#JanuaryJoy – Family Planning

A while back, following one of the medical posts I have written, a reader who shall remain nameless 😉 wrote to me and asked me to do a pre-conception post. I think a lot of women skip that pre-natal trip to the GP to ask advice before they get pregnant as so much is freely available on the internet and they feel they might be wasting our time. In fact nothing is more important than staying healthy and never more so than when creating a new life.

Image Credit: Baby Space

This isn’t intended to freak anybody out, nor to make those who simply got on with it and got pregnant feel bad. I figured that 2013 might well be the year that many of you have decided will be the year you’ll try to get pregnant, so thought this might be useful to stash away and read when the time comes. I won’t be covering getting pregnant as if you’re struggling that’s definitely one for your GP, and if you’re not then, well, I guess you knew what to do 😉

So here’s my check list of things to think about both from a health and sensible point of view.

1. Take Folic Acid
Number One on any pre-conception list has to be Folic Acid. Taking 400mcg of Folic Acid daily from the day you decide to start trying (all pregnancy vitamins contain the correct amount, or you can buy it alone,) will help prevent neural tube defects, or Spina Bifida. You might not think it’s important, but Scotland saw a nasty rise in Spina Bifida births in recent years when folic acid usage took a dip. The neural tube is the part of the baby that forms the spinal cord and surrounding structures and as the foetus develops it arises from the cells folding around the developing cord. This takes place from conception to 12 weeks, and if it doesn’t happen properly can cause problems below the level of the defect (with the bladder, bowels or legs for example) and babies born with deformities in their back. All these things can often be corrected but prevention is better than cure, especially as most people don’t know they’re pregnant until 4-6 weeks. It’s never too late to start taking folic acid if you find out you’re pregnant and haven’t been taking it, but it’s better even if you think there’s an outside chance of an accident happening to be covered all the same. (NB! Women with some conditions such as epilepsy are recommended to take a higher dose of 5mg daily – check with your GP if you are unsure.)

Now we have covered my number one issue, onto the other stuff.

2. Get in shape.
To give yourself the best possible chance of pregnancy you need to be fit and healthy, which also gives you a head start on enjoying your pregnancy. If you’re overweight, think about trying to shift a few pounds as obesity makes a pregnancy higher risk and can affect your chances of getting pregnant in the first place too. Whether you stop drinking entirely is up to you, but reducing your alcohol intake to an occasional glass won’t hurt and if you smoke it goes without saying, just stop.

3. Review your medications.
Plenty of medications are fine to take in pregnancy and often we have to weigh up the pro’s of mum being happy and healthy against the possible risks to the baby, but some are not, including anti-depressants, anti-epileptics and acne treatments. Unsurprisingly there is always a lack of evidence for drug use in pregnancy as nobody tests drugs on pregnant women, so the advice will often be to stop if you can. In the case of essential drugs however like anti-epileptics, it’s often just a matter of switching to a baby friendly variety in good time before you get pregnant. Diabetics should also see their GP prior to trying to concieve.

4. Get your cervical smear.
You can’t have a smear early, (and don’t forget you’re due one every three years from the age of 25,) but you also can’t have one when you’re pregnant, or for 3 months after having a baby as the cells the test samples are different due to the hormones of pregnancy. If you’re trying and a reminder comes through, don’t delay!

5. Lastly, check you are up to date with your jabs.
Once pregnant you will be offered (correct at time of posting, Jan 2013,) a flu jab and whooping cough vaccine. However your immune system is slightly suppressed whilst pregnant and catching some diseases like rubella or measles can seriously damage an unborn baby. We’re seeing a big risk in incidence of these diseases due to the fear over MMR vaccines some years ago now. If you aren’t sure if you have been vaccinated, check with your GP and get up to date.

One last thing. You may not be ready to try for a baby yet but if it’s on the cards in the next few years you might want to re-think your contraceptive choices. Especially if you’re a little older, it pays to be able to start trying as soon as possible from when you discontinue your chosen contraceptive, so you want one that’s immediately reversible rather than taking ages for your fertility to return. The main one to watch out for is the Depo Provera contraceptive injection. This can take several months to fully leave the system before your fertility comes back and you start ovulating again, so I don’t recommend it for women thinking of having a family in the next 12-24 months, or even between babies, unless you’re happy to deal with a long wait. When coming off the pill your periods can take a few months to settle into a normal pattern but it’s not a widely recognised problem. The coil, Mirena or IUS and implant are all immediately reversible.

Do let me know if this was useful and of course, remember, reading this is no substitute for a chat with your GP – we really enjoy seeing people for chats like this – it’s our job! Now I’d love to hear if any of you have been thinking about getting ready for trying, or if you’re already a mum or pregnant, how did you prepare? (Feel free to write anonymously if you want to stay private.)

Happy weekend readers!


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29 thoughts on “#JanuaryJoy – Family Planning

  1. This is one concise, well informed post, well done Rebecca! From a fellow medical freak (vet in this case).
    We have been trying for a baby for 2 years now.. I knew all the things you said, I religiously take folic acid and vitamin D, we have no risk factors, every single test has come out textbook perfect. The doctors have no idea what’s going on with us, the diagnosis is unexplained.
    I just wrote about how when planning for a family the first thing you have to do , the first huge challente is to let go of control. It is scary, terrifying even, but you do not know what you’re in for, how it will be. Even fertile couples can not really “control” what their bodies do, they are just under that impression because they are so incredibly lucky.
    Anyhow, I don’t want to freak anyone out. If you have healthy habits, there is 75-90% chance that you will be pregnant within 1 year of unprotected, properly timed intercourse, so my story will most probably (just based on odds) not be yours, but this is such an isolated boat to be in, such a taboo subject, that it is the only thing I could write about (we can only write from personal experience).

    • It’s not just you Amanda! And it is an incredibly isolating place to be. I knew in advance I would probably have trouble conceiving, so I have been well prepared for it. I think that has helped me deal with things enormously. It’s worth being aware of all the possibilities though, and being conscious that it might not happen straight away – I know lots of friends who have got pregnant immediately and they were more than a little shocked, but also people who have been disappointed so far and found it hard to come to terms with. The good news is that statistically speaking, most people will be fine, but I would also say don’t hesitate to get medical assistance if you’re concerned! My GP has been GREAT, but I had to be persistent.


      • Thanks so much Penny. And I wish you all the best of luck.
        We are in contact with doctors, we just started medical treatment 3 months ago, so we are hoping, and also aware of the options, and coming to terms with the possibilities of what the future may look like. Hugs to you.

  2. REALLY interesting post. Conception isn’t on my mind yet (get the May wedding done first) but there are discussions about ‘potenially’, ‘hypothetically’ coming off the pill towards the end of the year. I hadn’t thought about certain contraception being immediately reversible, and am interested to hear from ladies who have or have had the coil…? A friend has recently switched from the pill and is raving about it but you hear horror stories. Anything in particular I need to know about switching, Rebecca? X

    • All I would say is that most horror stories are exactly that, the stuff of urban myth and legend. It’s rare that someone tells me one of these tales in surgery and I’m not able to explain it within the boundaries of ‘normal’ for that method of contraception. Usually people just aren’t properly informed what to expect during the time they use a particular type of contraception (bleeding patterns etc) and particularly what comes after…

      All coils are immediately reversible. The way they work means that often (although not always,) you continue to ovulate whilst the coil is in place and it is implantation that is prevented rather than fertilisation, so remove it and everything is back to normal. The pill stops you ovulating so it can take a few months for that to resume normal function but not long enough for me to say you should switch. The Depo injection is the main culprit for delayed return to fertility.

      • Sama I’m just going to throw another contraceptive option into the mix – I’ve used nuvaring for 2 years now and love it – less ‘permanent’ feeling psychologically than the coil if you’re concerned about that but I’ve found it way better than the pill.

    • I had my Mirena coil removed a week ago as we decided that the time had come for us to start trying for a baby. And I will never ever choose any other method of contraception again! It has been brilliant for me. I have recommended it to lots of my friends and colleagues, some of whom have also given it a go and are very happy! I think people only really have problems when they aren’t put in properly but I might be wrong. I think there are lots of horror stories about all forms of contraception, you just have to try them and find the one that works for you. For me, Mirena is the best contraception available. Minimal side effects, effective for 5 years, no need to remember to take anything and instantly reversible.

      • And little or no periods with minimal amounts of hormones! I know I sound like I work for Mirena but honestly it’s been so good for me. You should give it a go, good luck with whatever you choose xxx 🙂

  3. Love these posts, so informative. Thinking about coming off the pill in the next couple of months or so, so this makes really interesting reading x

  4. This is my favourite JanuaryJoy post yet. It’s easy to assume when all your friends get pregnant that you already know all there is to know, and the basics are just common sense, but they’re not!

  5. Thank you for the interesting post! I would second the advice to be ready for anything – we had always planned to get going as soon as we got married but I was so surprised to find out I was pregnant on the day we got back from honeymoon. I am 32 and expected it to take months. Saying that, I had come off the pill a year before to give my body the chance to get back to normal and it took about 6 months for my periods to regulate.

  6. Great post – although I got pregnant a lot more quickly than I expected and wasn’t taking folic acid beforehand, I would definitely take this on board if and when there’s a next time!
    Really useful advice thanks Rebecca x

  7. Do not even mention that damn injection to me! I was told that it would take a long time to get out of my system but I wasn’t really interested in babies then, hence getting the injection in the first place!

  8. Fantastic post Rebecca. Babies aren’t on the agenda for us just yet, but still an interesting read, will save this for when they are! x

  9. Brilliant again, Rebecca. The two things that I would say as preparation for getting pregnant are 1) be prepared for it to happen straight away or take a long time – difficult to do both I know, but you need to have those conversations. And, 2) echoing what Rebecca said – be fit and active. Doing bits of exercise during my first trimester were the best parts of my day, the only times I didn’t feel sick. As I was only doing what I had done before I got pregnant (pilates, walking and cycling) I knew I was alright doing it and it was good for so many reasons. I have really weak joints anyway so I knew that as soon as the weight started to come on I would suffer, but by *remaining* active I didn’t gain any until around 20 weeks and I’m still able to do everything I want to (well, bending down not so easy!).

    It’s all about getting into good habits now so that you keep them up without thinking about it. Oh, and folic acid is about £6 in Boots for a few months’ worth of tablets, so it’s not hard to get.

    The coil: I would recommend it to anyone. I suffer from migraines so my contraceptive options were limited anyway, but I really loved it. When I had it removed to start trying for a baby I remember the nurse saying that I could be pregnant straight away because there is no lasting effect at all. That was a bit scary! I’ll be having another one put in as soon as this baby is out.

    • Esme you’ve hit the nail on the head there. It might sound obvious that it’s either going to happen really quickly or take a few – several months, but it’s true.
      From my friends experience many of them got pregnant in the first month or two of trying so the lesson I took away from that is that you have to be just as ready for it to happen straight away, as thinking ‘well if it takes a few months that will be fine’.

  10. Great advice and idea for a post I would never have thought to visit a doctor to discuss planning to have a baby, maybe I will next time! I definately think being fit and healthy helps to some extent and to remain so in pregnancy -because you most definately need to be fit for when its time to push!! 😉

  11. I fall into the very lucky camp of people who conceived really quickly.

    My implant expired shortly after the husband proposed and knowing we wanted to start a family very soon after our wedding I declined any further contraception from my doctors as I wanted all of my hormone levels to return to normal. I considered the coil but only really got around to thinking about it seriously 6 months before our wedding, at which point, having used good old fashioned condoms for a year, it seemed pretty pointless.

    This post would have been great a year ago as I didn’t know about taking folic acid until I was 6 weeks pregnant and would never have though about discussing family planning with my doctor. However I’m also surprised that my doctors didn’t bring it up as on a few different trips I was asked about what I was doing for contraception and mentioned that we were planning on starting a family.

    I think as women we put a lot of pressure on ourselves when it comes to conceiving so when it came it I told myself that we “weren’t trying”, we were just going to stop actively avoiding pregnancy and “see what happens”. My cousin had taken 3 years to conceive and her brother had taken 7 years so I didn’t want to think that it would happen easily.

    Fortunately for my sanity it happened very quickly and I now have a 31 week wriggly bump! I can’t wait for Bean to arrive and complete our family!

  12. Really informative post, thank you! We’re not planning to have children for another couple of years but it’s really good to know how to get yourself ready, when the time comes. I’ll be pointing baby-planning friends in this direction!

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