The Healthy Pregnancy Book

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To our "babies"

A Note to Pregnant Mothers: How We Birthed This Book, and How to Use It

Welcome to the Sears Parenting Library! Because pregnancy is one of the most important events in a mother's life, this could be the most important book you will read.

Assembling the right birth book team for you. In planning this book we interviewed expectant mothers, asking them, "What do you most expect from the authors of a book on pregnancy?" We found out that what they want most is authors with experience and credentials.

Naturally, readers want the advice of an experienced mother. We have just the person: Martha Sears, mother of eight (seven of whom she gave birth to), childbirth educator, and registered nurse. Martha has been there—and done that—a lot.

Next, expectant mothers want advice from an experienced obstetrician. So, our team includes Dr. Linda Holt, mother, obstetrician, University of Chicago professor of obstetrics, and birth attendant at some three thousand deliveries during her thirty-one years as an obstetrician.

The ultimate goal of a healthy pregnancy is a healthy baby, so we have Dr. William Sears, a pediatrician of forty years, former director of a university hospital newborn nursery, and specialist who has attended more than a thousand challenging births.

To complete this team, we have a certified, experienced midwife. Dr. BJ Snell, mother of two, has been a certified nurse midwife for twenty-five years and has experience delivering and caring for more than three thousand babies. We believe that she is one of the most credentialed and experienced midwives in America. We love having Dr. BJ's contribution to this book since midwives offer a balanced approach: they regard pregnancy not as a disease full of fear, but rather as a normal physiologic process.

What expectant mothers want to read. We also asked expectant mothers, "What do you most want to read in a pregnancy book?" They told us that they want the most up-to-date information on what they can do to enjoy a healthy pregnancy and deliver a healthy baby. So we begin this book with a strong focus on health tips and then follow with the usual month-by-month format of what you should expect on your way to having a baby.

And because mothers told us they really don't understand or appreciate the beautiful hormonal happenings going on inside their bodies while giving birth, we orchestrated a must-read section: "The Hormonal Symphony of Birth" (here).

Pregnancy is not the time for textbook-type reading. Mothers want to keep it simple and make it fun. As you will see, our goal is to make you smile on every page. We hope you enjoy our frequent "baby bubbles," as you imagine your little pregnancy coach inside nudging you with health tips.

Finally, we asked obstetricians, "What type of pregnancy book do you most want your expectant mothers to read?" They replied, "A book that shows mothers how to better care for their pregnant bodies and increase their chances of having healthier pregnancies, easier deliveries, and healthier babies."

We begin our journey by taking you inside the womb to watch a baby grow. We show you what's happening inside your body and inside your baby, and tell you what you can do to increase the chances of your birth wish coming true: delivering a healthy baby.

Over the past ten years new research has revealed that the health habits of the mother, for better or worse, can influence not only the health of her newborn baby but the lifelong health habits of her adult child. In putting together our maternal health program, we wondered why so many books and childbirth classes had left out some of these new insights on what a mother could do to safeguard her child's health.

A common worry among authors is "We don't want to increase a mother's guilt by telling her that her pregnancy habits might harm her baby." We believe this is old-fashioned—and baby-unfriendly—thinking. In our experience, mothers want to have science-based health tips and tools showing them what they can do to increase their chances of being healthy and giving birth to a healthy baby. We have included solid science revealing the amazing biological connections between mother and baby—not to worry you, but rather to educate and empower you.

We are entering a new wave of better birthing. During the first wave (from the 1960s to the 1980s), mothers became awake and aware and began to believe in their bodies' ability to give birth instead of someone else taking birth. The second wave occurred when birthing practices caused babies to come out via a different route: surgically instead of vaginally. The use of technology increased, the use of pharmacological births increased, and surgical birth rates tripled. In the current wave, mothers who understand the natural hormonal harmony of pregnancy and birth are "standing up" (back-birthing is what started this whole mess in the first place) for their right to physiological births instead of pharmacological births. We believe that the next twenty years will be the golden age of birthing, with more certified midwives and more certified birth centers adjacent to hospitals. This birth movement will be primarily directed by mothers who understand that their body is wired for the hormonal symphony of birth and choose birthcare providers and a birth place that enable them to conduct their own personal symphony of birth.

What expectant mothers don't want to read. Not only did we ask expectant mothers what they most wanted to read in a pregnancy book, we also asked what bothered them most when they read some of the popular pregnancy books. Their reply? A focus on all the things that can go wrong. We do address the "what ifs" of pregnancy and acknowledge that challenges can occur even for the most prepared and health-diligent mother. Throughout the book we discuss that even though things can go wrong, mothers can learn strategies to increase their chances of giving birth to a healthy baby. We want this book to inform, not alarm; to empower expectant mothers, not worry them.

How to use this book. Since the 1997 publication of the popular guide The Pregnancy Book: Month-By-Month, Everything You Need to Know (William Sears and Martha Sears), new and exciting studies have proven that a mother's health habits not only have profound effects on her pregnancy but can greatly influence the intellectual, physical, and emotional development of her baby and child. For this reason, we have written The Healthy Pregnancy Book to replace that older book.

To help you get started, in Part I we explain eleven health tools you can use even before you get pregnant, and certainly during your pregnancy. While unforeseen circumstances may cause some pregnancies to be difficult and some babies to be less than perfectly healthy, we promise that using as many of these tools as possible will greatly increase your chances of having a healthy pregnancy and giving birth to a healthy baby.

After you have learned about—and begun practicing—your health plan, Part II will take you on a tour of the changes that occur in each month of your pregnancy, including information on why they occur and how you can influence them for the better. You will learn why you have certain feelings and how to handle them. In each chapter you will learn how your baby is growing that month and discover the marvelous changes going on inside of you—specifically, your health habits that influence the health of your baby.

In Part III, we list common complaints, illnesses, and other quirks that mothers may experience. We purposely put these at the end of the book because most mothers don't experience them. The last thing you need to read while you're pregnant is a description of what could go wrong. In fact, one of the top health tips of this book is to worry less during your pregnancy.

Let's get started on your healthy pregnancy! As you're reading the next few chapters, keep clearly in your mind the amazing opportunity and privilege you have to prepare your body and mind for the journey we call motherhood, from the moment of conception onward.

Planning to Become Pregnant: Eleven Habits to Increase Your Chances

Give your baby the healthiest start possible: preconception planning is just what the doctor ordered. Is your body ready to birth a baby?

New insights into child development reveal that the healthier the mother is during her pregnancy, the healthier her baby is likely to be as an infant, child, and adult. Here's another incentive for you to start our Healthy Pregnancy Plan—now! There is a high correlation between mother's prenatal health and her ability to conceive. The sooner you start to follow the health tips in our book, the sooner you are likely to conceive.

Women expecting to get pregnant underestimate the overwhelming changes that will occur in their minds and bodies when they become pregnant. Every organ system will change. Every hormone will change. Your body will work harder than it ever has, 24/7. Take a look at one organ: your heart. When you are pregnant, your blood volume increases by 50 percent, and your heart has to work that much harder to nourish you and that growing little person inside. The awesome thing is that a woman's body is designed to pull that off, gradually and gracefully.

Are you fit for this feat? Waiting to get fit until you get pregnant is unfit timing. That's when your energy reserves will be used up by your growing baby, so it's the hardest possible time to make major lifestyle and habit changes. Now is the time to make healthier choices. Here's our preparing-for-pregnancy health plan:

1. Is Your Body Fit to Birth a Baby?

Are there L.E.A.N. (lifestyle, exercise, attitude, and nutrition) issues that need to be resolved, or at least worked on, before you get pregnant?

   Do you have dietary habits that may affect your fertility and your likelihood of having a healthy pregnancy?

   Are you taking medications that need to be tapered or changed?

   Do you have a chronic illness that needs to be better controlled, such as diabetes?

   Do you have harmful lifestyle habits that could affect fertility and pregnancy? (See here.)

   Do you have emotional issues that need to be stabilized before the hormonal havoc begins? (See here.)

   Do you have harmful habits, such as the use of illegal drugs, tobacco, or excessive alcohol, that need to be handled before becoming pregnant? (See here.)

   Are you using chemical birth control? If so, it's time to toss the pills. Discuss with your healthcare provider how to get off them immediately and switch over to natural family planning to learn about your fertility peaks. It's important to give your body at least three months before conceiving so that the effects of chemical contraception can wear off.

It's not necessary to wait for the best time, best lifestyle, best health to get pregnant. Many mothers with less-than-ideal lifestyles and severe chronic illnesses have gone on to birth healthy babies. Yet, the better you care for yourself now, the better your baby-growing and baby-birthing are likely to be.

2. Make Health Your Hobby

Pregnancy may just be the motivation you need to get off the couch, visit the produce section of the supermarket, eat in and not out, and do all the other good things for your body that your mother preached and medical talk shows highlight. Put up this reminder throughout your home and workplace:

Mama, make our health your hobby.

3. Schedule a Preconception Checkup

Consider having a thorough checkup with either your healthcare provider or a newly selected OB/GYN and/or midwife. Besides a general physical examination, your healthcare provider will:

• Review your medical history and family genetics history to see whether there are issues that might affect your pregnancy. Come prepared with your medical and family history.
• Review previous miscarriages or pregnancy-attempt history for clues on how to increase your chances of conception and birthing this time.
• Order a complete profile of laboratory tests to be sure you enter pregnancy with a stable biochemistry and an optimal balance of hormones.
• Give you advice on getting a chronic condition under control. Unless advised by your healthcare provider, don't let a chronic illness—such as an autoimmune disease, diabetes, or a mood disorder—put you off from getting pregnant. Often the hormonal and biochemical changes that take place in a pregnant woman's body become therapeutic for existing ailments, leading some women to conclude: "My health was never better once I became pregnant!"
• Check your immunizations. Your healthcare provider may do various antibody titers to see whether you need boosters. Be sure to bring your immunization record, especially if you have had any immunizations in the past ten years. (See "Getting Vaccines Safely While Pregnant" on our website: AskDrSears.com/topics/vaccines.)

Not only is a checkup by your medical doctor necessary for proper preconception planning, but one by your dentist is important, too. You want to enter pregnancy with healthy gums and healthy teeth for two reasons: Pregnancy hormones are going to mess with your mouth anyway, making already sore gums sorer. And gingivitis, or periodontal disease, can cause harmful inflammatory biochemicals and germs to enter your bloodstream and perhaps harm your pregnancy.

4. Preload Your Body with Nutrients

Now is the time to eat more of what you and your little one need and less of what you don't. Besides preloading with prenatal supplements (see "How to Choose the Prenatal Supplement That's Right for You" here), eat more foods containing the nourishing nine:

• Omega-3 fats
• Folic acid
• Iron
• Calcium
• Vitamin B₁₂
• Vitamin D
• Vitamin C
• Zinc
• Iodine

(See here to learn why you and baby need more of these nutrients, and which foods are highest in them.)

The reason we call this "preloading" is because now is when you can best stomach dietary changes. Those early pregnancy months of queasiness and picky eating are not the most tummy-friendly time to make significant dietary changes. So, store up those needed nutrients now.

5. Eat More of the Twelve Pregnancy Superfoods

In chapter 2, you'll learn what you should eat more of while you're planning to become pregnant and why. In a nutshell, you will now be eating, very simply, the Real Food Diet. You will need to become a "picky eater," selecting food based on quality and nutrient density—that is, the most nutrition in the smallest volume. This may be the first time in your life that you have to be scientifically selective about what you eat. Certainly this does not mean that you have to take all the fun out of eating and make it a mathematical exercise. In fact, calorie counting is just what the pregnancy doctor doesn't order. It's quality of calories rather than quantity that's important. In chapter 3 you will learn to eat a right-fat, right-carb diet rather than a low-fat, low-carb diet.

Reshape your tastes. Pre-pregnancy is the time to begin getting your body accustomed to the foods you and your baby need, not just those you want. Try this exercise in taste reshaping: Eat a diet of primarily the twelve pregnancy foods. Follow the "how to eat" and "what to eat" healthy pregnancy tips in chapters 2 and 3 at least 90 percent of the time. Over a few months you will experience metabolic reprogramming (simply put, taste reshaping), in which your food cravings and gut feelings change toward preferring real food over fake food. Then, by the time sperm meets egg and baby starts growing, your body is already craving those foods and a way of eating that is not only friendly to your more selective intestines but provides the best "grow foods" for your baby. It's as if that little motivator inside continues to prompt you to eat as you should have been eating all along anyway.

6. Get Used to Grazing

In chapter 2 you'll discover the three magic words of pregnancy cuisine: graze, sip, and dip. This way of eating is healthiest for people at all ages and stages, but is especially gut-perfect during pregnancy.

7. Get Lean

"Lean" means having the right amount of body fat for your body type, and the right amount of body fat for your health needs and those of your baby. "Lean" does not mean skinny. In fact, a woman needs a certain amount of body fat to produce the hormones that help her ovulate. This is why teen athletes, such as gymnasts, often have delayed menstruation: they have too little body fat.

On the other hand, too much body fat increases your chances of complications during pregnancy (see here), in addition to lowering your chances of getting pregnant in the first place. Getting your weight under control increases your chances of getting pregnant and lowers your chances of having a complicated pregnancy, gestational diabetes, and an unhealthy newborn. (See here for more on optimal weight control during pregnancy and here for our L.E.A.N. Expectations Program.)

8. Go Green to Get Pregnant

The cleaner and greener the air you breathe, the food you eat, the lotions you use, and even the lipstick you wear, the greater your chances of conceiving and birthing a healthy baby. Begin going green now to prepare for growing baby in a "green" house. (See chapter 8 for tips and strategies on how to go green during pregnancy. To increase your motivation for going green, turn to here to read about recent scientific breakthroughs showing how a green environment increases your chances of growing a healthy baby.)

9. Don't Worry, Get Pregnant!

If you suffer from stress or mood instabilities, now is the time to get help and get stable. In chapter 6 you will learn about new research showing that unborn babies and mommies share the hormonal effects triggered by thoughts, for better or worse. Learning natural stressbusters (see here) is especially important if you are now on mood-altering medications, many of which are not safe to take while pregnant.

10. Move!

If you're habitually sedentary and planning to get pregnant, now is the time to get moving. It is certainly easier to be mobile now than when you're heavily pregnant and off-balance. We're often surprised to learn how few people really understand the power of movement to help you make your own internal medicines (see here for more on this). The right exercise program for you is one that you will stick to. While you're still in the pregnancy planning stage, start an exercise routine that helps you feel so good you'll want to continue it.

11. "We're Pregnant!"

Long before you wow your mate with that little blue line on the pregnancy test, keep in mind that your baby needs happy parents. While making a baby, growing a baby, and then parenting a baby can strengthen a marriage, the sooner your partner learns to share the responsibility, the better. It's important for him to make preconception lifestyle changes with you, especially if he has habits like smoking, excessive drinking, or illegal drug use. Secondhand smoke, for instance, can be nearly as harmful to baby as mommy's own smoking—for example, it doubles the risk of sudden infant death syndrome (SIDS).

Following these strategies to increase your chances of getting pregnant will hopefully reward you with one of the greatest privileges of womanhood—growing a human being. In the following chapters you will learn habits that will increase your chances of having a healthy pregnancy and birthing a healthy baby.

I

The Healthy Pregnancy Plan

What's going on in there? Every mother wonders how her habits affect how her baby is growing. Once upon a time it was thought that a baby in the womb grew according to a predetermined genetic blueprint, and as long as a mother took reasonably good care of herself, her baby would grow according to that genetic blueprint. Genes were believed to be so powerful that they determined growth, and that there was not much that nurturing could change. In other words, it was thought that nature was much more important than nurture in regards to prenatal development.

New research shows that how the genes behave and how they affect your baby's growth, for better or worse, are very much influenced by what a mother eats and does, and even by her level of unresolved stress. And research in the new field of epigenetics shows that a baby's womb environment can set up a baby for health, or disease, for the rest of her life. Does diabetes or heart disease begin in the womb?

You are your baby's first filter. The brain grows the fastest during pregnancy, especially during the last three months, and it is the organ most susceptible to toxins. The mother, as well as the placenta, acts as a filter for these toxins. What goes into your mouth, your gut, even possibly your thoughts conceivably could pass into your baby. In this section, you'll learn how this happens. Following are the nine top tips for a healthy pregnancy and baby:

1. Learn about the fetal effect.
2. Graze for good health.
3. Eat the top twelve pregnancy superfoods.
4. Gain the weight that's right for you.
5. Exercise right for two.
6. Don't worry, be pregnant.
7. Sleep peacefully.
8. Go green; avoid environmental pollutants.
9. Practice the pills-and-skills model of self-care.

Get Motivated to Get Healthy

For many mothers, pregnancy is just the jump start they need to finally take up the health habits they've been putting off. Pregnant mothers who follow our Healthy Pregnancy Plan are more likely to:

• Enjoy more comfortable pregnancies
• Have their babies go to term
• Have an easier transition into parenthood
• Have babies who are smarter
• Have babies who are healthier
• Become emotionally and physically healthier themselves