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 40

Walk It Off

With the holidays here, I am finding myself getting hopelessly behind on my challenges!  I suppose it's just one of those life things I'll have to get over--I'm sure there will be more and more distractions and interruptions when kids are in the picture anyway.  But sometime a few weeks ago my weekly challenge was to add more walking to my daily routine and I've really made headway with that goal.

I live a 15-20 minute walk from my academic building which I go to approximately 2 days a week, but I normally get dropped off by my husband to save time.  Since adding this challenge to my routine, I have been able to walk to school at least once a week and sometime even more than once (it's usually later when I leave and I take the bus home).  I have noticed several time in recent months that walking any significant distance has caused me to have hip pain, but stretching my hips before I leave the house and walking for briefer periods seems to have helped.  Hopefully I am also building up my muscles for future longer walks. 

In addition, I've found lots of other opportunities to walk more, like walking to meetings in other buildings, shopping, walking the family dog while visiting for Thanksgiving, etc.  So far I have had no trouble adding an extra 30-60 minutes of walking to my weekly routine.  In the coming months, I will try to keep this up despite the increasingly wintry weather and plan to increase my walking intensity as I approach the TTC date.

Here's hoping I can keep up my motivation for this habit, because I think it's a good one.  I already added a pedometer to my Christmas list to give me a little mid-winter boost in enthusiasm.

How about you?  What's your favorite weight-bearing exercise to do outdoors?  Is walking your thing or do you find it boring?  How do you add more steps to your daily activity for good health?

For more in this countdown series, see last week's challenge about Strength Training.

Countdown to TTC: Week 43

See a Nutritionist

Normally, I avoid seeing medical or health professionals unecessarily.  I believe preventative care is important, but the U.S. healthcare system really isn't set up for people to visit their doctors and other care providers just to check in.  Plus, as a graduate student I really don't like to do anything that increases my medical expenses.  However, a flyer in the office recently reminded me that my university provides several free services to employees and students to help them stay healthy or get healthier.  One of these services is an initial consultation and several follow-ups with a nutritionist.  Given my ongoing goal of getting ready for pregnancy over the course of this year, it seemed like a perfect opportunity.  So, this past week I added consult a nutritionist about preconception planning and weight loss to my list.  

In preparation for the visit, I had to track my food for several days.  Since I am a veteran user of SparkPeople, the only difficult parts about that were (1) being more self-conscious about my food choices knowing they would be scrutinized by a dietitian and (2) having to simplify my tracking to fit onto the form I was asked to use (since I usually make my food, I am often tracking a dozen ingredients per meal).  In the end, I brought both a filled-out form that was impossible to read and a super long printout of my food from the same days taken directly from SparkPeople.  The dietitian didn't seem to mind and actually looked more at my long, detailed printout.  

I really wasn't sure what to expect from my appointment, since I didn't have any choice over the dietitian and her philosophy--I was just visiting the person who works for my school health center.  The only time I've ever known someone to visit a nutritionist was if they had to lose a substantial amount of weight for medical reasons, which is pretty different than my situation.  Plus, a university is unlikely to employ someone to work with undergrads whose expertise is in chronic medical conditions.  So I shouldn't have been surprised when I came to the appointment explaining that I was frustrated with my current weight loss efforts because I am not losing pounds despite having recently reduced my caloric intake and tracking my food vigorously and her first question was "What would you say if I told you that you should stop trying to lose weight?"  

I don't think she particularly believes I am at an ideal weight, but she is a person who subscribes to a philosophy of being healthy at any size.  Throughout our conversation, she encouraged me to focus on healthy behaviors rather than fixating on the number on the scale.  She also pointed out that I may be making physical changes in preparation for weight loss right now (don't see any evidence of that, but who know maybe I'm stealthily gaining some muscle mass).  She also discussed some flaws with BMI as an indicator of health risk (click here for some alternative measures of ideal weight and here for an article about a new way of calculating BMI that may be more accurate for adults).  I have not yet found any research on the subject, but she suggested that even the "common knowledge" that BMI is directly linked to negative health outcomes may be flawed.  According to the nutritionist, studies which are able to include health-related behaviors directly in their analyses along with BMI typically find that body mass has not additional impact on health outcomes above and beyond healthy behaviors like exercise and eating right.  I don't claim to endorse this opinion, but it certainly gave me something to think about and I will want to research this more.

Although I have made a lot of improvements in my healthy lifestyle and the nutritionist was very positive about my health indicators like cholesterol levels, I still couldn't quite get on board with the idea that I should stop caring about my weight.   But I agreed with her that I am focusing too much on the scale and too little on the positive health changes I am making.  In the end, I didn't have a great answer to her question about my weight.  Honestly, if someone told me I don't need to lose another pound to be maximally healthy and ready for pregnancy, I just wouldn't believe them.  I'm sure I am at a weight that would make it possible for me to get pregnant and probably have an uncomplicated pregnancy, but I know I could have more energy and a fitter body to deal with the stress of growing a new life and then caring for a small child.  Perhaps getting on the scale every day and agonizing over the number isn't the right way to do that, though.  Based on my appointment, we agreed I would cut back to weighing in twice a week and pay attention to my hunger cues.  At my next meeting, we'll discuss making some changes to my eating habits that focus more on hunger levels than on how many calories I think I have "left" for the day.  It's a good start.  Hopefully the scale and my healthy improvements will match up soon, but if not I will try to focus on getting healthy with weight being a secondary component rather than my main indicator.  

For more in this countdown series, see last week's challenge about Planning with Pinterest.  

Countdown to TTC: Week 45

Proper Posture

Again this week, I decided to begin working on something that's a bit more challenging for me than some of my early goals: posture.  Honestly, if I just make a little progress on this one it will be a big improvement, because I have been hunching for as long as I can remember.  Maybe it's because I'm taller than most women, or maybe it's a holdover from my awkward teenage posture, or possibly I'm just too lazy to stand up straight.  Certainly adopting a lifestyle that involves sitting at a computer most of the day hasn't helped.  Whatever the reason, I know it's probably bad for my neck and back in the long run and I especially want to improve my posture before I get pregnant.  I've read numerous times that posture during pregnancy is even more important than it usually is because your body is changing and working hard to support extra weight that's all concentrated in one spot.  Women are already understandably more prone to back pain during pregnancy, so I really don't want to make it even worse by slouching all the time.

Although the origin of my bad posture is somewhat unknown, the reason for its maintenance is fairly obvious--my core, back, and neck muscles are weak.  Plus, I am so used to having bad posture that I almost can't even tell if my posture is good or bad at any particular moment.  Thus, my first course of action was to buy an inexpensive posture corrector to remind me to sit and stand up straight.  The particular corrector I ordered is made of elastic material that stretches around your back and shoulders and wraps around under your chest to attach with velcro.  It could be worn by a man or woman, but I feel it is particularly designed to strap under a woman's bosom.  I opened it as soon as I saw that it had arrived and started wearing it.  As various reviewers had mentioned, the material and the velcro are not very comfortable, so I wore a t-shirt underneath and padded some of the spots that rubbed (under the armpits, probably because my arms aren't as slim as the models) with washcloths.  While it doesn't exactly force you into the correct posture, the elastic is strong and definitely pulls my shoulders back without me doing anything.  Because of the way the getup looks and the fact that I am wearing it over clothes, I have no intention of wearing it out of the house.  Instead, it is a way to practice a couple of hours at a time sitting with good posture and hopefully that will slowly train my muscles and also make me more conscious of what proper posture feels like.  Even after just a few days I do feel like it is a little more natural to rest with my shoulders back rather than hunched forward.  But I'm sure it will take a long time to break my bad habits for good.

In addition to my sessions with the corrector, I am beginning to try a few other strategies to make my posture improvement a speedier and less unpleasant process:

1. Work on back and core strength.  There are numerous online articles and video explaining and demonstrating exercises that promote good posture.  In general, it is easier to support your head and keep your shoulders back if you have good upper back strength and to support the weight of your body if you have strong abdominals.  My typical exercise routine doesn't focus much on strength, and when it does I focus mostly on my arms and legs, so these are definite weak spots for me.  
2. Stretch.  There are lots of good stretches that promote better posture and reduce back and neck fatigue/pain.  Stretches can even be done at a desk at work. 
3. Adjust my sitting position.  If you're going to sit all day, it's better to sit properly in an ergonomic chair with legs straight down and preferably feet slightly elevated.  Or even better to use an exercise ball or a kneeling chair rather than a traditional desk chair.  Since I share my office space and take whatever chairs are available, for now I'll settle for getting up frequently, setting my chair to the proper height for my computer monitor, and trying to to cross my legs or lean to one side for a long time while I work.  

What about you?  Have you done anything to improve your posture recently and, if so, what was your strategy?  Do you have any experience with the effects of good/bad posture during pregnancy or have any words of wisdom to share?

For more in this countdown series, see last week's challenge about Having an Active Lifestyle. 

Countdown to TTC: Week 48

Getting Fit:  Stairs!

Now that the first month of prep has passed and I have gotten myself into the right mindset and set the backdrop, it is time to get serious about getting healthy for a potential pregnancy in 11 months.  Over the last couple of years I've made significant improvements to the kinds of foods that are in my diet and have increased my physical activity substantially, but I could still benefit from fairly substantial weight loss and fitness training.  I am not obsessed with getting to a specific weight or strength level before I get pregnant, but the healthier I can be the better.  So my plan is to continue the good things I've been doing but also add on some additional strategies throughout the year to boost my wellness.  

Although I intend to slowly build up to new goals like target amounts of weekly strength training, it's important to me to begin with stuff I can stick with and add to throughout the remaining months.  I already boosted my water intake to try to meet the target 8 glasses a day (I am still struggling with that but tend to hover closer to 7 now, rather than 6), and this week I added another challenge that takes advantage of my natural environment and activities:  stairs.  Every time I have to go somewhere on a different floor, I am now challenging myself to walk up at least one flight, if not all of them.  

Why not commit to taking advantage of all the stairs I come across?  Admittedly, it is a combination of my lack of fitness and embarrassment.  One of the buildings I spend a lot of time in has 5 floors, and for my current fitness level it is a bit challenging to walk up more than 2 flights of stairs at once, so I think I'm more likely to stick with it if I say I at least have to do one floor and then just plan to add on if it's not too daunting.  Also, I get pretty winded after 2 or more flights and often other people I know will see me and talk to me in the stairwell.  I find it embarrassing to have this happen and then be unable to keep up talking because I am out of breath, so I will get off at a different floor just to avoid that situation.  Hopefully, once I commit to going up more stairs every day and week, I will have more endurance for climbing and won't have this motive to avoid stairs anymore.  

I started the challenge this week and already the first day I found myself cheating and using the elevator, although admittedly it was because I was carrying a bunch of things that I was at risk of dropping.  But I think it will be a good challenge to keep my mind set on the idea of fitness and a healthy lifestyle.  I also think it would be even more motivating if I could see exactly how many steps I'm adding to my day and how many more calories I'm burning, so I think sometime in the near future I will buy a simple pedometer to start taking with me (I'm considering the Omron HJ-112 Digital Pocket Pedometer, which gets very positive reviews).  A handy, inexpensive gadget seems like a good way to add a sense of accomplishment to what might otherwise be a fairly thankless process.  Although maybe just being able to walk up a couple flights of stairs without getting winded will be reward enough!

What about you?  What steps are you (or did you) take to get fit before pregnancy?  What do you wish you were doing (or had done) more of?  How do you stay motivated, especially if you aren't the type of person who easily loses weight or develops lean muscle?   

For more in this countdown series, see last week's challenge about Meeting Parents.