baby experienced are unlikely to be experienced by your next child.

Have you experienced vaginal bleeding late in pregnancy?

Bleeding in late pregnancy may indicate problems with the position or adherence of the placenta. Women who have experienced a full or partial placental abruption (that is, premature separation of the placenta) or placenta previa (when the placenta implants over the cervical opening) are at increased risk of experiencing similar problems in a subsequent pregnancy.

Bright Idea

Create a detailed health record for yourself and bring it with you to each medical appointment. Start by compiling a complete family medical history. Then, keep a chronological record of information worth noting about your own health: symptoms and illnesses, results of any medical tests you take, a record of prescriptions, and so on.

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