When I approach the topic of genetic screening in pregnancy with my patients, I am often  interrupted with a condescending smile about half way through my spiel.

“No, thanks.  We are CHRISTIANS, therefore we would never terminate a pregnancy.  We will love this baby no matter what.”  Often this reply takes on a southern  “why bless your little heart”  type of tone.

Because this is now a popular political football, moms should know that there are many reasons for genetic screening other than termination. Actually, in my 11 years of delivering babies I have never seen a patient who elected to have a termination due to the results of a genetic screening test. Having the testing can provide reassurance to perceived high risk moms and can help those who receive the diagnosis to better plan for the challenges ahead.

I spend a lot of time in our book discussing the many options for genetic screening. Many women get peace of mind and reassurance from having the testing. Having a normal test result is extremely comforting. Having a peaceful, faith filled pregnancy is the entire purpose of our book. And to me this is an important topic to consider in order to have the most peace-filled pregnancy possible.

Women over 35 often worry about being at higher risk for having a child with down syndrome. While the risk does increase with age, most down syndrome babies are born to women in the low risk age group, because these women HAVE the most babies.  This is why we make testing available to all moms.

For more discussion on age related risks check out this previous post.

There are findings that can pop up on ultrasound called soft markers. One of these findings can be seen on up to 4% of normal pregnancies, but also can in certain instances be associated with down syndrome. In most cases they are not (yes, confusing I know) and they can cause undue stress if genetic testing has not been previously preformed.

While I have no doubt that you would love and cherish a child born with down syndrome, having a child with special needs does change your life. Being able to plan ahead by meeting with support groups and mentors can be very valuable. Special needs children can often not attend traditional childcare centers, so being able to plan for childcare can be essential.

Knowing about abnormalities can help you and your doctor plan for delivery. For instance, if the baby has down syndrome (or any other type of syndrome), it is often helpful to deliver at a larger hospital with a neonatal specialist on staff. These babies can sometimes have special needs after delivery. Up to fifty percent of babies with down syndrome will be born with a heart defect, so delivering at a hospital that has a pediatric cardiologist on staff would be beneficial. As another example, babies who have spina bifida are usually allergic to latex. If your doctor knew ahead of time, special precautions could be taken at the time of delivery. So, testing can have an effect on pregnancy management.

A new test that has recently become available is the MaterniT 21.  This is a blood test that can be performed at any point after 10 weeks that can detect down syndrome with a sensitivity of 99%.  The test amplifies DNA particles and looks at free circulating fetal DNA. This test seems better than traditional screening tests (such as the QUAD screen) because it can be performed at any time and is more accurate.  It also does not have the risk of miscarriage that can be seen with amniocentesis.  The technology is quite amazing if you think about it.

One of the biggest issues people have with the other screening tests is a high false positive rate (up to 20%).  Meaning that the results come back positive 20% of the time when everything is actually OK, which can definitely cause some serious anxiety. The data on the MaterniT21 also shows a false positive rate of .5%, which is extremely low and thus is a huge benefit. It is currently approved for women over 35 or other risk factors for down syndrome (e: abnormal QUAD screen).

Genetic screening is not for everyone.  It is a very personal decision that each women should prayerfully make based on her situation and risk.  I attempt to lay out the options for my patients and let them decide what they feel is right for them.  This additional option gives them one more choice that is accurate and doesn’t have a risk of miscarriage.

Correction: The first version of this post stated that MaterniT21 was FDA approved.  This is not correct.  The data from the initial trials have been published in peer reviewed journals and is ontrack for approval for 2013.

In honor of Valentine’s Day, we’re talking today about how dads-to-be can show LOVE to their wives throughout their pregnancy. Dr. Rupe had an OB appointment a few weeks back when the father-to-be pulled her aside to ask what he could do to help his wife throughout her pregnancy. I think we can all agree this dude deserves the father-to-be of the year award for that move! It prompted Dr. Rupe to think about what husbands can do to serve their pregnant wives. We asked our community of moms to weigh in as well on how their men helped them while they were carrying baby.

We’ve all seen the commercials or the scenarios played out on countless sitcoms. . .mama has a craving and daddy must run out wearing only his boxers (for fear that taking too long to change his pants would put his ice cream-craving, pregnant wife over the edge) in the middle of the night to grab some mint chocolate chip or heavenly hash. This may not be the best way for your man to show his love and care for you. . .but there are many other things he can do to serve you during your pregnancy.

Ladies, this post is not meant to make you feel badly for all the things your husband isn’t doing. It’s not meant to make you mad at him for not thinking to ask your doctor what he could do for you. We hope you will share this post with them in an effort to communicate what you might need from him during this time.

Dads-to-be. . .if you’ve not yet taken an active role in serving and caring for your pregnant wife, we hope this post will give you some ideas and encourage you to do so. There is no way you could understand how taxing it is to grow a life inside your body. It’s wonderful yet exhausting. It’s effortless yet challenging. It’s beautiful yet ugly. Those dichotomies alone are enough to make you mad!

With all of these suggestions, the important thing is to offer to do it before she has to ask. That is what makes a woman feel the most cared for. I don’t know many men who will refuse when asked to do something but it means so much more when we don’t have to ask and when you serve us with joy.

10 Ways Husbands Can LOVE On Their Pregnant Wives

1. Bring her a snack or drink. Learn her pregnancy eating habits and offer it before she has to ask.

2. Rub her back or feet or legs. Heck, rub anything that makes her feel better! Her body is likely aching a lot!

3. Offer to cook a few meals. This may not be your strength daddy but grilled cheese will do. Or pick up take out on the way home from work.

4. Send her to take a bath. She may not even want to make the effort but once she is soaking in that warm, bubbly tub, she will feel so much better!

5. Help out more with household chores. . .especially those that require bending over (in the 3rd trimester).

6. Be sensitive about sex and intimacy. Talk openly about it. Let her know your needs but understand her feelings as well.

7. Tell her she’s beautiful. Every. Single. Day.

8. Engage in baby prep and planning. She will be nesting. Big time. Don’t fight it. Surrender to her baby bliss and get involved!

9. If you already have children, help her with bath and bedtime routines (more so than you normally would) as this is when she is likely exhausted.

10. Be a good sport and joyfully take pregnancy photos with your beautiful, pregnant wife. You will cherish them in years to come.

I’m sure there are countless more ideas for how men can serve pregnant mamas. We’d love to discuss your ideas as well. Leave a comment to start the conversation!

We’re linking up with oh amanda’s Top Ten Tuesday again today. Check out her post with great encouragement for bloggers and many other links to super fun Top 10 posts!

Praying we will know how to give and receive LOVE today and everyday,

Jessica

When I’m on call, I frequently get phone calls from patients concerning whether or not they are in labor. The two most frequent scenarios are:

A. “My contractions have been every 5 minutes for an hour, so I think this is it. Should I come to the hospital?” says the patient quite calmly.

“Which baby is this for you and how far dilated were you at your last visit?” I inquire.

“First baby,” patient says giggling. ”I was only 1 cm, but I’m just so excited. All the books say to come in when your contractions are 5 minutes apart!”

“Are you having any pain?” I ask, a little skeptical.

“Oh, I definitely felt some ’twinges’ with that last one,” she says with more giggling.

“Why don’t we give it a little longer. Wait until they really hurt, then check back with me,” I say {she can’t see the grin on my face}.

B. “Doctor, I think I’m in labor, but I’m not…… huff, huff, pant… sure…..if I should come in yet,” patient asks in obvious distress.

“How far apart are your contractions?” I inquire.

“They are…. just a second….” I hear phone being put down.

{Insert blood curdling shrieks and moans for the next 60 seconds.}

“…. about 6 minutes apart.”

“Yes, please come in right away!” I reply.

I don’t fault these women for not knowing exactly what is going on in their body. A woman’s first labor is a totally new experience. She can’t possibly know fully what to expect.

TV has also given everyone a warped view of the labor process. There are the cheesy sitcoms, where women have one contraction and then nearly have the baby in the car. On the other hand you have “A Baby Story” where they nicely edit an entire pregnancy and delivery into one half hour show*. Real life is not quite so predictable and usually not so fast.

Latent or early labor refers to the time from when contractions first start until you reach 5 centimeters of dilation. For the first time mom, this time period can be upwards of 24 hours with the average being about 12. Also, many moms will have false starts where their labor will kick in and then putter out over a few hours. After 5 centimeters, active labor thankfully kicks in and dilation happens at closer to 1-2 centimeters per hour.

A good rule of thumb for first time moms is that you should come to the hospital when your contractions are every 5 minutes for a hour and so uncomfortable that you can’t talk through them. When you time your contractions, start from the beginning of one contraction until the beginning of the next.

Women often get concerned about WHERE IN THEIR BELLY they should feel contractions. Are real contractions in the back? Pelvis? Everywhere? In active labor, contractions are usually felt as a total abdominal tightening pain that then causes a severe pressure into the pelvis. Real labor contractions CAN be felt anywhere in the abdomen, though more important than where is the intensity in which they are felt. Labor pain has often been described to me as ‘knife like stabbing pains in your vaginal area’ {often there are also expletives in this description…but I will leave those out}.

“But my cousin knows this girl who knows this other girl whose ex-roomate’s best friend didn’t even know she was in labor and she had her baby in the car on the way to the hospital!” you might say.

Ah yes. Everyone’s biggest fear. While crazy things like that DO happen on occasion, in my 11 years of delivering babies it has never happened with a first time mom.**

Now with additional babies, the rules change. By the time you have your sixth, we usually tell you to come to the hospital if you sneeze. I have had few patients deliver en route with third and fourth babies.

When you reach 35 weeks, usually your doctor will begin examining your cervix at each visit. She will use your dilation, combined with which baby it is for you and how far from the hospital you live to determine how soon you should come to the hospital.

And when in doubt, just call.

*Doctors hate it when you say “This isn’t how they do it on ‘The Baby Story’.”

** Full disclosure: While I’ve never had a patient give birth to her first baby in a car, it did happen to a relative of mine. But it’s really rare, so don’t sweat it.

7 Week Ultrasound

Dr. Rupe shared a wonderful, comprehensive list on what to know while waiting for your first OB appointment last week. It was chock full of helpful medical facts and guidelines for you to follow even before you ever set foot in a room with the person who will deliver your baby. For all you information junkies, this list will hopefully fill your craving for knowledge as you wait for your 6-10 week check up.

As I was considering what to write about this week, I felt an overwhelming pull to follow up Dr. Rupe’s post with encouragement on what to set your mind on while waiting for that first appointment. If, like me, you have suffered pregnancy loss you may be very guarded during these first few weeks.  Perhaps you’ve never experienced loss but this is your first pregnancy and you’ve heard so many stories about loss that thoughts of the possibility are consuming your mind. Your reservations and your fears are understandable but they do not have to rule your heart.

5 Things Your Heart Needs to Know While Waiting for Your 1st OB Appointment

1. He is holding your baby’s life together in his capable hands {Colossians 1:16-17}.
2. He knows every concern in your mind but bring them to him so he can help you deal with it.
3. Worrying about it will not change anything. It will only make you miss out on the miracle happening inside you.
4. Now is the time to begin praying fervently for every little piece and part of your growing baby. These early stages of growth are so intricate. Cover    them with prayer instead of fear.
5. Faith and fear cannot dwell in the same place. Let faith in to push fear out.

{from, The Pregnancy Companion Introduction}

Now, before we jump into all of the stats, rules, and regulations, here’s what I want you to do. I want you to take a deep breath. In and out. Slowly. (This is good practice for your impending labor.) Breathe in slowly. And with that breath, I want you to take in a fresh infilling of the Spirit of God. Allow him to permeate your entire being and fill you with fresh faith, peace, and perspective. Now breathe out. Slowly. And with that release, I want you to let go of every concern or fear you’ve carried up until this point and every concern or fear you might be tempted to carry over the next nine months. Let go of every question, every symptom, and every insensitive, stupid thing your friend or family member will say to you. Let it go. Let it all go.

You see, when you allow God to come and fill you with his peace, there is no longer room for your fears. Faith and fear cannot dwell in the same place. So let him in and push fear out. Remember this exercise every time you encounter fear on this journey. You will likely encounter fear or worry or anxiety at some point. The important thing is not to give it place in your mind or your heart.

We are always praying for the mommies-to-be in our community so know that you are covered during this time of waiting. I know it can be hard, believe me! But a peaceful body is the best place for your baby to flourish so commit yourself to promoting peace within your heart and mind.

Rejoicing in the miracle with you,

Jessica

From the first moment you see the test turn positive until you sit down with your doctor for the initial appointment, the waiting can sometimes feel like an eternity. Some of you will spend those weeks worrying if you really are pregnant since you feel so normal.  For others, the pregnancy symptoms will be so severe that you will be desperate for some relief. The following is a list of common concerns that I get asked about at the first pregnancy appointment as well as some helpful hints for common symptoms.

Vitamins
If you are not already on a prenatal vitamin, then please start one as soon as you find out you are pregnant. Folic acid is the most important ingredient in a prenatal vitamin. We recommend 1 milligram of folic acid per day during pregnancy. Taking folic acid can significantly reduce the risk of birth defects like spina bifida. If someone in your family has had a baby with spina bifida you may need to take higher doses of folic acid, so talk to your doctor.

One common question of expectant mothers is “Do I need a prescription prenatal vitamin?” The main difference in over the counter and prescription prenatal vitamins is a higher dose of the all-important folic acid that is included in a prescription vitamin. They have 1 mg, whereas most over the counter prenatals have 600 micrograms. Other “extras” that come with a prescription strength prenatal vitamin are stool softeners, special coatings to help you swallow, DHA (for brain development) and a special form of iron that causes less stomach upset. It’s usually easier to take the prescription prenatal because it has everything you need and it’s easier on your stomach. If it’s too expensive you can take the over the counter prenatal and simply add a folic acid and DHA supplement. It is important to note that folic acid is best absorbed as a supplement rather than its natural source.

You can take too many of some vitamins (like vitamin A) so you should not add additional supplements in pregnancy without talking to your doctor first. I’ve heard lots of women say that their prenatal vitamins upset their stomach so they took ‘a few’ Flintstone’s chewable vitamins instead. This is probably not a great idea because as I said, you can have too many of some vitamins. A better option would be to take one Flintstone chewable and then an additional folic acid supplement if you really can’t tolerate prescription prenatals. Here is link to a company that sells prenatals by mailorder for less than you can usually get them at the pharmacy: http://www.vitamedmd.com

Nutrition
Pregnancy should be a time of very purposeful, deliberate eating. Look at how many calories your body needs, and fill those calories with the most high yield nutritious foods. There are several websites that will tell you the amount of calories you need for your height and activity level. www.choosemyplate.gov is a good site that will give you a sample food pyramid based on your caloric needs. The best strategy is to plan ahead. Focus on getting 5 servings of fruits and vegetables a day with at least one of those vegetables being a dark green or leafy vegetable (sorry pickles don’t count). Drink lots of water. Around 8 glasses a day is ideal. Also make sure at least half of your grains are whole grains. You only need an additional 100 calories a day in the first trimester, so you not need to increase the amount of food eaten at this point.

Food Precautions:

Meat. All  meat should be well cooked. Raw sushi should be avoided as well as rare and medium-rare steak.

Alcohol. There is no known safe amount of alcohol during pregnancy so please discontinue all drinking.

Fish. Shark, swordfish, king mackerel, and tilefish contain high levels of mercury. It is recommended that they be avoided while pregnant. Salmon and tuna should be eaten in moderation. Please note that fish sticks and fast food fish sandwiches are in general made from low mercury fish. See the following link for a complete breakdown of fish safety. http://womenshealth.gov/publications/our-publications/fish-facts.pdf

Caffeine. Caffeine intake should be limited to 200 mg a day during pregnancy.

Unpasteurized food. Cheeses, milk and juices should all be fully pasteurized.  Soft cheeses such as feta and bleu cheese are some times sold in the unpasteurized form, so read labels.

Listeria associated foods. Several different foods have been associated with outbreaks of Listeria bacteria, which can be associated with miscarriage and bad pregnancy outcomes.  While the overall incidence of this bacteria is extremely low, precautions should be taken to make sure that all vegetables are thoroughly washed.  If a food cannot be well cleaned (such as fresh sprouts) it should probably not be eaten. Deli meats should be eaten only if fresh and for added precaution can heated in the microwave until sizzling to kill any possible contaminating bacteria.

Other precautions:

Smoking. Please stop smoking immediately when you find out you are pregnant. Smoking is associated with an increased risk of miscarriage, stillbirth, preterm delivery and fetal growth restriction. If you smoke more than a pack a day and are having difficulty quitting, talk to your doctor about whether the nicotine patch would be appropriate for you.

Cats. Toxoplasmosis is a parasite that can live in cat feces. If it is contracted during pregnancy it can cause severe pregnancy complications. You should avoid handling cat litter or being in the room when the cat litter is being changed. You can still pet your cat and be in the same room as the cat litter if needed.

Exercise. We recommend you stay active during pregnancy. This helps you maintain your overall stamina, avoid excess weight gain and decreases your risk for gestational diabetes. If you are not already active, then I recommend you start walking or swimming 30 minutes daily, or at least 5 times a week. As you exercise, you want to maintain your heart rate at under 150 beats per minute. This is an exertion level of about 6-7 (on a scale of 1-10). At this level you should still be able to talk.

If you are already active in an exercise routine such as running or aerobics, you can usually continue with the above modifications. Make sure to keep your heart rate under 150. It is also a good idea to maintain your flexibility and strength. A prenatal yoga or pilates class (or DVD) can help you maintain your core muscles to help reduce the back pain associated with mid-pregnancy. After 15 weeks, exercises that involve laying flat on your back should be avoided. Additionally weight lifting should be limited to under 40 pounds.

Heat. There are a few things that are known to cause malformations at this stage of development. One of them is extreme heat. This is a time when it is especially essential to avoid hot tubs or very hot baths (higher than body temperature). Having a high core temperature in early pregnancy has been shown to cause malformation of the spinal cord. If you have a fever at this time it is best to take acetaminophen (Tylenol) to help keep your temperature down. If that does not lower your temp, call your doctor.

Medications. Be cautious of taking any medications that might interfere with the development of the baby. Check with your doctor before taking any additional medication: prescription, over the counter, herbal supplements and/or additional vitamins. Thyroid medication and asthma medications are probably the most common medications that women can take in pregnancy. They are safe for the baby and can be harmful if discontinued suddenly.  If you care taking any other mediation, then notify your doctor’s office to determine if it is safe to continue.

Medications that are generally accepted as safe in pregnancy:

Tylenol

Benedryl

Guafenesin

Throat lozenges

Tums

Volace

Milk of magnesia

Immodium

Other things that are considered safe:

Hair dye has not been proven to cause malformations because it is minimally absorbed by the skin. Coloring your hair is considered safe, but if you want to be overly cautious you can wait until you are 12 weeks along.

Self-tanning lotions are also minimally absorbed and are considered safe to use. We always recommend you stay away from tanning beds and this applies during pregnancy as well.

Regular cleaning supplies are fine (sorry, I can’t give you an excuse to get out of your housekeeping). Just make sure you keep all areas well ventilated while cleaning. Avoid solvents such as paint thinner. Use common sense, if a chemical requires specialized disposal, you probably shouldn’t handle it while you are pregnant.

Most cosmetics and lotions are safe. If you use Retin-A, you should probably discontinue use during pregnancy. If you have questions about any prescription lotions, ask your doctor.

Sex is safe as long as you are not having any bleeding or complications.

Symptoms

Cravings. If you are craving a specific fruit, then go with it. If you need a Hershey’s bar every afternoon then you may need to slow down. I tell patients to give into their ‘bad’ cravings once or twice a week, just not once or twice a day!

There are weird cravings that could be a signal that something abnormal may be going on. For instance if you crave plain ice all the time, you could be anemic. Also some women will crave dirt or laundry soap, as well as other non-foods. This could be a signal of specific vitamin deficiencies. If this is the case inform your doctor. Needless to say, don’t give in to these ‘bad’ cravings!

Fatigue. I think fatigue is the least discussed early pregnancy symptom. Everybody knows about the “morning sickness,” but sometimes fatigue can be the most debilitating symptom in early pregnancy. The source is thought to be a combination of the high levels of HCG and Progesterone. But whatever causes it, from about 6 weeks to 12 weeks most pregnant women just want to sleep. Like 12 hours a night…and then take a nap later. If you can get away with it, go for it. The good news is that fatigue and nausea seem to get better after 12 weeks.

Links to discussions on other symptoms:

Nausea

Constipation

Vaginal Discharge

In our book I go into greater detail on all these issues and symptoms, with Jessica adding a faith based perspective on how to journey through pregnancy without fear. If you are looking for additional resources,  I also recommend the ACOG Pregnancy Guide.

Hopefully this post will help fill the information gap that may crop up during those weeks between peeing on the stick and your initial pregnancy appointment. As an obstetrician, I love seeing patients for their first pregnancy visit. The joy and excitement on their faces when they see that first tiny flicker of the heart beat on the sonogram, still melts my heart.  Thank you for letting us be a part of your journey and congratulations during this exciting time in your pregnancy.

If you ‘like’ us on Facebook or follow us on Twitter, you’ve seen my New Mom Tool of the Week posts over the past 6 months. These are items that I have loved having around since welcoming baby #2 back in July. It’s funny how, as a brand new mom welcoming baby #1, we have a long list of must have items that we see online or in magazines. I think with each subsequent child, however, we learn that less is more and we tend to gravitate towards the absolute ‘must haves’. There are many items I thought I needed when my first child was born that I am doing just fine without the second time around.

Those ‘must haves’ will vary from mom to mom because, let’s face it, we all have different lifestyles and preferences. We could probably sit around and chat for hours about our favorite baby items and why we just can’t live without them. I’ve asked several moms of multiple young children and these are the items we simply can’t live without. I’ve noted the approximate cost of these items along with some money saving tips as well as the time frame you are likely to use the item. So much of your baby gear is used temporarily (like 2-6 months) so it’s helpful to know how long your invest is going to last.

This list is, of course, in addition to general items such as clothing, various linens, a crib, bottles (if bottle feeding), etc. If you have our book, these special items would fall under the “Would Be Nice To” haves or the “Everyone In Hollywood” haves that I write about in Chapter 7.

Thank you to Facebook friend Bethany for the wonderful reminder that above all else, grace and wisdom are the two most important tools for any new mom. And you can’t find them at Babies R Us or your local consignment sale. Those tools come only from your relationship with God so remember to pray first and foremost as you go throughout your day with baby!

1. Graco Snap & Go Stroller – Twitter friend @mommyzabs seconds my vote that this is the way to go for an infant stroller. The Snap & Go is a frame that carries your infant seat so you simply pop the seat out of the car and into the frame without moving or disturbing baby. I found this much easier than a separate stroller and very compact. Several companies make these frames so find one that is compatible with your preferred infant seat. For baby #2 I purchased the double Snap & Go stroller and we love it! There is a place for my preschooler to sit and once baby is out of the carrier, there is a full seat for him up front.

Approximate Cost: $50-$75 (for the single) depending on where you buy and what brand you land on. These are pretty easy to find at consignment sales or wait for a sale or coupon at Babies R Us.

When You Will Use It: 0-9 months, possibly longer if baby is small.

2. Baby Monitor/Video Monitor - Facebook friends Carrie and Shawn love their baby monitors. Shawn shared that although the video monitor is more of an investment, it’s worth it to be able to see baby while they are sleeping. Either way, the peace of mind that comes with hearing (or seeing) your baby while they are sleeping is worth the investment.

Approximate Cost: $35-$200 depending on brand (video monitors are between $100-$200). This is a good item to look for on Craigslist but make sure it works well before purchasing. I would not recommend buying an item like this at a consignment sale because there is no way to ensure it works before purchasing. Sign up for Amazon Mom and watch for weekly deals on high dollar items like this.

When You Will Use It: We still use a monitor for our 3 1/2 year old. It’s just helpful to hear her, especially when she is sick.

3. Swaddle Blankets – Our mommies love their swaddle blankets and it’s pretty unanimous that Aden + Anais are the blanket of choice. Facebook friends Claire and Colleen shared how much they love their Aden + Anais blankets. I couldn’t agree more. I don’t know what I did with baby #1 before they were around. These muslin blankets are soft, lightweight and worth the price. Target sells a few exclusive packs or you can purchase directly off of their website (more choices). Perfect for summer babies since they are light and breathable! They are a great, larger size so you can use them as baby grows.

Approximate Cost: $35-$50 (pack of 4)

When You Will Use Them: As long as possible!

4. Boppy - If you think the Boppy is only for breastfeeding, you are missing out! Facebook friend Brandi shared how she uses her Boppy for everything. Once again, I couldn’t agree more. Brandi used her Boppy as a neck pillow in the hospital (brilliant) as well as for nursing, sitting support and tummy time support for her little one.

Approximate Cost: $35-$50 for new pillow and cover but this is a great item to pick up at a consignment sale.

When You Will Use It: 0-10 months

5. Hylands Teething Tablets - This is one of my picks for mommies. Hylands went away between my two little ones but are back and better than ever with a new formula (perfect timing for me). These homeopathic tablets really do sooth teething babies.

Approximate Cost: $6-$10

When You Will Use Them: Approx 3-4m until baby stops teething

6. Sheet Savers – This is one of those items that some new moms don’t know about. I want to shout it from the rooftops and I think Facebook friends Angela and Carrie would join me. No one wants to change a crib sheet in the middle of the night (believe me it’s hard). Sheet savers are truly life savers! You can use the small size or the ones that cover the entire surface (I write about these in the book). Either way, they will save you the trouble of changing a hard-to-remove crib sheet at 2am enough times to warrant their price!

Approximate Cost: $8-$20 depending on size

When You Will Use Them: 0-12 months at least

7. Infant Carrier/Wrap – With my first baby, I didn’t use an infant carrier. She simply did not like it. With my second the need for two hands to care for my 3 year old outweighed his resistance to it. Many moms swear by the convenience and comfort of infant carriers and would recommend using them from the get go. Like anything, the more you use it, the more baby will become comfortable with it. There are many types of carriers on the market including wraps and slings. Facebook friends Mindy and AnnRose love the Moby Wrap (this is the one I used for my baby boy) while friends Adina, Kemmely and Grace @ourarmswideopen love the Ergo Baby carrier. You will need to do your research and find what works best for you. But we definitely recommend taking the time and making the investment in this helpful tool. . .especially for baby #2 and beyond!

Approximate Cost: $40-$200 depending on carrier (wraps are less expensive options). These are great items to pick up at a consignment sale. I got my Moby Wrap for 1/2 the price used. Just make sure with more involved carriers that all pieces are in proper working order.

When You Will Use It: 0m-2years depending on carrier choice and baby’s size. Wraps can typically be used sooner however the Ergo Baby has an optional infant insert.

8. Breast Pump - If you are planning to breastfeed your baby then a breast pump in a must (unless you plan on never leaving their side during the first year). They are expensive but worth the investment. If you have trouble with your milk supply, a pump can also aide to keep you flowing until your supply picks up. Since I knew I would have trouble with my supply due to a surgery I had years ago, I used a breast pump for a month after baby was born to get as much milk as I could for my babies. I chose to rent a pump from our hospital medical supply since I knew I wouldn’t be using it long term. Breastfeeding moms would tell you to invest in an electric (non manual) pump if you can. And a double pump is much more efficient than a single. Believe me, you’ll appreciate getting it done in one shot when you are juggling a million things as a new mom. Twitter friend Grace @ourarmswideopen loves her Lansinoh pump and @SarahCaitS chose Medela. Once again, do your research and find the pump that you think would work well for you and is in your budget.

Approximate Cost: $200-$400 for double, electric breast pump, $60-$150 for single electric. $40-$50 for single or double manual pump.

When You Will Use It: 0-12m or as long as you breastfeed

9. Nursing Cover – Facebook friends Claire and Colleen could not live without their nursing cover. If you want to be discreet while feeding in public, a nursing cover is a must!

Approximate Cost: $30-$50

When You Will Use It: 0-12m or as long as you are breastfeeding

10. “Baby Stations” – A swing, a bouncy seat, a playmat and/or an exersaucer. . . I like to call these items “baby stations”. Because baby’s attention span in only a few minutes, you will find yourself moving throughout these stations with baby as you go through your day. If you have room in your budget, I recommend purchasing a few of these items to offer baby variety and you as much time hands free as possible. But these tools are not only about passing off baby for a few, sacred, hands-free moments. These toys help baby explore color, shapes, sounds and the world around them. Twitter friend @SarahCaitS chose her swing as a favorite. Facebook friend Bethany loves her bouncy seat while Kristy recommends a playmat and Crista swears by an exersaucer. These items vary in cost and appropriate age of use so think about your budget and what you will need throughout baby’s first year when deciding what to purchase.

Approximate Cost: Swing $75-$200 depending on size, Bouncy Seat $30-$70, Playmat $25-$75, Exersaucer $50-$120. These are all good items to pick up at a consignment sale or to borrow from a friend who is not currently using them.

When You Will Use Them: Swing 0-9m, Bouncy Seat 0-6m, Playmat 0-12m, Exersaucer 3-12m

11. Soothing Sounds – One of the most important tools you can have in your tool box for baby is anything that promotes peace in your home. Babies can sense stress and tension so the more peaceful you make your environment, the more peaceful they can be. As I write this, my 6 month old is watching a Praise Baby DVD. Twitter friend @mommyzabs and Facebook friend Crista both shared that they love worship music for their baby.  Kemmely shared that her baby loved their womb sound machine. Whether going throughout your day with worship music as your soundtrack or putting baby down for a nap and nighttime with a sound machine or lullabies, soothing sounds are a must for every mom. One of my personal favorites is the Rock A Bye Baby Collection. Sweet and soothing renditions of YOUR favorite music mom, including Coldplay, U2 and others!

Approximate Cost: Sound Machine $20-$50, CD/DVDs $10-$15

When You Will Use It: At least the first 3 years!

12. Baby Schedule Tracker – While in the hospital after having my second baby, the nurse instructed me to write down when baby ate, slept and pooped. She told me to do this for about a week. Then she jokingly said, “If you do it any longer than that, you need to get a life.” Facebook friend Shawn and I would definitely disagree with that statement. With the horrible effect that having a baby has on the brain, new moms cannot be expected to remember anything. . .even the last time they fed their little one. I found a schedule tracker so valuable for at least the first 3-6 months. Once baby was sleeping more consistently and eating regular meals, I was able to transition out of this practice. But before then, I simply had to write everything down. My personal favorite schedule tracker is The Essential Baby Organizer while Shawn loved her electronic Itzbeen Baby Timer.

Approximate Cost: $15-$25

When You Will Use It: 0-6m or possibly longer

Some other items suggested by our moms for baby’s body. . .Facebook friend Jessice loves California Baby Calendula Cream for babies with Eczema and Carrie loves Aquaphor for everyday use. I personally have really enjoyed Johnson’s Natural line this time around for baby wash, shampoo and lotion.

We’d love to hear from other moms on essential items that did not make this list. What other tools do you believe new moms (especially moms with 2+) need in their toolbox?

{No, we are not closing the blog or taking the book off the shelves. Keep reading and you’ll see exactly what “shop” I’m closing up this year.}

My sweet miracle boy

As I write this, I am sitting in Dr. Rupe’s office waiting for a procedure that will permanently prevent me from becoming pregnant again. It seems oddly monumental to be putting an end to my season of infertility and child bearing. After all of the longing and waiting and struggle, it’s almost ironic to be “closing up shop” as I like to say.

I hope that this post does not create controversy. I’m simply sharing my story, not trying to posture my beliefs on birth control and pregnancy prevention. It’s an extremely personal decision that should be deeply covered in prayer. My husband and I feel very peaceful about our decision. We believe the Lord has completed our biological family (we are open to adoption in the future) and with my history of miscarriage, it feels almost irresponsible for me to get pregnant by surprise. So we are taking the steps we feel led to take in order to close this chapter of our lives and peacefully move forward.

Part of me is excited to move on…to put all of the energy I used to spend on hoping and praying for children into loving and leading them. Yet, there’s a part of my heart that is grieving…the hope, the excitement and the joy of new life. Never again will I feel those tiny baby flutters inside my belly. Never again will I experience the breathtaking miracle of childbirth. As long as it took to travel this road and as hard as the journey was, in hindsight it was a mere blink of the eye.

“So as the sufferings of Christ overflow to us, so through Christ our comfort also overflows.” 2 Corinthians 1:5

My dad and I were talking this morning about how suffering was built into the cross of Christ. It was part of his story and thus it is part of ours. But the purpose of our suffering is to bring deeper intimacy with Jesus. I’ve said it before but I’ll say it again…I often miss the sweetness that came with the sorrow of infertility and loss. It drew me so close to Jesus. As I stand here, at a major crossroad of my adult life I pray that I can take what I’ve learned about suffering and carry it with me through every season ahead of me. In those moments when I feel like a mothering failure…when I think my children will never “get it”…someday if I lose a loved one…or if we hit a financial hardship…may I allow the reality of his presence to carry me through. Whatever it takes to keep me desperately clinging to him, that I will joyfully bear.

Thank you for allowing me to share my journey so openly here. It’s been wonderfully therapeutic to get it all out in the blogosphere and I feel like I’ve been surrounded by a community of women – some on a similar journey and some on an altogether different path – all cheering me on from the sidelines. I pray this blog does the same for all of you no matter where you are. We are in this together and once we are on the other side of child-bearing, we can hopefully walk together in child-rearing {Man, do I need support there! And I thought getting pregnant was hard…}.

My deepest desire for this blog is to use what he has taught me through this journey to love and support all of you. I am committed to hearing from him on all he has for me to share in the future. But that does NOT mean we will stop talking about infertility, miscarriage and trying to conceive. That is part of both my and Dr. Rupe’s hearts and stories and it’s a large part of the reason we wrote the book and started this ministry. I suppose this post is a bit self-indulgent. I just felt I needed to express my innermost thoughts and utmost gratitude to you, my Pregnancy Companion community. Thank you again for walking with me.

Looking forward to where he leads next,

Jessica

With all of my patients, as they enter the third trimester, I discuss what their contraceptive plans are for after the baby is born.

Many smile a beautiful, blissful, glowingly pregnant smile and say, “Oh no. I don’t think we will ever use contraception again.  Hopefully we will get pregnant again right away!”

Fast forward to their postpartum visit. A sleep deprived, exhausted new mom sits before me. Her first topic of conversation: contraception.  While she is madly in love with her new baby, the thought of having another right away is a little overwhelming. She is not physically ready to go down that road again.

Some women are ready right away. I once had a women ask me at delivery when she could try for another baby. My answer, “Well, you at least have to wait for me to get the placenta out!”

The decision on when to try for your next child, obviously depends on many factors. Finances, age, personal goals and beliefs on contraception are just a few. I was recently asked on our FB page what the ideal timing between pregnancies is from a medical stand point. According to studies looking at pregnancy outcomes, it is best to conceive 18 months to 4 years after your last delivery.

I find it interesting that the ‘optimal’ time for conception of the next child is about 18 months since this is when children are truly at their most adorable. Full of toothy grins and giggles as they toddle around.  This stage of ultimate cuteness entices people to have another baby. They then proceed to conceive before their child hits the ‘terrific twos.’ Which while adorable, at least in my house, is a challenging time.

Pregnancies conceived less than 18 months since the last delivery have an increased risk of preterm delivery and low birth weight. Pregnancy takes a lot out of your body, and it takes time for a woman to recover from the stress and for her nutrient supplies to get back to normal. The theory is that the body has not fully recovered at less than 18 months causing the baby’s extra risk of not growing as well (low birth weight). The risk of preterm delivery is further amplified in teens who conceive again quickly, since teens have often used their nutritional supplies on their own growth as well as their baby’s.

VBAC: Women who attempted a trial of labor after a cesarean section have an increased risk of uterine rupture if the pregnancies are less than 18 months apart.

Pregnancies conceived less than 12 months since the last delivery have an increased rate of placental abnormalities, such as placenta previa and placental abruption. Placenta previa is a condition where the placenta covers the opening of the cervix making vaginal delivery unsafe and increasing the risk of hemorrhage. Placental abruption occurs when the placenta begins to detach from the uterus before the baby is delivered.  It can result in hemorrhage and fetal distress.

Pregnancies conceived less than 6 months from delivery have an increased rate of neural tube defects and autism. Neural tube defect is associated with low maternal folate levels, so most likely in pregnancies less than 6 months apart, the mother has not had time to fully replenish those supplies.

Pregnancies conceived greater than 4 years from the last delivery  have an increased rate of preeclampsia, fetal growth restriction and cesarean section. It is unsure why this increased risk is seen other than the possible health changes in the mom over this time.

The actual ‘increased risk’ in each of the cases is statistically significant but overall low for the average woman. Take preterm delivery, the risk increase with conceiving early is 20%. For the average mom with no history of preterm birth, this changes her risk from 1% to 1.2%, which is negligible. However, a woman with a previous preterm delivery sees her risk go from 15% to 18%. These increased risks are most significant for those moms who already have risk factors for these conditions.

For the average healthy mom with no medical problems and a vaginal delivery, the increased risks of these complications with conceiving again soon are extremely low. Women with a cesarean section should wait 18 months for their scar to fully heal, especially if they desire a trial of labor (VBAC). Those with a history of pregnancy complications listed above are advised to wait the suggested interval before conceiving.

Lots of prayer and being on the same page with your spouse should be at the forefront when you are making the decision on when to have another child. But knowing the medical facts is equally important for making sure you are ready – both body and mind – to grow your family.

From a practical standpoint, we’d love to hear from our readers who have multiple children on how the timing worked for you.

“…they found Mary, Joseph and the baby who was lying in a manger…but Mary treasured up all these things and pondered them in her heart.” Luke 2:16-19

Moms-to-be. . .take a moment to ponder the miracle growing inside of you. Consider Mary and the unfathomable joy she experienced knowing the life she bore would save mankind. The life you are carrying may not be the Savior but with his help, you can guide your child to an amazing destiny. Praying for him to prepare your hearts to steward the life you will bring into this world. Amazing!

Waiting mommies-to-be. . .I know that holidays can be hard, thinking about your longing for a little one to share the joy with. I remember those days. They could have ruined me. I pray you will allow the peace of Christ to dwell in you this holiday season and as you consider the awesome miracle of his life, be filled with the HOPE this tiny baby brought to Earth. That HOPE is for you.

And may we all experience true peace and joy leading up to Christmas this week. I want to honor the savior by choosing HIM instead of busyness and stress. It’s a daily choice I am trying desperately to make. Will you join me?

Today I am linking this post up with a new blog I recently discovered. Check out Imparting Grace this week to read lots of other encouraging posts about Christmas!

Merry {week before} Christmas!

Jessica

The majority of women will experience at least occasional nausea during the first trimester, with about 2% experiencing severe daily vomiting. Symptoms usually peak at around 10 weeks as pregnancy hormone levels peak and then slowly improve over the next few weeks.

Because morning sickness is usually at the top of a mommy-to-be’s list of concerns, I wanted to offer my best advice for dealing with this unwelcome side effect of pregnancy.

As a starting strategy, eat small meals throughout the day. Stop before you are full, and try to eat again before you are hungry. High carbohydrate meals seem to be the most helpful. Sucking peppermint candy has been shown to reduce nausea after meals. Keep crackers beside your bed so you can eat them before you get up in the morning. Getting up very slowly can also be helpful.

Some women will have specific foods or smells that trigger the nausea. If you know what the troublesome foods are then you can plan ahead and avoid them. In general steer clear of spicy, rich or fried foods. Other women will experience nausea with brushing their teeth (but please don’t avoid this one!) or other activities like pumping gas.

Try to to take your prenatal vitamin at night with a small snack.  If the vitamin still causes nausea, then switch to one without iron.  It is very important to get adequate folic acid during the first trimester. So if you can’t hold down an entire vitamin, try a folic acid supplement.

If the nausea is not improving, the next option would be a combination of Vitamin B6 (10 mg) + doxylamine (10 mg…like Unisom) taken every 6 hours as needed. It is safe and is available over the counter. Obviously a sleeping pill may make you tired, but it does help the nausea. Natural ginger supplements have been shown in some studies to reduce nausea. A product that some of my patients have found helpful is  Tranquil Tummy Crackers. These are saltines with added ginger.

Another great option is the Prima Bella.  It is a medical device that is worn on your wrist that feeds an electrical impulse through the nerves in your arm that modulate the nausea centers of your brain and stomach. It is FDA approved and drug free. You do need a prescription from your provider.  Several of my patients have gotten significant improvement from this device.

If you’ve tried these tips and you’re still vomiting regularly or find your nausea incapacitating, then please call your doctor’s office. There are several prescription medications that can help reduce the nausea.

Reasons that you may need to be seen urgently are: vomiting blood, dehydration that results in decreased urination, or not being able to hold down anything for 24 hours.  Please let your provider know if you have these symptoms.

I found nausea to be the most challenging symptom in my own pregnancy. I found that keeping snacks close by during the day was helpful. At times, I took the anti-nausea medication in order to function and found it helpful. I would love to hear from our readers about any other helpful hints or products they found beneficial.

As always, we encourage you to discuss these remedies with your doctor so together you can determine what is best for you.

Dr. Rupe