Читать книгу The Expectant Father - Armin A. Brott - Страница 11

The Doctor Will See You Now

WHAT’S GOING ON WITH YOUR PARTNER

Physically

• Continuing fatigue

• Continuing morning sickness

• Frequent urination

• Tingly fingers

• Breast tenderness and darkening nipples

Emotionally

• Continued elation and at the same time some ambivalence about being pregnant

• Inability to keep her mind on her work

• Fear you won’t find her attractive anymore

• Continuing moodiness

• Fear of an early miscarriage, especially if you used ART

WHAT’S GOING ON WITH THE BABY

During this month, the baby will officially change from an embryo to a fetus. By the end of the month, he or she (it’s way too early to tell which by looking) will be about the size of an almond and will have stubby little arms (with wrists but no fingers yet), sealed-shut eyes on the side of the face, ears, and a tiny, beating heart (on the outside of the body). If you bumped into a six-foot-tall version of your baby in a dark alley, you’d run the other way.

WHAT’S GOING ON WITH YOU

The Struggle to Connect

Just about every study that’s ever been done on the subject has shown that women generally connect with their pregnancies sooner than men do. Although they can’t feel the baby kicking inside them yet, the physical changes they’re experiencing make the pregnancy more real for them. For most men, however, pregnancy at two months is still a pretty abstract concept. For me—as excited as I was—the idea that we were really expecting was so hard to grasp that I actually forgot about it for several days at a time.

Excitement vs. Fear

But when I remembered we were about to become parents, I found myself in the midst of a real conflict—one that would plague me for months. On the one hand, I was still so elated that I could barely contain myself; I had visions of walking with my child on the beach, playing catch, reading, helping him or her with homework, and I wanted to stop strangers on the street and tell them I was going to be a father. On the other hand, I made a conscious effort to stifle my fantasies and excitement and to keep myself from getting attached to the idea. That way, if we had a miscarriage or something else went wrong, I wouldn’t be devastated.

Dads who have been through a miscarriage on a previous pregnancy or done several unsuccessful ART cycles are especially susceptible to this kind of self-protective (and completely understandable) denial.

Increased or Decreased Sexual Desire

It was during the times when I let myself get excited about becoming a father that I noticed that my wife’s and my sex life was changing. Perhaps it was because I was still reveling in the recent confirmation of my masculinity, or perhaps it was because I felt a newer, closer connection to my wife. It may even have been the sense of freedom resulting from not having to worry about birth control. Whatever the reason, sex in the early months of the pregnancy became wilder and more passionate than before. But not all men experience an increase in sexual desire during pregnancy. Some are turned off by their partner’s changing figure; others are afraid of hurting the baby (a nearly impossible task at this stage of the game). Still others may feel that there’s no sense in having sex now that they’re pregnant.

Whatever your feelings—about sex or anything else for that matter—try to talk them over with your partner. Chances are she’s experiencing—or soon will be—very similar feelings. One thing you may not want to discuss with your partner is your dreams. According to Berkeley, California (where else?), psychologist Alan Siegel, a lot of expectant dads experience an increase in dreams about having sex—with their partner, old girlfriends, and even prostitutes. For some guys, these dreams are an expression of their concern that the pregnancy will mess with their sex life. The brain is probably saying to itself, “Well, big guy, if you can’t get any in the flesh, you can still have some pretty wild fantasies … ” For other guys, sexual dreams are a way of reassuring themselves that fatherhood—and all those mushy, protective feelings that go with it—in no way detracts from their masculinity.

STAYING INVOLVED

Going to the OB/GYN Appointments

The general rule that women connect with the pregnancy sooner than men has an exception: men who get involved early on and stay involved until the end have been shown to be as connected with the baby as their partners. And at this stage, the best way to get involved is to go to as many of your partner’s OB/GYN appointments as possible.

Although I always love being told that I’m healthy as a horse, I’ve never really looked forward to going to the doctor. And going to someone else’s doctor is even less attractive. But over the course of three pregnancies, I think I missed only two OB medical appointments. Admittedly, some of the time I was bored out of my mind, but overall it was a great opportunity to have my questions answered and to satisfy my curiosity about just what was going on inside my wife’s womb.

There’s no doubt that you can get at least some basic questions answered by reading a couple of the hundreds of pregnancy and childbirth books written for women. But there are a number of other, more important reasons to go to the appointments:

• You will become more of a participant in the pregnancy and less of a spectator. In other words, it will help make the pregnancy “yours.”

• It will demystify the process and make it more tangible. Hearing the baby’s heartbeat for the first time (in about the third month) and seeing his or her tiny body squirm on an ultrasound screen (in about the fifth month) bring home the reality of the pregnancy in a way that words on a page just can’t do.

• As the pregnancy progresses, your partner is going to be feeling more and more dependent on you, and she’ll need more signs that you’ll always be there for her. While going to her doctor appointments may not seem quite as romantic as a moonlit cruise or a dozen roses, there are very few better ways to remind her that you love her and reassure her that she’s not in this thing alone.

• The more you’re around, the more seriously the doctor and his or her staff will take you and the more involved they’ll let you be (see pages 75–76 for more on this).

Looking for Validation

If you’re adopting, the time between your decision to adopt and the actual arrival of your child could be considered a “psychological pregnancy.” Unlike a biological pregnancy, you won’t, in most cases, know exactly how long it’s going to take from beginning to end. But what’s interesting is that most expectant adoptive parents go through an emotional progression similar to that of expectant biological parents, says adoption educator Carol Hallenbeck. The first step is what Hallenbeck calls “adoption validation,” which basically means coming to terms with the idea that you’re going to become a parent through adoption instead of through “normal” means. During their psychological pregnancy, adoptive parents often experience the same kind of denial that I described above, not letting themselves get too excited out of fear that the adoption could take far longer than they expected or that it will fall apart completely.

If you and your partner have hired a surrogate, there’s a good chance that you’ll be going through a psychological pregnancy as well. Unlike an adoptive couple, you have a much better idea of when your baby will be born, but you may still go through what might be called “surrogacy validation.”

This may seem straightforward, but it’s usually not. For many parents, according to researcher Rachel Levy-Shiff, adoption (or surrogacy) is a second choice, a decision reached only after years of unsuccessfully trying to conceive on their own and after seemingly endless disappointments and intrusive, expensive medical procedures. Infertility can make you question your self-image, undermine your sense of masculinity (how can I be a man if I can’t get my partner pregnant?), force you to confront your shattered dreams, and can take a terrible toll on your relationship. If you’re having trouble accepting the fact that you won’t be having biologically related children, I urge you to talk to some other people about what you’re feeling. Your partner certainly has a right to know—and she might be feeling a lot of similar things. In addition, the adoption agency you’re working with will probably have a list of support resources for adoptive fathers. Give them a try.

If you’re planning to go to your partner’s checkups, you’d better get your calendar out. Here’s what a typical schedule looks like:

MONTH	IF YOU’RE EXPECTING ONE BABY	IF YOU’RE EXPECTING MULTIPLES
1–5	Monthly	Monthly
6	Monthly	Every other week
7	Every other week	Every other week
8	Every other week	Weekly
9	Weekly	Weekly

Of course, taking time off from work for all these appointments may not be realistic. But before you write the whole thing off, check with the doctor—many offer early-morning or evening appointments.

Screening and Testing

Besides being a time of great emotional closeness between you and your partner, pregnancy is also a time for your partner to be poked and prodded. Most of the tests she’ll have to take, such as the monthly urine tests for blood sugar and the quarterly blood tests for other problems, are purely routine. Others, though, are less routine and sometimes can be scary.

The scariest of all are the ones to detect birth defects, most commonly Down syndrome and other chromosomal abnormalities. One of the things you can expect your partner’s doctor to do is take a detailed medical history—from both of you. These medical histories will help the practitioner assess your risk of having a child with severe—or not so severe—problems (see pages 59–60 for more on this). If you’re in one of the high-risk categories, your doctor may suggest some additional prenatal screening.

The words screening and testing are often used interchangeably, but there’s actually a big difference between them. Noninvasive procedures such as ultrasounds and blood tests are used to assess potential risks. If the risk is high enough, the doctor may order a test to confirm a diagnosis. Those tests are usually invasive (to your partner and your baby) and involve some risk. The OB will be able to help you decide whether the benefits of taking the test (knowing whether your baby is healthy) outweigh the potential risks (causing a miscarriage).

If you did ART and PGD (preimplantation genetic diagnosis; see pages 298–299), you and your partner may not have to be tested at all—the lab was able to test the embryo itself for more than a hundred diseases and abnormalities. If any were found, that particular embryo wouldn’t have been implanted. However, because there is a small risk of getting a false negative on the PGD, many fertility doctors will recommend additional testing once the pregnancy is underway.

NONINVASIVE PROCEDURES

ULTRASOUND (SONOGRAM)

This noninvasive test is painless to the mother, safe for the baby, and can be performed any time after the fifth week of pregnancy. By bouncing sound waves around the uterus and off the fetus, ultrasounds produce a picture of the baby and the placenta. To the untrained eye, standard, 2-D images look remarkably like Mr. Potato Head, without the glasses and mustache. 3-D ultrasounds generate a more complete image of the fetus. And 4-D ultrasounds (sometimes called dynamic 3-D) actually let you see your future baby in action, sucking his thumb, napping, swimming, and doing whatever else fetuses do to pass the time.

In the first trimester, your doctor will probably recommend an ultrasound only if there’s something going on that’s a little out of the ordinary. The most common reason is that the size of the uterus doesn’t correspond to the age of the fetus when measured from your partner’s last period. The doc may also order an ultrasound if your partner has experienced any bleeding, if there’s any doubt as to the number of fetuses, or if he or she suspects an ectopic pregnancy (a pregnancy that takes place outside the uterus). At this stage, the ultrasound can confirm that there’s a heartbeat and can measure the baby (starting with the charmingly named Crown-Rump Length, which will give you a better due date estimate).

Depending on your partner’s risk, her doctor may offer or recommend a nuchal translucency ultrasound (NT scan), a special type of ultrasound that measures fluid in the nuchal fold, a spot at the base of your baby’s head. Excess fluid in that area is often associated with chromosomal abnormalities and some heart conditions. The test needs to be done between 11 and 14 weeks and is usually part of what’s called the combined first trimester screening, which includes a blood test measuring your partner’s levels of pregnancy associated plasma protein A (PAPP-A) and a hormone called hCG. The combined test is about 85 percent accurate and has a false-positive rate of 5 percent.

There’s also an integrated screening, which uses the results of the combined screening and adds in the Quad test I describe below, which is done between 15 and 20 weeks. Taken together, this increases the detection rate and reduces the false-positive rate to about 1 percent.

Second-trimester ultrasounds are usually the ones that low-risk couples see first. They’re used to determine the sex of the baby (this one is optional), to get a more accurate estimate of the due date, or just because you’re curious about what the baby looks like. If this is the first ultrasound, your practitioner will want to confirm the number of residents in the uterus, see how well they’re moving around, and make sure all the body parts and organs are the right size and in the right place. The test may also be used to firm up the due date and to confirm anything that may have come up in other prenatal testing, including the Triple or Quad Screen, amniocentesis, and CVS (see pages 61–62).

During the last part of the pregnancy—and especially if the baby is overdue—your partner’s doctor may order additional ultrasounds to determine the baby’s position, to make sure the placenta is still functioning, or to confirm that there’s still enough amniotic fluid left to support the baby.

TRIPLE OR QUADRUPLE SCREENS

The Triple Screen measures three chemicals that may show up in your partner’s blood: AFP (Alpha-Fetoprotein), hCG (human chorionic gonadotropin), and estriol. The Quad adds one more substance, Inhibin A, to the screen, and there’s actually a Penta, which includes yet another substance, ITA (Invasive Trophoblast Antigen). Together they’re used to flag potential abdominal wall abnormalities and a variety of neural-tube defects (defects relating to the brain or spinal column), the most common of which are spina bifida and anencephaly (a completely or partially missing brain). Whether you have the Triple, the Quad, or the Penta (is this is sounding like Olympic gymnastics judging, or is it just me?) will depend on what your doctor orders. Theoretically, the more things you test for, the lower the false-positive rate.

These simple blood tests are conducted when your partner is 15–20 weeks pregnant, and the results are usually available within a week, sometimes even the next day. It’s important to understand that a “positive” result is not necessarily an indication of the presence of an abnormality, just that there might be a problem. Most turn out perfectly fine, but if your partner does get a positive result, she’ll be asked to take additional tests, such as an ultrasound and amniocentesis, which should clear up any doubts you have. Since these screens are really designed to let your partner know whether she needs additional testing, she may not want to bother if she’s planning to have an amnio or an in-depth ultrasound test.

TESTS YOU MAY HAVE TO TAKE

No, you’re not pregnant, but there are still a few times when you may need to give a little blood to make sure all is well with your baby. A variety of genetically transmitted birth defects, for example, affect some ethnic groups more than others. So, based on your family histories, your partner’s doctor may order one or both of you to get additional blood tests. OB Saul Weinreb told me that “every person in the world is estimated to carry thousands of potentially harmful genetic mutations, which means that every couple has an approximately equal chance of having a baby with a random genetic disease they had no idea they carried.” The good news is that science has been able to identify certain diseases that occur more commonly in certain ethnic groups. So rather than think of these groups as somehow genetically worse off than others, think of them as being lucky that there are tests for conditions that may affect them. New tests are being developed every day. Among the most commonly identifiable conditions are:

• Sickle-cell anemia. If you’re African American or if your family came from the Caribbean, Italy, Sardinia, or India, you may want to be tested whether your practitioner suggests it or not. If your partner knows she’s negative, though, ask the doctor whether you should bother.

• Tay-Sachs and Canavan Disease. If either you or your partner is of Ashkenazi (Eastern European) descent, get tested. Tay-Sachs is also found in some non-Jewish French Canadians. Interestingly, once your partner is pregnant, it is more accurate to test you for these conditions than to test her. If your results come back positive, she’ll need to be tested, though.

• Cystic fibrosis. The American College of Obstetricians and Gynecologists now recommends that OBs offer cystic fibrosis testing routinely.

• Thalassemia. Affects mainly families of Asian, Southeast Asian, African, Middle Eastern, Greek, or Italian origins.

You may also have to be tested if your partner has a negative Rh (for rhesus, like the monkey) factor in her blood. If you’re positive (and most of us are), your baby might be positive as well. If this is the case, your partner’s immune system might think the Rh-positive baby is some kind of intruder and try to fight it. This can lead to fetal brain damage or even death. Fortunately, this problem is preventable: your partner will have to get some anti-Rh injections, starting around the 28th week of the pregnancy.

INVASIVE PROCEDURES

AMNIOCENTESIS

This extremely accurate test is usually performed at 15–18 weeks, and can identify nearly every possible chromosomal disorder, including Down syndrome. It can’t, however, detect deformities such as cleft palate. If your baby is at risk of any other genetic conditions, your partner’s doctor can order additional testing (but these tests are not done routinely). Amnio is also sometimes used in the third trimester of pregnancy to help doctors determine whether the fetus’s lungs are mature enough to survive an emergency premature delivery, if they’re worried about that. The test involves inserting a needle through the abdominal wall into the amniotic sac, where about an ounce of fluid is collected and analyzed. Results are usually available in one to three weeks. Unless your partner is considered at high risk (see page 61), or either of you needs to be reassured that your baby is healthy, there’s no real reason to have this test. The chances that a twenty-five-year-old woman will give birth to a baby with a defect that an amnio can detect are about 1 in 500. The chances that the procedure will cause a miscarriage, however, are 1 in 200. For women over thirty-five, though, amnio begins to make statistical sense: the chances she’ll have a baby with chromosomal abnormalities are roughly 1 in 190 and rise steadily as she ages. At forty, they’re about 1 in 65; at forty-five, 1 in 20.

Reasons Your Partner (or You) Might Consider Genetic Testing

• One of you has a family history of birth defects, or you know you’re a carrier for a genetic disorder such as cystic fibrosis, muscular dystrophy, or hemophilia.

• One of you is a member of a high-risk ethnic group, such as African Americans, Native Americans, Jews of Eastern European descent, Greeks, Italians, and others (see “Tests You May Have to Take,” pages 59–60).

• Your partner is thirty-five or older.

• Your partner has had several miscarriages.

• Your partner had a positive Triple (or Quad or Penta) Screen (see page 59).

• One of you might be a carrier of specific genes that have been linked with birth defects.

Other Reasons for Prenatal Testing

Prenatal testing is also available to people who, while not considered at risk, have other reasons for wanting it done. Some of the most common reasons include:

• Peace of mind. Having an amniocentesis or a Chorionic Villi Sampling (CVS) test can remove most doubts about the chromosomal health of your child. For some people, this reassurance can make the pregnancy a much more enjoyable—and less stressful—experience. If the tests do reveal problems, you and your partner will have more time to prepare yourselves for the tough decisions ahead (for more on this, see pages 71–72).

• To find out the sex of the baby (or, in some cases, to determine who the biological father is).

CHORIONIC VILLI SAMPLING (CVS)

Generally this test is performed at 9–12 weeks to detect chromosomal abnormalities and genetically inherited diseases. The test can be done by inserting a needle through the abdominal wall or by threading a catheter through the vagina and cervix into the uterus. Either way, small pieces of the chorion—a membrane with genetic makeup identical to that of the fetus—are snipped off or suctioned into a syringe and analyzed. The risks are about the same as for amnio, and the two tests can identify pretty much the same potential abnormalities. The main advantage to CVS is that it can be done a lot earlier in the pregnancy, giving you and your partner more time to consider the alternatives. That’s why the number of amnios is falling, while CVSs are rising.

Cell-Free Fetal DNA

One of the most exciting developments in prenatal testing is Cell-Free Fetal DNA (also called cfDNA or cffDNA) testing, which has the potential to eliminate the need for the vast majority of invasive diagnostics. Cell-Free Fetal DNA testing, which can be done as early as 10 weeks, analyzes tiny bits of the fetus’s DNA that are running around in the mom-to-be’s blood. According to Diana Bianchi, a pediatric geneticist at Tufts Medical Center, the results are ten times more accurate in predicting Down syndrome, and five times more accurate in predicting several other genetic conditions. The CffDNA test is nearly 100 percent accurate in ruling out problems, meaning that a negative result should relieve your anxieties. But it does produce some false positives, so a positive diagnosis would still need to be confirmed by amnio, CVS, or PUBS. Still, according to Bianchi, “Nine out of 10 women who are currently being referred for further testing would not need invasive tests.” The test is expensive, isn’t available everywhere, and may not be covered by insurance, so if you’re interested, check with your partner’s doc.

PERCUTANEOUS UMBILICAL BLOOD SAMPLING (PUBS)

No, PUBS has nothing to do with bars, although you may need one after thinking about all this. The PUBS test is usually conducted at 17–36 weeks and is sometimes ordered to confirm possible genetic and blood disorders detected through amnio or CVS. The procedure is virtually the same as an amnio, except that the needle is inserted into a blood vessel in the umbilical cord; some practitioners believe this makes the test more accurate. Later in the pregnancy, PUBS may be used to determine whether the fetus has chicken pox, Toxoplasma gondii (see page 42), or other dangerous infections. Preliminary results are available within about three days. In addition to the risk of complications or miscarriage resulting from the procedure, PUBS may also slightly increase the likelihood of premature labor or clotting of the umbilical cord, and because it can’t be performed any earlier than 17 weeks, it’s not nearly as popular as amnio or CVS.

Dealing with the Unexpected

For me, pregnancy was the proverbial emotional roller-coaster ride. One minute I’d find myself wildly excited and dreaming about the new baby, and the next I was filled with feelings of impending doom. I knew I wanted our babies, but I also knew that if I got too emotionally attached and anything unexpected happened—like an ectopic pregnancy, a miscarriage, or a birth defect—I’d be crushed. So, instead of allowing myself to enjoy the pregnancy fully, I ended up spending a lot of time torturing myself by reading and worrying about the bad things that could happen.

ECTOPIC PREGNANCY

About 1–2 percent of all embryos don’t embed in the uterus but begin to grow outside the womb, usually in the fallopian tube, which is unable to expand sufficiently to accommodate the growing fetus. Undiagnosed, an ectopic pregnancy would eventually cause the fallopian tube to burst, resulting in severe bleeding. Fortunately, the vast majority of ectopic pregnancies are caught and removed by the eighth week of pregnancy—long before they become dangerous. Unfortunately, there is no way to transplant the embryo from the fallopian tube into the uterus, so there’s no choice but to terminate the pregnancy. As quickly as technology is advancing, though, I’m sure transplantation will be possible in the not-too-distant future.

PREECLAMPSIA

This is one of the most common pregnancy complications—about 10 percent of pregnant women, most between the ages of eighteen and thirty, suffer from it, although the highest risk groups are very young teens and women in their forties. Preeclampsia is sometimes referred to as toxemia or PIH—protein-induced hypertension—because one of the symptoms is high protein in the urine. Basically, it’s an increase in the mother’s blood pressure late in the pregnancy. This can deprive the fetus of blood and other nutrients and put the mother at risk of a stroke or seizure. Women who have a history of high blood pressure or blood vessel abnormalities are especially prone, as are daughters of women who had preeclampsia when they were pregnant. And Norwegian researchers Rolv Skjærven and Lars J. Vatten found that “men born after a preeclampsia-complicated pregnancy had a moderately increased risk of fathering a preeclamptic pregnancy.” But most of the time it comes as an unpleasant surprise to everyone.

In its early stages there usually aren’t any symptoms, but it can be detected by a routine blood pressure check. If the condition worsens, the woman may develop headaches, water retention, vomiting, pain in the abdomen, blurred vision, and seizures. Interestingly, researchers now suspect that preeclampsia is actually a disorder in which the mother’s immune system rejects some of the father’s genes that are in the fetus’s cells. They suspect that women may be able to “immunize” themselves before getting pregnant if they build up a tolerance by exposing themselves to their partner’s semen as often as possible. This explains why preeclampsia is far more common during first pregnancies, or at least the first pregnancy with a new partner. It also explains why fewer women over thirty develop this condition. (Still, it can happen to older moms or those who have multiple children.)

There’s no guaranteed way to prevent preeclampsia, but there are a few things that could reduce the risk. Staying well hydrated, cutting back on salt, and getting enough exercise may help your partner keep her blood pressure under control. So can increasing her fiber intake. One study found that women who ate over 25 grams of fiber every day cut their risk by 50 percent. And in one of the greatest pieces of good news for pregnant women, Elizabeth Triche and her colleagues found that “women who had five or more servings of chocolate each week in their third trimester were 40 percent less likely to develop preeclampsia than those who ate chocolate less than once a week.” Apparently, there’s a chemical in chocolate, theobromine, that dilates blood vessels and reduces blood pressure. But do you really think your partner needs an excuse to eat more chocolate?

MISCARRIAGES

The sad fact—especially for pessimists like me—is that miscarriages happen fairly frequently. Some experts estimate that between a fifth and a third of all pregnancies end in miscarriage (sometimes also called “spontaneous abortion”). In fact, almost every sexually active woman not on birth control will have one at some point in her life. (In most cases the miscarriage occurs before the woman ever knows she’s pregnant—whatever there was of the tiny embryo is swept away with her regular menstrual flow.)

Before you start to panic, there are a few things to remember: First, over 90 percent of couples who experience a single miscarriage get pregnant and have a healthy baby later. Second, many people believe that miscarriages—most of which happen within the first three months of the pregnancy—are a kind of Darwinian natural selection. Some have even called them “a blessing in disguise.” In the vast majority of cases, the embryo or fetus had some kind of catastrophic defect that would have made it incompatible with life. Still, if you and your partner have a miscarriage, you probably won’t find any of this particularly reassuring. And it won’t make it hurt any less.

Until very recently, miscarriage, like the pregnancy it ends, had been considered the exclusive emotional domain of women. Truth is, it isn’t. While men don’t have to endure the physical pain or discomfort of a miscarriage, their emotional pain can be just as severe as their partner’s. They still have the same hopes and dreams about their unborn children, and they still feel a profound sense of grief when those hopes and dreams are dashed. And many men, just like their partners, feel tremendous guilt and inadequacy when a pregnancy ends prematurely.

Some good friends of mine, Philip and Elaine, had a miscarriage several years ago, after about twelve weeks of pregnancy. For both of them, the experience was devastating, and for months after the miscarriage they were besieged by sympathetic friends and relatives, many of whom had found out about the pregnancy only after it had so abruptly ended. They asked how Elaine was feeling, offered to visit her, expressed their sympathy, and often shared their own miscarriage stories. But no one—not even his wife—ever asked Philip what he was feeling, expressed any sympathy for what he was going through, or offered him a shoulder to cry on.

If You’re Expecting Twins

If your partner was carrying twins (or more), miscarrying one “does not seem to have negative implications regarding the health or genetic integrity of the surviving fetus,” say doctors Connie Agnew and Alan Klein. Miscarrying a twin may, however, put your partner at a slightly higher risk of going into preterm labor.

If your partner is carrying three or more fetuses, you may have to deal with the question of “selective reduction.” Basically, the more fetuses in the uterus, the greater the risk of premature birth, low birth weight, and other potential health hazards. Simply—and gruesomely—put, all these risks can be reduced by reducing the number of fetuses. It’s an agonizing decision that only you and your partner can make. Since 1980, the number of twin births has doubled, and the number of unplanned triplets, quads, and so on has more than quadrupled. Fortunately, as ART methods improve, that trend has been slowly declining, which means that fewer and fewer couples will be faced with this heartrending decision.

Psychologists and sociologists have conducted many studies on how people grieve at the loss of a fetus. But the vast majority of them have dealt only with women’s reactions. The ones that have included fathers’ feelings generally conclude that men and women grieve in different ways. Dr. Kristen Goldbach found that “women are more likely to express their grief openly, while men tend to be much less expressive, frequently coping with their grief in a more stoical manner.” This doesn’t mean that men don’t express their grief at all, or that they feel any less grief than women. Instead, it simply highlights the fact that in our society men, like my friend Philip, have virtually no opportunity to express their feelings—at least not in the “traditional” way. Many men respond to their grief by doing everything they can to get life back to normal. That often means going back to work and putting in extra-long hours. It’s a way of getting away from the self-blame and feeling of helplessness at not knowing how to comfort their partner. It’s a way of avoiding the barrage of baby images that was probably always there but now seems much more pervasive. It’s a way of coping with their grief and, unfortunately, of ignoring it.

Trying Again

If you’ve suffered a miscarriage and have decided to try to get pregnant again, your goal is to prepare a healthy environment for the baby to swim around in, and to prevent birth defects or other complications.

One of the most crucial times of the pregnancy is between 17 and 56 days after conception. That’s when the organs start developing. But because this stage happens so early on, it’s entirely possible that your partner might not know she’s pregnant. And by the time she finds out, she may have already done all sorts of things that could affect the baby—things she’ll wish she hadn’t done.

For that reason, it’s important to prepare yourselves for the next pregnancy as far in advance as you can. From six to nine months would be great, but even a month or two can make a big difference.

Preconception

The rest of this book is devoted to how to have a healthy, safe pregnancy and a healthy mom and baby. But right now, we’re talking about steps you can take before your partner conceives again that can boost your chances of getting pregnant, make for a less eventful pregnancy, and potentially help you reduce or avoid the expense and emotional ups and downs of fertility treatments.

You never know when your partner is going to burst out of the bathroom waving a little white stick and announce, “Honey, I’m pregnant!” So before the two of you hop in the sack, there are a few things that she should do, you should do, and the two of you should do together to get ready.

Pregnancy after a Miscarriage

Getting pregnant after having lost a baby can bring up a jumble of feelings for both you and your partner. For example, you’ll probably be feeling incredibly happy that you’re expecting again. But you may also be worried that this pregnancy will end the same way the last one did. That could keep you from allowing yourself to become truly engaged in and enjoy the pregnancy—at least until after you’re past the point when the miscarriage happened last time. If your partner is feeling this, she may deliberately keep herself from bonding with the baby, trying to save herself the grief if the worst happens again. If it’s been a while since the miscarriage, you might be angry—in an abstract sort of way—that you’re still expecting, when by all rights you should be holding a baby in your arms right now. But if your partner got pregnant right away, you might be feeling guilty at not having let an appropriate (whatever that means) amount of time pass.

Everyone deals with post-miscarriage pregnancy differently, but there are a few things that may make it a little easier:

• Try not to worry. It may have happened before, but chances are it won’t happen again. Only 1 in about 200 women are what are called “recurrent miscarriers,” meaning that they have had three miscarriages and have never delivered a child.

• Don’t pay attention to other people’s horror stories (you’d be amazed at how insensitive some people can be).

• Don’t tell anyone about the pregnancy until you’re absolutely ready to, and then tell only people you’d want to support you if something bad were to happen (see pages 82–83 for more on this).

• Get some more ultrasounds or listen to the heartbeat—this might help to reassure you that all is well.

• Get some support. If your partner can help you, great, but she may be preoccupied with her own thoughts. Otherwise, find someone else who’s been there and tell him or her how you’re feeling.

• Support your partner. Encourage her to talk about what she’s feeling and don’t make any judgments about what she says. And try to keep her calm. As the pregnancy progresses, for example, and she can feel the baby’s movements, she may become fixated on counting them—worried that there are either too many or too few. Just so you know, anywhere from 50 to 1,000 a day is normal.

WHAT SHE SHOULD DO

• Make an appointment with her health-care provider for a preconception physical. The doctor will:

• Evaluate any and all medications your partner is taking to see whether they’re safe during pregnancy.

• Probably prescribe prenatal vitamins and possibly folic acid supplements (folic acid lowers the risk of some birth defects of the brain and spinal cord).

• Address any medical conditions, such as diabetes, asthma, high blood pressure, depression, epilepsy, obesity, or any problems with previous pregnancies. All of these reduce her ability to get pregnant, and if she does conceive, can increase pregnancy complications and the risk of miscarriage, preterm delivery, and birth defects.

• Make sure her immunizations are up-to-date, in particular chicken pox (varicella), German measles (rubella), and hepatitis B.

• Screen her for sexually transmitted diseases.

• Discuss the birth control methods she’s been using. If she’s been on the pill, she may need to go through a couple of pill-free months before trying to conceive.

• Get healthy. According to the Centers for Disease Control (CDC), 11 percent of women smoke during pregnancy, and 10 percent consume alcohol. Of women who could get pregnant, 69 percent don’t take folic acid supplements, 31 percent are obese, and about 3 percent take prescription or over-the-counter drugs that are known teratogens (substances that can interfere with fetal development or cause birth defects). Getting healthy means:

• Limit caffeine. Some studies show that caffeine can decrease a woman’s fertility and increase the risk of miscarriage or other problems. Other studies find no connection. Just to be safe, though, it’s probably best if she cuts back to no more than two or three cups of coffee per day or switches to decaf.

• Exercise. It’s much better for a pregnant woman to continue an exercise routine she already has in place than to start a new one. If your partner hasn’t been working out regularly, add this to the list of things to talk about with her health-care provider.

• Watch her weight. If she’s overweight (her doctor will tell her whether it’s a problem or not), now’s the time to start slimming down. She definitely doesn’t want to be dieting during the pregnancy. According to the CDC, “reaching a healthy weight before pregnancy reduces the risks of neural tube defects, preterm delivery, diabetes, Cesarean section,” and other conditions associated with obesity.

• Pay attention to diet and nutrition. What your partner eats immediately before conception and in the first days and weeks of the pregnancy can have a big impact on fetal development and the baby’s long-term health. See pages 35–44 for details on her diet and nutritional needs.

• Quit smoking and drinking. Both decrease fertility and increase the chances of a premature or low-birth-weight birth, or pregnancy loss.

• Stay out of hot tubs. A recent study by health-care giant Kaiser Permanente found that women who used a hot tub after conception were twice as likely to miscarry as women who didn’t. Other studies haven’t found much of a connection, but Kaiser’s lead researcher, De-Kun Li, recommends that “women in the early stages of pregnancy—and those who may have conceived but aren’t sure—might want to play it safe for the first few months and avoid hot tubs” as a way of reducing “unnecessary risk of miscarriage.”

WHAT YOU SHOULD DO

• Talk to your doctor. Give him your medical history and tell him about your plans to do the dad thing. You want to find out whether there are any issues that you need to address before you start planning those romantic, candlelit, birth-control-free evenings. One especially important topic you’ll want to discuss is how to make sure your sperm is healthy. Here are some ways to do that:

• Keep your balls cool. Sperm is very sensitive to heat, which is why your testicles—where those little swimmers of yours live—hang outside your body, where it’s a few degrees cooler. Heating them up by a couple of degrees (say, by spending any more than five minutes in a hot tub or hot bath, sitting with your legs crossed for extended periods of time, or wearing tight underwear that keeps your testicles up against your body) could reduce sperm production or cause abnormalities. We all know that women have fertility cycles, but were you aware that we do too? Turns out that sperm are on a ninety-day cycle, meaning that whatever happens to them today won’t show up for three months or so.

• Call in the vice squad. Smoking, using illegal drugs (or misusing legal ones), and drinking alcohol have all been linked to lowered fertility, miscarriage, and birth defects.

• Watch the toxins. Hazardous chemicals, pesticides, and even noxious fumes could damage sperm and, if you inadvertently bring them home (for example, on your clothes), they could hurt your partner too.

• Lose some weight. Dr. A. Ghiyath Shayeb, from the University of Aberdeen, Scotland, found that obese men produce lower volumes of seminal fluid (the liquid that carries the sperm) and have a higher proportion of abnormal sperm. “[M]en who are trying for a baby with their partners should first try to achieve an ideal body weight,” writes Shayeb.

• Have a little more fun. Traditional thinking has it that if you want to improve your chances of getting your partner pregnant, you should not ejaculate for at least a couple of days before trying. But Australian OB David Greening disagrees. Greening studied men with DNA-damaged sperm. After seven days of ejaculating daily (no, it didn’t matter how), the percentage of damaged sperm dropped significantly. And motility—a measure of how straight and how quickly sperm swim toward those ever-elusive eggs—increased.

• Hang out with some dads. Talk to other guys about what it’s like to be a dad, the challenges they’ve faced, and how they overcame them. Ask a ton of questions.

WHAT BOTH OF YOU SHOULD DO

• Make sure you’ve discussed any possible medical issues with a qualified health-care provider. If you haven’t already, talk over any and all pregnancy-related risk factors. These include:

• Her age. Getting pregnant at thirty-five or older increases the risk of certain genetic abnormalities, such as Down syndrome.

• Your age. (See pages 296–297 for more).

• Family history. Could either of you be a carrier of any genetic disorders, birth defects, or conditions such as cystic fibrosis or hemophilia?

• Belonging to a high-risk ethnic group. African Americans may want to be tested for sickle-cell anemia. Individuals of African or Mediterranean descent may want to be tested for thalassemia; Jews of Ashkenazi (Eastern European) descent may want to be tested for Tay-Sachs and/or Canavan disease.

• Take a quick look at your HR manual and investigate your family leave options. We’ll talk about this more on pages 136–42. But the more time you have to prepare yourself and your employer, the better.

• Look at your finances. How are you going to pay for all this? Do you have insurance? If so, check your deductibles and copays—and whether you have maternity coverage at all. If you or she just started a job, does the policy have a waiting period before benefits kick in? If you don’t have insurance, what are your options? Could you qualify for Medicaid?

• Sit down with your partner and have some serious discussions about your plans. Hopefully she’ll get pregnant at the perfect time. But if that doesn’t happen, how do you feel about fertility treatments? Would you consider artificial insemination using your sperm? Would you consider using donor sperm? How about in vitro (test tube) fertilization? What about using donor eggs? And if you do use any kind of technology, are you prepared to parent twins or more? Don’t try to resolve anything in a single conversation.

Birth Defects

If one of the tests discussed earlier in this chapter indicates that your baby will be born deformed or with any kind of serious disorder, you and your partner have some serious discussions ahead of you. There are two basic options for dealing with birth defects in an unborn child: keep the baby or terminate the pregnancy. Fortunately, you and your partner won’t have to make this decision on your own; every hospital that administers diagnostic tests has specially trained genetic counselors who will help you sort through the options.

There’s no question that the availability of genetic testing has changed the landscape with regard to birth defects. Two recent studies analyzed birth data from a fifteen- to twenty-year period. One found a slight increase in the number of Down syndrome births, the other a slight decrease. As we’ve discussed, more and more women are putting off childbirth. And since women over thirty-five are about five times more likely than those in their twenties to have a Down syndrome baby, researchers would have expected the number of births to double. The reason that didn’t happen is quite simple: with genetic testing able to identify Down syndrome babies very early in the pregnancy, many couples are choosing abortion. If you’re considering terminating the pregnancy for genetic reasons, remember that communicating clearly and effectively with your partner is probably the most important thing you can do during this stressful time. The decision you make should not be taken lightly—it’s a choice that will last a lifetime—and you and your partner must fully agree before proceeding with either option. But ultimately, your partner should make the final decision.

Coping with Your Grief

If you and your partner choose to terminate your pregnancy or reduce the number of fetuses, or if the pregnancy ends in miscarriage, the emotional toll can be devastating. That’s why it’s critical for the two of you to seek out the emotional support you’re entitled to as soon as possible. While there’s nothing that can be done to prepare for or prevent a miscarriage, telling your partner how you feel—either alone or with a member of the clergy, a therapist, or a close friend—is very important. And don’t just sit back and wait for her to tell you what she’s feeling. Take the initiative: be supportive and ask a lot of questions.

Avoid the temptation to try to “fix” things. You can’t. And don’t try to console your wife with statements like, “We can always have another one.” Your intentions are good, but it won’t go over well.

You and your partner do not have to handle your grief by yourselves: counseling and support are available to both women and men who have lost a fetus through miscarriage, genetic termination, or selective reduction. Going to a support group can be a particularly important experience for men—especially those who aren’t getting the support they need from their friends and family. Many men who attend support groups report that until they joined the group, no one had ever asked how they felt about their loss. The group setting can also give men the chance to escape the loneliness and isolation and stop being strong for their partners for a few minutes and grieve for themselves. If you’d like to find a support group, your doctor or the genetic counselors can refer you to the closest one—or the one that might be most sympathetic to men’s concerns.

Some men, however, are not at all interested in getting together with a large group of people who have little in common but tragedy. If you feel this way, be sure to explain your feelings tactfully to your partner—she may feel quite strongly that you should be there with her and might feel rejected if you aren’t. If you ultimately decide not to join a support group, don’t try to handle things alone; talk to your partner, your doctor, your cleric, or a sympathetic friend, or read—and maybe contribute to—some of the blogs that deal with grief from the dad’s perspective. Keeping your grief bottled up will only hinder the healing process.