Pre-conception tension

Pre-conception planning: The great expectation
As if having a baby wasn't hard enough, today's parents-to-be have to contend with pre-conception planning as well, which means pregnancy is now a 12-month affair


By Susan Daly

Saturday March 27 2010

Human biology hasn't suddenly altered. It still takes nine months to grow a baby in the womb. The fertility industry, however, has different ideas. It is no longer enough for women to take all due care throughout their pregnancy: the experts are now advising that the lead-up months before conception need attention too.

Pre-conception planning is the hottest thing in the want-a-baby sphere. It's not a novel suggestion that fertility is affected by lifestyle. The famous London fertility guru Zita West has been counselling wannabe parents -- including Cate Blanchett and Stella McCartney -- for years that the state of their general health can hugely affect their chances of having a baby. But recently the common-sense advice about what to eat, drink and wear -- no tighty whiteys, dads-to-be! -- has acquired the tag of a burgeoning science.

You can now buy pre-conception tablets, containing fertility-friendly nutrients for women, off the shelf in pharmacies. There are also versions for men which claim to help improve the production of sperm (zinc is daddy's little helpers' little helper, apparently). I ring my nearest branch of Boots in Dublin and, sure enough, the assistant rattles off a number of different brands in stock for prospective parents. A month's supply of Sanatogen Mother & Father-To-Be tablets, for example, cost €19.49.

There are also a number of new books instructing women -- and men -- on how to be conception-fit. West has a new one out, and alternative health expert Emma Cannon has just published The Baby-Making Bible. The mother of them all is the latest addition to the What to Expect series by American "mom-on-a-mission" (her description) Heidi Murkoff.

The book, "the prequel" to her phenomenally successful What to Expect When You're Expecting tome, is called -- naturally -- What to Expect Before You're Expecting.

"There is research that shows that a healthy pregnancy and a healthy baby don't begin at conception like we always thought it does," says Murkoff. "Doctors all over the world are pushing pre-conception planning."

Murkoff is a small, slight woman in her early 50s and when we meet in her London publishers' offices she's suffering from a touch of jet lag. Nonetheless, she is alert and intensely focused on what she calls her "mission to inform".

She says that the book is necessary precisely because there is so much anxiety out there about fertility now -- and the solutions being proffered are not always coming from the most agenda-free sources.

"There are a lot of people preying on expectant parents and on their fears, their hopes," she says. "There's that baby-from-a-box thing in the book that I mention [a commercial baby-making kit] but most people don't need that! If you have a real fertility issue, you probably need something more high-tech, but it's the kind of thing that people see on the internet and think, 'Oh, I should be buying that'."

It was the same annoyance that drove Murkoff to write What to Expect When You're Expecting, with the help of her mother and sister. When it was published in 1984, it was revolutionary in terms of baby books, presenting a month-by-month field guide to pregnancy in plain English. It has become such a totemic volume that there is a Hollywood movie in the works inspired by its title.

Murkoff had an unexpectedly sudden pregnancy with her first child Emma. She was filled with anxieties and questions but "that was when doctors were still God and when you asked a question, they would say, 'Well, you don't need that information'."

She turned to the pregnancy books available at the time but she found them either "too factoid or too frightening". So she wrote her own.

"Two hours before I went into hospital to deliver Emma, I delivered the proposal of What to Expect When You're Expecting, so it was a really, busy, productive day!" she says.

We have the internet now, a source of information that didn't exist in Murkoff's time as a new mum -- but that may not have been a bad thing.

"There is so much misinformation on the internet," says Murkoff, "But there are also these incredible virtual communities of moms online, who are like a virtual support group. It can be incredibly reassuring but of course, again, you are taking everybody's word as gospel sometimes."

Murkoff also points out that there is a genuine heightened interest in fertility advice that is not generated by corporate sources, but is coming from prospective parents themselves. The average age at which a woman gives birth in the Western world has been climbing for years.

In Ireland, a first-time mum is now, on average, aged 31.

So far from pre-conception planning being another stick with which to beat the woman who has put off pregnancy in favour of further education and some semblance of a career, it's necessary, argues Murkoff.

"If Mother Nature had her way -- and a lot of our mothers! -- we'd have our babies in our early 20s," she says,

Still, the research into what makes conceiving difficult for one woman, and seemingly easy for another, is not definitive. Perhaps because of this, much of the advice in Murkoff's book seems as much a design for a healthy life in general as it is specific to baby-making. Losing weight, eating vitamin and mineral-rich natural foods, cutting down on smoking and not drinking too much alcohol or caffeine: all this advice is not, as Murkoff admits herself, "exactly rocket science".

To be fair, the book is pretty extensive, from preparing you for the financial cost of a baby, to a sensitive and informative chapter on miscarriage and trying again. On the other hand, there is so much information, it can make your head spin. I'm pretty much the target audience for this book; early 30s and, so far, childless. By the end of reading it, all I could think was: "What's Tay-Sachs Disease, and what am I going to do with my terrible hayfever if I can't take anti-histamines if I'm trying for a baby?"

I put this amalgamation of anxieties to Murkoff, who says: "Some personalities are more given to that [worrying], but you can choose to NOT have that information. It's your choice. But I think I'm careful in the book to be as reassuring as possible and completely positive."

Perhaps I'm not in the baby zone yet -- the parade of cutesie acronyms used in the book also grates. Sex is never 'sex'; it's the 'BD' (Baby Dance). Your partner is your 'DP' or 'Dancing Partner'. Murkoff is ready for this complaint, saying she is just trying to help readers get to grips with the language that TTC ('Trying To Conceive') women use on internet message boards.

"Myself, I believe in calling it sex," she laughs, "I believe in sex, period. I'm in favour!"

She's also in favour of dads being involved in the process of baby-making -- and not just in the obvious way. The book has special grey boxes dotted around the pages with information for prospective dads on what they can eat, drink and do to help the chances of mum conceiving a healthy child.

"It's not to put pressure on them," she explains. "It's just I think that men are often pushed to the side."

To illustrate, she tells the story of how her husband, Eric, coped with the arrival home of their first child, Emma (they also have a son called Wyatt). "I'm 24 at the time, I'm not prepared, I'm a hormonal wreck and this baby felt like a stranger to me. She wouldn't stop crying and I am just sobbing. Eric just instinctively takes Emma out of my arms, he puts me to bed and says, 'Don't worry, I'll take care of it'.

"He'd never held a baby before but his instincts kicked in and he figured it out. He was an amazing, amazing dad, still is. Dads are totally capable of it, but sometimes women say, 'Oh you're doing it wrong, I'll do it'. Well maybe he's just doing it differently, not wrong."

Anecdotes like this make clear why What to Expect is such a big hit -- empathy. "You have to have walked a mile in a pregnant woman's shoes to know that the reason her shoes don't fit is because her feet are swollen," says Murkoff.

What To Expect Before You're Expecting, by Heidi Murkoff with Sharon Mazel, is published by Simon and Schuster and in bookshops now.

WTE when you’re TTC (What to Expect when you’re Trying To Conceive)
Confused by all conflicting advice out there on the best way to conceive? Wait till you encounter some of the dizzying array of acronyms typically used on internet message board to describe the baby-making process:
BD – Baby Dance (sex)
DP – ‘Dancing Partner (spouse or significant other)
BFN – Big Fat Negative (negative pregnancy test result)
BFP – Big Fat Positive (positive pregnancy test result)
EW – Egg White (re: the consistency of cervical mucus)
FTTA – Fertile Thoughts To All
The Big ‘O’ – Ovulation

Heidi Murkoff’s top tips for being conception-ready:
Take a pre-natal vitamin: “The science is so interesting – it can reduce your risk of having a baby with birth defects, reduce your risk dramatically of delivering prematurely. And there is no downside. If you decide not to have a baby after all, you’ll have great hair and skin, right?”
Tip the scales in your favour: “Ten per cent of infertility cases are linked to overweight. The more fat cells you have, the more oestrogen you produce. That sounds like an ideal scenario, but in fact having too much or too little of any hormone is going to affect fertility. The really interesting thing is the same situation holds true for men.”
Eat fertile-friendly foods: “No excesses of refined grains or saturated fats, sources of omega-3 fatty acids, lots of brightly-coloured fruit and vegetables, including berries, yams, red pepper. It’s also important for men. An interesting factoid is those brightly-coloured vegetables encourage sperm to swim faster. It probably wasn’t what his mother had in mind when she told him to eat his vegetables, but there you go!”
Lifestyle ‘vices’: “Smoking, obviously, and cut down on alcohol because heavy drinking can mess with your cycle. Caffeine you don’t have to cut out altogether but you should be down to 200mg a day or about a cup because excess caffeine is linked to lower fertility and to increased risk of miscarriage if you do conceive.”
Medications: “Take a look at the medications you take regularly. You need to check with your doctor if they are fertility-friendly and it’s not just prescription medications but also over-the-counter stuff. Anti-histimanes, expectorants (cough syrups) work by drying chest and nasal mucus but they don’t differentiate between the different mucus in your body, ie, cervical mucus.”