Pregnant at Last

Women who have spent some time considering pregnancy in general want to make sure they are in the best health and have done everything possible to ensure they have a healthy child. Older women in particular may be anxious to do everything they can to offset the possible risks involved in being an older mother. You can take practical steps in advance to prepare yourself for the healthiest possible pregnancy.

It’s important to check that you are immune to rubella (German measles) before you start trying to conceive. Catching this disease, particularly in the first months of pregnancy, causes severe disabilities in the child or a miscarriage. If you are not immune, you can be vaccinated against rubella before you conceive. It is also a good idea to check whether you may be carrying a sexually transmitted disease. Hard-to-diagnose infections such as Chlamydia, Gardnerella and Mycoplasmas may be implicated in miscarriage and premature delivery. Blood tests for viruses such as cytomegalovirus, which can cause abnormalities in the baby, may also be worthwhile.

Stopping Contraception

If you have been relying on an IUD, you will need to have it removed by a doctor before you conceive. As soon as an IUD is removed, you can get pregnant. If you get pregnant by chance with an IUD in place, it does carry risks for mother and baby. You are more likely to have an ectopic pregnancy-a pregnancy that occurs outside the womb, usually in the Fallopian tubes-and there is a high risk of miscarriage. As many as 60% of such pregnancies end before term. The miscarriages are more likely to occur in the second three months of pregnancy. IUDs are usually removed while you have a period, because the cervix is slightly dilated then and this aids removal.

If you have been taking the Pill, stop taking it two or three months before you wish to conceive. You can use a barrier method, such as the condom or diaphragm, or natural family planning (rhythm method) during this time. (But be aware you are unlikely to use natural family planning effectively if you have not spent some time learning the technique and observing your menstrual cycle.) Studies have shown that women who took the Pill inadvertently in early pregnancy have only a very slight extra risk of having an abnormal pregnancy or a child with disabilities. Those who conceive as soon as they stop taking the Pill face no extra risk.

All the same, it is a good precaution to make sure that your body is free of all drugs before you get pregnant. It also helps to date the pregnancy if you have had one or two normal menstrual cycles before you conceive because this allows for good pregnancy care.

There is, however, some evidence that women who conceive while using spermicides, whether on their own or in combination with the diaphragm, cap or condom, run a slightly higher risk of a miscarriage (and, incidentally, also a greater chance of having a girl). It is obviously better to conceive when there are no traces of spermicide in the vagina. If you intend to try to conceive, it may be a good idea to ask your doctor to do a cervical smear and perhaps to take a swab to check that you do not have any vaginal infection, such as thrush, before you get pregnant. This will usually be done at your first prenatal appointment when you are pregnant anyway, but some women prefer not to have a vaginal examination in early pregnancy, especially if they have had a miscarriage or threatened miscarriage in the past. It also makes sense to clear up any infection before rather than after a pregnancy has begun.

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