The Perfect Enough Pregnancy

Sure, you want to do everything right during your pregnancy, but going too far can turn you into an unhappy stress case. (It's not good for your baby, either.) Here, experts in nutrition, exercise, emotional health and more help you find a healthy balance.


Researchers know a lot about how to build healthy babies, so it makes sense to follow their guidelines. But if you’re making yourself crazy chasing pregnancy perfection, it’s time to rethink your expectations. Some cut-and-dried rules—always wear a seat belt, for example, and never smoke cigarettes—merit 100 percent compliance. But with most others, pretty good is perfectly fine.

“You don’t need to be extreme to have a healthy baby. You just have to use common sense,” says Alice D. Domar, Ph.D., founder of The Domar Center for Mind/Body Health in Waltham, Mass., and co-author of Be Happy Without Being Perfect (Three Rivers). In fact, all-or-nothing thinking can have downsides for both you and your baby (see “The Perils of Perfectionism”). Pregnant women often strive for perfection because it gives them a sense of control over the often-scary experience of becoming a parent, Domar says. “But even if you follow every recommendation to the smallest detail, you don’t have complete control. You can do everything ‘right’ and still have problems.” So give yourself a break, aim for “good enough” with the following expert advice and enjoy your imperfectly healthy pregnancy.

Do I have to live in a bubble?

THE IDEAL Adopt a 100 percent clean and green lifestyle.

GET REAL Make small changes that have big returns.

»It’s OK to be selective about organics “Don’t lose sleep if you can’t afford organic food,” says Elizabeth Ward, R.D., author of Expect Your Best: Your Guide to Eating Healthy Before, During, and After Pregnancy (Wiley). But do try to buy organic varieties of the fruits and vegetables on the Environmental Working Group’s “Dirty Dozen” list of produce with the most pesticide residue: celery, peaches, strawberries, apples, blueberries, nectarines, bell peppers, spinach, cherries, kale/collard greens, potatoes and imported grapes.

»Take into account how much of a particular food you eat “If you’re craving strawberries and are eating a quart a day, buy organic strawberries,” Ward says.

» Don’t feel compelled to throw away every chemical in the house But stay away from garden chemicals; pesticides; smoke and fumes; synthetic fragrances; personal-care and cleaning products, paints and solvents that contain harmful chemicals; and plastics that may contain BPA or phthalates. (To learn more about what to avoid, go to

» Avoid home improvement projects that may release lead dust This includes sanding of old paint. Lead is known to cause neurological damage and developmental problems in children.

Do I really have to work out so much?

THE IDEAL Get 30 to 60 minutes of moderate-intensity exercise at least five days a week.

GET REAL Work out when you can, and squeeze in bits of activity when you can’t.

» Walking around the block will do Don’t worry if you don’t have time to go to the gym or an exercise class. “Anything is better than nothing,” says Karen Nordahl, M.D., co-founder of Fit to Deliver International.

» Spread exercise throughout the day If you’re more likely to do three 10-minute spurts of exercise rather than one 30-minute chunk, that’s OK; just try to break a light sweat each time.

» Make exercise fun Take a prenatal exercise class (you’ll meet other moms-to-be), walk with an exercise buddy (she’ll keep you entertained and motivated) or borrow a dog and go for a hike.

» Set up short-term goals and rewards You’re less likely to skip your workout if you’ve promised to buy yourself flowers when you meet your weekly goal.

I only get to gain how much weight?

THE IDEAL Gain precisely what the guidelines recommend (25 to 35 pounds if your prepregnancy weight was normal; 28 to 40 pounds if you started off underweight; 15 to 25 pounds if you were overweight; and 11 to 20 pounds if you were obese).

GET REAL Do your best, and focus on healthy habits.

» Set realistic expectations with your care provider She’ll help you determine a weight range that’s right for you based on your personal health needs, medical risks and weight-gain history.

» Find a happy medium between deprivation and overindulging “Many overweight women are used to dieting, but it’s really important not to be excessively restrictive during pregnancy,” says OB-GYN Amanda Calhoun, M.D., assistant director of women’s health for Kaiser Permanente Northern California. On the other hand, you need only about 300 extra calories a day in the second and third trimesters.

» Stay active regardless Exercise helps reduce the risk of gestational diabetes, high blood pressure and some of the other complications that occur more commonly in women who gain too much weight.

» Keep trying If you overeat today, don’t give up and eat whatever you want for the rest of your pregnancy. Just start over tomorrow. » Remember, it’s not just about weight “I care more about healthy living than just the numbers on the scale,” Calhoun says.

Should we be on one long babymoon?

THE IDEAL Enjoy romantic getaways and dates as often as you can before the baby comes.

GET REAL Reconcile romance with the daily grind.

» Squeeze in couple time It’s easy to get so wrapped up in choosing baby names and shopping for strollers that you forget about having fun as a couple. Whether or not you can get away, make time whenever you can.

» Exercise together It will improve your fitness levels and your relationship.

» Do a parenting-expectation exercise Each of you folds a piece of paper in half. On one side, write your parenting hopes and expectations for yourself. On the other, list your expectations for your partner (and vice versa). Swap your lists and look for discrepancies. “It’s a great way for a couple to begin to have some conversations about fantasies, expectations and assumptions about parenting so both of you are on the same page,” says Deborah Issokson, Psy.D., a psychologist in Wellesley, Mass.

» Be realistic Understand that having a child strains even the best relationships. “Babies don’t make relationships better, they bring stress,” Issokson says. “They bring disruptive disorder to two lives that are in a groove.”

» Give your relationship a close look If there are any problems, face them head-on. “Pregnancy is a wonderful time to take stock and work out the kinks,” Issokson says. “You’re not going to have a lot of time for that once the baby comes.”

» Consider at least a single session of couples therapy Do this even if things seem good. Says Issokson, “It can’t hurt to check in to ask, ‘Where are we, what are our fragile points, what are the red flags and how can we intervene now to keep the relationship healthy?’ ”

Do I have to give up my fave foods?

THE IDEAL Eat all good things and no bad ones.

GET REAL Realize that you have more eating options than you might think.

» Eat a variety of healthy foods If you do this, you’ll likely get the nutrients you and your baby need without having to obsess about the fine points. Most important are fresh fruits and vegetables (especially brightly colored ones), whole grains, low-fat dairy, beans, lean meats and fish with omega-3 fatty acids.

» Let yourself enjoy occasional treats Just keep portion sizes small.

» Don’t like fish? Get omega-3s elsewhere “The fetus needs DHA to build healthy brain and nerve tissue and eyes,” says Melinda Johnson, R.D., a spokeswoman for the American Dietetic Association. “Most women simply do not get enough of it in their typical diets.” Nonseafood sources include high-omega-3 eggs, flax seed oil, supplements (they’re safe) and some prenatal vitamins. (For more information, see “Something Fishy?”.)

» Don’t like milk? Get calcium from other sources These include low-fat yogurt, cheese, fortified soymilk and fortified orange juice. Or discuss taking calcium supplements with your care provider.

» Don’t eat meat? You can have a healthy vegetarian or even vegan pregnancy Just be careful to get enough protein, iron, vitamin B12, calcium, vitamin D3 and omega-3s from nonanimal sources. You may need to consult with a dietitian.

» Go ahead and have some coffee Up to 200 milligrams of caffeine daily is fine—that’s about one 12-ounce cup of joe. Keep these other caffeine counts in mind: tea (40 to 120 milligrams per 8-ounce cup); cola (35 to 47 milli- grams per 12-ounce can); chocolate (9 to 31 milligrams per 1.55-ounce bar); and energy drinks (100 to 500 milligrams, depending on size).

Not stressing is stressing me out!

THE IDEAL Eliminate every source of tension from your life.

GET REAL Avoid aggravation when you can, and use smart coping skills when you can’t.

» Make a list of what causes you stress Brainstorm changes you can make to reduce it. You may not be able to eliminate your long, aggravating commute, but you may be able to lower your stress by one-fifth by working from home one day a week.

» Practice appreciating the present “We spend a lot of time focusing on the future and the past,” says Gina Hassan, Ph.D., a perinatal psychotherapist in Berkeley, Calif. The antidote is to cultivate mindfulness—“paying attention to the present moment on purpose and without judgment,” she explains.

» Do mini-relaxations when you’re particularly stressed Close your eyes, take a deep breath for a count of four, hold for a moment, then exhale deeply for a count of four. Repeat two or three times.

» Ask for help Most people are happy to chip in if you’re going through a tough time, especially when you’re pregnant or have a new baby.

» Make sleep a top priority Do so even if it means letting other things go. Being exhausted makes you less capable of coping with stress.

» Don’t beat yourself up if you can’t relax “Trying to force yourself to relax is like trying to force yourself to fall asleep—the more you try, the harder it is,” says Hassan.

» Build a support system You’ll need a network of family, friends, neighbors and others who can sustain you through pregnancy and beyond, especially if you don’t have a partner.

» Get professional help for emotional problems This is crucial if you’re feeling especially anxious, depressed, angry or uninterested in activities you usually enjoy.

Rules to live by

Always . .

1 Call your caregiver if you experience vaginal bleeding, sudden or severe pain or swelling, blurred vision, severe headaches or rapid weight gain.

2 Get good prenatal care. Be sure to tell your doctor or midwife about any pre-existing conditions, such as diabetes or thyroid disease.

3 Take a daily prenatal multivitamin with at least 400 micrograms of folic acid.

4 Brush, floss and see your dentist for a checkup early in pregnancy. Gum infections raise the risk of preterm delivery.

5 Seek help if you’re being abused emotionally or physically; abuse can lead to depression, anxiety, miscarriage, preterm birth and fetal death.

Never . . .

1 Use alcohol, tobacco or illegal drugs, and don’t take supplements or medications of any kind with-out your doctor’s OK.

2 Ignore an infection. Even a minor one, such as a UTI, can lead to preterm birth if untreated.

3 Change the cat’s litter box without wearing gloves. Toxoplasmosis, which can cause vision and learning problems in your baby, is a potential risk.

4 Eat raw or undercooked meats and fish; unpasteurized cheeses or other dairy products; unheated deli meats and hot dogs; or high-mercury fish.

5 Forgo wearing a seat belt. They’re proven to protect against miscarriage, early labor and fetal death.

The perils of perfectionism Perfectionism causes stress and anxiety. When you’re stressed, your body pumps up production of the hormone cortisol, excessive amounts of which may play a part in preterm labor. Later, perfectionistic parenting can boost your child’s risk of developing anxiety, depression, self-doubt, eating disorders and low self- esteem, says Alice Domar, Ph.D., who has studied the problem as it relates to pregnancy.

Notch down perfectionist thinking by looking at the black- and-white thoughts and judgments that float around in your mind and try to reframe them so they’re less rigid and judgmental. If perfectionist thoughts persist, consider meeting with a prenatal therapist, Domar suggests. True perfectionists have an elevated risk of postpartum depression, so it makes sense to get it under control before your baby arrives. thinking, make small but effective changes: set aside bits of “couple time,” work exercise into your regular daily activities and try one (healthy) new food a day.