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 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.

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.