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转几篇关于孕前保健(Pre-Conception Health)及孕前检查(Preconception checkup)的文章(下)
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发表时间:2012-05-01
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●10 steps for getting a healthy pregnancy
●Pre-conceptual health check
●Pre-Conception Health for Women
●Pre-Pregnancy Health
●What It Costs to Have a Baby
●How Much Does It Really Cost to Have a Baby?
●How much does having a baby cost?

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10 steps for getting a healthy pregnancy
marchofdimes.com

What you do before pregnancy can help you and your baby have a healthy pregnancy.

1.Take folic acid.

Take a multivitamin with 400 micrograms of folic acid every day. Taking folic acid before and during early pregnancy can help your baby's brain and spinal cord develop properly. Look on the label of the vitamin bottle to see if it contains the necessary amount of folic acid.

Eat a healthy diet that includes foods that contain folate, the natural form of the vitamin. Such foods include fortified breads and breakfast cereals, beans, leafy green vegetables and orange juice.

2. Get a checkup before pregnancy.

Preconception care is medical care you get before you're pregnant. The goal is to evaluate your health and identify health and lifestyle risks that may affect your pregnancy.

One of the most important steps you can take to have a healthy pregnancy is to see your health care provider before you conceive. Your provider can help you be as healthy as possible before and during your pregnancy. Ideally, you should see the provider who will take care of you during your pregnancy, although you also can visit your primary care provider.

Don't forget about dental health! See your dentist before you get pregnant. If there's any chance you may be pregnant, tell your dentist and wait until after the baby is born to have dental x-rays.

3. Eat right and maintain a healthy weight.

You'll feel better and start your pregnancy off right if you eat a variety of nutritious foods every day. Avoid foods high in fat and sugar. Eat foods from each of the five food groups: fruits, vegetables, proteins (like chicken, fish and dried beans), grains, and milk products.

Moderate amounts of caffeine per day appear to be safe during pregnancy. Up to 12 ounces of caffeinated coffee a day may be okay during pregnancy. Remember, the amount of caffeine in coffee varies, depending upon the type of coffee, how it is prepared, and the amount of coffee used. Caffeine can also be found in soft drinks, medications and other foods. Try coffees and teas that are decaffeinated, or drink water, milk or juice. Be sure to read labels on food, drinks and medicine to know how much caffeine you're getting.

For more information about eating right, read the March of Dimes fact sheet about food-borne illness and pregnancy.

Try to get to a healthy weight before you get pregnant. If you're underweight (weigh too little), it may be easier to get pregnant if you get to a healthier weight. If you're overweight (weigh too much), try to lose weight before you get pregnant. Check with your health care provider if you're unsure what your ideal weight is. It's not safe to try to lose weight once you're pregnant.

4. Stop smoking and avoid secondhand smoke.

Smoking may make it harder for you to get pregnant. If you smoke while you're pregnant, your baby is at greater risk for being born prematurely or too small. Smoking during pregnancy increases the risk of pregnancy complications and SIDS (sudden infant death syndrome). The best time to stop smoking is before you get pregnant. If you need help, ask your health care provider for advice. Smoke from other people's cigarettes can also be harmful. Try to avoid secondhand smoke, too.

5. Stop drinking alcohol.

Drinking alcohol (beer, liquor, wine and wine coolers) can make it harder for you to get pregnant. Drinking alcohol before or during pregnancy can cause your baby to have conditions that can create lifelong problems like:
●Fetal alcohol syndrome (FAS), a combination of physical and mental defects
●Low birthweight
●Heart defects, growth problems and problems with brain development

If you need help to stop drinking, ask your health care provider.

6. Don't use illegal drugs.

Taking illegal or "street drugs" during pregnancy is risky for mother and baby. Women who use cocaine are at higher risk of miscarriage and preterm labor. Babies exposed to heroin are likely to be born addicted. Babies exposed to illegal drugs also are more likely to have learning or behavioral problems later in life. Women who use methamphetamines or marijuana may have babies that are too small. If you need help to stop, ask your health care provider.

7. Avoid infections.

Some infections can harm a developing baby. Wash your hands well with soap and water after using the bathroom, blowing your nose or touching soil. Avoid potentially unsafe foods such as raw meat and fish and unpasteurized milk products.Wash all fruits and vegetables well. If you have a cat, ask someone else to change the litter box. Stay away from rodents, including pet mice, hamsters and guinea pigs.

Find out if you have a sexually transmitted infection (STI). Without treatment, these infections pose special risks for pregnant women and their babies. At a preconception visit, ask your provider about screening tests for HIV or other STIs. To avoid STIs, have sex with only one person who doesn't have any other sex partners and who doesn't have an STI.

8. Limit exposure to hazards.

Avoid hazardous chemicals, like cleaning supplies and insect killers. Stay away from strong-smelling cleansers, chemicals and paint. You may reduce your risk by wearing rubber gloves and working in a well-ventilated area. If your water pipes are old, you may want to have them tested for lead or drink filtered or bottled water. Ask your health care provider for advice about hazardous substances and chemicals.

9. Learn about genetics.

Your health care provider will take your health history and ask about the health of members of your family. Based on this information, your doctor or nurse may recommend that you see a genetic counselor to learn about your risk of having a baby with a birth defect.

10. Avoid stress and get fit.

Too much stress may be harmful for you and your baby. High levels of stress may increase the risk of preterm labor and low birthweight. Start reducing stress now. Identify causes of stress and try to reduce them. Ask partners, family and friends for emotional support. Or get professional help. Use relaxation techniques, such as deep breathing. Call a hotline or ask your health care provider or another trusted person for help if you're in a relationship where you're in danger of being harmed. This could be verbal or physical abuse.

Exercise regularly and get fit. Exercising for 30 minutes on all or most days of the week is a good way to help maintain or lose weight, build fitness and reduce stress. If you aren't already exercising, now is a good time to start. Talk to your health care provider about fitness activities that are right for you. Some good choices before and during pregnancy include walking, swimming and yoga.

Don't forget to help Dad get healthy, too! To improve your chances of getting pregnant, it's important for your partner to take care of himself, exercise, eat right and stop smoking, drinking or taking illegal drugs.

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Pre-conceptual health check

●Options for caregivers
●What to expect at your pre-conceptual health check
●Do you need any tests?

When planning a pregnancy, many women consider seeing a health professional for advice and possibly a 'physical check-up' (if required) before trying to conceive their baby. Some women have a pre-conceptual health check after trying to have a baby for a few months, feeling they need to check that everything is 'OK', or seek advice, information and support. Some men also seek out pre-conceptual health checks. They may make a separate appointment for themselves with their own preferred caregiver, or go along with the woman to have the consultation together.

In recent years, there has also been a trend for practitioners, health organisations and natural health clinics to conduct regular group information sessions or seminars to provide information about a couple's pre-conceptual health and how to physically prepare for pregnancy. These may be something you do in addition to a pre-conceptual health check as part of your preparations.

1. Options for caregivers

Who you choose to see for your pre-conceptual health check will depend on your personal preferences, convenience and who is available in your area. The following are some caregiver options you may wish to consider for providing your pre-conceptual health check. Be aware that these relate to an Australian context. Women living in other countries may have different options.

Your local doctor (GP). Many women find it convenient to visit their local doctor (or 'GP') for their pre-conceptual health check, especially if they know their doctor well and feel comfortable seeing them.

Family planning, community health centre or women's health nurse. Most metropolitan areas and rural communities have family planning clinics, community health centres or women's health nurses that are able to provide a pre-conceptual health check. Women often feel comfortable using these services, especially if they normally go there for other reproductive health care services such as a pap test or obtaining contraception.

Maternity hospital clinic. Public maternity hospitals often have clinics available to cater for women requiring a pre-conceptual health check. Some hospitals allow you just to ring up and book in directly for these, while others require a referral from your local doctor.

Pre-conceptual health clinics. There are now a few clinics and natural health organisations that specifically work with couples, aimed at optimising their knowledge about their fertility and providing information and education on health, stress management and lifestyle changes to prepare for pregnancy. Some of these clinics also provide services to perform tests if required, or they may simply offer information, natural therapies and individual counselling.

Private obstetrician/gynaecologist. If you already have a private obstetrician and gynaecologist ('O&G' or 'ObGyn'), you may prefer to see them for a pre-conceptual health check, particularly if you consulted them for previous reproductive services, health conditions or pregnancies. Many O&G's are also fertility specialists who may be able to provide future services if you are having difficulty conceiving. To see a specialist you usually need to have a referral from your local doctor.

Specialists and physicians. Women who have specific health conditions that require prescribed medications (such as epilepsy, diabetes or depression) should ideally see their specialist doctor or physician before they conceive as part of their pregnancy preparations. This is aimed at planning the management of your condition during the pregnancy and discussing the use of medications, which may need to be slowly reduced, changed or adjusted to be more suitable for pregnancy. Your doctor may also be able to provide other aspects of a pre-conceptual health check, or you may need to see another caregiver in addition to seeing your specialist.

2. What to expect at your pre-conceptual health check

The main aims of a pre-conceptual health check are to provide information, discuss health issues and perhaps perform some tests (if appropriate) before you begin trying to conceive a baby. Contrary to what most people believe, a pre-conceptual health check does not necessarily involve a 'hands on' physical check, but rather more of an opportunity to obtain information and discuss issues relating to the preparation for your pregnancy.

For the man, a pre-conceptual health check will usually just entail a discussion of their health and medical history. However, if they (or their caregiver) have reason to be concerned about the man's fertility, they may also want to examine the man's genitals and perhaps organise a sperm count (semen analysis).

Each caregiver will vary in exactly how much (or how little) they do during a routine pre-conceptual health check. However, there are a few basic components that are widely accepted as being fairly routine, such as going over your medical and reproductive history and recommending folic acid supplements for the woman.

A pre-conceptual consultation is also an opportunity for you to discuss any concerns you may have, or perhaps your plans for your pregnancy and birth care once you conceive. Many couples also want information about their fertility and how to increase their chances of naturally conceiving a baby soon after they start trying. If there are things you specifically wish to discuss, write down a list to take with you, so you remember what you want to ask.

The following is a general guide as to what may be discussed during a pre-conceptual health check for both the woman and her partner:
●Your general health
●Past pregnancies
●Menstrual cycle and contraception
●Lifestyle changes
●Education about infections and viruses
●Folic acid supplements

●Your general health.
Your caregiver will probably enquire about your age and check your blood pressure as well as asking several questions relating to your medical history and overall general health. This is aimed at assessing your fertility and identifying any potential problems you may have conceiving a baby. It also highlights any health conditions that may affect a pregnancy or require further testing, adjusting of medications or perhaps genetic counselling.

Questions may include:

Are you generally in good health? Do you (or your family) have any medical conditions such as diabetes, high blood pressure, epilepsy, thyroid conditions, metabolic disorders, mood disorders, blood disorders, genetic disorders, asthma, heart or kidney disease? If so, you may require tests to be ordered or perhaps have medications stopped or changed or need referral to a specialist doctor or a genetic counsellor. NOTE: It is important that you do not simply discontinue prescribed medications without first seeking advice from your doctor.

Have you had any illnesses or medical conditions in the past? If so, you may require tests to see if they have resolved, stabilised or possibly caused any underlying alteration to your body's normal functioning (such as your kidney function). For the man, suffering from mumps in teenage or adult years can be of concern, because it may cause infertility.

Do you smoke and drink alcohol and if so how much and how often? Are you taking any medications, recreational drugs, vitamin supplements or natural remedies on a regular basis? Have you recently stopped a medication or treatment during the last 3 to 6 months? For example, some prescribed medications and natural therapies are so toxic they need to be stopped for 1 to 3 months or more before a woman conceives a baby and some can stay in sperm for 1 to 2 months before conception. You can read more in lifestyle changes.

Have you had any operations, injuries or accidents in the past? Did you experience any complications or side effects from any treatments of these? Any past episode would be relevant for the woman, but for the man this would be specifically related to an injury or operation to the genital region.

Have you been vaccinated for any viruses or diseases (for travel, occupational or health reasons) or do you intend to be vaccinated during the next few months? Sometimes pregnancy needs to delayed for the woman after certain vaccinations (for example, in the case of rubella) and/or the caregiver may suggest vaccination (if appropriate) before you try and conceive.

What is your occupation and where do you live? This is aimed at assessing whether you may be at risk of exposures to toxins, radiation, chemicals, infectious diseases, pesticides, electronic equipment and air pollution in your work environment, home, neighbourhood or through travelling to developing countries. You can read more in occupational hazards.

Have you ever had a blood transfusion or received blood products? Do you have any allergies that you know of?

Have you ever had a sexually transmitted infection or do you suffer from genital herpes? Have you used IV drugs in the past and do you think you may be at risk for having hepatitis B or C or HIV-AIDS? If so your caregiver may suggest testing for these.

For the woman- have you had urine infections in the past or experience vaginal infections such as thrush and Gardnerella? Have you ever had a pap test, and if so when was you last one and have these results of your previous tests been normal? Have you ever had any treatments for abnormal pap tests in the past? You may require tests and/or treatments in relation to these.

●Past pregnancies.
Your caregiver will probably ask you whether you have had any pregnancies in the past and what the outcome of these were, for example the birth of previous children, miscarriages or a stillbirth. You may want to discuss time frames for conceiving again after a recent pregnancy loss or perhaps after the birth of a previous child. This is discussed further in variations for conception.

NOTE:Be aware that it may be important for your caregiver to be aware of past terminations of pregnancies (or abortions), adopted babies and pregnancies with past partners. For this reason, some women (or their partners) may choose to see their caregiver individually, especially if they do not want their current partner to be aware of this information.

●Menstrual cycle and contraception.
Part of assessing a woman's fertility is to find out about the regularity of her menstrual cycle and if she is using (or has just recently stopped) contraception. Your caregiver will probably ask you how often your period comes. This is counted in days from the first day of a menstrual period to the first day of the next period (usually averaging 28 days) and how long the bleeding lasts for. You may also use this opportunity to ask about how you can time sex for conception to optimise your chances of conceiving a baby sooner.

Your caregiver will also ask you about contraception if you are using anything at the moment and what you have used in the past and when you stopped these. Some methods of contraception do not interfere with a woman's fertility (such as condoms and diaphragms), while others can delay a woman's fertility significantly (such as Depo-Provera injections). You can read more in variations for conception.

NOTE: It may be a good idea for the woman to consider charting her menstrual cycles (including taking her daily temperature and observing her physical signs, such as vaginal mucous changes) to detect her fertile days. This can help with the timing of sex for conception, but it may also become invaluable in helping you if you eventually come to the situation where you are having difficulty conceiving. Being able to give your caregiver 3 to 6 months or more of menstrual cycle patterns assists them greatly in exploring the reasons why you are not conceiving and is something that will save you much time. You can download a fertility chart and read about charting your cycle in fertility chart and physical signs.

●Lifestyle changes.
You may be asked about various aspects of your lifestyle and be given information on some changes aimed for optimising your fertility and putting in place some beneficial habits for pregnancy. Your caregiver may discuss your diet and ways to make it nutritious and well-balanced, they may ask about whether you exercise and what types of activities you are involved in and they may weigh you (or ask you what your average weight is) and discuss aspects of being within an ideal weight range.

●Education about infections and viruses.
There are many infections and viruses that can cause complications for pregnancy (such as miscarriage or stillbirth) and in some cases birth defects for the baby. These include listeria, rubella, cytomegalovirus and toxoplasmosis. A pre-conceptual health check is a good opportunity to obtain information about these conditions, how the infections are transmitted and ways you can avoid them.

●Folic acid supplements.
It is now well recognised through extensive research that women who have adequate intakes of folate for around 1 to 2 months before they conceive a baby, and for the first 6 to 12 weeks of their pregnancy, improve their chances by up to 70% of not having a baby with abnormalities known as 'neural tube defects' (or NTD's). It is for this reason that all women are advised to take folic acid supplements pre-conceptually when planning a pregnancy. You can read more about this and the recommended dosages in more detail in folic acid supplements.

3. Do you need any tests?

Depending on your medical history, your caregiver may recommend (or offer you) some investigative tests. These may be blood tests or other tests such as ultrasounds (if appropriate). A person's individual need for pre-conceptual tests is somewhat varied and in some cases controversial. Some tests are universally regarded as necessary if required (such as a blood test for rubella immunity if you are considering having a vaccination or a pap test if the woman is due to have one done). Other tests are essential if the woman has a specific health condition or is taking certain medications. However, a few caregivers will routinely perform a wide range of tests for everything imaginable, which may or may not always be necessary. You may be happy to have extensive testing or you may question the need for them. This is something you will need to discuss with your caregiver.

The following is a guide to some of the more common tests that may be recommended as part of a pre-conceptual health check.
●Rubella immunity
●Pap test
●Full blood count
●Urine test for infection
●Genetic testing

●Rubella immunity.

Women planning to have a baby will often be offered a blood test to check their level of immunity to the rubella virus (or German measles). This is called a 'rubella titre'. Most adults have good immunity to rubella, either naturally through experiencing the virus as a child or by being previously vaccinated for rubella as a teenager. However, being vaccinated against rubella (or even experiencing the rubella virus) does not always guarantee immunity for life and a person may NOT be immune if:
☆ Their previous immunity has diminished over time, meaning that immunity as a teenager or for an earlier pregnancy may not guarantee immunity for a subsequent pregnancy.
☆ Their body does not respond in a way to create adequate immunity after a rubella infection or vaccination. The immune reaction may be insufficient or for some reason the person remains non-immune, even after experiencing rubella or being vaccinated against it. This can happen for up to 5% of people.
If the rubella titre shows you are 'not immune', then your caregiver may offer you a rubella vaccination before trying to conceive your baby. (Bear in mind that it is generally recommended women do not become pregnant for at least 1 to 2 months after having a rubella vaccination.) You may wish to have another blood test about 3 months after the rubella vaccination to check that your immune reaction was sufficient. However, a rubella titre is also a routine test done as part of your first pregnancy visit after you conceive. You can read more in rubella during pregnancy.

●Pap test.

A pap test involves the caregiver using a speculum to gently brush or scrape a small sample of cells from a woman's cervix with the aim of detecting changes in the cells that may lead to cancer of the cervix at a later stage (if left untreated). In general, pap tests are recommended at least every 2 years, more often if you have had past pap tests that were irregular or abnormal in the past, or cell changes that have required medical treatments. If you are due to have a pap test (or are due for one in the next few months) your caregiver will probably recommend having the test before you conceive. You can read more in pap test.

If you do not need a pap test there should not really be any reason for your caregiver to perform a vaginal examination as part of your pre-conceptual health check (unless you feel you need to have tests to screen for sexually transmitted infections).

●Full blood count.

A 'full blood count' (or FBC) looks at many components of the blood. However, the main aspect considered before pregnancy is a woman's haemoglobin (or Hb), which is related to iron levels and being anaemic. If the level is low (below 11.5 gm/dl or 115 g/L) your caregiver may discuss how to include iron rich foods in your diet or perhaps suggest taking iron supplements. You can read more in iron and iron supplements.

A few women will need further tests to investigate blood disorders such as Thalassemia or sickle cell.

●Urine test for infection.

About 5 -10 % of women have what is called 'asymptomatic bacteriuria'. Put simply, this is a small amount of bacteria present in the bladder without the woman actually having any physical signs of an infection. In non-pregnant women asymptomatic bacteriuria does not tend to cause any problems. However, during pregnancy, the hormone progesterone relaxes the walls of the bladder and ureters and the growing baby can often compress these organs. The results of these changes can lead to urine 'refluxing' back up into the kidneys and pooling in the woman's bladder after urination, encouraging bacteria to multiply, sometimes leading to an infection of the urine (called 'cystitis') and possibly the kidneys as well (called 'pyelonephritis').

This urine test to check for an infection is called an MSU (or midstream urine test). This involves passing a little bit of urine into the toilet, then passing a small amount of urine into a sterile container (this is the 'middle of the stream'), then passing the rest of your urine into the toilet. If your urine shows bacteria present, your caregiver will probably prescribe a course of antibiotics to treat it before you conceive.

●Genetic testing.

After discussing your medical and family history, your caregiver may suggest you see a genetic counsellor and perhaps consider having genetic testing. You may already be aware of a health condition that runs in your or your partner's family, or you or your partner may have a genetic disorder (or have had a previous baby with a disorder), or experienced recurrent miscarriages. This is discussed in the next section of the class called genetic counselling.

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Pre-Conception Health for Women

Pregnancy should not be considered only a 9 month journey but as a year long journey. Knowing that the first few weeks of pregnancy are the most vital to the development of the baby, a mother should be healthy and avoid any harmful activities and substances near the time of conception. Some habits are harder to break, and some health issues take longer to address. Getting a jump start will be beneficial to you and your baby. Following these simple guidelines can help you prepare for pregnancy.

If you are trying to get pregnant, you should get a copy of the Essential Guide for Getting Pregnant. This ebook is one of the easiest and up to date resources for getting the information and tips you need to get pregnant quicker and easier.

Before you become pregnant you want to make sure that you cut out any habits that are harmful for your baby. These habits include:
●Smoking - Smoking during pregnancy is estimated to account for 20 to 30 percent of low-birth weight babies, up to 14 percent of preterm deliveries, and about 10 percent of all infant deaths according to the American Lung Association.
●Drinking Alcohol - There is no safe amount of alcohol to consume while you are pregnant.
●Recreational drug use – For example, smoking marijuana during pregnancy can increase the chance of miscarriage, low birth-weight, premature births, developmental delays, and behavioral and learning problems.
●Prescription drugs – There are many prescription drugs that are teratogenic (cause birth defects). Talk with your healthcare provider about any and all prescription drugs you are taking.
●Hazardous chemicals – There are some chemicals that can also be teratogenic. For example, most studies show that the greatest risk of exposure to pesticides is during the first three to eight weeks of the first trimester when the neural tube development is occurring. This is often before a woman knows she is pregnant.
●Stress – Stress has been linked to delayed or missed periods which can cause difficulty tracking ovulation and getting pregnant. Limit your amount of stress as much as possible. You may find it helpful to employ relaxation techniques or yoga to help calm things down.
●Herbs – Most herbs and herbal remedies are not mandated by the FDA, and therefore, there is little to no research on the effect they have on pregnancy. Discuss any herbs with your healthcare provider.
●Caffeine - Some studies have shown a link between high levels of caffeine consumption and delayed conception. A few studies have shown that there may be an increase in miscarriages among women who consume more than 200 mg (one 12oz cup of coffee) a day versus those who do not consume any caffeine.

You should replace these old habits with new healthy habits. These healthy habits include:
●Exercise – Start exercising now. Set goals for what you want to achieve. Ask yourself if you want to lose weight, gain weight, build muscle, or improve lung capacity. Some good exercise options include walking, swimming, bicycling, and aerobics. Yoga is an excellent choice for exercise because it incorporates posture, breathing, and concentration which will be beneficial for you during labor. Talk with your healthcare provider about what is best for you.
●Read – Read books on pregnancy and child birth. It is important that you are educated and prepared.
●Track your menstrual cycle – This is very important. Your doctor will ask you about your menstrual cycle, so you need to be prepared. Keeping track of your cycle will also help you track your ovulation and increase your chance of pregnancy. Products to Help Track Ovulation
●Practice relaxation techniques – Relaxation can help minimize stress, and as you have already read, stress is not a woman’s best friend. Try Yoga or listening to soft relaxing music in a warm bath. View yoga DVD
●Get lots of sleep – If you are not receiving 8 hours of sleep a night, you should start. Adequate amounts of sleep can also help relieve stress and tension.
●Eat healthy – Nutrition is vital to your health. The healthier you are the easier the pregnancy will be for you. You might start on some supplements to make sure you are getting all the nutrients you need. Just make sure to tell your health care provider about any supplements you are taking.

Nutrition

You are what you eat, and so is your baby. Make sure that you are getting lots of vitamins in your diet, and start taking folic acid now. Studies have shown that folic acid (300-400mcg a day) can help reduce the risk of neural tube defects when taken before conception.

For more information on the suggested amount of vitamins to consume during pregnancy (which is the same for preconception) look at our chart on Essential Nutrients & Vitamins.

Maintain an ideal weight

Your weight can play a significant role during conception and pregnancy. When planning to conceive you want to avoid being over or under weight.

Underweight (10% below normal range)
●Exercise to build muscle
●Increase energy intake
●Eat at least three meals a day
●Eat more food at each meal
●Eat more snacks
●Drink juices and milk

Overweight (20% above normal range)
●Choose a realistic eating plan
●Make sure your eating plan includes nutritional adequacy
●Drink adequate amounts of water
●Combine your eating plan with exercise

Discuss any plans for weight loss or gain with your healthcare provider.

Make a doctor’s appointment

It is important that you see your doctor before you become pregnant. There are medical conditions that you may not be aware of that can affect your pregnancy. Some of the most common conditions include:
●Diabetes – If you are diabetic you should get your diabetes under control. Pregnancy increases the chances of diabetes, and it can make it hard for a mother who is already suffering from diabetes.
●High blood pressure – If you have high blood pressure before pregnancy, you must closely monitor your blood pressure during pregnancy.
●Anemia – A complete blood count (CBC) can measure your hemoglobin, red & white blood cell count, and the appearance of your platelets. Anemia can cause weakness and fatigue during pregnancy.
●Thyroid problems – The test to check for thryoid issues consists of a blood test which measures your thyroid-stimulating hormone (TSH). Hyperthyroidism (overactive) can lead to premature birth and low birth weight if left untreated. Hypothyroidism (underactive) can lead to infertility or miscarriage when left untreated.
●STDs – It is best to know if you have an STD before getting pregnant, since some STD's can cause pregnancy compliations. For example, ectopic pregnancy is a risk for a woman who has chlamydia. If chlamydia is left untreated, it can also lead to Pelvic Inflammatory Disease (PID) which can cause infertility.

Other testing and screening that is common during a preconception health check up are:
●Pap Smear – A pap smear can check for cervical dysplasia.
●Breast exam – If over the age of 35, you may receive a mammogram.
●Blood type – If you are RH negative you will have to be desensitized prior to labor.
●Immunity to Rubella (measles) – The March of Dimes recommends that all women be tested for immunity to rubella before they become pregnant and that they consider being vaccinated at that time if they are not immune. The Centers for Disease Control and Prevention (CDC) recommends that a woman wait at least 4 weeks after receiving the vaccination before trying to conceive.
●Immunity to Varicella (chicken pox) – As with rubella it is recommended that all women be tested for immunity to varicella before they become pregnant and that they consider being vaccinated at that time if they are not immune. The CDC recommends that a woman wait at least 4 weeks before trying to conceive after receiving the vaccination.

At your appointment you will also be asked for your medical and family history.

Medical history may include:
●Medications you take
●Past pregnancies
●Diet
●Exercise
●Medical conditions

Family history may include:
●Diabetes
●High blood pressure
●Seizure disorders
●Mental retardation
●Twins

Some couples may also need to seek Genetic Counseling. For the majority of couples, genetic counseling is not necessary.

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Pre-Pregnancy Health

Pre-Pregnancy Health at a Glance
●Good nutrition, exercise, and healthy lifestyle choices are important before and during pregnancy
●Schedule a visit with a health care provider before getting pregnant
●Look for a prenatal care provider before your pregnancy

All women thinking about getting pregnant want to have the healthiest pregnancies possible. One way to have the best pregnancy you can have is by planning for it ahead of time. If you are planning to become pregnant, it is a good idea to start making some changes as if you already were pregnant. You may benefit from changing your diet or lifestyle habits.

Doing your best to keep yourself healthy before and during pregnancy will help you to be more prepared to handle the changes that come with being pregnant. Here are some questions we hear women ask when thinking about getting pregnant. We hope you find the answers helpful.

★Should I Visit a Health Care Provider Before Getting Pregnant?

Many women and their partners can benefit from talking to a health care provider about their plan to become pregnant. A health care provider can tell you about any tests that you may want or need, as well as any lifestyle or diet changes that you may want to make. These kinds of appointments are sometimes called pre-conception or pre-pregnancy planning visits.

At a pre-pregnancy visit, your health care provider will take your medical history. Your provider may also ask about the potential father's medical history. This checkup may also include an overall physical exam, Pap test and pelvic exam and blood and urine tests.

Pre-pregnancy visits especially benefit women with certain conditions that can make a pregnancy more difficult. Make sure to schedule a pre-pregnancy visit if you
●have heart or kidney disease, high blood pressure or other chronic conditions such as diabetes, lupus, or HIV/AIDS
●have a history of unexplained stillbirths, miscarriage, or have had other children born prematurely
●know you are at personal risk of having a child with birth defects or a genetic disorder
●have or have had a sexually transmitted infection
●have a weight problem or a history of eating disorders
●are older than 35

★Do I Need to Change What or How Much I Eat?

Once you become pregnant, you will need to eat about 100–300 more calories per day. If your weight falls within a normal range, you should gain no more than 35 pounds by the end of the pregnancy. If you have trouble keeping a healthy weight, this may be different for you.

Before you get pregnant, it's a good idea to try to eat healthy foods so that you are as healthy as possible. Many of us know of ways we could improve our diet. But we also know how hard it can be to change what and how much we eat.

It can make it easier to begin by first adding more healthy foods into your diet before taking away unhealthy foods. Start by adding more fresh fruits and vegetables into your diet. This will put you on the right track toward a more balanced diet that contains
●Carbohydrates
A little more than half of what we eat should be carbohydrates (carbs). Try to get most of your carbs from whole grains, like whole grain bread and brown rice. Avoid sugary foods and drinks like candy and soda.
●Protein
Protein helps the fetus grow. Protein is found in meat and dairy products as well as tofu and beans. If you follow a vegetarian or vegan diet, you can still have a healthy pregnancy. But talk to your health care provider to make sure you are getting enough protein.
●Fats
Fats help us absorb vitamins. Most of us get enough fat in our diet. It is important during pregnancy to get fat from fish and vegetable sources.
●Fiber
You can get fiber through fruits, vegetables, and whole grains. Have at least 3–5 servings per day. Many women experience constipation when they are pregnant. Eating fiber can help you avoid constipation.

★Do I Need Extra Vitamins?

Yes. One of the most important changes you should make in your diet is adding more foods that contain folic acid — a type of vitamin B. Folic acid helps prevent birth defects in the brain and spinal cord if taken before pregnancy and very early in pregnancy. Folic acid is found in
●leafy, green vegetables
●fortified breakfast cereals
●beans
●oranges

But it's often difficult for women to get enough folic acid and other vitamins from food alone. Taking a multivitamin will help you to get folic acid and other vitamins that are important before and during pregnancy. Beware that it is possible to get too much of some vitamins and minerals during pregnancy. For example, too much vitamin A can cause birth defects. Health care providers often prescribe a prenatal vitamin for women to take before and during pregnancy to make sure they get the right amount of vitamins.

★Do I Need to Change My Lifestyle?

Some of the most important changes you make before and during pregnancy have to do with exercise, smoking, using drugs or alcohol, reducing stress, and making sure you are safe at work. Changing certain habits can be stressful, so it may be easier to start now, rather than waiting until you are pregnant.

1. EXERCISE REGULARLY.

Exercise will make you feel better and give you more energy. It can help to make you stronger and better able to handle delivery.

If you do not exercise now, talk to your health care provider about the best way to start. Many women enjoy walking, swimming, yoga, and other moderate exercise while pregnant. And most women can continue moderate exercise throughout their pregnancy. Talk to your health care provider about what type of exercise is right for you.

2. STOP SMOKING.

Quitting smoking is a lifestyle change that can help everyone — women and men — improve their health. Many women are especially motivated to quit smoking when planning a pregnancy. There are many reasons to stop smoking before becoming pregnant.

Women who smoke
●take longer to get pregnant than nonsmokers
●have higher rates of miscarriage than nonsmokers
●expose the growing fetus to dangerous chemicals
●are more likely to have low birth weight babies with serious health problems

Remember, "passive smoking," or breathing secondhand smoke, can also have negative effects on pregnancy. If you live with someone who smokes, ask him or her to smoke outside.

3. STOP DRINKING ALCOHOL.

Most health care providers tell women not to drink at all during pregnancy. There is no known safe amount you can drink during pregnancy. There is also no safe time to drink during pregnancy.

Women who drink put their babies at risk for Fetal Alcohol Syndrome (FAS), which can cause serious physical and developmental harm.

It is a good idea to cut down or stop drinking alcohol around the time you are trying to get pregnant. This is because you will not know right away that you are pregnant.

4. DON'T ABUSE DRUGS OR PRESCRIPTION MEDICATIONS.

Using addictive or habit-forming illegal drugs such as cocaine, crack, heroin, crystal meth, LSD, and marijuana can cause serious problems for a developing fetus.

Legal prescription drugs can also be addictive and cause harm during pregnancy. You should check with your health care provider before taking any medications.

5. REDUCE STRESS AND AVOID DANGERS.

Get plenty of rest and relaxation. Be sure to take the time to do things that you enjoy and that relax you. Enjoy your sexuality, too. Having sex can help reduce stress and the tensions that can build up when planning for and during a pregnancy. Most women who want to are able to enjoy sex throughout pregnancy.

Beware of dangers on the job. Some jobs may be harmful before and during pregnancy. Talk with your boss and health care provider to figure out how you can avoid dangerous substances and situations, such as standing too long or working too many hours in a row. Try to find ways to reduce job stress, too.

★What Is a Man's Role in Pre-Pregnancy Health?

If you are planning a pregnancy with a male partner, his health is also important. There are things that can cause his sperm count to be low and affect the quality of semen. Low sperm count can make it difficult to get pregnant.

Some habits that can affect sperm count include
●drinking alcohol
●smoking or other tobacco use
●using steroids
●using illegal drugs
●using certain prescription drugs and over-the-counter medicines
●using saunas, hot tubs, or whirlpools over 102° F
●having an unhealthy diet

Talk to your partner about making lifestyle choices that can increase his health and help you and your future pregnancy.

★Do I Need a New Health Care Provider During Pregnancy?

Now is also a good time to begin looking for a health care provider who you will see for prenatal care once you become pregnant.

You may want to continue to see your current gynecologist or family doctor throughout your pregnancy. Or you may want to find a new health care provider for your prenatal care. Ask people you trust — friends, family members, health care providers — for recommendations for doctors or midwives.

It is most important that you feel comfortable talking freely about what kind of pregnancy and birth you want to have. Feel free to interview any health care provider that you want to help with your pregnancy, labor, and delivery. Do not be afraid to change providers if you do not feel comfortable.

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What It Costs to Have a Baby
The expenses you’ll face when you have your first baby, and tips for spending wisely on your newborn.
By Heather Hatfield
Reviewed by Laura J. Martin, MD

For future moms who are thinking about having a baby, you usually ponder the excitement of pregnancy and the joy of holding your newborn in your arms. The price tag of actually bringing your child into the world is an afterthought.

But when you sit down with a calculator and start adding up the expense of pregnancy, giving birth, and what you need to survive the first few weeks with a newborn, the dollar signs appear.

From the price of diapers to the going rate for a cesarean section, here’s the bottom line for moms-to-be who want to learn more about the cost of having a baby, as well as where to save, and where to spend wisely.

The Price of Pregnancy

Although it’s easy to get excited about the countless number of baby supplies you can buy during the course of your pregnancy, your focus here should be not so much on spending but on your health, and your baby’s.

“Early and continuous prenatal care is essential both before and throughout your pregnancy to help ensure a healthy delivery, and healthy baby,” says Jeanne Conry, MD, an obstetrician with Kaiser Permanente in Sacramento, Calif.

This is where health insurance comes into play for the first time during your pregnancy -- if you have it, these visits and any diagnostic tests like ultrasounds will likely be covered and are generally considered preventive care. If not, be prepared -- the average cost of prenatal care is about $2,000, if you're paying out of pocket.

One of the most important elements of prenatal care is a prenatal vitamin, which contains at least 600 mcg of folic acid and aids in preventing some birth defects, like neural tube defects. This is one cost that should be incurred even before you get pregnant; because about half of all pregnancies are surprises, women of childbearing age should be on a multivitamin that contains folic acid, Conry says.

Ranging in price from $10 to $20 for an over-the-counter option, or the cost of a co-pay if covered by your insurance company and prescribed by your doctor, this could be one of the most important pregnancy investments you make.

Other pregnancy-related costs are maternity clothes, which can range from free if you hit up your mom-friends for hand-me-downs, to middle-of-the-road department store finds, to designer duds that cost hundreds of dollars. If you’re looking to save, this is one way to pinch pennies by borrowing and consignment shopping.

Preparing for Baby

Shopping for a newborn baby can be overwhelming, especially for first-time moms who aren’t sure what is necessary, and what’s just nice to have. Even more intimidating than the endless aisles of baby supplies is the chance of going overboard on baby luxuries that you’ll never use, but cost a fortune.

“There are thousands of baby products on the market for new moms to consider, but frankly speaking, most are nice-to-haves,” says Lori Hill, a certified doula with the Doulas of North America in Williamsburg, Va.

You need to focus on what you and your baby can’t go without first from a cost perspective, she says, and then figure out how much you have left over to spend on accessories.

The fundamentals can be simple: a car seat, a crib, diapers and wipes, a changing table, a few baby clothes to get you started, and a baby monitor. A thrifty mom can make these buys for about $450 by shopping bargains, but don’t sacrifice safety to save a buck, especially on the car seat and crib. The American Academy of Pediatrics recommends avoiding older, used car seats to ensure maximum protection for your child and using cribs certified by the Juvenile Products Manufacturers Association (JPMA).

Diapers and wipes are other essentials that you need to purchase during pregnancy in preparation for baby’s arrival. The good news is these both offer opportunities to save by either buying in bulk -- a 250-pack of diapers usually costs about $40 -- or by using cloth diapers. Wipes can also be substituted for washcloths, saving you about $10-$15 for a box of almost 400, which typically lasts a few weeks for one child.

Baby clothes are like maternity clothes -- you can spend hundreds or even thousands outfitting your little one, or ask around for gently worn hand-me-downs that will get you started. Since baby grows out of her outfits so fast, this might be a way to save.

Another important cost when you are getting ready for baby’s arrival is childbirth education, says Hill. Ranging in price from approximately $50-$200, these classes can help a new mom with the trials of pregnancy and childbirth, and surviving the first few weeks with a newborn.

“Education, preferably in the form of childbirth, infant care, and breastfeeding classes, really is an important part of preparing for delivery and bringing baby home,” Hill says.

The Hospital Expense

Where the cost of having a baby can really add up is at the hospital. With the average charge of an uncomplicated cesarean section more than doubling from 1993-2007, and the cost of an uncomplicated vaginal delivery almost tripling during that same time period, first-time moms really need to make sure they are well-prepared financially for this part of pregnancy -- especially if you don’t have health insurance.

“Looking at a sample of nine states, researchers found that 17% to 41% of childbearing women lacked insurance before coming pregnant," says Carol Sakala, director of programs at Childbirth Connection, a national nonprofit organization that works on behalf of mothers and babies to improve the quality of maternity care in the U.S. “While 13% to 35% of the pregnant women qualified for Medicaid coverage, many either didn’t qualify or didn’t apply, finding private insurance or paying out of pocket," Sakala says.

For these women, the costs of childbirth can be a significant financial pitfall. Data gathered from 2008 by the Agency for Healthcare Research and Quality shows that the charge for an uncomplicated cesarean section is approximately $15,800, while an uncomplicated vaginal birth runs about $9,600.

The underinsured run a risk here as well. Women who have individual policies often find that maternity care coverage is completely excluded, versus Medicaid or group private insurance plans that cover almost all pregnancy-related healthcare costs, Sakala says. This means that coverage is only available with a large surcharge, or that only a portion of maternity care services are covered.

“It’s important to be aware that these numbers reflect the amount a hospital will charge for these services, rather than the actual cost,” says Anne Elixhauser, PhD, senior research scientist at the Agency for Healthcare Research and Quality. “The actual amount of what it costs the hospital to perform the service is about 30% of what’s charged.”

For an uninsured woman or someone facing out-of-pocket costs, this is an important negotiating tool.

“Ask and negotiate with a hospital to pay a discounted rate,” Sakala says. “Since what is being charged is significantly higher that the actual cost, you have some room to potentially save.”

The Bottom Line

When it all adds up, bringing your firstborn into the world can either break the bank if you don’t have health insurance, or run the cost of a few important supplies if you do. Here’s a cheat sheet of some of the approximate costs -- or ranges, depending on your insurance situation -- you’ll face when you decide to its time to have a baby:
●Prenatal care: $0-$2,000
●Prenatal vitamin: $15/30-day supply
●Maternity clothes: Free, if shared
●Crib: $200
●Wipes: $10/box of 400
●Diapers: $40/box of 250
●Monitor: $25
●Changing table and pad: $125
●Baby clothes: Free, if shared
●Car seat: $125
●Childbirth classes: $50-$200/class
●Hospital costs: $0-$15,000

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How Much Does It Really Cost to Have a Baby?
A lot more than you think, according to results from our survey.
By Pamela Paul

Everybody knows that having a child puts a dent in your family finances, but not everybody plans for it. What's worse, even those who do plan have lots of misperceptions about just how big an impact a little baby can have, according to a survey of 1,000 new and expectant parents commissioned by Redbook and VISA. And in this case, what you don't know can hurt you: Financial strain only compounds the emotional challenges a newborn brings to a household. "The smartest thing you can do is sit down before you have your baby and map out a financial plan," says Rosetta Jones, a vice president at VISA USA, which provides a baby budgeting calculator at practicalmoneyskills.com. Unfortunately, fewer than half of expectant parents surveyed even bothered to create a new budget that includes expenses for their baby. Read on to learn about other money mistakes new parents make the most — and what you can do to avoid them.

Where'd All the Money Go?

76% of expectant parents say they feel financially prepared for having a baby — but 41% of new parents admit that, in hindsight, they were not as financially prepared as they thought.

Why the huge discrepancy? It turns out there's a major financial roadblock that expectant parents often fail to account for: hospital bills. One in four new parents ended up spending more than $2,000 on out-of-pocket costs for services associated with a normal delivery — costs that they thought would be covered by insurance. On average, expectant parents are allotting just $776 to cover out-of-pocket delivery costs.

Call your insurance company to find out exactly what will be covered for your delivery. And make sure you have the right idea about postdelivery costs too: Log on to the Internet to see what you could be paying for day care, a crib, a car seat, a stroller — even baby wipes, formula and diapers (at eight a day for newborns, they add up fast!). Then tally up what your costs will likely be, factoring in your family's lost income due to maternity and paternity leave. But don't forget — you'll have new savings, too, since you'll be going out a lot less once the baby arrives! "New parents don't spend on personal indulgences the way they used to," says Brette McWhorter Sember, author of Your Practical Pregnancy Planner. "These savings bring some balance to the enormous new costs."

Hey, Big Spender!

Nearly half of new parents say they spent more money than necessary on a car seat; 36% overspent on strollers; about 25% went overboard on baby photos, a crib and clothing.

All new parents say they won't lavish their child with toys and clothes. But many respondents to our survey did just that. And you can't really blame them. "There's been a huge surge in luxury items for babies," says Tamara Draut, author of Strapped: Why America's 20- and 30-Somethings Can't Get Ahead. "No matter what a couple's financial status is, they feel pressure to buy these things — the bar has been raised for everybody."

How can you fight the urge to splurge? Let someone else do it for you. If you've really got to have that $300 stroller, put it on your gift registry. Expectant parents in our survey were counting on their friends and family to buy 46 percent of their baby's first year of clothes, 40 percent of toys and 39 percent of baby-care items as gifts. Another alternative: Hit thrift stores or eBay to find what you want, albeit used. Miriam Nunberg, a 41-year-old mother of two from Brooklyn, scours yard sales for toys and tricycles. "People get rid of this stuff when their babies grow out of them and you can buy them for almost nothing," she says. Another tactic: Borrow. Ask your friends and family for hand-me-down clothes, used toys and gear.

Sweating the Small Stuff

48% of expectant parents think that managing everyday expenses will be their biggest financial worry, but only a third of new parents feel the same way.

Even though expectant parents tend to underestimate the overall financial impact of having a baby, they also overestimate the cost of daily expenses. Expectant parents figure on spending an average of $120 a month on diapers; new parents actually spend half that. What gives? New parents are savvier shoppers: Three-fourths of them shop for baby items at discount retailers, compared with only half of expectant parents. It makes sense: A Consumer Reports comparison recently found that some store-brand diapers work just as well as brand-name ones and cost a lot less — assuming you change six diapers a day, you'd save about $220 a year.

The best news about basic baby costs: "Daily baby expenses, such as for food, diapers and wipes, actually haven't gone up dramatically over the years," says Alan Fields, coauthor of the shopping guide Baby Bargains.

And Baby Makes Stress

36% of expectant parents anticipate that tension in their relationship will increase after their baby's birth. Watch out: Nearly half of new parents found that to be the case.

Of course, not getting any sleep and dealing with a crying baby don't help matters, but the added financial responsibilities also put a lot of added strain on relationships: Most new parents say baby expenses have increased their stress level, and the majority of expectant parents predict that they'll be in the same boat. In addition to the simple strain of all the new costs, there's uncertainty and disagreement as to what's really necessary — a sure formula for conflict. And once the baby arrives, couples tend to work together less on their finances. In our survey, the percentage of couples who split their family's financial management equally dropped from 44 percent before the baby was born to 32 percent after the baby's arrival. Who's taking on the added responsibility? Mom! Half of new mothers report that they handle the family money, up from 37 percent prior to the baby's birth.

"The combination of having a kid and all the financial pressures that involves, especially when one parent stays home for a while, naturally leads to relationship stress," says David Bach, author of Smart Couples Finish Rich. What can you do to cut down on the stress? Richard Ryan, a psychology professor at the University of Rochester, advises couples to keep one concept in mind: teamwork. Whether it's a big-impact issue like a budget or a small one like buying a toy, keep each other in the loop and discuss concerns openly. "The goal is to focus on agreement," says Ryan. That's not easy to do, but according to our survey, couples believe they can make it work: The majority of new and expectant parents say they are prepared to tackle any challenge. And that mutual optimism is money in the bank.

Baby Budgeting, Then and Now

Surprise — the prices on many baby items have gone down in the last decade. (1994 prices have been adjusted for inflation.)

Diapers
1994: Huggies 100 count Step 1 diapers at Costco, $19.58
2005: Huggies 100 count Step 1 diapers at Costco, $13

Wipes
1994: 336 count Pampers Baby Fresh Wipes at Sam's Club, $10.22
2005: 336 count name-brand wipes at Costco, $7.70

Formula
1994: 16-oz. can of name-brand formula at grocery store, $10.17
2005: 16-oz. can of name-brand formula at grocery store, $17.60

Crib
1994: average, $196
2005: average, $220

Clothes
1994: average cost of first year's layette, $653
2005: average cost of first year's layette, $500

Source: babybargains.com

How They Manage

The Bargain Hunters

Kam Aures, 31, a stay-at-home mom, and T.J. Aures, 29, a corrections officer, Boulder Junction, WI - Parents of Cayden, 18 months

Kam and T.J. were both raised by stay-at-home moms and wanted the same experience for Cayden. So they saved for months before Kam even got pregnant. Once she did, she combed library sales for books and garage sales for clothing. "I've found Ralph Lauren outfits for a dollar," she says. Kam nursed Cayden for about nine months, then got three months of free formula by using coupons. The Aureses have kept their daily expenses low, so they can afford to splurge now and then. "Sometimes there's a really cute outfit that you just can't pass up," says Kam.

Caught Off Guard

Lisa Hazen, 34, a Web designer, and Shawn Hazen, 32, an art director, Oakland
Parents of Finn, 4 months

The Hazens knew a baby meant all kinds of new expenses, but they were still surprised: "Living in the San Francisco Bay area, I've been shocked by how expensive everything is for a baby," Lisa says. "Child care is going to cost $1,000 a month, even with me going back to work only three days a week." The Hazens have curtailed dinners out and other expenses, but they're still just scraping by. "We're trying to cut wherever we can," says Lisa.

Smarter with the Second

Caroline Morris, 35, a communications manager, and Andrew Morris, 38, a management consultant, Atlanta Parents of Lindsay, 3, and Claire, 7 months

The Morrises spent hundreds of dollars on high chairs, bouncy seats and other gear for Lindsay. "When you're a first-time mom, you just don't know what will work when you have a screaming baby," says Caroline. But once she realized that every toy looked battered within a few days, Caroline decided to shop at consignment stores. With Claire, the Morrises were money-conscious from the get-go, shopping at Costco for store-brand diapers. Says Caroline, "The child doesn't know the difference and it's usually just as good."

Facing a Scary Surprise

Devona Burt, 30, a stay-at-home mom and student, and Charlie Burt, 34, a construction manager, Houston, TX - Parents of Byson, 15 months

Devona and Charlie Burt thought they were financially prepared for their baby — they even had $4,000 saved for baby-related expenses. But Byson was delivered prematurely, and the Burts were hit with, among other bills, $200 in monthly insurance co-payments and $45 a week for hospital parking. "Our savings were completely wiped out," says Devona. Byson's health is improving, she says, a blessing that offsets any financial setback.

The 10-Year Plan

Here's what you can expect your annual kid expenses to be through your child's 10th birthday, depending on your income.

Child's Age  Household Income
      Less than $41,700  $41,700 to $70,200  $70,201 or more
< 1       $7,040       $9,840       $14,620
1         7,250       10,140       15,070
3         7,890       11,070       16,370
5         8,380       11,760       17,380
10         9,750      13,380        19,540
Source: U.S. Department of Agriculture

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How much does having a baby cost?
10 Money Saving Tips for Prenatal Care, Labor and Delivery
By Robin Elise Weiss, LCCE, About.com Guide

So, what does having a baby cost? A lot of money. Whether you have maternity insurance or not, babies are expensive. There are, however, ways to save yourself money when having a baby. Here are some ways you might consider;

1.Know what your insurance covers and what it does not cover.

You will want to find out, preferably before you are pregnant, what you will be expected to pay. Don't be waved off with the statement that "everything" maternity related is covered. Ask specific questions. Will you have a co-pay or deductible? Will your baby have a separate co-pay or deductible? What procedures and tests are covered in pregnancy? At birth? For newborns?

2.Check your hospital or birth center bill.

There are very likely errors on your hospital bill. If you go over the detailed bill, even if you don't have to pay it out of pocket, you can find the errors and get them fixed. Even having your insurance company save money benefits you in the end with lower premiums. Examples of hospital bill errors include being charged twice for procedures or being charged for medications or procedures you didn't have.

For example, I was charged for a circumcision kit when my daughter was born, she certainly didn't have a circumcision. Another friend of mine was charged for a cesarean section, when she had a vaginal birth. You will also hear stories of being charged for multiple epidurals or other medications.

3.Negotiate a price for prenatal care and birth package.

If you are paying out of pocket for your prenatal care and labor and delivery see if you can get a "deal." Will you save money if you completely prepay all the fees that can be known ahead of time? Will they offer you a discount for going to a certain hospital or birth center? Do not hesitate to shop around for prices for both your practitioner and your place of birth. You are the consumer of their product.

4.Do you really need that?

When you are getting your prenatal care, you might simply take every test that is offered to you. Before you agree to have a medical test or procedure, whether it is an amniocentesis, blood work or an ultrasound, be sure to find out why it is being offered or ordered. Get informed consent. Is this test really necessary? What do you hope or expect to find out from the test? How much does the test cost? Do you really need the test or procedure? You might be really surprised at the answers to all of these questions.

One mother I work with asked her doctor about a test he had ordered. She was really only concerned that the doctor thought something was wrong with her baby. Come to find out that the doctor ordered it for everyone because it was available. He didn't know how much it cost but when she checked into it, the test was nearly $900 and it was not covered by her insurance and didn't really offer her baby any benefit. She declined the test rather than find a surprise $900 medical bill.

5.Prenatal Vitamins

This is a category that most people forget about. Your practitioner may write a prescription for prenatal vitamins. But very rarely do you need a big fancy prenatal. Most mothers are fine with the generic over the counter variety. Can you skip the $25 co-pay for fancy vitamins?

6.Twins on the way?

Twins are tricky when it comes to medical costs. As soon as you know that you are having twins or other multiples call your insurance company. Ask if they can assign you to a case manager. This allows you the ability to call one person to handle your questions. Since being pregnant with multiples increases the risks of complications, though it does not mean that everyone will have complications, you could be looking at a much larger bill. Even if you only pay 10% of your bill, the difference between 10% of $7,000 for a vaginal birth at term and a bill of $200,000 for an extended NICU stay for premature babies is very big.

Your case manager can let you know of special programs to help you stay healthy and increase the odds that your babies will go to term. She can also be your go to gal when it comes down to being charged multiple times incorrectly or, more commonly, having charges denied payment because it was already paid. Think of it like this, two babies, same problem, both get the same drug the same day. Your insurance thinks that the hospital is double billing and denies the second charge. Guess who gets to eat that bill?

7.Consider your birth attendant alternatives.

Did you know that using a midwife may be less expensive? This is true regardless of your insurance status. The cost of midwifery care is a fraction of the cost of the care of other practitioners, mostly because they see only low risk women and they do not do high risk procedures like cesarean sections, forceps, etc.

You may also find that your insurance covers some types of midwives. It may cover a certified nurse midwife in a physician's practice. Or it may cover all midwives in all practices. Talk to both the midwives you are interviewing about insurance costs and bill practices as well as your insurance company.

8.Where you give birth does matter.

Birth center births and home births are typically less expensive than hospital births for a variety of reasons. The first is that there are no high risk procedures done, only low risk mothers are given this option. So you save money by not having to pay for those outright or even a fee because it's there in case you need it.

Another big way that costs are kept down in these settings is the length of stay. With a home birth, you don't go in to any facility for your birth or postpartum care unless there are complications requiring a hospital. The typical stay at a birth center for postpartum care is usually about six hours.

Some women have to pay out of pocket for this birth option. You can use flexible spending money to cover it with most plans. You can set up a payment plan. Some facilities and practitioners still barter. Even if your insurance says that they will not pay some mothers have been successful in submitting it to their insurance. It can take time and energy on your part but even a partial reimbursement is a good thing. Some states have mandated coverage for these options, your insurance company may not tell you this or the person you are talking to may not know. Be sure to ask the home birth practitioner or the people at the birth center.

9.Procedures at Birth

One way to cut costs is to avoid costly procedures when possible. This can include epidural anesthesia and cesarean sections. You may also ask about early discharge from the hospital, say 24 hours rather than 48 for a vaginal birth.

Some women will choose to do this while others will not. The good news is that you can try to avoid these and change your mind as needed. So let's say you decide to go without pain medications and half way through your labor change your mind, you can still do that.

10.Use a doula.

Using a doula can help you lower the need for pain medications as well as help you reduce the need for some costly procedures. While the majority of doula fees are not covered by insurance, the small out of pocket price is worth it for many families. You can also ask a doula for a sliding scale and about bartering, as you could with all of your practitioners.

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