“Making the decision to have a child - it is momentous. It is to decide forever to have your heart go walking around outside your body.”
This is a famous quote on motherhood from the American non-fiction author and Fordham University English Department professor Dr Elizabeth Stone.
However, preparing for motherhood involves much more than merely deciding to have children.
Careful planning and preparation are required to ensure that you and your partner achieve a successful pregnancy journey.
In this article, I will focus on the three main aspects that you need to focus on.
They are pre-pregnancy care, fertility tests and treatments, and the psychological aspects of parenthood.
By taking the time to prepare, you may increase your chances of having a healthy pregnancy and a smooth transition into parenting.
Pre-pregnancy care
Your first step before conceiving actually starts months in advance.
Pre-pregnancy care is crucial to ensure a healthy pregnancy and baby.
Make an appointment to see your gynaecologist or a fertility doctor as soon as you plan to start a family.
During this appointment, you can review your medical history, assess any potential risk factors, and go over your options for reproductive testing and treatment.
A basic pre-conception check includes general blood screening for both women and men, which also includes screening for thalassaemia carrier status, rubella antibody level, and sexually-transmitted infection (STI) status.
You would also need a pelvic ultrasound scan to look for structural abnormalities such as uterine fibroids and ovarian cysts.
The man can do a basic semen analysis test, in addition to the blood screening tests.
Taking folic acid supplements – at least 400 micrograms daily – both before and throughout pregnancy, can significantly reduce the chance of birth disorders such as neural tube malformations.
However, folic acid is not the only supplement you need.
Prenatal vitamins are suggested to make sure you are getting the vitamins and minerals needed for a healthy pregnancy.
Along with other essential ingredients, prenatal vitamins usually contain adequate folic acid, thus you do not need to take additional folic acid.
Smoking, drinking alcohol and taking recreational drugs can all have a harmful impact on the development of your unborn child even before you are aware that you are pregnant.
It is beneficial to stop these behaviours for at least three to six months before trying to conceive.
Fertility research has proven that smoking and alcohol abuse have a detrimental effect on both the semen quality and ovarian egg reserve.
If you need help quitting, talk to a healthcare provider or clinic offering quitting programmes.
You can also join a support group to help motivate yourself and support your efforts.
Keeping within a healthy weight range and exercising frequently can improve your chances of having a safe pregnancy.
Being overweight may raise the chance of complications during pregnancy, such as gestational diabetes mellitus and pregnancy- induced hypertension (high blood pressure).
These complications may affect the pregnancy in the form of iatrogenic (caused by medical treatment or examination) preterm labour or stillbirth.
It is best to work towards a healthy weight before getting pregnant.
Regular exercise, like walking, swimming or playing your favourite sports, can keep you active and improve your general health.
If you are taking prescription medications for your health, it is critical to discuss this during your pre-pregnancy period.
Some medications may need to be changed before or during pregnancy in order to ensure the best results for you and your unborn child.
For example, some medications for hypertension are not safe to take when you are pregnant.
Your doctor can suggest an alternative medication that is safe for pregnancy.
Any pre-existing medical illnesses such as diabetes mellitus, hypertension and thyroid disorders need to be well controlled prior to conception.
Uncontrolled medical illnesses can increase your risk of a miscarriage.
Apart from the Covid-19 vaccination, an important vaccine to consider would be for rubella.
From your pre-pregnancy blood screening tests, you would know if you have adequate rubella antibodies.
These antibodies will protect your baby in the womb from rubella infection.
Rubella can cause miscarriages, stillbirths and severe birth defects.
So, if you are not immune to rubella, do consider taking the vaccine at least one to two months before attempting to conceive.
In rare circumstances where either you or your partner have a family history of a genetic condition, discuss with your gynaecologist about the possibility of your baby inheriting this condition.
Remember, not all genetic diseases are passed down via the parents; many occur by chance.
Genetic testing can help you detect any potential risks to your unborn child and give you the knowledge you need to make pregnancy-related decisions.
By taking the time to address any medical issues, maintaining a healthy lifestyle, and discussing your options with your doctor, you may increase your chances of having a safe pregnancy and healthy baby.
Fertility tests and treatments
One in six to seven couples face infertility.
If you have been trying to get pregnant for more than a year (or six months if you are over 35), it is time to visit a fertility specialist.
In many circumstances, basic fertility tests can help you understand the obstacles faced and allow you to plan your fertility journey with confidence.
Fertility testing typically involves both partners.
These tests include semen analysis to assess sperm quantity and quality, and an egg reserve test.
The former can be done by conducting an antral follicle count via an ultrasound scan or by a blood test called anti-Mullerian hormone (AMH).
An imaging test called a hysterosalpingography can determine the patency of your fallopian tubes.
Other hormonal blood tests can be done if your fertility specialist suspects any underlying illnesses based on your fertility history.
Once the underlying cause is identified, appropriate fertility treatment can be started.
In women who do not ovulate regularly, especially in a woman with polycystic ovarian syndrome (PCOS), ovulation-inducing medication is a common treatment that can increase the likelihood of pregnancy.
Another treatment option is intrauterine insemination (IUI), which involves injecting sperm directly into the womb during ovulation to increase the likelihood of fertilisation.
In-vitro fertilisation (IVF), which includes fertilising eggs in a fertility lab and transferring the embryo/s into the womb, is another fertility treatment option.
IVF may be more suitable for couples with male factor infertility or blocked Fallopian tubes, or who have undergone multiple unsuccessful IUIs.
The age of the woman plays an important role in deciding the initial fertility treatment option.
You should be aware that fertility treatments can be expensive and local insurance plans do not cover them.
It is essential to plan and do your fertility tests at the right time and place to avoid any financial burden.
Dealing with infertility can be emotionally exhausting.
Support groups are available for couples who need assistance in coping with the emotional and psychological repercussions of infertility and fertility treatments.
In summary, timely and appropriate fertility testing and treatments can be helpful for couples who are having difficulties getting pregnant.
Psychological preparation
Mental preparation for parenting is just as important as physical preparation.
While being pregnant can be a joyful and exciting time, it can also be emotionally challenging.
Hormonal changes, physical discomfort, and the possibility of becoming a parent, can all make anxiety worse.
It is important to maintain your mental wellness throughout your pregnancy.
If you feel stressed out or overwhelmed, you should talk to your obstetrician about your issues.
They can provide you with proper guidance and support.
A referral to a psychiatrist should be considered in severe circumstances.
Psychiatric illness during pregnancy can be easily overlooked, thus it is important for the partner and close family members to keep an eye out for this issue.
It can also help to make friends and get support from other pregnant women through online forums or support groups.
By swapping stories and discussing similar worries, you might feel more connected and less alone.
Deep breathing exercises, yoga and meditation are a few stress-relieving techniques that may be beneficial.
These techniques can help you reduce and manage your stress, which is good for your overall mental health and well-being.
Every woman’s pregnancy journey is different, so it is crucial to pay attention to your body and get help when you need it.
You have a wealth of tools at your disposal, like your doctor, support networks and online communities, to guide you along the path.
By actively taking part in your pregnancy preparation, you can create the foundation for a fruitful and pleasurable journey towards parenting.
Whether you are just starting to consider having a child or are well on your way, the key is to take things one step at a time and enjoy the experience.
Best wishes as you start your journey to motherhood.
Dr Agilan Arjunan is an obstetrician and gynaecologist, and fertility specialist. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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