Monday, March 14, 2011

Planning a professional pregnancy, part 2: put this on your calendar

This is the second part of a two-part post.  In the first part, I talked about the factors that I considered when deciding when to pregnant.  Now I'd like to  turn to a discussion of some aspects of conception, pregnancy, and the postpartum period that you may want to consider in planning how your own pregancy might fit into your professional life.

[A warning:  this post may be pretty boring for those readers who have been pregnant/had a baby.  It's primarily meant for those who have not yet started a family!  The first few stages of this are also not going to be that useful to those who are using IVF or other methods to get pregnant; I just don't know that much about that experience, but will add any links here that readers might suggest.]

Arguably some of the most major events happen during the first 8 weeks of development; since you may not know you're pregnant until week 4-5, you'll want to start making choices that will be healthy for your body and for a growing embryo before you find out you're pregnant.  Stay active, stay rested, and eat well, for starters.  Cut down on caffeine (which can reduce fertility and increase the risk of miscarriage when consumed in large quantities), and alcohol.  Additionally, it's a good idea to start taking a prenatal vitamin with folic acid (to prevent neural tube defects) a month or two before you start trying to conceive; it can take a little while for folic acid levels to build up in your body.

If you're on hormonal birth control, try to switch to a barrier method at least a few months before trying to conceive; although you certainly can get pregnant in your first month after stopping the pill (and there appear to be no adverse consequences to the fetus if this happens), most research shows that it takes at least a few months to return to full fertility after stopping hormonal birth control (but that in a full year of trying to conceive, the same number of women who were using hormonal birth control prior to that year will become pregnant as women who were not using hormonal birth control).  (1).

If you're the type who doesn't usually pay attention to when your periods stop and start, it may make sense to keep track of that for a few months prior to trying to conceive, because you'll be able to get some idea of when you're ovulating and therefore when you're most fertile.

This may seem self-evident, but if you are trying to conceive in a particular month, you should have a lot of sex that month.  So it's probably not a good idea to try to get pregnant when one partner or the other is going to be traveling a lot, or working late.  What little research there is suggests that the best strategy is to have sex every 2 to 3 days after your period stops, and then every day during the days leading up to and including the day of ovulation--then back to every 2 or 3 days.

You can buy kits that tell you when you're ovulating by peeing on a stick, but ideally for conception purposes you should have sex before you ovulate, so those kits aren't actually that useful (unless you just use them for a few months before you start trying, to see what your cycle is like).

You can even buy iPhone/iPad apps for tracking your cycle.

Post-conception, you ask?  Don't you mean pregnancy?  No, no, I don't.  This was one of those surprises for me.  If you've paid attention to your cycle, and you're really trying to get pregnant in a given month, then you will realize that there is a 2 week period after you've ovulated, while you're waiting for your period to come and/or to take a pregnancy test.  People call this the 2-week wait.  If you're like me, these 2 weeks will find you more distracted, impatient, and daydreamy than you have EVER been in your entire life.  Am I pregnant?  Am I pregnant?  Oh my god, if I'm pregnant, then gastrulation is probably happening, like, right now!!! (Admittedly, if you're not a medical student than that last thought probably won't occur to you).   Anyway, it's worth keeping in mind that it may be particularly difficult to stay focused and/or evince an interest in anything other than the contents of your uterus during these 2 weeks.  Happily for me, I got pregnant during our women's health block in medical school, so no one thought it was weird to want to talk a lot about fertility and development.  I highly recommend this approach.

Another warning:  make sure you get one of the pregnancy tests that comes in a 2-pack, because you will inevitably take the first one too soon, and it will be negative.  Take another a few days later.

The first few weeks:
Most people will feel fine physically in the first few weeks after learning that they're pregnant.  Your main dilemmas will be figuring out whom to tell (I told my parents and brother and a few close friends right away--oh, and the women that I attended a Medical Students for Choice conference with, during week 7!--and waited to tell other people till I'd had a healthy ultrasound at 12 weeks), and starting to ask around for recommendations for a healthcare provider for your pregnancy (a midwife, family doctor, or OB).

The first trimester:
This was surprise number two.  Somehow I'd always assumed that pregnancy was physically exhausting because you were huge.  That can be true.  But for most women, the fatigue during the first trimester will be worse than anything later on.   There was about a month during which I really had a hard time doing anything other than lie around and groan melodramatically.  I was lucky in that I never threw up, but I was nauseous and exhausted all day.  I napped often, despite sleeping at least 9 hours a night.

So although you might think that the first trimester would be a good time to be productive at work...think again.  You're not likely to be at your peak performance during these months.  I was lucky enough that winter vacation, which was nearly a month long, coincided with the worst of the first trimester for me.  If you can have helpful family members visit, this is a good time (although they shouldn't expect you to be much fun).

In terms of getting to work, this trimester can be frustrating for another reason.  You don't look pregnant yet, but largely because of bloating, you may already be unable to wear your pants...and yet maternity pants will be far too big.  This can make it difficult to look professional.  Longer-length tops and something called a Bella Band (a band of stretchy fabric that you wear over your belly and the waistband of your pants, allowing you to leave them unbuttoned and unzipped) will be crucial.

When things go wrong:
One reason to think carefully about whom to tell that you're pregnant is to consider whom you would want to tell in case the pregnancy ends.  Somewhere between 8 and 20 percent of pregnancies will end spontaneously; 80% of the time, this happens in the first 12 weeks.  Many women choose not to tell their  professional colleagues and more casual acquaintances until the 12 week mark, for this reason.

The second trimester:
For many women, this is their favorite stage of pregnancy.  I emerged gradually from the cloud of nausea and fatigue between weeks 12-14.  I was actually able to enjoy eating again, which was nice, and bought a few pairs of maternity pants, which helped my self-image!  In terms of work, this is a good time to let your colleagues know that you're pregnant, and maybe to begin discussing maternity leave options with your boss.

One difficulty in terms of working during the second trimester is that doctor/midwife appointments begin to eat up a lot of your time.  Although check-ups are still only monthly at this point in your pregancy, there are also a number of standard screening tests during this trimester, so between one thing and another, you wind up spending an awful lot of time in waiting rooms.  It's a good idea to think proactively about how you want to use that time, and come prepared with something to do.  I worked my way through a good chunk of my boards review book just sitting in the doctor's waiting room.

It can also be helpful to ask to schedule your check-ups farther in advance than might be typical for your doctor's office.  I realized that there was one time on Wednesdays that was convenient for my check-ups, and at some point during my second trimester, I went ahead and scheduled my check-ups for the rest of my pregnancy.  This made it easier to fit in other obligations later.

One nice thing about becoming more visibly pregnant is that you may find other women at work or school offering advice and mentorship.  They've been there, and they want to help.  Occasionally the advice will not be welcome for one reason or another, but often this companionship will make you feel like you've joined a secret society that you never knew existed.

The third trimester:
There's a lot of variation in how energetic women will feel during their third trimester.  I stayed quite physically active during my pregnancy, even biking everywhere until somewhere past 7 months (when I finally got my very first car!); I think this helped my energy level throughout my pregnancy.  But a lot of it is probably luck!

If you sit a lot at work, my best advice is to buy a bouncy exercise ball and use it at your desk.  Yes, you will look silly (although some people have pointed out that you would fit right in at a number of Silicon Valley companies...), but the back pain common during the third trimester is exacerbated by sitting, and relieved by sitting on this ball.  I took my boards when I was 7.5 months pregnant, and so between months 6-7.5 I spent up to 8 hours a day sitting and studying...and the ball helped a lot.  As a bonus, bouncing on the ball can also feel great during early labor, rocking with your chest on the ball feels good in later labor, and newborns often love being held while you bounce on the this is a useful purchase in many ways.

On the other hand, if you are on your feet a lot at work, fear not!  Yes, you should wear comfortable shoes, and you may get somewhat swollen feet/ankles, but in general, being active is great for your comfort and health and may also help the baby to get into a good position for birth.

Sometimes I hear people exclaim (and I've been known to do this myself, prior to having a baby) that "she worked up to the day she delivered!"  Now what would I say?  Sure!  If you're in good health, there's no reason not to work right up until the end.  In fact, I found that when my academic obligations ended just after 8 months, I got kinda bored sitting around--at least, once all the getting-the-household-ready-for-a-baby stuff was done.  It's true that in the last few weeks especially, you may start getting more tired and swollen because of  your sheer size.  I developed carpal tunnel because of swelling.  But otherwise, work can help keep you from obsessing over whether that twinge you just felt was possibly a contraction.  Plus, working at 8+ months pregnant makes you look--and in some ways feel--like a superstar.  Certainly if you have to choose between taking time off before the baby comes, or after...I would go for after.

Well, I have a lot to say about childbirth and the ways that it is both managed and mismanaged in the modern medical model...but that doesn't really have a lot to do with your life as a professional, so I'll avoid that topic for now, except to say this:  for professional or other reasons, you may be tempted to "schedule" your birth via labor induction.  You should know that induction, even at term (40 weeks), is associated with greater risk of requiring a Caesarean section and with iatrogenic prematurity (meaning an infant who is born premature as a result of a medical intervention).

It's worth considering ahead of time how you might want to announce your baby's birth to various groups of friends, coworkers, and acquaintances.  You might even draft an email, or at least the To: line of an email, so that you don't have to think about it later.  Make sure you let people know how you feel about visitors, so that they don't have to guess.  If you do want visitors, you can be sure that they will not arrive empty-handed, so don't be shy about letting people know (if they ask) what would be most helpful.  Prepared meals were definitely my personal favorite visitor's gift!

Postpartum: the first few months
It is unbelievable to me that 6 weeks is considered an acceptable maternity leave at some workplaces.  In my experience, my body was just starting to feel somewhat healed after 6 weeks, although I was by no means back to normal.

For the first three weeks after birth, you may not feel tired at all, despite sleeping only a few hours a night, thanks to the endorphins that flood your system during and after labor.  But the sleepless nights do usually catch up to you after the first few weeks...and then you will be incredibly tired all the time, although you may not even realize it.  I would not recommend trying to do anything especially intellectually challenging for the first 2 months postpartum.  I didn't realize how tired I was until I attended a medical education think-tank at about 7 weeks postpartum, and found that I was barely capable of putting together a cogent, grammatical sentence.

Despite having read about it, I was still shocked by how much time I spent breastfeeding for the first few months.  Newborns nurse every 1.5 to 2 hours, and that's measured from the beginning of a nursing episode, which could last up to 45 minutes.  So basically, you could be looking at (worst-case scenario) nursing fully half your time.  And it's a two-handed job for a while--meaning that doing anything else is quite tricky, if not impossible (although I did get pretty good at surfing the web with my toes)!

Even if your husband is committed to being an equal partner, it may surprise you how little he is able to do at first.  Sadly, he just can't lactate.  I also found that since my husband went back to work after 10 days, it made more sense for me to get up with our daughter even for non-nursing needs at night, since he had to get up to go to work in the morning and I didn't.  At least, that's how I reasoned at the time.  In retrospect, I think this deprived my husband of some opportunities to both bond with and learn how to care for our daughter, and we may do things differently when we have another child.

Preparing to go back to work
In terms of what you will need when you eventually return to work, my best advice is to plan ahead for the introduction of a bottle.  You don't necessarily have to try to introduce it until the recommended 5-6 weeks (although the small existing body of research suggests that as long as breastfeeding is going well, even 2-4 weeks is probably fine)!  But you should start thinking about it well before then.  The reason for this is that figuring out the equipment involved in pumping and storing breastmilk, and then putting together a bottle, can be quite daunting.  I would highly recommend finding some time in your third trimester to have a new mom show you how her pump works and how she stores milk and prepares bottles.  (I would have been/am happy to do this for another mom)!

Then buy a few starter supplies; you can wait until later to really stock up on bottles, nipples and such, but at least get a few things so that you can practice using the pump and are able to make a bottle by the time the 5-6 week mark hits.  I did not think ahead, and by the time I got everything together to give my daughter her first bottle, she was 8 weeks old, and she did NOT like it.  This meant that (a) it was very difficult for me to leave her in the care of others (until finally, around 5 months, we had a break-through with the bottle), and (b) it made it difficult for her father to bond with her, since he never had the opportunity for a peaceful feeding session--she would only take a bottle after a significant amount of screaming, which was traumatic for them both.

These are the basic supplies you will need to make up a first bottle of breastmilk:

  • A breast pump (manual or electric; you can buy a used electric pump and simply buy new tubing and sterilize the flanges!)
  • A couple of milk storage bottles that fit your breast pump's parts.  (I have a Medela electric pump and a Medela hand pump, and use the Avent glass bottles which can be attached directly)
  • A bottle and nipple with the slowest flow you can find, suitable for a newborn.
  • At the beginning you do NOT need: milk storage bags (just use bottles at first), special sterilizing equipment (boil things before you use them the first time for a few minutes; after that, hot water and soap is fine), a special bottle brush or drying rack, or a bottle warmer.

Going back to work
I began doing some part-time work, 2 afternoons a week, when my daughter was 3 months old.  This felt right to me; it gave me a chance to get out of the house a bit, and it gave my daughter a chance to get used to another caretaker.  When she was 6 months old, I was working or attending class or clinic about 20 hours a week.  I'll be going back to school/clinic full time when she is 9 months old.  Not everyone has the luxury of such a long maternity leave.  But no matter the length of your leave, I think that a graduated return, if you can do it, is a good way to go.  It gives you an opportunity to work out the kinks in your baby routine--and for you to refresh your professional skills after some time away.

If you are self-employed, or a graduate student slogging away at a dissertation, you may think you've got it made--you can do your work at home, AND take care of your baby!   Be aware that most people find it very difficult to get work done with a baby around.  Naps are frequent in the early months, but irregular; many babies also want to be held most of the time when they're young--even during nap time!--so this time may not be as useful as you think.  I'm not saying it's impossible to do anything, but it can be difficult to be productive when you're stopping and starting all the time.  Once a nap schedule has been established, you do have a couple hours a day to work...but you may find that there are lots of other things (eating, showering, cooking, cleaning, napping) that you also want to get done during that time.

I hope you found some of these tips useful; they were based on my own experience.  If you disagree with some of my advice, or have additional tips or tricks to share, please share your disagreement and/or tips in the comments!


  1. bummer that we don't have repro until next spring, so i can't take advantage of your "get pregnant during women's health" advice (though it did make me smile). =)

    thoughts on the efficacy of trying to get pregnant in a particular month? an OB told me that 50% of TTC couples will get pregnant in the first 6 months. my husband has always been the lucky time, so i'm figuring we can give ourselves a 6-month window of possibility and just play his odds. =)


  2. Katie: if you have access to UpToDate, figure 1 in their article on "Optimizing natural fertility in couples planning pregnancy" might be a good place to start. It shows about 30% of couples conceiving in their first month of trying (although a significant number of those pregnancies will undergo spontaneous abortion, in some cases within that same month--sometimes called an "occult" pregnancy).

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