The Before-Baby Plan

It can be extremely helpful to prepare for the life-changing leap into parenting: both for the physical maternal-marathon of pregnancy and childbirth, as well as the lifelong ultra-marathon of raising a small human into adulthood. Certainly, it is not always possible to plan for every pregnancy: There are plenty of “oops” babies born every day and doing just fine. Plus, even the most thoughtful and thorough preparations won’t remove all of the bumps along the parenthood journey. Still, the experts agree that a bit of pre-pregnancy planning goes a long way toward helping mama have a heathier pregnancy and easing couples into the complexities of caring for a child.

PREPARING YOUR BODY
When Stephanie Rappazzo and her husband decided that they were ready to start making plans to expand their family, she knew there were things she wanted to do to prepare for this major life change.

“I’ve always been someone who tries to exercise, eat well, and take care of my overall health,” explains Rappazzo. “But once my husband and I started getting to the point where we wanted to try to have kids, I think I probably just ate a little more carefully. I started taking prenatal vitamins and looked into what foods I should be eating and which ones to avoid.”

Rappazzo is onto something, as housing a human for 40 weeks is no small feat. That’s why the experts say that helping a mother-to-be boost her pre-pregnancy health is a worthy goal. “Pregnancy is a normal physiologic process, but it does put extra work on our body,” says Jenifer Fahey, CNM, a certified nurse midwife with the University of Maryland Medical Center and an assistant professor of obstetrics, gynecology, and reproduction at the University of Maryland School of Medicine. “Just as we know it would be easier to run a long distance when we are at our ideal weight, versus not an ideal weight, the same is true for pregnancy; helping your body be at its best is going to help this normal process go even better.”

To build a body that’s ready to be baby’s abode, Fahey recommends implementing the hallmarks of healthy living: Eat a colorful diet of vegetables and lean proteins, reduce sugar and processed foods, be physically active, and quit smoking and substance use. But Fahey also advises that a healthy body does not mean a perfect body.

“The body is actually pretty good at putting a baby together, so people don’t have to be in perfect health,” explains Fahey. “People can get worried and sometimes they can even lose too much weight. If you don’t have a certain percentage body fat, you might have a hard time getting pregnant because the body is programmed to make sure that there’s not a famine. Staying in that healthy range on both ends is important. Being ‘healthy’ doesn’t mean being in the stereotypical ‘bikini-shape’ we sometimes see on social media.”

The pre-pregnancy health checklist also includes getting up-to-date with vaccines, establishing health insurance, and considering prenatal genetic testing. “It’s easier to learn about and have counseling for potential risks when there’s not already a baby,” explains Fahey. “Especially if you know your family is at risk for certain conditions, it may be helpful to discuss your family’s genetic background before becoming pregnant.”

PREPARING YOUR HEART
Caring for all of the needs of a tiny person, plus managing the rigors of work and maintaining a home—all on a reduced amount of sleep—can be overwhelming for new parents. “I was very surprised at how sleep deprivation rocked my existence. l didn’t realize how exhausted I would be,” recalls Rappazzo. “Plus, I used to teach high school and I stopped working when I had my first son. I’m an extrovert and so the transition to being home with the baby was really rough.” Rappazzo quickly realized that she could not do this alone, but relied on a close community of friends and family to answer late-night questions and drop off food. Gathering a group of trusted people to be part of a support network is key.

“In those first two weeks after baby is born, the only people who should come to the house are those whom you could ask to pick up a gallon of milk, and when they get there, they might need to throw the laundry into the wash, and they may or may not see you, because you might be sleeping. Those people who would answer, ‘Great, I just want to help,’ are the ones who should be in your network,” says Fahey. These small kindnesses can really add up and help new parents, and their young ones, thrive. In addition to accepting kindness from others, new parents need to remember to also go easy on themselves.

“I advise all my patients to just to be kind to themselves,” advises Fahey. “Be patient with your body, and know that you will have your own, unique journey. Sometimes people struggle to get pregnant, some people may struggle to stay pregnant. Many people have to find alternate ways to motherhood that do not involve pregnancy.

Whatever your journey, kindness must start with yourself, so that we can create the world that we all want as mothers for our children, no matter how our children come into our lives.”

MANY PATHS TO FAMILY
Stephanie Rappazzo can relate to Fahey’s wise words. She found her own journey was altered when she experienced secondary infertility—the inability to become pregnant after previously having healthy pregnancies.

“We wanted to have at least one more. After a year of trying, I got pregnant but I miscarried at nine weeks. It’s been almost two years since then and we still haven’t gotten pregnant. I haven’t had any conclusive answers that say I will never get pregnant, but we’re just kind of living in this limbo,” says Rappazzo.

EXPERIENCING INFERTILITY
According to Endrika Hinton, M.D., a reproductive endocrinologist with Greater Baltimore Medical Center, there are many reasons why a couple may have difficulty or be unable to become pregnant. “The main areas where people run into problems would be whether the woman is making eggs regularly or ovulating, or if they have had some kind of damage to the ‘plumbing’—the fallopian tubes,” explains Hinton. “Another cause is due to a low sperm count in the man.”

Age is also a factor, with egg amounts decreasing over time. “When we run out of eggs, we’re technically going through menopause,” Hinton continues. “During that process, your eggs have been sitting in your body for 40 years and they may not divide as well, so that’s when we see more chromosomal abnormalities.”

Fortunately, a number of fertility treatments are available. The first treatment Hinton advises is a lifestyle change: Become more fit and quit smoking.

“Obesity definitely contributes to miscarriage, infertility, and ovulation problems,” says Hinton. “Smoking reduces your likelihood of conception by about 20 percent. Improving these lifestyle factors can increase your likelihood to become pregnant.” After lifestyle factors are addressed, a fertility specialist will try to identify if there is a reason for infertility, such as damaged fallopian tubes or low sperm count. Then they will evaluate if the woman is ovulating correctly and prescribe medications to regulate ovulation if that is found to be a cause. If this still is ineffective, doctors will try various therapies.

“We practice empiric therapies that work to get the egg and sperm closer together, such as ovulation induction with intrauterine insemination.

This just means we’re getting the egg higher up into their reproductive tract and concentrating it by adding a couple more eggs to the mix. We’re hoping to get two eggs to roll down the system and then we increase the amount of sperm that fertilizes the eggs,” explains Hinton.

If this still does not result in a viable pregnancy, the next thing to try is in vitro fertilization. “With in vitro fertilization, we extract the eggs and the sperm separately, and then mix them together in a test tube or a petri dish. We allow fertilization to happen outside the body, and then a fertilized egg is implanted back into the woman,” shares Hinton. Families are elated when these treatments work. But Hinton cautions that the process can be emotionally exhausting.

“The stress level for couples in fertility therapy can be as high as someone going through chemotherapy. It can cause a lot of tension within the relationship,” cautions Hinton. “It can be very distressing if your fertility, which you take for granted, is compromised. For a woman, there’s nothing more feminine than being pregnant. For a man, it can be a hit to your ego if you have an abnormal semen analysis. I advise couples to reach out for therapy and be kind to themselves during this process.”

A DIFFERENT JOURNEY
Pregnancy is not the only path to making a family. Adoption or foster care can be extremely rewarding and fulfilling—something that the Rappazzo family discovered.

“Foster care has always been something that I thought I’d look into once we decided we were done having kids,” explains Rappazzo. “But experiencing secondary infertility pushed us to jump into it now, rather than waiting. So far, we have had one placement, a boy who was close in age to our other two boys.”

Just as parenting biological children is filled with joys and struggles, caring for a child in foster care also offers plenty of highs and lows. “Adding another kid to parent and teach was a lot harder than I anticipated. He was very emotional, in the sense that when he was happy, this joy just emanated from him. When he was not happy, he was equally as emotional, but in the opposite direction,” shares Rappazzo, who also found it challenging to keep up with the various meetings with parents, social workers, and other requirements that come along with having a youth in care. But she believes that these struggles made the successes that much sweeter.

“It was really special to be able to impact him and see how my other boys shared their space and welcomed him into our home. It was rewarding to know that we were giving him a safe place where he could learn and grow,” says Rappazzo. “I feel like foster care helped our family become even closer, because our kids were partners with us in the work of helping another child.”

PREPARING FOR THE ADVENTURE
Whichever path prospective parents take on the journey to create a family—pregnancy, adoption, or foster care—a little bit of preparation can smooth out some of the bumps along the way. Still, caring for a child will stretch parents in ways they could never anticipate. Parenting is a hilarious, tedious, humbling, overwhelming, elationfilled, anxiety-fueled, heart-bursting adventure of a lifetime. There’s no way to fully prepare for this life-altering experience—but parents can still try.