Pregnancy Life: First Trimester

After getting ready to try for so long, then putting my preparations into high gear and trying to conceive earlier than planned, and then trying to conceive for 10 months, I am finally pregnant and nearing the end of the first trimester!  Hopefully I will go back and have time to share more about my TTC experience at a later date, but at this point I want to focus in on my experiences of pregnancy and share what's been happening.  

Here's a quick overview of weeks 1-12 (I know gestational counting is a bit confusing, but I am counting day 0 as the first day of my last menstrual period because that's what doctor's do.  Later I'll just start saying what week I'm in - so 12 weeks will mean that I have fully finished 12 weeks gestation and am sometime between 12 and 13 weeks):

• 0-1 weeks pregnant - Finally completed the requirements for my PhD!!!  Wouldn't it be crazy if this was the month DH and I were successful at TTC?  I wonder when I'll ovulate this month...

• 1-2 weeks pregnant - What an unexpected surprise - I ovulated on time (early even)!  I guess I'll be thankful to Thanksgiving for speeding up my cycle.

• 2-3 weeks pregnant - I literally JUST finished my degree (seriously, I don't even have the diploma to prove it), do I really need to start working full time already?

• 3-4 weeks pregnant - No way?!  Positive pregnancy test at 8dpo?  I can't believe it!  Hoping the third time is the charm.  It's been 3 months since my last chemical pregnancy.  Thanks to a standing appointment at my doctor's office, I get a positive blood test at 10dpo (HCG = 40).  Progesterone looking good too (hopefully the supplements will help).

• 4-5 weeks pregnant - Still not feeling very pregnant, but the tests are actually getting darker this time and no sign of dropping temperatures.  Follow-up HCG test at 16dpo = almost 800. 

• 5-6 weeks pregnant - Christmas time!  Have a confirmatory OB appointment this week - pelvic exam looks fine, HCG up to almost 10,000, progesterone levels still holding.  Disappointing, though, because I was told I'd get my dating ultrasound at this appointment.  Oh well, I'll have it soon and we should be able to see more (maybe even the heartbeat!).  Glad I can spend the time with loved ones and still feel good eating whatever I want.  Sadly, nausea starts to kick in at the very end of this week. 

• 6-7 weeks pregnant - So nauseated, ugh, and getting worse!  Everything sounds gross to eat, but if I don't eat I feel worse.  Smells are overpowering.  DH, mom, and lil sis all come with me to my dating ultrasound at the end of this week (I keep a barf bag with me during, just in case).  There we can clearly see one little bean with a tiny heartbeat!  Baby is supposed to be the size of a cranberry now.  His or heart is beating away at 126 bpm, measuring about half a centimeter crown to rump.  Ultrasound dating puts me at 6 weeks, 3 days.  At the end of this week, I break down and ask for a prescription for nausea medicine (so far still no vomiting, despite some close calls).  Doctor's office prescribes Zofran.  There are, of course, shenanigans with insurance that delay me getting my medicine.  Even then I can only get 12 pills!  Sunday morning, I take the smallest possible dose (cutting one 4mg pill in half) and head off to church.  The nausea relief seems to last full on for 2-3 hours, then I feel a bit yucky.  But overall the day is much better than the previous.

• 7-8 weeks pregnant - I continue with a daily dose of 2mg of Zofran, which seems to definitely take the edge off of my nausea.  Some days it's still fairly unpleasant in the evening, and I still hide out in bed as much as possible (reclining and staying away from the smells of the main house seems to settle my stomach).  By this point, DH is doing all the household chores and shopping (sorry, honey!).  Our dog barely sees my face and misses his usual pets and attention.  I am very grateful this week that I'm not doing this on my own.  At the end of the week, I have a sudden reprieve from nausea and actually feel well on Sunday when I go with Lil Sis to the first practice of the adult choir I'm joining with her.  Sadly, the nausea is replaced by very intense constipation (not that things have been moving that well the past 2-3 weeks either).  Sunday evening is occupied with a trip to get some emergency stool softener (Colace) and then several unpleasant sessions on the potty.  By bedtime, the toilet is clogged and I feel a bit better, although I still sense a backlog.  Oh, the indignities of pregnancy.  The next day will require DH to shop for a better plunger :(

• 8-9 weeks pregnant - Things on the nausea and digestion front are mostly unchanged.  I keep up with my Zofran and Colace regimen and some days are better than others.  I thank my lucky stars that working from home is an option for me a couple days a week.  If I had to put on real clothes and sit at my desk every day of the week, I don't think I'd make it.  Toward the end of this week, I receive a surprise gift in the mail - a fetal heart doppler!  Naturally, I set to work right away trying to find the baby's heartbeat and at 8w3d I am able to find it after several minutes of searching.  What a joy and relief <3  It is too faint to pick up the exact rate, but I estimate that baby's heart is now beating about 160bpm.  The nausea has been a comforting sign, but it's so nice to have some additional evidence that everything is okay with the little one.  Given the unknowns about doppler safety (although they are most likely perfectly safe), DH and I decide to limit use of our home doppler to once a week for no more than 5 minutes.  Baby is now supposed to be the size of a raspberry.  

• 9-10 weeks pregnant - Nausea continues, but otherwise nothing interesting going on this week.  For a few days I think maybe the nausea is ebbing, but then toward the end of the week it hits again full force and I end up doubling my Zofran dose (2mg twice a day instead of once).  DH and I begin to evaluate the room that will become the nursery and actually clean it up a bit. 

• 10-11 weeks pregnant - I have my first real prenatal appointment this week.  Other than thinking I might throw up in the waiting room (still no actual vomiting to this point, fingers crossed), the visit goes well.  The midwife takes a good 20 minutes to answer all my questions and uses the office fetal doppler.  She finds the heartbeat quickly and measures it at 170bpm.  Still signs of just one baby.  So far I haven't gained any weight (but seems I've about regained any I lost earlier).  Hoping to continue healthy gain throughout pregnancy.  Also, blood tests reveal no concern about anemia, which is a relief.  Looks like I can continue my gummy vitamins until I feel better (which I really hope will be soon). 

• 11-12 weeks pregnant - Nausea is still going strong, but constipation is much improved by this point.  I am able to eat a variety of things now, many of which resemble healthy choices (except the Girl Scout Cookies that just came available this week!).  Still some aversions, of course, with meat being a big one (luckily I can still get my protein in by hiding it in sauces).  I don't think I'm showing yet, but I keep thinking maybe my belly is pooching a bit more than normal.  But maybe it's just my imagination.  Either way, I'm glad it's winter and I'm relying on loose pants and big sweaters to get me through.  I plan to start taking bump pictures next week so I can have a basis for comparison week to week.  Evidently baby is now the size of a lime and looks a lot like a full-sized baby. 

Please share your first trimester experiences in the comments below.  What symptoms did you have and when?  What were your must-have maternity items?  

Fertility Forums Dictionary and Usage Guide

If you have ever visited an online discussion board for women trying to get pregnant, you will see that there are apparently an incredible number of individuals spending an impossible amount of time scrutinizing every bodily symptom and agonizing over a variety of signs and omens.  Because much of the trying to conceive process involves waiting and watching, and it can be somewhat lonely especially if the people in your life don’t know what you are up to in your private time, an online community has built up around this whole experience and there are many places you can go to discuss at length any aspect of fertility, conception, and pregnancy (for example, Fertility Friend, Baby and Bump, and JustMommies among many others more specific and more general).  Although so far I have only started to explore the world of trying to conceive, there also seem to be similar communities for women who are expecting and parents with infants too. 

But if you are just exploring this online community for the first time, you might find yourself completely overwhelmed by the odd terminology and unintelligible acronyms used by this society.  Although I am a bit of a newbie to this whole world myself, I have been a lurker for a while and have picked up on most of the commonly-used jargon.  But it took a lot of searching and context clues before I could read even the most straightforward posts at first.  To help you get past that initial learning curve, below you will find a guide to the basic terms you need to know to successfully read through a post on these discussion boards/forums (as well as an introduction to some of the general online jargon you might need to know). 

Status:

• TTC = trying to conceive.  This is the process of actively attempting to achieve conception.  It usually involves more than just giving up using contraceptives and is an active process (as opposed to NTNP, see below).
• NTNP = not trying not preventing.  As opposed to TTC, this is a passive way of achieving pregnancy.  Individuals in this category have ditched contraceptives but aren’t doing anything special to try to get pregnant.  These are the people to whom the oft-quoted statistic “it can take a fertile couple up to a year to get pregnant” applies. 
• WTT = waiting to try.  These folks are planning to have kids and often have a specific date in mind to start trying to get pregnant, but for one reason or another are currently putting conception attempts on hold.  Reasons range from financial concerns to waiting for a current child to reach a certain age to waiting for a reluctant spouse to feel ready.

Sex:

• BD = baby dance.  Having sex with the hope of conceiving (see also BMS).
• DTD = do(ing) the deed.  Having sex more generally.  On fertility forums, this usually means having sex with the hope of conception but could also refer to sex when pregnancy is not at all expected/intended.
• BMS = baby making sex.  Sex intended to result in pregnancy.

Fertility Monitoring:

• O = ovulation (see also OV).  When the dominant follicle ruptures and releases an egg from one of a woman's ovaries and begins to travel down the fallopian tube.  Once ovulation occurs, the egg will only live for 12-24 hours and conception must occur during this time frame (but note that sperm from acts of intercourse that occurred up to several days before ovulation can still be alive in a woman's body and waiting to fertilize the egg once it is released).
• OV = ovulation.  Can also be used as a verb (e.g., "I OVed on CD 12).
• CD = cycle day.  The day in a given menstrual cycle, counting up from the first day of a menstrual period (which is counted as CD 1).  
• DPO = days past ovulation.  The number of days it has been in the current menstrual cycle since ovulation occurred.  This number is typically an estimate, since neither OPKs nor BBT charting can perfectly identify the day of ovulation (although a temperature shift is thought to be a fairly reliable indicator that ovulation occurred the day before). 
• Fertile window = the several days during which a woman is most likely to conceive if sperm are introduced into her body.  There is debate about the length of this window, but it certainly includes the few days before ovulation and the day of ovulation.  
• BBT = basal body temperature. Technically, this is a person's lowest body temperature at rest, although for the purposes of fertility monitoring it is really an approximation of BBT as measured after a solid block of sleep usually at the same time each morning.  For women, this temperature fluctuates depending on the presence of certain hormones in the body.  During menstruation, a woman's hormones all reach their lowest point and body temperature drops.  Just following ovulation, a woman's progesterone levels increase dramatically causing a spike in BBT that persists throughout the second half of her menstrual cycle until the next menstrual period (see also charting).   
• Charting = The practice of monitoring BBT throughout the menstrual cycle to detect ovulation and identify the fertile window.  Keeping a personal chart over the course of several months allows a woman to determine the cycle days on which she is typically fertile and can also help to identify any problems with ovulation.  Perhaps its most useful feature for women who are TTC, however, is to confirm that ovulation has occurred (following a sustained temperature shift) which indicates that additional baby making sex is no longer needed during the present cycle. 
• OPK = ovulation predictor kit.  A type of test that is intended to help women identify when they are about to ovulate.  The type most commonly referred to on discussion boards is urine-based test strips that detect high levels of luteinizing hormone, although the term may also refer on occasion to a fertility microscope (which detect a high concentration of estrogen in saliva or cervical fluid).  There are a variety of brands of these test kits, ranging in cost, and most are meant to be used for several days in a row (once or more times per day) during the estimated most fertile time of a woman's cycle.  For the urine-based tests, a woman can expect to ovulate within 12-36 hours from the time that the test becomes positive (although in some cases the LH surge may be detected but ovulation does not follow, or occurs after a second surge some days later).  A positive test is most commonly indicated by a test line that becomes as dark as the control line after exposure to the woman's urine, although some tests indicate a positive result in other ways (e.g., smiley face).  For fertility microscopes, a positive test (indicated by a ferning pattern observed in the dried saliva or cervical fluid) indicates an increased level of estrogen in the body which is a symptom of approaching ovulation.  However, there is more variance on this type of test between the time of the positive result and the time of ovulation.  Some women can see a positive test up to 5-6 days before ovulation while others never see a positive result.  Use over repeated cycles may be required for a woman to accurately predict the relationship between a positive result and her ovulation using a fertility microscope.
• LH surge = luteinizing hormone surge.  A rapid increase in the hormone that triggers ovulation, which is itself first initiated by a substantial increase in levels of estrogen.  Most OPKs are designed to help detect this surge, which may last between 4 and 48 hours.  Women with a very brief LH surge may have a difficult time detecting the LH surge using OPKs.
• POAS = pee on a stick.  The act of taking a urine-based fertility or pregnancy test.  The same term applies even if the specific test involves dipping a strip in urine rather than peeing directly on it.  The acronym is versatile and can be used to indicate any verb tense (e.g. "I POAS last week and got a BFN" or "You should definitely POAS first thing tomorrow!").  See also, POAS addict.
• POAS addict = someone who is obsessed with taking urine-based tests.  Rather than being frustrated by a string of negative or ambiguous test results, this type of person loves the additional data provided by each OPK or pregnancy test.  A POAS addict will often take multiple inexpensive tests in a single day, and will almost certainly start testing for pregnancy well before a positive result is likely.  The term is typically only used self-referentially (e.g., "Since I started using OPKs, I've become a total POAS addict"), as the neurotic tendencies implied by the term could potentially be offensive if used to describe another person.
• AF = aunt flow.  Monthly menstrual period or, in some cases, the withdrawal bleed that occurs during the placebo week while taking hormonal contraceptives.  Women who are TTC dread the appearance of AF and spend a considerable amount of time analyzing potential symptoms of its approach, including temperature changes, PMS symptoms, and cramps (although many premenstrual symptoms can also be early pregnancy symptoms). 
• ICs = internet cheapies (e.g., Wondfo).  OPKs or pregnancy tests that can only be purchased online and are typically quite inexpensive compared to store-bought tests.  This type of test is usually purchased in large quantities (25-100 per pack) and are much more utilitarian-looking than the more heavily-marketed tests.  Although they do not offer any smiley faces to indicate a positive result and may be more error-prone, these tests are typically quite accurate and are also economical.  Additionally, their small size (usually just a few inches long and a quarter inch wide or less) and plain design make them much more discrete than the familiar test brands.  They are especially preferred by POAS addicts. 
• PCOS = polycistic ovary syndrome.  A medical problem affecting as many as 10% of women that causes ovarian cysts, infrequent ovulation, and irregular menstrual periods.  Women with PCOS may find it much more difficult to conceive because they ovulate less frequently and at less predictable intervals.  There seems to be a large community of PCOS sufferers on the fertility message boards who provide mutual support and encouragement. 

Pregnancy:

• TWW = two week wait.  The two weeks after ovulation before a pregnancy test is expected to be positive if conception did occur.  Women appear to spend the most time on fertility forums during this portion of their cycle (presumably before that they were occupied with BDing at every opportunity).  Popular activities during the TWW include debating the probability of conception this month and asking the community to scrutinize possible pregnancy symptoms, BBT charts, and various test results.  The consensus is that this is the most agonize part of the TTC process.  Although the term refers to a two week time span, many women on fertility discussion boards don't actually wait two weeks before testing.  Some test as early as 6 days after ovulation and are usually disappointed, while others wait until 10 DPO (the first date on which many early detection tests are somewhat successful at detecting pregnancy). 
• HPT = home pregnancy test.  Any kind of test that can be used at home by a woman to determine pregnancy, including familiar brands such as Clear Blue as well as internet cheapies.  These tests function like urine-based OPKs, but instead detect the presence of a hormone called hCG.  Because hCG is only present in the body in tiny amounts in a non-pregnant woman, any visible test line indicates pregnancy on an HPT (unlike OPKs which require a test line that it is as dark as the control line to be considered a positive result).  Although not designed for this purpose, some women also use urine-based OPK tests to detect pregnancy, because evidently hCG and LH are chemically quite similar.  Note that the relationship does not go the other way, however--pregnancy tests cannot be used to detect the LH surge.
• BFP = big fat positive (see also, BFN below).  A positive pregnancy test result (whether by HPT or blood test conducted by a medical professional). 
• BFN = big fat negative.  A negative pregnancy test result--an outcome most feared by women who are TTC.
• Squinter = a positive pregnancy test result that is so faint it can only be seen by squinting or holding the test in a certain light or at a specific angle.  Often what is hoped to be a squinter is later revealed to be an evap line instead (see below).  Positive pregnancy test results that happen very early in terms of days after ovulation are often this type of result (followed by a stronger positive some time later that confirms it was not an evap instead). 
• Evap (line) = a visible test line on a pregnancy test that does not indicate pregnancy and happens when the test line becomes more visible or colors slightly as the liquid evaporates.  An evap line is more likely to appear on a test that is scrutinized after the time span the test instructions allow (e.g., the instructions say to read the results after 5 minutes, but the evap line is only visible after 20 minutes).  Unfortunately, both a squinter and an evap line can appear after the allowable test time.
• Chemical pregnancy = a pregnancy that results in a positive pregnancy test but is miscarried very early, usually around the time of the next expected menstrual period.  Accurate early pregnancy tests have only recently made it possible for chemical pregnancies to be detected.  In the past, almost all chemical pregnancies occurred without a woman's knowledge.  Although they are not unusual, recurrent chemical pregnancies could indicate a medical problem such as a hormonal imbalance, nutrient deficiency, or luteal phase defect. 
• Angel baby = most commonly, an embryo that was miscarried very shortly after implantation.  Presumably the term has a religious origin, referring to a soul that was brought into being and then immediately called up to heaven.  This is a term for the fertilized ovum that results from a chemical pregnancy (see above).

General:

• OP = original poster.  The person who initiated a discussion topic on the message board.  Used as a way to refer to the person who posted the question or topic without knowing his or her name. 
• PP = previous poster.  A person who posted on the message board before the current poster (often the person who posted most recently).  
• DH = dear husband.  Refers to the writer's husband.  This is general message board jargon.  The term (and others like it, see DD and DS below) allows posters to use an anonymous placeholder instead of the individual's name while also indicating that person's relationship to the poster.  Some prefer to use initials or nicknames instead of the generic DH.    
• DD = dear daughter.  See DH above.  Can also be modified to refer to multiple daughters.  In this case, DD1 would refer to the first born daughter, DD2 to the second, etc.
• DS = dear son.  See DH and DD above.

Miscellaneous:

• OCs = oral contraceptives.  Methods of pregnancy prevention that involve taking hormone pills by mouth (e.g., The Pill).  Many women on fertility forums have recently stopped using OCs and are now trying to get pregnant. 
• Baby dust = a blessing and a common valediction or signoff.  Baby dust is the presumed mystical substance that is present in the atmosphere when a woman is able to conceive (conceptually similar to Tinkerbell's pixie dust, which grants magical abilities).  Often accompanied by the adjective "sticky", which indicates that the baby dust in question is particularly potent (e.g. "Wishing you all lots of sticky baby dust this month!").  The term can be applied prior to conception attempts (that is, before ovulation in a given month) or after during the two week wait or just prior to taking a pregnancy test (apparently baby dust's magical properties allow it to defy the natural conception timeline).  Wishing someone baby dust is the fertility forum equivalent of saying "Good luck".  The writer may also wish baby dust upon herself, as long as others are included in the blessing as well. 

There are so many terms out there and they vary from board to board so no one person can know them all.  What popular fertility forum slang am I missing?  Do you have any corrections or updates? Please share a comment below and I will add to my list as needed.   

P.S., This is what I'm doing during my first TWW.  Wishing sticky baby dust to all who read this post (but if you don't want it, feel free to send it someone else's way)!

Preconception Checklist: 100 Things To Do Before Trying To Conceive (Part 3)

At last it is time for part three in my 4-part series about preconception preparation.  As crazy as it seems to me, I have finally reached the 3-6 month mark before my own planned trying-to-conceive date!  Below are 25 tips and suggestions I have gleaned from a variety of sources that ideally would be considered at least 3-6 months before TTC.  Note that we are now getting into the time frame that most medical websites and other sources of preconception advice actually consider important for conception wellness and success, so you are likely to find additional research fruitful at this stage in your family planning.

Relationships

1.  Now might be the time to share with select friends or family members that you will be trying to TTC within the year.  This can be a good time to let people know you have conception in mind without them knowing exactly when you are trying.  This step is especially recommended if there are people in your life who would be hurt or offended not to be included in your plans but who you would rather not be stressing you out every month about whether you are pregnant yet.

Education/Career

2.  If you live in the United States, start learning about laws that protect pregnant women and provide certain rights for new parents.  This is a good exercise whether or not you currently work or plan to work after having your first child.  If you live outside of the U.S., begin to learn about your local laws and also take a few moments to be thankful that your country’s maternity policies are likely to be more generous and family-friendly (although of course not ALL are).
3.  If you are working, find out if you have been working long enough in your current job to be eligible for the benefits your employer offers.  Certain federal laws in the U.S. require employers to offer job security benefits for employees who have been working for at least one year, but these laws apply only to employers of a certain size and only require that a limited set of benefits be offered (specifically the ability to take off a total of 12 weeks unpaid leave during the year of the birth or adoption of a child without risk of losing a current position).  Many employers offer additional benefits, however, but these are determined by the employer and are subject to change.  Find out who is eligible where you work and for what.
4.  If you work and are not self-employed, determine what options your employer has for new parents.  How much time are you allowed to take off work?  Is any portion of maternity/paternity leave paid by your employer?  Are there policies for new dads too?  Is affordable childcare offered at your work facility?  Designated areas for expressing breast milk?
5.  You might also want to think about alternative approaches to your current work schedule while you have a newborn.  Would a more flexible work schedule, teleworking, job sharing, or coming back to work part time be an option?  If you work for a small company or don’t want to draw attention to your fertility plans, just look through the employee manual to find out what you can for now.  If there is a large HR department or you don’t think your inquiries will be looked upon negatively, go ahead and speak to someone in HR about the policies and benefits available.
6.  If you are a student, find out how much time you are permitted to take off for illness or other medical reasons without having to reapply for your program.

Physical & Mental Health

7.  Start taking an Omega-3 fatty acid supplement to support good fetal brain development (as well as maternal heart health—perhaps any prospective fathers might also want to join in on this good habit).  If you have any moral or digestive qualms about taking fish-based supplements, there are some high quality vegetarian/vegan options available on the market as well that don’t have a fishy aftertaste and might be more palatable during early pregnancy.
8.  Work on improved posture.  There are numerous exercises to help strengthen your back, core, and neck muscles to improve posture.  You could even invest in an inexpensive trainer that reminds you to keep you shoulders back, or a back support to improve your posture while sitting at a desk/computer.  Since lower back pain is epidemic during pregnancy and your body goes through a lot to try to support a growing fetus, establishing good posture now will help to prevent and minimize common posture-related pregnancy ailments.
9.  Begin drinking red raspberry leaf tea to strengthen and tone uterus and minimize menstrual pain when resuming regular ovulation.  Although the research on this herb is not entirely conclusive and its effects are likely to be small, it has been found in some studies to reduce the length of the pushing stage of labor.  It is also recommended as an all-around supplement for female reproductive health.  Stop taking this supplement before trying to conceive unless specifically advised by a health care provider, however, as its potential to stimulate the uterus could possibly be detrimental during early pregnancy.  Many naturally-oriented health care providers recommend resuming consumption of the tea in the second or third trimesters.  As always, be sure to consult with medical professionals you trust and to listen to your own body when making decisions about herbal supplements.
10.  Set targeted, personal goals for health, wellness, and preparation during the remaining months until TTC.  Perhaps make a list of specific goals and try starting to tackle one each week, or list 5-10 key outcomes you’d like to achieve before TTC and measure progress on each of them biweekly.  Sites like SparkPeople.com help you to track nutritional, fitness, and other wellness goals easily.
11.  Invest in good workout gear—quality tennis shoes, a supportive sports bra, etc.  You want to be safe and reduce injury during pre-pregnancy and early pregnancy workouts.  Plus, during this crucial preparation time you do not want to be incapacitated by sprains and strains.  Take extra care as you seek to tone and strengthen in preparation for your pregnancy.  You are aiming for sustainable, quality physical activity that will ready your body for carrying a baby and that you can continue well into pregnancy.
12.  Track daily caffeine consumption and begin to cut down to a level that is safe during trying to conceive and pregnancy.  Although ACOG has not issued an official recommendation, they have released a summary of research supporting the opinion that less than 200mg per day does not increase the risk of miscarriage or preterm birth.  This seems to have been adopted as the standard recommendation.
13.  Now is the time to start ditching alcohol altogether.  The substances in your body 3-4 months prior to conception have the most impact on fertility and early fetal development, so stocking up on good nutrients and eliminating toxins now is the best strategy.  That goes for prospective fathers as well, although total abstinence from alcohol may not be strictly required.
14.  Speaking of toxins, there are many everyday substances from cleaners to personal care products that can have an unhealthy impact on a developing fetus.  You may not be able to eliminate every possible source of pollutants and toxins from your life, but identifying your big risk factors and swapping for healthier/more natural products and environments when possible is a good idea.  See the Get Ready to Get Pregnant book for lots of specifics and a bit of a dire perspective about potential toxins, as well as some more open-minded and practical sources about what to worry most about (e.g., WebMD).
15.  Enjoy the last of your pregnancy no-no items.  Both potential parents may want to give some of these items up together out of solidarity and to keep temptation at bay.  Items to enjoy for a last hurrah include sushi, smoked meats, soft cheeses made with unpasteurized milk, and any other dietary items considered to be unsafe during pregnancy.  This could also include any hobbies that are unsafe for a fetus.  If you have a definite habit, start weaning yourself off of these treats or research some pregnancy-safe modifications.
16.  Work on reducing “wasted” calories in your diet (excessive sugar, fat, etc.).  You won’t need to increase your caloric intake much during early pregnancy, but you want all of your calories to be good ones.  Now is not the time to start a radical deprivation diet, but rather to make small changes toward a more balanced and healthy eating mindset.
17.  Instead, begin trying to view every consumption choice as an opportunity to meet both your body’s needs for nutrients and energy, as well as your needs for enjoyment and psychological satisfaction.  Consider:  Is what I’m about to eat going to leave me feeling satisfied?  If not, is there something else I could eat that I would still enjoy but might be more satisfying or do a better job of meeting my nutritional needs?

Finances

18.  Develop a specific pregnancy savings plan.  If you’ve already looked into the cost of an uncomplicated pregnancy and childbirth under your health insurance plan, use that as a starting point for a savings goal.  Add an amount you’d like to be able to spend on maternity clothes and other pregnancy expenses and then figure out how much you’ll need to save in each of the weeks leading up to your TTC date to save the amount you figured.  Of course you can plan to continue saving during pregnancy, but you never know what circumstances or unexpected expenses may come up later.  This is just a start.

Practicalities

19.  Start Pinning/tracking your baby research and making Amazon wish-lists of products that stand out to you.  Perhaps start a secret Pinterest page to post discretely any findings that have associated images or media, plus a Word document or favorites list that allows you to save relevant links you might want to revisit.  You are getting to the stage where you might soon be making some very real decisions about how to begin trying to conceive, what to do during your pregnancy, and how to prepare for the birth of your child.  You don’t want to lose track of anything important you might learn during this time of preparation.
20.  Time to seriously read some preconception books.  There are many available out there that target prospective parents with different goals and interests.  For the scientifically-minded, books like Get Ready to Get Pregnant and Before Your Pregnancy are ideal.  For those who want a more friendly, personal voice the What to Expect series might be a better bet.  Of, for the impatient types who don’t really want to read a book about it but want key information fast, perhaps try The Impatient Woman’s Guide to Getting Pregnant.  Or take a selection of all of them.  You will find overlapping information in most, with more or less detail.
21.  Begin to explore community resources available to you during pregnancy and parenthood (especially free ones).  Are there active meet-up groups in your area for pregnant women or new moms (www.meetup.com)?  Does your local hospital provide free educational classes or yoga sessions for expecting parents?  What about your church community?
22.  Research the schools in your neighborhood (greatschools.com) and also the childcare options nearby.  Read parent reviews as well as looking at standardized test scores and other indicators for schools.  Are you happy with what you find?  If not, start working out a plan to make positive change in your local school system or to seek out alternative options as your kids age.  
23.  If you have a pet that isn’t used to being around small children, try to find opportunities for him or her to interact with little ones in controlled settings.  You might need to start with just being near kids and providing lots of positive reinforcement, or even using recordings of baby sounds.  Do not attempt any direct contact until your pet is ready and of course make sure parents give permission before you introduce your pet to any child.  If you suspect or know firsthand that your pet is not good with small children, consider working with an animal behavior specialist or trainer who can help you move toward a positive interaction pattern.

Fertility & Backup Plans

24.  Make final decisions about who you would like your prenatal care provider to be.  If there are several potential candidates, begin scheduling some appointments and dust off those interview questions you prepared a few months ago (or start a new list if needed).
25.  Spend some time thinking very specifically about the childbirth experiences of other women you know.  What did their care providers do or not do?  What do you think they wish they had asked before deciding on a provider?  If you don’t know anyone who has given birth recently, look online for stories or read reviews about your local hospital to get ideas.  This should provide you with additional questions to ask your potential care providers.

    

What other tips would you suggest for women who are thinking about trying to conceive but still have a while to go before beginning the process?  What preparations did you or do you plan to make 3 to 6 months before trying to get pregnant for the first time?

*For further reading, see Get Ready to Get Pregnant: Your Complete Prepregnancy Guide to Making a Smart and Healthy Baby. Although the author can be a bit too negative at times and the information a bit overwhelming, this guide provides comprehensive coverage of most preconception topics and cites a wealth of scientific research. 

Countdown to TTC: Week 37

 

Get HAPI ... Fork

For the holidays this year, I received many lovely gifts and some of them have even caused me to change around my weekly challenges for my countdown to TTC.  One such gift was the HAPI fork (pictured above).  I had been thinking about various habits I could try to adopt that encourage mindful eating (such as putting down my fork between bites, counting how many times I chew, serving my food on a smaller plate and waiting a certain amount of time before going back for seconds, etc.), but this new gadget really gave me a way to get started on those mindful eating goals without quite so much "mindfulness".  

The HAPI fork is a mindful eating tool that subtly warns you when you are eating faster than you should be.  The fork has an internal brain that measures each bite you take and then records how long you wait until the next bite.  If your next bite is sooner than a preset interval (default is 10 seconds), then the fork vibrates and a little light briefly turns red.  If you are eating at the preferred interval, you can see the light turn green with every bite but otherwise it just acts like a normal fork.  

Of course, I do think it is good to move toward actual mindful eating and a deep awareness of what is going on between myself and my meal, but for someone who has a hard time slowing down while eating and a tendency to shovel food this HAPI fork is a great help.  Even when I start a meal with focus, I tend to become kindof zombie-like about midway through and just hork down the second half of my portion without really thinking or sometimes even tasting it.  Part of that is related to other bad habits, but some of it is that I start to pick up speed as the meal goes on and I'm no longer quite as hungry.   

Although I find it inconvenient to use this fork at every meal (that's a fair bit of re-washing throughout the day), I find that I can use it once a day or so pretty easily.  Conveniently, the non-electronic part of the fork is dishwasher safe so I can give it a thorough clean once in a while.  Just have to make sure to remove the electronic "brain" before immersing it in water!

You are supposed to turn the fork on at the start of a meal and turn it back off at the end.  Any time there's at least a 15 minute interval after eating, the fork decides you have finished eating and records all the bites taken before that time as a meal.  Using the HAPI website, you can track your eating stats and monitor your progress toward goals by plugging the fork's "brain" in and letting it download your data.  I don't have a smart phone, but I also think the fork is wireless Bluetooth enabled and can transmit your data directly to a smart phone or tablet, which would probably be more convenient.

Below is a picture of the output the site gave me after my first HAPI fork meal (which happened to be Christmas dinner):

  
You find out how much of the time you were eating faster than target, how long on average you waited between bites, how long you spent on the meal, and how many total bites you took during the meal.  Although these data might not be particularly important for any one meal (except perhaps to discover how long you spent eating a specific meal), over time they do allow you to monitor your success and progress.  Plus, if you have a scientific way of thinking, like myself, it's just a pleasure to see so much quantitative evidence about yourself presented in such an appealing manner.   

As I approach my TTC start date, I will continue to use the HAPI fork but also try to move toward a more internalized mindful eating habit.  Still, when I know I'm really cognitively depleted and just can't pay any attention to how long I'm taking between bites, it's nice to know I can have a good angel reminding me to slow down and care about what I'm putting into my body.  

What about you?  Any great strategies or gadgets that help you eat mindfully or live a healthy lifestyle?  What do you think about the HAPI fork -- brilliant or evil?  What eating habits of yours would you most like to be more conscious about or improve on?

For more in this countdown series, see last week's challenge about Counting pregnancy costs. 

Countdown to TTC: Week 38

Calculate the Costs

As a result of the holidays and various other obligation, I am getting behind on writing up my "weekly" posts, but I have been working toward my goals and trying to remember everything I experience so I can eventually write up my backlog of activities.  A few weeks ago, I decided it was time to think seriously about medical expenses of a future pregnancy.  As we enter the new calendar year (the year in which I sincerely hope I will be able to conceive my first child), I intend to begin experimenting with prenatal vitamins and other supplements I want to take to have a healthy conception and pregnancy.  But diving into this more medical aspect of the process made me curious about the actual costs of pregnancy and childbirth.

Of course, there are perhaps more unknowns than knowns in this arena (Will I be able to have the vaginal birth I desire? Will I experience any pregnancy complications? Will my health insurance coverage change before I become pregnant?), but I decided the responsible thing to do would be to research what the costs might be for my current health insurance provider given some reasonable assumptions.  In addition, I was interested in figuring out what my maximum possible out-of-pocket expense would be given my current insurance situation.  Although I wouldn't be willing to place any bets on the accuracy of these calculations, they should give me an idea of what I should be aiming to save over the next several months.

Step 1:  I began my calculations by going onto my insurance provider's online member site and using their cost estimator tool (a nice service if you have access to it).  I asked for an estimate of the total medical costs associated with a pregnancy and vaginal hospital delivery in my geographic area (see below for the output).  The results I got were a bit confusing, but it seems to me that the numbers given for each expense category were total expected billings (not amount owed out of pocket, as I would have expected). 

Step 2:  Once I learned what the expected total billings would be for this type of pregnancy and birth, I had to consult my health plan's summary of benefits to determine what proportion I might be expected to pay of these total expenses.  My medical deductible and pharmacy deductibles are $250 and $100.  Once those are met, my plan expects me to pay the following for prenatal care and delivery costs:

Step 3:  Now that I had figured out the expected costs (assuming a vaginal delivery and a pregnancy that was not high risk) and what proportion I would probably have to pay, I could make some estimates.  I began by evaluating the maximum possible costs.  Knowing my deductibles and the additional out-of-pocket maximum for my plan, I determined that $2350 was the absolute most I would have to pay for a pregnancy that spanned only one policy year (I could of course be unlucky and accrue some high prenatal costs in one policy year and then some additional high costs for labor and delivery in the next policy year when new deductibles and out-of-pocket maximum would apply).  So, worst case scenario has me paying as much as $4700 for one pregnancy. 

Step 4:  Finally, I wanted to estimate the real expected out-of-pocket cost of the standard vaginal delivery pregnancy the cost estimator summarized for me.  Assuming a $200 copay for the delivery facility (even though the cost estimator predicted no charge for this actually), plus 20% coinsurance on all the medical tests and doctor's bills (although some portion of this would no doubt constitute no-charge prenatal care), and the full estimated amount for pharmacy, I came up with an expected total cost of $1836.  It would also be reasonable to predict an amount a few hundred less than this if much of my doctor's costs came from fully covered prenatal care and if my birth hospital did not charge a facility fee.  On the other hand, any sort of complications or need for additional tests or specialized care would quickly bring this up to the maximum possible cost. 

So, in summary, I learned that I should probably expect to spend a couple thousand dollars on my birth.  Even if I switch insurance plans (which I actually expect to do), I will most likely select one that has a similar deductible and out-of-pocket maximum.  I also realized that small changes in my assumptions can make a substantial difference in how much I would overall expect to pay for a single pregnancy and birth.  This could be a scary realization, but I think my response to the information is reasonable.  I will make tentative plans based on what is most likely to happen, but I will also be prepared for things not to go according to plan.  Probably a good approach to new parenthood as well, now that I think of it...

What about you?  Do you or did you know down to the dollar how much your pregnancy should cost?  Have you come by any useful information about paying for pregnancy and childbirth or tips for dealing with health insurance providers?  What are some top dos and don'ts when it comes to pregnancy-related medical expenses? 

For more in this countdown series, see last week's challenge about Eating right while eating out.