PREPARING FOR A BABY
Fertility Awareness
What is fertility awareness?
Fertility awareness is knowing and recognizing when you are fertile (when you can get pregnant) in the menstrual cycle. If you are trying to get pregnant, you should have sexual intercourse on your fertile days, ideally every day or every other day.
A menstrual cycle is defined from the first day of menstrual bleeding (called day 1) of one menstrual period to the first day of the next menstrual cycle. An average menstrual cycle lasts 28 days. In a normal menstrual cycle, an ovary releases an egg (ovulation). In an average menstrual cycle of 28 days, ovulation occurs about 14 days before the start of the next menstrual period.
When can I become pregnant?
After its release, an egg can survive in the fallopian tube for about 24 hours. You can become pregnant if you have sex anywhere from 5 days before ovulation until 1 day after ovulation. Your chance of pregnancy is highest if live sperm is already present when the egg arrives in the fallopian tube. A man’s sperm can survive inside a woman’s body for about 3 days (and sometimes up to 5 days) after sexual intercourse.
The following methods are based on fertility awareness:
The fertile window
Cervical mucous method
Basal body temperature (BBT) method
Ovulation testing
The 'fertile window’ is the days in a woman’s menstrual cycle when pregnancy is possible. The ‘fertile window’ depends on the length of the menstrual cycle, which varies among women.
The ‘fertile window’ is the day an egg is released from the ovary (ovulation) and the five days beforehand. Having sex (intercourse) every day or every other day during this time gives you the best chance of getting pregnant. When you know your average menstrual cycle length, you can work out when you ovulate and your fertile window.
Ovulation happens about 14 days before your period starts.
If your average menstrual cycle is 28 days, you ovulate around day 14, then your fertile window is from day 9 to day 15
If your average menstrual cycle is 35 days ovulation happens around day 21 and your fertile window is from day 16 to day 22
Some women have very irregular cycles or find it difficult to work out an average cycle length. This can make it hard to work out when ovulation happens. If it’s all too hard, having sex every 2-3 days covers all bases and improves your chance of getting pregnant.
A few days before ovulation, you may notice your vaginal mucus becomes clear, slick and slippery, and feels a bit like egg white.
This is a sign that ovulation is about to happen. It’s the best time to have sex, as sperm travel more easily in this kind of mucus.
What is the basal body temperature method?
The BBT is your body’s temperature when you are fully at rest. Your BBT rises after ovulation and remains high until the end of the menstrual cycle. BBT by itself is not a good way to prevent or promote pregnancy. It shows only when ovulation has already occurred, not when it is going to occur.
You can use a predictor kit from a pharmacy to test your urine for signs of ovulation. It detects the “LH surge” which is the signal the brain sends to the ovary for releasing an egg. If you start testing your urine a few days before the day you next expect to ovulate, a positive result means you are going to ovulate within the next 24 to 36 hours (one to two days). You should have sex the day you test positive and the next day.
Basal Body Temperature (BBT): The temperature of the body at rest. Cervix: The lower, narrow end of the uterus at the top of the vagina. Egg: The female reproductive cell made in and released from the ovaries. Also called the ovum.
Fallopian Tube: Tube through which an egg travels from the ovary to the uterus.
Fertility Awareness: A collection of ways to track a woman’s natural body functioning and determine when she is most likely to get pregnant.
Menstrual Cycle: The monthly process of changes that occur to prepare a woman’s body for possible pregnancy.
Ovary: Organ in women that contains the eggs necessary to get pregnant and makes important hormones, such as estrogen, progesterone, and testosterone.
Ovulation: The time when an ovary releases an egg.
Sexual Intercourse: The act of the penis of the male entering the vagina of the female. Also called "having sex" or "making love."
Preconception Healthcare: Planning for Pregnancy
Preconception health care is the medical care a woman or man receives from the doctor or other health professionals that focuses on the parts of health that have been shown to increase the chance of having a healthy baby.
Preconception health is important for every woman―not just those planning pregnancy. It means taking control and choosing healthy habits. It means living well, being healthy, and feeling good about your life.
Preconception health care is different for every person, depending on his or her individual health―ask us about it!
Planning for pregnancy:
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Make a plan and take action
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See your doctor
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Take 400 micrograms of Folic acid every day
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Stop drinking alcohol, smoking and using certain drugs
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Avoid toxic substances and environmental contaminants
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Reach and maintain a healthy weight
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Learn your family medical history
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Get mentally healthy
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Get help for violence
Your doctor will want to discuss your health history and any medical conditions you currently have that could affect a pregnancy, any previous pregnancy problems, medicines that you currently are taking, vaccinations that you might need, and steps you can take before pregnancy to prevent certain birth defects.
Avoid harmful chemicals, environmental contaminants, and other toxic substances such as synthetic chemicals, metals, fertilizer, bug spray, and cat or rodent feces around the home and in the workplace.
People who are overweight or obese have a higher risk for many serious conditions, including complications during pregnancy, heart disease, type 2 diabetes, and certain cancers (endometrial, breast, and colon). People who are underweight are also at risk for serious health problems.
Collecting your family’s health history can be important for your child’s health. Your doctor may recommend you or your spouse consider genetic counseling before getting pregnant. Reasons people go for genetic counseling include having had several miscarriages, infant deaths, trouble getting pregnant (infertility), or a genetic condition or birth defect that occurred during a previous pregnancy.
Mental health is how we think, feel, and act as we cope with life. To be at your best, you need to feel good about your life and value yourself. Everyone feels worried, anxious, sad, or stressed sometimes. However, if these feelings do not go away and they interfere with your daily life, talk to your doctor.
Violence can lead to injury and death among women at any stage of life, including during pregnancy. The number of violent deaths experienced by women tells only part of the story. Many more survive violence and are left with lifelong physical and emotional scars.If someone is violent toward you or you are violent toward your loved ones―get help. Violence destroys relationships and families.
Contraception
BIRTH CONTROL METHODS
Many elements need to be considered by women, men, or couples at any given point in their lifetimes when choosing the most appropriate contraceptive method. These elements include safety, effectiveness, availability (including accessibility and affordability), and acceptability. Voluntary informed choice of contraceptive methods is an essential guiding principle, and contraceptive counseling, when applicable, might be an important contributor to the successful use of contraceptive methods.
In choosing a method of contraception, dual protection with condoms from the simultaneous risk for HIV and other STDs also should be considered. Although hormonal contraceptives and IUDs are highly effective at preventing pregnancy, they do not protect against STDs, including HIV. Consistent and correct use of the male latex condom reduces the risk for HIV infection and other STDs, including chlamydial infection, gonococcal infection, and trichomoniasis.
Levonorgestrel intrauterine system (LNG IUD)—The LNG IUD is a small T-shaped device like the Copper T IUD. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant. The LNG IUD stays in your uterus for up to 3 to 6 years, depending on the device. Typical use failure rate: 0.1-0.4%.
Copper T intrauterine device (IUD)—This IUD is a small device that is shaped in the form of a “T.” Your doctor places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. Typical use failure rate: 0.8%.
Implant— The implant is a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains a progestin that is released into the body over 3 years. Typical use failure rate 0.1%
Injection or "shot"— Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. Typical use failure rate: 4%.
Combined oral contraceptives— Also called “the pill,” combined oral contraceptives contain the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than 35 years and smoke, have a history of blood clots or breast cancer, your doctor may advise you not to take the pill. Typical use failure rate: 7%.
Progestin only pill— Unlike the combined pill, the progestin-only pill (sometimes called the mini-pill) only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. It may be a good option for women who can’t take estrogen. Typical use failure rate: 7%.
Patch— This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. Typical use failure rate: 7%.
Hormonal vaginal contraceptive ring— The ring releases the hormones progestin and estrogen. You place the ring inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. Typical use failure rate: 7%.
Diaphragm or cervical cap— Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm. The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup. Before sexual intercourse, you insert them with spermicide to block or kill sperm. Visit your doctor for a proper fitting because diaphragms and cervical caps come in different sizes. Typical use failure rate for the diaphragm: 17%.
Sponge— The contraceptive sponge contains spermicide and is placed in the vagina where it fits over the cervix. The sponge works for up to 24 hours, and must be left in the vagina for at least 6 hours after the last act of intercourse, at which time it is removed and discarded. Typical use failure rate: 14% for women who have never had a baby and 27% for women who have had a baby.
Male Condom— Worn by the man, a male condom keeps sperm from getting into a woman’s body. Latex condoms, the most common type, help prevent pregnancy, HIV and other STDs, as do the newer synthetic condoms. “Natural” or “lambskin” condoms also help prevent pregnancy, but may not provide protection against STDs, including HIV. Typical use failure rate: 13%.Condoms can only be used once. You can buy condoms, KY jelly, or water-based lubricants at a drug store. Do not use oil-based lubricants such as massage oils, baby oil, lotions, or petroleum jelly with latex condoms. They will weaken the condom, causing it to tear or break.
Female Condom— Worn by the woman, the female condom helps keeps sperm from getting into her body. It is packaged with a lubricant and is available at drug stores. It can be inserted up to eight hours before sexual intercourse. Typical use failure rate: 21%, and also may help prevent STDs.
Spermicides— These products work by killing sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm, or cervical cap. They can be purchased at drug stores. Typical use failure rate: 21%.
Fertility awareness- based methods— Understanding your monthly fertility pattern can help you plan to get pregnant or avoid getting pregnant. Your fertility pattern is the number of days in the month when you are fertile (able to get pregnant), days when you are infertile, and days when fertility is unlikely, but possible. If you have a regular menstrual cycle, you have about nine or more fertile days each month. If you do not want to get pregnant, you do not have sex on the days you are fertile, or you use a barrier method of birth control on those days. Failure rates vary across these methods. Range of typical use failure rates: 2-23%.
For women who have recently had a baby and are breastfeeding, the Lactational Amenorrhea Method (LAM) can be used as birth control when three conditions are met:
amenorrhea (not having any menstrual periods after delivering a baby)
fully or nearly fully breastfeeding, and
less than 6 months after delivering a baby.
LAM is a temporary method of birth control, and another birth control method must be used when any of the three conditions are not met.
Emergency contraception is NOT a regular method of birth control. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke.
Copper IUD— Women can have the copper T IUD inserted within five days of unprotected sex.
Emergency contraceptive pills— Women can take emergency contraceptive pills up to 5 days after unprotected sex, but the sooner the pills are taken, the better they will work. There are three different types of emergency contraceptive pills available in the United States. Some emergency contraceptive pills are available over the counter.
Femail Sterilization—Implant Tubal ligation or "tying tubes"— A woman can have her fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization. The procedure can be done in a hospital or in an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately. Typical use failure rate: 0.5%.
Male Sterilization-Vasectomy— This operation is done to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. The procedure is typically done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero; this takes about 12 weeks. Another form of birth control should be used until the man’s sperm count has dropped to zero. Typical use failure rate: 0.15%.
Sexual Health
Sexual health relates to healthy relationships, family planning and prevention of sexually transmitted diseases. Sexual health is not limited to the expression of sexuality but includes the mental, emotional, spiritual and psychological aspects of one’s being. Sexual wellness includes a respectful approach to sexual relationships that is free of harassment, prejudice and violence. The World Health Organization states that sexual health is not merely the absence of disease, dysfunction or infirmity.
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Miscarriages
Early miscarriage
This information is for you if you want to know more about miscarriage in the first 3 months of pregnancy. It may also be helpful if you are a relative or friend of someone who has had an early miscarriage. Losing a baby is a deeply personal experience that affects people differently. It can be very distressing, and you may need a great deal of support afterwards. Don’t hesitate to talk to your provider for support options.
What is an early miscarriage?
If you lose your baby in the first 3 months of pregnancy, it is called an early miscarriage. Most women experience vaginal bleeding but occasionally there may be no symptoms. If this is the case, the miscarriage may be diagnosed by an ultrasound scan.
Why do early miscarriages happen?
In most cases, it is not possible to give a reason for an early miscarriage. The most common cause is thought to be a problem with the baby’s chromosomes (the genetic structures within the body’s cells that we inherit from our parents). If a baby does not have the right number of chromosomes, it will not develop properly, and the pregnancy can end in a miscarriage.
What are my chances of having a miscarriage?
Sadly, early miscarriages are very common. Many early miscarriages occur before a woman has missed her first period or before her pregnancy has been confirmed. In the first 3 months, one in five women will have a miscarriage, for no apparent reason, following a positive pregnancy test.
The risk of miscarriage is increased by:
your age – at the age of 30, the risk of miscarriage is one in five (20%); over the age of 40, the risk of miscarriage is one in two (50%) medical problems such as poorly controlled diabetes lifestyle factors such as smoking, being overweight or heavy drinking. There is no evidence that stress can cause a miscarriage. Sex during pregnancy is not associated with early miscarriage.
What should I do if I have bleeding and/or pain in the first 3 months?
Vaginal bleeding and/or cramping pain in the early stages of pregnancy are common and do not always mean that there is a problem. However, bleeding and/or pain can be a sign of a miscarriage. If you have any bleeding and/or pain, call your provider.
How is an early miscarriage diagnosed?
An early miscarriage is usually diagnosed by an ultrasound scan. You may be advised to have either a transvaginal scan (where a probe is gently inserted in your vagina) or a transabdominal scan (where the probe is placed on your abdomen) or occasionally both. A transvaginal scan may be recommended as it gives a clearer image. Neither scan increases your risk of having a miscarriage.
You may be offered blood tests that could include checking the level of your pregnancy hormone (βhCG). If you are bleeding or have pain, a vaginal examination may be carried out. You should be offered a chaperone (someone to accompany you) for a vaginal examination or a transvaginal scan. You may also wish to bring someone to support you during your examination or scan.
Some women will miscarry quite quickly but for others the diagnosis and ongoing management may take several weeks.
What are my choices if a miscarriage is confirmed?
If your ultrasound scan shows that you have miscarried and nothing remains in your womb, you may not need any further treatment. If the miscarriage is confirmed but some or all the pregnancy is still inside your womb, your healthcare professional will talk to you about the best options for you. You may choose to wait and let nature take its course, or to use medicines or to have an operation.
1. Letting nature take its course (expectant management of a miscarriage)
This is successful in about 50 out of 100 women who choose this option. It can take some time before the bleeding starts and this may continue for up to 3 weeks. It may be heavy, and you may experience cramping pain. If you have severe pain or very heavy bleeding, you may need to be admitted to hospital. You should be given a follow-up appointment about 2 weeks later. If the bleeding and pain has settled by then, it is likely that all the pregnancy has come away.
If bleeding fails to start within 7–14 days or is persisting or getting heavier, you will be offered a further ultrasound scan. The options of continuing expectant management, medical treatment or having an operation will then be discussed with you.
2. Taking medication (medical management of a miscarriage)
This is successful in 85 out of 100 women and avoids an anesthetic. You will be given medication called misoprostol, usually to be inserted in the vagina although tablets to swallow may be taken if you prefer. The medication helps the neck of the womb (cervix) to open and lets the remaining pregnancy come away. It will take a few hours and there will be some pain with bleeding or clotting (like a heavy period). You will be offered pain relief and anti-sickness medication. Some women may experience diarrhea and vomiting.
After the treatment, you may bleed for up to 3 weeks. If the bleeding is heavy, you should contact your provider. If the treatment has not worked, you will be given the option of having an operation.
3. Having an operation (surgical management of a miscarriage)
The operation may be carried out under general or local anesthetic. It is successful in 95 out of 100 women. The pregnancy is removed through the cervix. You may be given tablets to insert in the vagina before the operation to soften your cervix. Surgery will usually take place within a few days of your miscarriage, but you may be advised to have surgery immediately if:
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you are bleeding heavily and continuously
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there are signs of infection
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medical treatment to remove the pregnancy has been unsuccessful
The operation is safe but there is a small risk of complications including heavy bleeding, infection or damage to the womb. A repeat operation is sometimes required. The risk of infection is the same if you choose medical or surgical treatment.
4. What happens to the pregnancy remains?
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Some tissue removed at the time of surgery may be sent for testing in the laboratory. The results can confirm that the pregnancy was inside the womb and not an ectopic pregnancy (when the pregnancy is growing outside the womb). It also tests for any abnormal changes in the placenta (molar pregnancy).
What happens next?
Vaginal bleeding
You can expect to have some vaginal bleeding for 1–2 weeks after your miscarriage. This is like a heavy period for the first day or so. This should lessen and may become brown in color. You should use sanitary towels rather than tampons, as using tampons could increase the risk of infection. If you normally have regular periods, your next period will usually be in 4–6 weeks’ time. Ovulation occurs before this, so you may be fertile in the first month after a miscarriage. Therefore, if you do not want to become pregnant, you will need to use contraception.
Discomfort
You can expect some cramps (like strong period pains) in your lower abdomen on the day of your miscarriage. You may get milder cramps or an ache for a day or so afterwards. You should call your provider if:
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Heavy or prolonged vaginal bleeding, smelly vaginal discharge
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Severe abdominal pain not relieved by regular pain killers.
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Fever and flu-like symptoms
Emotional recovery
A miscarriage affects every woman differently and can be devastating for her partner too. Some women come to terms with what has happened within weeks; for others, it takes longer. Many women feel tearful and emotional for a short time afterwards. Some women experience intense grief over a longer time. Your family and friends may be able to help. Talk to your provider if you feel you are not coping.
Returning to work
When you return to work depends on you and how you feel. It is advisable to rest for a few days before starting your routine activities but returning to work within a day or two will not cause you harm if you feel well enough. Most women will return to work in a week, but you may need longer to recover emotionally.
Having sex
You can have sex as soon as you both feel ready. It is important that you are feeling well and that any pain and bleeding has significantly reduced.
When can we try for another baby?
You can try for a baby as soon as you and your partner feel physically and emotionally ready.
Am I at higher risk of a miscarriage next time?
You are not at higher risk of another miscarriage if you have had one or two early miscarriages. Most miscarriages occur as a one-off event and there is a good chance of having a successful pregnancy in the future. A very small number of women have a condition that makes them more likely to miscarry. If this is the case, medication may help.
Is there anything else I should know?
Like anyone else planning to have a baby, you should:
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Take 400 micrograms of folic acid every day from when you start trying until 12 weeks of pregnancy to reduce the risk of your baby being born with a neural tube defect (spina bifida)
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Be as healthy as you can – eat a balanced diet and stop smoking.
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Not drink alcohol as this may increase your chance of
Key points
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Early miscarriages are very common and one in five women have a miscarriage for no apparent reason.
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Bleeding and/or pain in early pregnancy can be a warning sign of miscarriage and you should seek medical advice if you are in this situation.
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You may be offered tests including an ultrasound scan to check your pregnancy.
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Once a miscarriage is diagnosed, your healthcare professional will tell you about your options, which include expectant, medical or surgical treatment.
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Most miscarriages are a one-off event and there is a good chance of a successful pregnancy in future.