The Unofficial Guide to Having a Baby

Last Editorial Review: 7/23/2004

By Ann Douglas
WebMD Live Events Transcript

Event Date: 08/07/2000.

Author Ann Douglas will join us online to discuss her book the Unofficial Guide to Having a Baby. She will share vital information, money-saving techniques, time-saving tips and the latest trends that all pregnant women should know about.

The opinions expressed herein are those of the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Hello and welcome to the Parenting Today Program on WebMD Live.

Today's guest is Ann Douglas, co-author with John Sussman, MD, of The Unofficial Guide to Having a Baby. She has written other books for parents and children including Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss, and The Unofficial Guide to Childcare. An experienced journalist, she regularly writes on pregnancy-related topics for WebMD and Ann is the mother of four children, ages two through 12.

Welcome to WebMD Live, Ann. It's a pleasure having you here today. Before we begin taking questions, would you tell everyone a little bit about your background and area of expertise?

Douglas: Thanks. I'm glad to be here. I specialize in writing about pregnancy and birth, mainly because I have such a strong personal interest in these issues. I have four young children, and I've also been through miscarriage, stillbirth, and infertility myself.

Moderator: What suggestions do you have when one is preparing to have a baby?

Douglas: I think something that's important to do is to schedule a preconception health checkup with your doctor. You can use this appointment to go over such important issues as your medical history, your birth control method, your gynecological history and other important health issues. You should also start acting as if you're pregnant, even though you haven't started trying to conceive yet. By this, I mean you should stop smoking, quit drinking alcohol, discontinue with your doctor's permission any medications that may be harmful to the developing baby, and make other lifestyle changes that will make you healthier for pregnancy.

saralg_webmd: Could you tell me the different experiences I might have with a midwife over a obstetrician?

Douglas: Sure. I've had deliveries with midwives, a family doctor, and an obstetrician, so I feel qualified to speak on this. I think the main difference you'll see between having a midwife and an obstetrician is the length of time that each caregiver can spend with you. Your prenatal appointments with a midwife will be 45 minutes to an hour, where as with a doctor, it's typically 15 minutes or less. The same thing applies to labor. Your midwife will make herself available at whatever point in labor you feel you would benefit from her support. A doctor will monitor the progress of your labor and will check in and out with you as labor progresses, but typically won't be spending a lot of time with you until the moments before the birth. This is not to say that one is necessarily better than the other. You have to decide which approach to birth is most comfortable to you, and which caregiver is going to meet your medical needs.

ladyg2_webmd: What sort of training does a midwife have, and are midwife provider births usually at home?

Douglas: Unfortunately, there's no universal legislation across the entire U.S. Some midwives are nurses who have done some additional midwifery training. Others have been trained by other midwives, and the legality of midwifery in various states varies. Most midwives, other than midwives affiliated with particular hospitals, will attend home births. In other words, if you're a midwife on staff at a large hospital, you will probably do all your practicing within the hospital.

Moderator: How long does it take a healthy couple to conceive their first child?

Douglas: This really varies a lot according to age. A healthy couple in their early twenties has a 93% to 97% chance of being pregnant within one year. A couple in their late thirties, on the other hand, has a 65% to 72% percent chance. So as you can see, there is no "one size fits all" rule about how quickly you will conceive.

abigale_webmd: Are prenatal supplements a good idea and what vitamins are important?

Douglas: The American College of Obstetricians and Gynecologists does not routinely recommend prenatal supplements to all pregnant women. What they do recommend, however, is that all women of childbearing age consume at least 0.4 mg of folic acid. You should also, as your pregnancy progresses, consider taking an iron supplement if your caregiver feels it is necessary. It's not unusual for pregnant women to become anemic over the course of a pregnancy. In terms of other vitamins, you should talk to your caregiver about what he or she recommends, and you should stick to a prenatal supplement rather than taking a standard multivitamin. Prenatal supplements are designed to have the recommended doses of important nutrients. Other vitamins may have excessively large doses of certain nutrients, doses that could be dangerous to the developing baby.

jcorr_webmd: How important is exercise during pregnancy?

Douglas: It is very important to continue to be physically active during pregnancy if you are able. I say if you are able, because some women with high risk pregnancies are not able to exercise during pregnancy. Most women will feel better and will be able to keep their weight in the healthy weight range for pregnancy if they exercise regularly. Obviously, you have to use some common sense. This is one time in your life you can sit out the mountain climbing activities. You want to avoid any activity that could put your baby at risk. In addition to avoiding activities that could result in a fall or other physical injury, you want to avoid raising your core body temperature too high by exercising too vigorously, as this may contribute to birth defects in the developing baby. Your doctor or midwife will be able to talk to you about your specific situation and make some recommendations.

manasabs_webmd: How many months/weeks prior to conception should we ideally start taking the prenatal vitamins?

Douglas: The folic acid should be started two to three months prior to conception, and continued throughout the first trimester of pregnancy.

bbqlee_webmd: How soon before childbirth can intercourse continue to take place?

Douglas: Unless there is a medical reason not to have sex late in pregnancy, most couples can continue to be sexually active right up until delivery date. Of course, sometimes where there's a will, there isn't necessarily a way, and you do have to get a bit creative with positioning as time goes on. It is also not at all unusual for a pregnant woman to be tired and physically uncomfortable, or to simply be so preoccupied with the upcoming birth that sex is the last thing on her mind. If this is how you feel, you're perfectly normal.

Moderator: Do you have any suggestions for saving money for your child's future?

Douglas: Believe it or not, I am currently writing a book on this subject. The book is called Family Finance: The Essential Guide For Parents, and it will be published by Dearborn Publishing next year. You can dramatically cut the cost of raising children by shopping second hand, borrowing items, and avoiding the brand name trap that so many first time parents fall into. You're unlikely to show up as a guest on Oprah just because you put your toddler in store-brand overalls. The moral of the story is buy good quality items that are truly necessities, and skip a lot of the frills. An experienced mom on your street will help you to distinguish between necessities and frills.

saralg_webmd: What sorts of testing can be done to learn about the health of an unborn baby?

Douglas: There are tons of different prenatal tests that can be done. Some of them are genetic tests designed to find out if the baby has an underlying genetic problem. These are tests like the AFP (alpha-fetoprotein) test, also called the triple screen test or the quad screen test, amniocentesis, and chorionic villus sampling. There are also other highly specialized prenatal genetic tests. You will also likely be screened for gestational diabetes and/or group B streptococcus at some point during your pregnancy. You can also expect to have one or more ultrasounds during your pregnancy. As you can see, there is a lot of information that can be gathered prenatally, but it is important to realize that no test or group of tests can necessarily guarantee you a storybook, happy ending to your pregnancy. There simply aren't tests available to detect every possible problem with the developing baby. I hope you don't find that alarming, but I think it's important to be real.

jcorr_webmd: How does pelvis size impact delivery?

Douglas: I'll start out by reminding everyone that I'm not a medical doctor. What I can tell you is you can run into delivery problems if the pelvis is disproportionately small as compared to the baby's size. In other words, if the baby is very large and the mother's pelvis is very small, the mother may have difficulty giving birth vaginally. Obviously, this was considerable cause for concern a few generations ago when many women died during childbirth. But today, early detection of these types of problems can allow for a low risk cesarean delivery.

Moderator: Could we talk now about miscarriage? How common is miscarriage and what are the causes?

Douglas: Between 20% and 25% of pregnancies end in miscarriage, ectopic pregnancy, molar pregnancy, or stillbirth. This means that each year, about one million American women experience the heartache of having a baby die prior to birth. There are numerous causes of these losses, but unfortunately, as many as half of all losses are never able to be explained by a medical cause. What we do know, however, is that chromosomal problems, structural defects of the uterus, immunological problems, and other causes can result in these heartbreaking losses. You might be interested to know that my book, Trying Again: A Guide To Pregnancy After Miscarriage, Stillbirth, and Infant Loss, will be out in October.

ladyg2_webmd: What support can friends give?

Douglas: The most important thing to do is to listen to your friend and take her loss seriously. So many women who have miscarried or otherwise lost a baby are subjected to insensitive comments from family members and friends. Don't say things like, "At least you didn't have a chance to get attached to the baby," because this is not true. The pregnant woman starts becoming attached to her baby as soon as she finds she's pregnant. Instead, let her know you're sorry she's been through this heartache, and that you will talk to her about her baby whenever she feels the need. She is lucky to have such a caring friend.

Moderator: What are a pregnant employee's rights?

Douglas: There are two important pieces of legislation that every U.S. woman needs to know about: The Pregnancy Discrimination Act, and the Family and Medical Leave Act (FMLA). The Pregnancy Discrimination Act is designed to prevent you from being discriminated against just because you're pregnant. Unfortunately, it only covers employees of companies with 15 or more workers. Workers in smaller companies are generally covered by similar state legislation. Basically, the Pregnancy Discrimination Act ensures that you cannot be fired or denied your regular employment benefits such as health insurance just because you're pregnant. Now let's talk about the Family and Medical Leave Act. If you're covered by this piece of legislation, you're entitled to up to 12 weeks of unpaid, job-protected leave because you're pregnant. There's a lot of fine print, as you might expect, so you'll want to visit the Department of Labor web site to get more information on both of these pieces of legislation. Their web site is The Equal Employment Opportunity Commission is at There's tons of information on these sites.

waldy2_webmd: Who makes the decision concerning an episiotomy during delivery, the woman or her doctor?

Douglas: In most cases, it is a joint decision, but in emergency situations, the caregiver may have to make the call. If this is your first baby, you may be interested to know that practicing perineal massage may significantly reduce your chances of requiring an episiotomy. I recently wrote an article on this topic for WebMD, and you should be able to find it by using the search tool.

abigale_webmd: I have just discovered that a friend is unexpectedly pregnant. Her boyfriend is not exactly ideal partner material though she has decided that she is ready to be a mom. How can I help her?

Douglas: I think the main thing that you need to do is what you are already doing -- offering support to your friend. You might want to help her to research resources for single moms in the community in the event that her relationship does not work out over the long term. You might also offer to be a labor support person if you feel that her partner is not going to be up to the challenge. If there is any question of abuse, you should urge her to talk to her doctor or midwife about the situation. Abuse tends to escalate during pregnancy, and your friend may be at true risk.

Moderator: How common is postpartum depression among new mothers?

Douglas: Studies have shown that between 50% and 80% of women will be hit with a brief episode of mild depression at some point during the week after the birth. Postpartum depression, on the other hand, occurs in approximately one in five women. It generally appears at some point during the first six to eight weeks after the delivery, but can show up at any point during the first year. It can last anywhere from several weeks to several months, with 4% of cases lasting for a full year. In one to two out of every 1000 births, a woman will develop a more severe form of postpartum depression, which puts both herself and her baby at risk. Postpartum depression is particularly common in first-time mothers and women who have suffered from postpartum depression in the past. If you suspect you are experiencing postpartum depression, it is very important to seek help. Your doctor or midwife will be able to recommend resources in your community.

Moderator: Can you give us some insight on what labor and delivery are like?

Douglas: I think the most important thing to remember is that there is no such thing as a one-size fits all delivery. If you wait to experience each and every labor symptom that your pregnancy books list, I can practically guarantee you'll be giving birth on your kitchen floor. Something else you need to know is that your contractions won't necessarily feel like your best friend's contractions felt like. People also seem to forget to tell you about the endless supply of amniotic fluid that you have. Don't expect it to disappear all at once when your membranes rupture. It'll dribble, and dribble, and dribble. In fact, that endless dribbling of amniotic fluid is one of the most annoying aspects of labor, and one that far too few pregnancy books talk about. Something else you need to know is that you will amaze yourself and your partner with your strength and resilience. Women have been giving birth for millions of years. You're about to enter the motherhood club.

I'd like to thank everyone for coming out today. As you can tell, I love talking and writing about pregnancy. Since my husband insists that four kids is more than enough, I have to content myself with writing about it from now on. I wish you all the best, no matter where you are in the journey of motherhood -- trying to conceive, pregnant, waiting for the birth, enjoying the thrill that comes with having a baby. Thanks again.

Moderator: Ann, thank you very much for joining us for this important discussion. Members thank you for all of your questions. Ann Douglas' book (that she co-wrote with John R. Sussman, MD), The Unofficial Guide to Having a Baby, is available now at your local or online bookstore.

The opinions expressed herein are those of the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

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