Planning for Pregnancy

By Sue Sveum

Deciding to have a baby is a big decision. It can be an exciting time full of tests and information and choices—from picking the perfect name to the best color for the nursery. Home birth or hospital? Doctor or midwife? And of course, how much weight should you gain? But for others this can be a time fraught with anxiety. How soon should you worry when pregnancy doesn’t come? What can you do about it? Here, three local medical professionals offer advice, encouragement and answers to your most commonly asked questions.

So, you’re expecting!

Congratulations! If you’re like many women, you probably took a home pregnancy test to find out you’re pregnant. But what’s next? According to Dr. Frederic Melius, an OBGYN with Melius, Schurr and Cardwell, the next step is to schedule your first prenatal appointment—usually about two weeks later. In the meantime, start taking your prenatal vitamins.

Among the most common questions Melius gets is how much weight a woman should gain during pregnancy. “The goal is to maintain a healthy weight, gaining about 25 to 30 pounds,” he says.

Smaller women should gain a little more and larger women, less.

What about alcohol? “The threshold between safe and unsafe is unknown,” says Melius, “but there’s really no upside to alcohol.” Caffeine is OK. Just stay under 300 mg, or about two 8-oz. cups of coffee daily.

And that Friday fish fry? Go for it! “Fish is actually a good choice, as long as it’s cooked properly,” says Melius. “In fact, we suggest eating fish two to three times a week, especially salmon.” Foods to avoid? “Stay away from raw or undercooked meats—even unheated deli meat,” he says. “And fruits and vegetables are great choices as long as you wash them well.”

As for other vices: “Pregnant women should not smoke anything,” Melius stresses. No cigarettes, marijuana or vaping. “Smoking can decrease amniotic fluid, resulting in smaller babies and still births,” he warns.

It is ok to exercise. “You shouldn’t be huffing and puffing, but if you can carry on a conversation, you’re fine,” he says. “And swimming is good exercise—but stay away from the high temps of hot tubs.”

“You can, and should, use insect repellent with DEET—especially in high-risk areas,” says Melius. “And visit your dentist; poor oral health may result in pre-term births.” Traveling by plane, using your car’s shoulder harness, and dying your hair are all also doctor-approved.

But don’t worry—you don’t have to know everything. “Just relax and trust your body; the baby knows what to do,” says Melius. “This is a wonderful, magical time. Don’t worry yourself out of the fun.”

Worries aside, most women truly do enjoy being pregnant, with all the anticipation and excitement it brings. And besides, when else can you gain 25 pounds and have people still say you’re glowing?

It takes a team

Having an OBGYN team you trust on this journey can play a big role in helping you find the joy and alleviate those worries, says Kim Bertram, certified nurse midwife. She joined the SSM Health team when they added three certified nurse midwives to their staff last year.

“Midwives are becoming much more common,” says Bertram. “It’s a re- ally popular option nowadays.” But if your idea of a midwife comes from the popular PBS series, “Call the Midwife,” think again. Midwifery has come a long way since the 1950s and ’60s.

Certified nurse midwives, like Bertram, are required to have a master’s degree or doctorate. Those at SSM only assist with hospital births.

“Midwives are most known for assisting with childbirth,” explains Bertram, “but here we actually follow our patients from pregnancy through birth and postpartum.” Although many choose to see a specific midwife, patients meet all three over the course of their prenatal visits, so they’re familiar with whoever is on call when they go into labor.

Many people choose a midwife because of the personal relationship they develop during pregnancy. “We do bring in some holistic elements and refer patients to physical therapy and chiropractic options if indicated,” Bertram says. “And we also focus on the social and mental health aspect of pregnancy and postpartum.”

But that doesn’t mean that midwives are opposed to medical interventions, such as epidurals, if needed. “People tend to think of midwifery as being against medical intervention but that’s not the case,” says Bertram. “We need to bust that myth.”

The main difference between a midwife and a traditional provider, according to Bertram, is probably the time spent together during labor. “Physicians frequently check in on their patients’ progress but don’t usually sit with them for long periods of time,” explains Bertram. “We generally spend more time at our patient’s bedside, helping them relax and focus throughout labor.” In the hospital, doctors are always available for a consult, she says, but unless the patient is high risk or there’s a complication or a cesarean section needed, midwives generally handle the actual delivery as well. “I don’t like to say we ‘deliver babies,’” she says. “It’s the moms that deliver the babies—we just assist.”

But midwives don’t stop with childbirth—they conduct follow-up visits as well. “We see our new moms at two weeks and six weeks after birth,” she says. “Those are such big visits. We cover both psycho-social and physical healing. We want to know how it’s going, and how they’re feeling, both physically and emotionally.”

And for patients that become attached to their midwife, there’s good news. It doesn’t have to stop after baby. “Midwives are trained in a wide range of women’s health issues,” Bertram explains. “Now you can see us for your annual physical, breast exam, contraception, when trying to get pregnant and more.”

“Our OBs are fantastic and the whole department works as a team,” Bertram stresses, adding that everyone helps in their own way. “But we’re all here to make sure you feel heard and respected,” she says.

When pregnancy doesn’t come easy

Empathy and understanding seems to be a common trademark among all the professionals that work in the field of pregnancy and family planning. And as the Wisconsin Fertility Institute can attest, fertility can be a sensitive and important element in family planning, as well.

“Most patients see us because they’re having a hard time conceiving,” says Dr. Gretchen Collins, who’s certified in both OBGYN and Reproductive Endocrinology and Infertility. “We mostly focus our time on helping couples achieve pregnancy, but we also help with gynecologic issues such as endometriosis and polycystic ovary syndrome.”

She says Wisconsin Fertility is also starting to see more young women wanting to freeze their eggs. “Many women are waiting to conceive until they’re financially secure and well-established in their profession,” Collins says, “but they’re also wishing to preserve the option of having a child in the future.”

Others come in due to a cancer diagnosis requiring a treatment that could result in infertility. And still others, for reproductive surgery. “We also see many patients in same-sex relationships who wish to start a family,” she says, adding they assist prospective parents through egg donation, sperm donation and gestational carriers.

But infertility still remains the prime focus. So is there a typical patient? Not really.

“People come to us at all different times along their fertility journey,” says Collins, explaining that infertility is defined as a lack of pregnancy after trying for one year if you’re under 35 years old and after six months for those over 35.

“However,” she stresses, “this doesn’t mean you need to wait for that length of time to see a fertility specialist if you think something may be wrong.” According to Collins, reasons that may bring women in sooner include a lack of regular periods, loss of both fallopian tubes, or maybe they’re part of a same- sex couple or their male partner has had a vasectomy.

On the other hand, there are many couples that wait much longer than that one-year marker to come in. “Most people are very hesitant to see a fertility specialist or talk about their infertility,” she says. In fact, it takes many patients years to come in.

“Infertility is a team sport that usually involves both the male and female,” Collins explains, “and receiving the diagnosis of infertility is very stressful for couples.” The psychological impact of an infertility diagnosis is like a diagnosis of cancer, with couples mourning the loss of a life they cannot make.

Collins says 1-in-8 couples deal with infertility. “We want them to know they’re not alone—and we’re here to help and support them on their fertility journey.”

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