Calm, Cool & Collected

Being pregnant and giving birth should be joyous experiences, not anxiety-wracked ones. Here'’s the knowledge you need to keep common fears from spiraling out of control.

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From the moment we learn we’re pregnant until, well, until forever, we worry about our children. In fact, we even worry retroactively, about those martinis we downed before we knew we were pregnant or the dental X-rays we didn’t think twice about at the time. “I sabotaged my entire pregnancy with fears,” says Susan Sawyer, the Clovis, Calif., mother of 2-year-old Nolan. “Then, once my baby was born, I realized how much safer he was in the womb!”

“Rest assured that your body knows what to do even if you think you don’t have a clue,” says Stuart Fischbein, M.D., an OB-GYN in Los Angeles and co-author of Fearless Pregnancy (Fair Winds Press, 2004). Since a little preparation can go a long way toward helping us feel more secure, we’ve gathered the facts to help you conquer your fears about pregnancy and giving birth. And because having a baby kicks off a whole different set of anxieties, see “Fearless First Year” on pg. 117 to help put your post-delivery worries into perspective so you can relax and enjoy your new role.

the fear} I partied before I knew I was pregnant and am worried I may have hurt my baby.

the facts} Even if you smoked, drank, took drugs, had X-rays and were exposed to chemicals before your first missed period, experts agree there’s very little damage you can do at this early stage. It takes about seven days for the fertilized egg to travel through your fallopian tube and implant in your uterus. The placenta, which allows the exchange of blood between mother and baby, begins to develop at about 12 days after conception. “Very few things done before then will result in an abnormal newborn,” says Michael S. Broder, M.D., assistant clinical professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA and author of The Panic-Free Pregnancy (Perigee Trade, 2004).

solutions} Clean up your act as soon as you learn the good news. “The important things are simple,” Broder says. “Quit smoking and drinking, eat a balanced diet, exercise regularly and get enough sleep.”

the fear} I’ll have a miscarriage.

the facts} While it’s true that more than half of pregnancies detected very early on end in miscarriage, your risk drops to less than 10 percent after six weeks and stays there through 20 weeks (after that, it’s called a stillbirth). Most miscarriages are the result of genetic abnormalities with the developing embryo, not something you did, such as working out hard or having sex. And don’t assume the worst if you spot, or have light vaginal bleeding, in the first trimester—about one in three pregnant women experience this, with no ill effect.

solutions} Studies show that smoking and heavy caffeine consumption can slightly increase miscarriage risk, so limit yourself to one or two cups of java a day—300 milligrams maximum of caffeine—and toss the cigarettes. If you miscarry two or three times in a row, consult your OB-GYN; testing can sometimes help determine a cause and prevent recurrences.

the fear} My baby isn’t getting the necessary nutrients because I can’t keep anything down.

the facts} Seventy to 85 percent of pregnant women experience nausea, or morning sickness, which usually subsides around week 14. But for much of the first trimester, your baby is so tiny, she doesn’t need much, and what she does need, she’ll leach from your body.

solutions} Folic acid is an important first-trimester nutrient, so at the very least take a 400-microgram supplement daily from the time you start thinking about getting pregnant.

the fear} There will be something wrong with my baby, like a birth defect.

the facts} The vast majority of babies—slightly less than 97 percent—are born without abnormalities of any type. Of the remaining 3 percent, many defects are minor and easily corrected, such as webbed toes. Taking folic acid, ideally starting before you get pregnant, can dramatically reduce the risk of a neural-tube defect, one of the most serious types.

solutions} While not foolproof, routine screening tests, as well as a new first-trimester test, can help put your mind at ease. Performed around 11 weeks and combined with an ultrasound that measures fluid at the back of the fetus’s neck (nuchal translucency), the first-trimester test is better at detecting abnormalities than the standard expanded alpha-fetoprotein (AFP) test given between 15 and 20 weeks. Sharing your family history with your doctor can help determine if you’re at greater risk for particular genetic defects. Controlling certain medical conditions, such as diabetes, decreases your chances of having a baby with a defect, as does avoiding alcohol, cigarettes and illegal drugs.

the fear} I’m over 35 and therefore “high risk.”

the facts} High-risk complications, which occur in about 10 to 15 percent of all pregnancies in the United States, most often result in healthy babies and don’t automatically appear once you reach a certain age. Rather, “high risk” usually refers to problems such as high blood pressure, diabetes, autoimmune disorders and multiple gestations that require closer monitoring. True, as your eggs mature, you’re at increased risk for having a child with a chromosomal abnormality, but the odds are still with you: The risk for Down syndrome is one in 400 at age 35 and one in 100 at age 40.

solutions} Remember that most healthy women ages 35 and older have problem-free pregnancies. Meet with a genetic counselor to discuss your individual risks and whether you should undergo genetic testing.

the fear} I’m afraid exercising too strenuously or performing certain moves may harm my baby.

the facts} “There’s no study showing exercise damages a fetus,” says OB-GYN Broder, a former researcher at Rand Health, a think tank in Santa Monica, Calif. On the contrary, research points to many benefits of staying active, including more energy, better sleep and fewer aches and pains such as leg cramps, swelling and constipation. In 2001, the American College of Obstetricians and Gynecologists lifted its cautions against too much exercise, concluding that pregnant women don’t need to alter their fitness routine. However, certain health complications preclude vigorous exercise, and a few activities, such as scuba diving, are off-limits. Turn up your iPod and ignore sideways glances from fellow gym rats; instead, listen to your body’s signals. “Your body usually will tell you if you’re working out too hard,” says Gloria Bachmann, M.D., associate dean for women’s health at University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in New Brunswick.

the fear} I’ll go into premature labor.

the facts} One in eight babies are born before 37 weeks’ gestation, and half the time no one knows why. Prematurity is the leading cause of death in the first month.

solutions} While you may not realize it, the steps you’re probably already taking—such as avoiding alcohol, drugs, stress and prolonged standing, and monitoring health problems—help to stave off premature labor. Call your doctor if you experience any warning signs of premature labor, including contractions every 10 minutes or more often, or leaking of amniotic fluid or blood. Drugs can be given to delay labor and speed maturation of the fetus’s lungs and other organs.

the fear} I won’t be able to bear the pain of labor.

the facts} About 60 percent of women opt for pain relief via epidural, and the medications used today “have no negative effects on babies,” Bachmann says. What’s more, serious side effects are rare. Only if labor progresses very quickly—a rarity among first-timers—is there a chance you won’t have time to receive an epidural. (For more information, see “Epidurals: Fact vs. Fiction”)

solutions} Childbirth classes and CDs teach various ways to cope with pain, with or without medication; options include the Bradley Method (www.bradleybirth.com), Lamaze (www.lamaze.org) and HypBirth (www.hypbirth.com). If you aim to give birth “naturally” but change your mind in the moment, don’t feel that you’ve failed. “Birth doesn’t have to be painful to be successful,” says OB-GYN Stuart Fischbein.

the fear} The delivery won’t go the way I planned.

the facts} When it comes to delivery day, no one can predict how things will go down. Carrie Brace, 34, of Denver, was three hours into labor (she was planning a home birth) when her midwife suggested transferring to a hospital because the baby’s heart rate was low. “I didn’t like the idea of unnecessary interventions that often take place in hospitals due to their mandatory policies and procedures,” Brace recalls. “I thought I would lose all control over my delivery.” Instead, the obstetrician and nurses followed much of Brace’s birth plan by limiting the number of people in the room and occasionally removing the fetal monitors. “None of my concerns materialized,” she says.

solutions} If your doctor or midwife is dismissive of your desires regarding giving birth, you might want to check out other options, Fischbein says. “You need a practitioner who actively listens so you can build trust during your pregnancy,” he adds. “Communication is key. But you also need to remember that your expectations may be unreasonable and that you need to respect the doctor, too.”

Create a (flexible) birth plan with your partner so he can be your voice as you breathe through contractions. You also can hire a doula, a person who’s trained to be your advocate in the delivery room; visit www.dona.org to locate a certified doula in your area.

If you want to avoid a Cesarean section, choose a care provider and a hospital that have a low (10 to 15 percent) C-section rate. Discuss your desire to avoid surgery with your doctor or midwife ahead of time, and ask how she decides when it is necessary. Doulas can help here, too: Continuous labor support has been shown to reduce the C-section rate by 26 percent. Also, doulas can help you at home.

the fear} The baby or I will be seriously injured or die during delivery.

the facts} Giving birth in developed countries is extremely safe, with maternal mortality at one in 2,800. As for babies, nearly all doctors and midwives use fetal heart-rate monitoring to detect potential problems during delivery. A variety of techniques, from changing positions to vacuum delivery to C-sections, increase the odds of a safe outcome.

solutions} When this fear surfaces, close your eyes and imagine it as a cloud slowly floating away. You’ve chosen your doctor or midwife with care—trust her. Says Fischbein, “Fears are overplayed in the media, and almost all the time, happy outcomes are the result.”

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