Fighting Constantly After Baby? Read This

FIGHTING CONSTANTLY AFTER BABY? READ THIS

Jessica Grose

THE GIST

  • The vast majority of parents are less satisfied with their marriages after they have kids than they were before.
  • Mothers in heterosexual relationships report the lowest levels of marital satisfaction, mostly because they tend to take on more “second shift” work — housework and child care — than their partners do.
  • Listing and dividing household tasks (including child care) make both partners feel a greater sense of fairness, though those tasks do not have to be divided 50/50. 
  • Maintaining a sexual connection is also important — and reestablishing that connection takes time postpartum. 

The lowest point of my marriage was probably when I was excessively pregnant with our second daughter. It was 90 degrees outside every day, and I had blown past my due date with no signs of labor. I had trouble falling asleep but had finally drifted off one night when my husband came home from a work event and woke me up. I had a brief and fleeting desire to bludgeon him with a bedside lamp. 

I’m not alone: The majority of studies on marital satisfaction suggest that couples are less happy after they become parents, though the degree and length of unhappiness is more of an open question. Deeply unpleasant thoughts about your spouse will probably flit through your mind at some point during your child’s first year, mostly because of the extreme exhaustion infants create in their parents (there’s a reason extreme sleep deprivation is considered torture). 

I spoke to three experts — including a New York Times-bestselling author, a sociologist and a relationship-focused psychotherapist — about how to keep relations as positive as possible during your transition to parenthood. All the experts I spoke with said that taking a transparent, proactive approach to dividing household work — including child care — was the number one way to keep the rage-beast of new parenthood at bay. 

WHAT TO DO

Don’t be surprised if you’re not happy.

Though it’s normal for satisfaction to decline in any relationship over time, research performed within the past decade suggests that new mothers may be most vulnerable to that dip. Sociologists theorize that, in heterosexual relationships, mothers are more unhappy with their marriages after they have children because they tend to take on more “second shift” work — child care and housework — and begin to feel that their relationships are no longer fair. Surveys have shown that whether they work or not, mothers are doing more child care than fathers are. 

There is less data about same-sex and gender non-conforming couples, but there is some — albeit dated — evidence that biological mothers in lesbian couples spend more time doing child care than their partners do (though their partners still spend more time on child care than fathers in heterosexual relationships). Lesbian and gay couples tend to divide housework in a more egalitarian way than heterosexual couples do.

Take the same amount of parental leave as your partner (if you can).

If at all possible, make sure both partners are taking identical amounts of leave. Jennifer Senior, an Op-Ed columnist at The New York Times and author of the bestselling “All Joy and No Fun: The Paradox of Modern Parenthood,” said that imbalance in leave-taking can set the stage for an imbalance of caretaking that can last for years. The parent who takes less leave has less experience soothing the baby. So the parent who takes more leave — almost always the biological mother — becomes the default “baby whisperer,” because she has more experience. It’s hard to get out of that pattern once you’re in it. In countries where parents tend to take equal amounts of leave, like in Canada or Sweden, marital satisfaction rates are higher. The unfairness extends even to sleep: Past research has found that working mothers in America are significantly more likely to get up during the night with a sick or wakeful child than working fathers are — and sleep is more equal in countries with more egalitarian policies in place.

Manage your expectations.

“Take the image of the ideal parent and throw it in the garbage,” said Dr. Leah Ruppanner, Ph.D., a sociologist at the University of Melbourne who specializes in family and gender. She gives this advice especially to mothers, because there are much more aggressive cultural expectations about what a good mother is supposed to be. According to the Pew Research Center, the majority of Americans still believe that women do a better job caring for new babies than men do (only 1 percent of Americans think men do a better job), and almost 80 percent believe women face a lot of pressure to be an involved parent. 

Make a list of tasks, and divide them fairly.

Senior suggested that parents should list all of their household tasks, including child care, and divide them in a way that seems fair — not equitable. For example: If one partner works 15 hours more a week than the other partner, then they will probably be doing fewer hours of house- and child-related work. But all the experts we spoke with agreed that ad hoc arrangements led to the most strife (and, in hetero couples, usually leave the mom feeling shafted). Merely making the list provides a way for parents to work through all of the potential pain points. 

Get granular with your list.

The writer Alix Kates Shulman created a “Marriage Agreement” with her husband when she had children, so that household responsibilities would be distributed fairly. She wrote about it in 1970, and her list gets very specific: “Transportation: Getting children to and from lessons, doctors, dentists, friends’ houses, park, parties, movies, library, etc. Making appointments. Parts occurring between 3:00 and 6:30 p.m. fall to wife. Husband does all weekend transportation and pickups after 6.” Senior said you should get as granular as possible when you’re listing and dividing chores — the more specific you get, the less resentment will fester.

Don’t be a maternal gatekeeper.

Some mothers believe themselves to be the superior parent, and engage in what sociologists refer to as “maternal gatekeeping” — they mediate their spouses’ interactions with their children. Practically speaking it often means nitpicking: “Why are you swaddling Ruby that way?”; “Jasper doesn’t like his bottle so cold.” If mothers want child care to be divided fairly, they have to let fathers do things their own way, even if it’s not your way (if the child is truly in danger, that’s another story — you should always intervene in that case). “You’re letting them learn how to respond to the kids,” Ruppanner said. “They learn how to do it. It’s not astrophysics.” 

Ruppanner suggested that if a parent is really struggling not to meddle, they should physically leave the house when their spouse is on duty — go for a run, take a nap, give yourself some personal time. 

Redefine your sex life.

Having a child is a “complete reorganization of the structure of your life,” said Esther Perel, M.A., L.M.F.T., a psychotherapist and author of the book “Mating inCaptivity: Unlocking Erotic Intelligence” — and that includes your sex life. Many biological parents are given the go-ahead to have sex six weeks postpartum, but that’s because “at six weeks you can be penetrated without tearing,” Perel said — and that doesn’t mean you’re ready for it physically or psychologically. Perel added that it could take as long as a year before you’re ready to have penetrative sex — so don’t be discouraged if you’re feeling uneasy at six weeks. It takes time to re-establish the rhythm and get used to a changed body and a restructured life.

Parents who gave birth need time to recover, and nursing parents may experience vaginal dryness because of lowered estrogen levels. About 90 percent of mothers resume sex within six months of birth, though 83 percent are experiencing sexual issues three months postpartum, and 64 percent are still experiencing issues at six months. Perel encouraged parents to “broaden their erotic interests” outside of penetrative sex and experiment with new erogenous zones. Continuing to connect sexually is important for keeping those hostile feelings at bay, for both parents. “On the long list of what your kids need, making sure the couple remains intimately connected remains very high,” Perel said. “There’s nothing holding a family together except the contentment of the couple.”

SOURCES

Jennifer Senior, author of “All Joy and No Fun: The Paradox of Modern Parenthood,” July 24, 2018

Dr. Leah Ruppanner, Ph.D., associate professor and co-director of The Policy Labat the University of Melbourne, July 25, 2018

Esther Perel, M.A., L.M.F.T., author of “Mating inCaptivity: Unlocking Erotic Intelligence” Aug. 3, 2018

Who Helps with Homework? Parenting Inequality and Relationship Quality Among Employed Mothers and Fathers,” Journal of Family and Economic Issues, March 2018

Gender Equality and Restless Sleep Among Partnered Europeans,” Journal of Marriage and Family, 2018

7 facts about U.S. moms,” Pew Research Center, May 10, 2018

Why Are Pregnant Women So Sweaty?

WHY ARE PREGNANT WOMEN SO SWEATY?

Jessica Grose

A lot of parenting questions boil down to: Is this a thing, or is something wrong? We’re doing an occasional series explaining why certain things seem to happen to your kid (or to your body or to your relationships) as your child grows. This week, we’re talking about prenatal and postpartum night sweats. 

For this week’s edition, I put out a call on Twitter for questions about your weird prenatal and postpartum symptoms — and, wow, did you all deliver. In a beautiful and bizarre outpouring, you told us about painful carpal tunnel, constipation, thyroid malfunctions, excess drool, itchy nipples, strange divots in your thighs and shins that won’t go away, cured aversions to cilantro … the list goes on, because the human body is a magical, horrible wonderland. I tallied the responses, and by my extremely unscientific calculations, night sweats seemed to be the most common unexplained symptom from our respondents (e.g., “I had to sleep on a beach towel because of all the sweat and the milk leaking”). So that’s what I’m delving into today.

Q: Are pregnant and postpartum night sweats really a thing?

A: Waking up with a soaking nightgown during or after pregnancy is common. In a study of about 430 women published in 2013, for instance, researchers found that 35 percent reported nocturnal hot flashes while they were pregnant, and 29 percent reported them postpartum. In pregnant women, night sweats peaked during week 30, while in postpartum women, they peaked during the second week after birth.

Why it’s happening is a little more complicated, so we asked four ob-gyns and a researcher who has studied night sweats about what might be going on in your body, and what you can do about it.

Why are pregnant women so damn sweaty?

The short answer is, we don’t know for sure, because there’s a lack of systematic research on the topic (more on that in a bit). But it probably has to do with their ever-shifting hormones.

During pregnancy, there’s a huge rise in the levels of progesterone and estrogen. Once you give birth, the levels of those hormones fall off a cliff.

Rebecca Thurston, Ph.D., a professor of psychiatry and director of the women’s biobehavioral health program at the University of Pittsburgh who studies night sweats and hot flashes, said that nocturnal hot flashes in pregnancy seem to mirror hot flashes in menopause, and that those hormonal fluctuations might play a role. (Several of the experts I spoke with said that prenatal and postpartum night sweats were a rehearsal for menopause … yay?)

Do all pregnant women get hot flashes?

No. While every person who has given birth experiences these hormonal fluctuations, not all of them get night sweats, and we still don’t fully understand the underlying physiology as to why this might be, said Dr. Thurston. More than just hormones are probably causing the hot flashes, and they don’t just happen at night.

The hormonal shifts are part of a complex set of changes that happen during pregnancy, said Dr. Jen Gunter, M.D., an ob-gyn, frequent New York Times contributor and author of “The Vagina Bible.” (Dr. Gunter said she remembered sweating so much at night when she was pregnant with triplets that she’d think, “my bed is a swimming pool.”) “There’s an increase in body temperature, and there’s changes in the blood vessels — they dilate more and increase blood flow to the skin,” said Dr. Gunter. So some women may find that they’re more sweaty in general, not just at night.

According to what little research has been done, African-American women and women with depressive symptoms are more likely to report night sweats during pregnancy and the postpartum period. Women with high pre-pregnancy B.M.I.s were also more likely to have night sweats during pregnancy but not necessarily postpartum.

I find the connection between night sweats and depression particularly intriguing, as there is evidence that women who were depressed during and after their pregnancies may also be more sensitive to hormonal shifts.

What can we do about our sweaty, sweaty bodies?

First, report your night sweats to your doctor or midwife, said Dr. Dara Matseoane-Peterssen, M.D., chief of general obstetrics and gynecology at New York-Presbyterian Allen Hospital. If you’re experiencing other symptoms along with night sweats, such as a fever or a racing pulse, that may be a sign of a more serious problem, such as an infection or a thyroid issue.

If your sweats aren’t a sign of something more serious, exercising can be an effective first line of attack — whether you’re pregnant or not. Dr. Julie Chor, M.D., an assistant professor of obstetrics and gynecology at the University of Chicago, said there’s some evidence that women who exercise are less likely to experience nighttime hot flashes than women who don’t. While experts aren’t sure why this may be, exercising during and after your pregnancy is beneficial to your health in general, so you might as well try it (as long as you’re following safe exercising guidelines).

Focusing on creating an optimal sleep environment can help you avoid creating a veritable saltwater marsh in your bed, too. If your household and energy bill can tolerate it, set your bedroom’s temperature to around 65 degrees at night, said Dr. Thurston. Dr. Colleen Denny, M.D., assistant clinical professor in the department of obstetrics and gynecology at N.Y.U. School of Medicine, also suggested keeping cool water and a cold compress by your bed, and dressing in layers so you can take them off as the night, and your sweating, progresses.

As a fellow night sweater during pregnancy, my personal suggestion is to keep a second set of night clothes by your bedside so that you can make a quick change out of your wet pajamas in the middle of the night without groping around in the dark.

Why don’t we know more about night sweats?

“There are major gaps in knowledge about women’s health and women’s bodies,” said Dr. Thurston. Women overall have been less likely to be represented in clinical trials, because researchers have historically been men. And pregnant women in particular are “severely underrepresented,” in part because of fear of harm to their fetuses. Many of the experts I spoke with mentioned that we’re just starting to care about the health of the mother, and not just the health of the fetus, as vital to the overall health of the pregnancy.

But there is also a lack of study on the day-to-day experiences of women, said Dr. Gunter. Something like night sweats could just be a “nuisance” symptom — which is to say, uncomfortable but ultimately not harmful. But these sorts of symptoms could also be associated with better or worse pregnancy outcomes, and “we don’t know because they haven’t been studied,” Dr. Gunter said. In preparation for our interview, Dr. Gunter scanned her copy of the latest edition of a 1,400-page medical text book, and there were just two lines about sweating, referred to as “increased cutaneous blood flow” — she couldn’t even find the word “sweating” in the index.

Dr. Thurston emphasized the importance of reporting these kinds of symptoms to your midwives or doctors, not just to rule out serious problems, but also to add to the body of knowledge that exists on women’s health. “The more we know about these symptoms in the medical community, the more we can generate research around them,” she said.

How to Safely Exercise During Pregnancy

HOW TO SAFELY EXERCISE DURING PREGNANCY

Melinda Wenner Moyer

THE GIST

  • Exercising during pregnancy is generally safe and can reduce the risk for several conditions including excessive weight gain, gestational diabetes and preeclampsia.
  • Always consult with your doctor before starting any exercise routine, since certain conditions can make it more risky. 
  • Doctors recommend about 30 minutes of exercise a day — or 150 minutes a week — but no more than 45 minutes per day, which can increase your risk of overheating and dehydration. 
  • Aerobic exercise, including jogging, is safe during pregnancy, but you should be able to carry on a conversation while active. Start slowly if you rarely exercised before pregnancy or are obese.
  • Avoid inherently risky activities, such as scuba or sky diving, contact sports, horseback riding, gymnastics or downhill skiing. Hot yoga and hot pilates are also unadvisable since they can increase body temperature too much and endanger the fetus.
  • If you notice warning signs of early labor or pregnancy complications, such as vaginal bleeding, breathing problems, or painful contractions, stop and contact your doctor.

Both times I’ve been pregnant, I’ve felt conflicted about exercise. On the one hand, I was often tired and nauseous; napping felt way more appealing than sweating. On the other hand, I wanted to do what was best for my baby and ward off extra pregnancy pounds. So I began hunting for the perfect prenatal workout. I tried what felt like everything — elliptical machines, yoga, power walking and even weightlifting, which elicited a number of concerned comments from gym-goers to “take it easy.”

According to Dr. Margie Davenport, Ph.D., director of the Program for Pregnancy and Postpartum Health at the University of Alberta in Canada, the belief that it’s dangerous to exercise during pregnancy is common — but it’s wrong. “We recommend beginning exercise or continuing to exercise as soon as you become pregnant,” she said. In most uncomplicated pregnancies, exercise is safe and tied to a reduced risk for many complications including excessive weight gain, gestational diabetes, preeclampsia, back pain and depression. For anyone worried about the safety of exercise during pregnancy, like those judgey gym-goers, Dr. Davenport and her colleagues recently published a systematic review in the British Journal of Sports Medicine, which analyzed 46 studies, and concluded that prenatal exercise does not increase the risk of miscarriage or death of the fetus.

The research I consulted, along with the obstetrician and maternal-fetal medicine specialist I talked with for this guide, agreed with Dr. Davenport: In most circumstances, exercise is good for both mom and baby, although there are important things to keep in mind. 

WHAT TO DO

  • Understand the differences between safe and unsafe exercise

Most of the time, exercising during pregnancy is safe, but nevertheless “it’s really important that women speak with their health care provider to see if they have any contraindications, or medical reasons that they shouldn’t,” Dr. Davenport said.

According to the American College of Obstetricians and Gynecologists, women with certain health conditions — including certain heart or lung diseases, cervical issues, pregnancy with multiples, persistent bleeding during the second or third trimester, preeclampsia or anemia — shouldn’t exercise while pregnant at all.

ACOG’s guidelines also note that if you have certain conditions or habits, such as heavy smoking, high blood pressure, overactive thyroid or are morbidly obese or underweight, consult with your doctor before exercising, because the benefits of exercise may not outweigh the potential risks.

  • Recognize how exercise can help you

Exercising during pregnancy isn’t just about keeping off extra pounds (although it also does that). According to a recent review published in the British Journal of Sports Medicine, pregnant women who exercised in various ways had about a 40 percent reduced risk for gestational diabetes, gestational hypertension and preeclampsia. Studies also suggest that women who exercise during pregnancy are less likely to become depressed and develop less severe low back and pelvic pain. Regular exercise can help with labor and post-delivery recovery, too, by reducing the odds of having an instrument-assisted delivery — a delivery in which forceps or a vacuum device is used — and lowering the risk for urinary incontinence after birth. 

  • Take precautions before and during exercise — and avoid risky types

To reduce the chance of developing low blood sugar, you should eat before exercising, said Dr. Raul Artal, M.D., a professor and chairman emeritus of the department of obstetrics, gynecology and women’s health at the St. Louis University School of Medicine. Smoothies, fruits, nuts or whole-grain crackers are good choices. Drink water to stay hydrated, too, and don’t exercise outdoors at temperatures above 90 degrees. That’s because heat stress in the first trimester, such as from saunas and hot tubs, has been linked with birth defects of the brain, nervous system or spinal cord. According to recent research, though, exercising when it’s not really hot out does not increase core body temperature enough to cause problems. In fact, research suggests that exercising during pregnancy is linked with a reduced risk for neural tube defects.

ACOG recommends that pregnant women avoid the following activities, which could pose health risks:

  • Contact sports such as ice hockey, boxing, soccer and basketball
    • Activities with a high risk of falling, such as downhill skiing, water skiing, surfing, off-road cycling, gymnastics and horseback riding
    • Scuba diving
    • Sky diving
    • Hot yoga or hot pilates 
  • Choose activities you can do regularly

“Oftentimes, women think that exercise means going to a gym, and it doesn’t,” said Dr. Diana Ramos, M.D., M.P.H., an obstetrician and medical director for reproductive health at the Los Angeles Public Health Department. “It’s as simple as walking.”

Other activities ACOG recommends include swimming, stationary cycling, yoga, pilates and low-impact aerobics such as jogging and pool aerobics. What’s most important is that you choose an activity that you’ll be able to do regularly. My favorite prenatal workout ended up being one I did in my basement — where I was conveniently shielded from intrusive bystanders and just a few steps away from the essential re-fueling station (aka my kitchen).

ACOG’s guidelines recommend that pregnant women exercise for 150 minutes a week, or about 30 minutes a day, five days a week. They caution against exercising for more than 45 minutes at a time because doing so can increase the risk for low blood sugar, which can make you lightheaded or dizzy. If you didn’t exercise much before you got pregnant, or you are obese, it’s O.K. to start with as little as 10 minutes of activity a day and “build it up at a rate that is going to be sustainable,” Dr. Davenport said. Dr. Davenport also pointed out that some activity is better than none at all — exercising for fewer than 150 minutes a week still provides some benefits.

Aerobic exercise, such as jogging, is safe for women who were active before they got pregnant. Guidelines recommend that women be able to pass the “talk test,” meaning they can carry on a conversation while exercising. More intense exercise may also be O.K., but Dr. Gregory Davies, M.D., a professor and chair of the Division of Maternal-Fetal Medicine at Queen’s University in Canada, pointed out that very little research has been done to address this question. “Most, if not all, our knowledge about safety and pregnancy benefits is based on research protocols that reflected moderate exercise, at most,” he said. The same goes for strength training, so if you’re going to lift weights, don’t overdo it. A 2015 trialfound that pregnant women can safely lift 10 pounds or less, but studies haven’t evaluated the safety of heavier weight-lifting. 

  • Remember that your body is changing

During pregnancy, a woman’s joints become more relaxed, so it’s important not to overstretch, Dr. Davenport said. It’s also wise to avoid activities that require jumping or quick directional changes, which can stress the joints, too. Balance becomes less stable after the first trimester, which is why it’s also important to avoid activities that require careful balance, such as skiing. To stay safe, invest in supportive shoes — don’t go for your daily walk in flip-flops — because “you really need the right support for your feet,” Dr. Ramos said.

ACOG also suggests avoiding exercises that require you to lie on your back during pregnancy. Doing so can restrict blood flow to the heart, which might also restrict blood flow to the fetus. Usually, if this happens, you will feel light-headed and nauseous, Dr. Davenport said, which you can take as a sign to sit up.

WHEN TO WORRY

According to ACOG, women who experience any warning signs while exercising such as vaginal bleeding, regular painful contractions, amniotic fluid leakage, difficulty breathing, dizziness, headache, chest pain, muscle weakness, or calf pain or swelling should stop and contact their health provider immediately.

SOURCES

Dr. Margie Davenport, Ph.D., associate professor of kinesiology, sport and recreation and director of the Program for Pregnancy and Postpartum Health at the University of Alberta, Dec. 5, 2018

Dr. Diana Ramos, M.D., M.P.H., medical director for reproductive health for the Los Angeles Public Health Department, Dec. 5, 2018

Dr. Raul Artal, M.D., professor and chairman emeritus of the department of obstetrics, gynecology, and women’s health at the St. Louis University School of Medicine, Dec. 6, 2018

Dr. Gregory Davies, M.D., professor and chair of the division of maternal-fetal medicine at Queen’s University in Canada, Dec. 10, 2018

Prenatal exercise is not associated with fetal mortality: a systematic review and meta-analysis,” British Journal of Sports Medicine, October 2018

“Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis,” British Journal of Sports Medicine, October 2018

“Effectiveness of exercise interventions in the prevention of excessive gestational weight gain and postpartum weight retention: a systematic review and meta-analysis,” British Journal of Sports Medicine, November 2018

Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis,” British Journal of Sports Medicine, November 2018 “Exercise during pregnancy and the postpartum period,” UpToDate.com, November 2018

The Foods to Avoid When You’re Pregnant

THE FOODS TO AVOID WHEN YOU’RE PREGNANT

Rachel Meltzer Warren

THE GIST

  • Pregnant women are more susceptible to foodborne illness than most people because their immune systems are weakened. 
  • Microbes like salmonella, campylobacter and Toxoplasma gondii can be harmful to a pregnancy, but experts are particularly concerned about Listeria monocytogenes, a bacterium that can cause infection that can have devastating consequences. 
  • To minimize listeria risk, avoid foods most likely to carry it, such as certain types of processed meats (unless they’ve been thoroughly heated), smoked fish, soft cheeses and unpasteurized milk and dairy products. 
  • Although research on moderate alcohol consumption during pregnancy is mixed, experts have said that abstinence is the safest bet.
  • Unless your doctor suggests otherwise, you can keep your morning coffee, as long as you limit yourself to 200 milligrams of caffeine or less per day. 
  • Worried you ate the wrong thing? Don’t stress. Discuss it with your doctor, who can give you tips on what, if anything, to do next. 

WHAT TO DO

Take care with certain types of processed meats

  • There are dozens of bacteria, viruses and parasites that can linger in foods and cause illness. Experts are particularly concerned about listeriosis — a bacterial infection that can cause seemingly mild or even nonexistent symptoms in pregnant women, but which can be especially dangerous to an unborn baby — including causing miscarriage, preterm labor or stillbirth. 

Listeria infections during pregnancy are rare. Between 2009 and 2011, according to the Centers for Disease Control and Prevention, there were just 227 cases in pregnant women in the United States. But research suggests that pregnant women may be up to 20 times more vulnerable to a listeria infection than the rest of the population. 

“Your immunity is altered when you’re pregnant, and that makes you more susceptible to serious consequences of foodborne illness,” said Dr. Zoe Kiefer, M.D., M.P.H., an ob-gyn at Beth Israel Deaconess Medical Center in Boston. Nearly one-quarter of all listeria cases in pregnant women in the United States result in fetal loss or death of the newborn, according to the C.D.C. 

Listeria outbreaks tend to occur in certain ready-to-eat meat products such as hot dogs, sausages, and store-bought, meat-based salads such as those made with chicken or ham. Cold cuts and deli meats are a common source, too. In fact, on April 17, 2019, the C.D.C. reported that at least eight hospitalizations and one death were linked to a listeria outbreak among sliced deli meats and cheeses at several deli counters across four states. Other outbreaks have been caused by refrigerated pâtés, meat spreads, smoked seafood, carpaccio, produce like cantaloupe and lettuce, and dairy products like ice cream and soft cheeses (more on cheese below). 

Instead of cutting these high-risk foods from your diet completely, Mary Saucier Choate, M.S., R.D.N., a food safety field specialist at the University of New Hampshire Extension, recommended cooking foods that can be eaten hot to an internal temperature of 165 degrees, or until steaming, since high temperatures kill the bacteria. A hot open-faced turkey sandwich or a fully cooked hot dog would do the trick. Or, consider making your own alternatives, such as freshly prepared salmon salad (made from canned salmon), egg salad or a peanut butter and banana sandwich.

Experts have said to keep fruits and veggies (with the exception of sprouts; more on that below), in your diet unless there’s an outbreak. Cooking produce is another way to minimize potential risk, said Dr. Haley Oliver, Ph.D., an associate professor of food science at Purdue University.

In general, keeping kitchen surfaces clean, thoroughly washing fruits and veggies and properly storing them (like keeping cut melon refrigerated) can help keep you protected. 

  • Be flexible with fish choices

Fish is packed with nutrition and is an important addition to many people’s diets, especially if you’re expecting. It’s not only high in protein and essential vitamins and minerals, but supplies healthy omega-3 fatty acids that aid in your brain and heart health, and in your baby’s brain and retina development. 

That doesn’t make fish an all-you-can-eat food when you’re pregnant, though. Most fish contain some level of mercury, a metal that can cause brain damage as well as vision and hearing problems for babies exposed in the womb. But certain types tend to contain more mercury than others. Large, long-living fish like bigeye tuna, swordfish, shark, king mackerel and orange roughy have the highest mercury levels and are best avoided. 

Federal health agencies recommend that pregnant women eat two to three servings (8 to 12 ounces) of fish per week, including a variety of low-mercury fish including cod, flounder, salmon, sardines, shrimp or canned light tuna; or one serving per week of moderate-mercury fish like halibut, snapper or albacore tuna. 

There is debate, however, over whether some types of tuna are safe for pregnant women to eat at all. In 2014, Consumer Reports analyzed Food and Drug Administration data and found that while canned light tuna on average was low in mercury, the amount varied greatly from can to can, with some containing unsafe levels of the toxin. Since there’s no way to tell which can is which, or which type of tuna the can contains, the group recommends avoiding all types of tuna while you’re pregnant. Talk with your doctor about the best diet plan for you.

  • Take care with raw foods

Raw fish known to harbor parasites (such as the anisakiasis worm, which can cause abdominal pain, nausea, vomiting and diarrhea) are typically frozen before they’re sold for consumption as sushi in the United States. Freezing can also halt the growth of bacteria like salmonella, which may be present. 

But freezing is not foolproof against foodborne illness, explained Dr. Christina A. Mireles DeWitt, Ph.D., an associate professor of food science and technology at Oregon State University. And it doesn’t prevent cross contamination. Most people’s immune systems can handle the temporary G.I. distress resulting from eating a contaminated food, said Dr. DeWitt, but pregnant women and their babies are at higher risk for complications (as are young children and the elderly or immune-compromised), so it’s best to avoid uncooked fish, such as sushi and raw oysters, when you’re pregnant.

It’s also best to avoid raw or undercooked meat. While most pregnant women are advised to avoid cleaning their cat’s litter boxes due to the increased risk of infection from Toxoplasma gondii — a parasite that thrives in cat feces — about half of the yearly toxoplasmosis infections in the United States result from eating food. Common sources include undercooked pork, lamb and wild game meat; as well as raw fruits and vegetables (which could contain infected soil).

Consult the F.D.A.’s “heat chart” for instructions on how to ensure your meat is fully cooked. And wash your hands with soap and warm water after touching soil, sand, raw meat, cat litter or unwashed vegetables. The F.D.A. also recommends thoroughly washing and, if possible, peeling, fruits and veggies before eating.

  • Abstain from alcohol

While some studies suggest that light-to-moderate drinking — defined as no more than one drink per day for women — is no big deal during pregnancy, there’s enough evidence to the contrary for many experts to agree that no amount of alcohol is safe. A 2013 review of 34 studies, for example, concluded that women who drank up to three drinks per week throughout their pregnancies were more likely to have children with behavioral issues like poor impulse control or difficulty interacting with other kids than women who didn’t drink at all.

Drinking during pregnancy has been linked to an increased risk of fetal alcohol spectrum disorders, such as fetal alcohol syndrome, which can lead to facial abnormalities, improper growth and intellectual disabilities. A 2018 study published in the journal JAMA estimated that as many as 5 percent of children in the United States have an F.A.S.D. 

“We really don’t know what amount is safe,” said Dr. Kiefer. So for now, skip the booze.

  • Avoid unpasteurized drinks

Pasteurization, or the process of heating foods to kill harmful bacteria, has made many foods safe for pregnant women to consume. But be on the lookout for milks, juices, dairy and other products that haven’t gone through the process.

Raw, unpasteurized milk can harbor germs like listeria, salmonella, campylobacter or cryptosporidium. In 2014, the American Academy of Pediatrics said that since no studies have found any benefits of drinking unpasteurized milk, pregnant women who drink milk and milk products should only consume those that have been pasteurized. (The same advice goes for infants and children.)

Most juices sold in the United States are pasteurized, including all that are shelf-stable. But some refrigerated juices sold at certain types of stores like high-end chains, local organic juice joints, corner bodegas or farm stands may not be. If you don’t see a label stating a drink has been pasteurized, ask whether it has been. If they’re not sure if it has, skip it.

  • Be choosy about cheeses

As with refrigerated meat and unpasteurized dairy products, cheese can harbor listeria and other pathogens. But unlike the “cook it or skip it” recommendation for meat products, the advice on cheese isn’t always straightforward. 

In general, the softer — and wetter — a cheese gets, the more you have to worry about pathogens surviving and growing. Bacteria like moisture, said Dr. Dennis D’Amico, Ph.D., a professor of food microbiology at the University of Connecticut, so pathogens tend to grow on soft cheeses more quickly than they grow on harder ones. 

“As you go from a mozzarella with high moisture to something like a cheddar or a Monterey Jack, the risk is starting to go down,” said Dr. D’Amico. Dry, hard cheeses such as a traditional Parmigiano or a Pecorino Romano have virtually zero risk of foodborne illness, said Dr. D’Amico. 

Soft cheeses made with unpasteurized milk are by far the riskiest: C.D.C. estimates suggest they’re as much as 160 times more likely to cause foodborne listeria infection than soft cheeses made with pasteurized milk. But even pasteurized soft cheeses are not risk-free: A 2018 C.D.C. report revealed that there were 12 times more listeria outbreaks linked to pasteurized soft cheeses between 2007 and 2014 than there were between 1998 and 2006. One such outbreak in 2015 hospitalized 28 people — six of whom were pregnant. Latin-style cheeses, like Queso Fresco, have been implicated in more outbreaks than other types. 

While the F.D.A. says it’s O.K. for pregnant women to eat soft cheeses made with pasteurized milk, Dr. D’Amico and other experts have suggested that pregnant women consider avoiding them to be safe.

  • If you drink coffee, stick to one cup

Decades of research has linked consumption of coffee and other sources of caffeine to increased risks for miscarriage, preterm birth and low birth weight babies. But the research isn’t clear on how much is safe to consume. Most public health groups, including the American College of Obstetricians and Gynecologists, agree that limiting caffeine to no more than 200 milligrams per day will not majorly increase such risks. 

“I tell my patients it’s O.K. to have one cup of coffee daily,” said Dr. Kiefer, no matter your stage of pregnancy. 

But caffeine content can vary depending on what you drink. At Starbucks, a shot of espresso has 75 milligrams of caffeine; whereas its Tall-sized brewed coffee drinks have closer to 190 to 280 milligrams. The English breakfast tea I ordered at the coffee shop that day probably had around 50 milligrams. 

Also keep in mind that caffeine can pop up in unassuming places, such as in decaf coffee, colas, iced teas, energy drinks, kombucha and chocolate. 

  • Avoid raw eggs

Eggs can carry salmonella, a bacteria that can cause infections resulting in fever, nausea, vomiting, diarrhea and dehydration. And if you’re infected during pregnancy, symptoms can be so severe that they may lead to serious complications for both you and baby.

Salmonella can’t withstand high heat, so eggs cooked to 160 degrees or more will be safe to eat. Cook eggs thoroughly until the whites and yolks are firm and no clear or runny sections remain. 

Most liquid eggs sold in refrigerated cartons are pasteurized and likely won’t have the potential to make you sick. Pasteurized shell eggs probably can’t make you sick either, though these are harder to find. Also remember that raw eggs can be found in seemingly innocuous foods and drinks, too, such as Hollandaise sauce, Caesar dressing, eggnog, raw cookie dough, aioli, meringue, mousse and tiramisu. 

After handling raw eggs, wash your hands and disinfect surfaces they’ve touched to prevent cross contamination. 

  • Go nuts

Past A.A.P. guidelines have advised pregnant women to avoid eating peanuts — and to delay introducing them to high-risk children (such as those whose parents have allergies) until age 3 — so as to prevent peanut allergies in their children. But as peanut allergies increased despite this advice, and more research emerged, the A.A.P. rescinded that recommendation in 2008 (and reaffirmed their stance in 2019). 

However some pregnant women still haven’t gotten that memo. 

If anything, newer research suggests that allergen exposure may reduce food allergy risk. A 2014 study of more than 8,000 women and their offspring published in JAMA Pediatrics, for example, found that moms who ate peanuts and tree nuts (like almonds or walnuts) five or more times per week during, shortly before or shortly after their pregnancies had kids who were 69 percent less likely to develop nut allergies than those whose moms ate them less than once per month. 

That’s good news, since nuts are good sources of the protein, healthy fats and vitamins and minerals that pregnant women need. 

  • Avoid sprouts

All raw sprouts — including alfalfa, mung bean, radish and clover—are risky for pregnant women. “Seeds may become contaminated by bacteria in animal manure in the field or during the postharvest stage,” said Choate, the food safety field specialist at the University of New Hampshire Extension. These bacteria can grow to high levels during sprouting, and are impossible to wash out. To play it safe, ask for your sandwich with no alfalfa sprouts, and for the bean sprouts to be left off your pad Thai.

  • Review the recalls

Every few days it seems there’s another healthy food we’re told to avoid due to an outbreak, from romaine lettuce to tahini to sliced melon. To stay on top of the latest news, sign up to get notified about alerts and recalls from both the F.D.A. and the Department of Agriculture by email here. You’ll also get an email when the recall is over, so you won’t unnecessarily need to limit your diet for longer than you have to. 

WHEN TO WORRY

Ate something on the “do not eat” list? Don’t freak out. The chances that one slip-up will damage your pregnancy are relatively slim, said Dr. Kiefer. “If a patient calls me and says, ‘I had a ham sandwich,’ I try to reassure them that they’re probably O.K.” 

You do need to worry, however, if you experience symptoms that could signal actual food poisoning, such as nausea, vomiting, diarrhea, fever, chills or dizziness; or any signs of preterm labor such as cramping or bleeding. If you have any of these symptoms or if you’re unable to keep fluids down for more than a few hours at a time, call your doctor or head to the E.R. so you can be monitored for hydration and treated as needed. 

As for that before-you-knew-you-were-pregnant party night, bring it up with your doctor. While experts have said that no amount of alcohol is safe, one isolated exposure to alcohol may not cause problems for you or your baby, said Dr. Kiefer. Talk with your doctor about concerns you have regarding drinking at any point in pregnancy, especially if you’ve had any significant alcohol intake since your last period. 

SOURCES

Dr. Zoe Kiefer, M.D., M.P.H., an ob-gyn at Beth Israel Deaconess Medical Center in Boston, January 2019

Mary Saucier Choate, M.S., R.D.N., a food safety field specialist at the University of New Hampshire Extension, January 2019

Dr. Christina A. Mireles DeWitt, Ph.D., an associate professor in food science and technology and director of the Oregon State University Seafood Research and Education Center, January 2019

Dr. Dennis D’Amico, Ph.D., a professor of food microbiology at the University of Connecticut, January 2019

Dr. Haley Oliver, Ph.D., an associate professor of food science at Purdue University, March 2019

“A.C.O.G. Practice Advisory: Update on Seafood Consumption During Pregnancy,”The American College of Obstetricians and Gynecologists, March 2019

“Talking About Juice Safety: What You Need to Know,” Food and Drug Administration, March 2019

“Consumption of Raw or Unpasteurized Milk Products by Pregnant Women and Children,” American Academy of Pediatrics Policy Statement, January 2014

Listeriosis Outbreaks Associated With Soft Cheeses, United States, 1998-2014,” Emerging Infectious Diseases journal and the Centers for Disease Control and Prevention, June 2018

“Cheese Microbial Risk Assessments — A Review,” Asian Australasian Journal of Animal Science, March 2016

“The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas and Timing of Introduction of Allergenic Foods,” Pediatrics, March 2019

“Listeria (Listeriosis),”Centers for Disease Control and Prevention, March 2019

Postpartum Body Changes You Should Know About

POSTPARTUM BODY CHANGES YOU SHOULD KNOW ABOUT

Anna Nowogrodzki

THE GIST

  • Many women who’ve given birth have postpartum pelvic floor issues that can require physical therapy. Look out for peeing when you laugh, sneeze or exercise, or for very frequent urges to pee.
  • Treatment for pelvic floor issues isn’t just Kegels (and a lot of people do Kegels wrong).
  • If penetrative sex hurts after the first few times, go slow, use lube and try non-intercourse forms of sex. If it still hurts, see a pelvic floor physical therapist.
  • If you feel like something is falling out of your vagina, you may have prolapse. Consult your doctor for a referral to a pelvic floor physical therapist.
  • Scar pain is common after both C-sections and vaginal births even up to a year postpartum. Scar massage may help.
  • If your back, shoulders or hips hurt, make sure you’re carrying your baby and baby gear on both sides of your body equally, and see a physical therapist.

When I was pregnant, I read four books on pregnancy and two on childbirth. I read no books on what my body would be like during the first year postpartum, because I had never heard of any. During that first year, many people are underinformed about their own bodies, even as they learn vast amounts about their babies. Many of us are cleared for sex and exercise at six weeks postpartum, but a body that grew another human can take much longer than that to heal — and can be permanently changed in some ways. 

For this piece, I discussed health in the first postpartum year with two ob-gyns, a nurse, two physical therapists who specialize in treating postpartum bodies and two mothers. All the experts said many people have questions about what is normal, and they recommended calling your obstetrician, midwife or primary care provider if you’re concerned about something specific. For many symptoms, a next step will be a referral to a physical therapist. The experts stressed that you don’t have to live with pain, discomfort or leaking urine, and that your health is as important as your baby’s.

WHAT TO DO

  • Don’t ignore concerning changes.

Peeing a little when you sneeze, laugh or exercise is such a classic postpartum symptom that many assume it can’t be fixed. Not so. It’s called stress incontinence, and it’s a symptom of a problem with your pelvic floor, a set of muscles that stretch, bowl-shaped, between the tailbone and the pubic bone. Urge incontinence, in which you feel the need to urinate very frequently, feel you have a very small bladder or feel you can’t hold it, is also due to pelvic floor muscle stress.

If you have any kind of incontinence, a good first step is a referral to a physical therapist who specializes in pelvic floor issues. “Being pregnant puts stress on your pelvic muscles” because of the weight of the fetus, said Dr. Tamika Auguste, an ob-gyn at MedStar Washington Hospital Center in Washington, D.C. Vaginal delivery or a C-section can further stress your pelvic floor, especially if the C-section was unplanned and occurred after some amount of labor. “Oftentimes women don’t always recognize immediately how much of a toll that still took on their vaginal canal and pelvic floor,” said Alison Colussi, D.P.T., a physical therapist specializing in pelvic health. Muscles that stretch during delivery can either remain too loose or over-tighten in response.

  • Do pelvic floor exercises — but not just Kegels.

When you think pelvic floor, you probably think Kegel exercises — in which you contract your pelvic floor muscles. But Kegels are not always helpful, and they’re hard to learn how to do properly on your own, Colussi said, so it’s best to visit a physical therapist if possible. Some women’s pelvic floors are overly tight, “in a constant state of mini-Kegel,” as Colussi puts it, which Kegels would only exacerbate. Even when pelvic floor muscles are weak and need strengthening, “the focus is much more on finding the full range of motion of those muscles, which includes both relax and contract,” Colussi said.

The relaxing part is hard. I tried to do it while on the phone with Colussi. “I’m not entirely sure if they’re relaxed or not,” I told her. “Am I actually trying to contract something accidentally?” She laughed. “I hear that 10,000 times a day,” she said.

Often, Colussi said, patients come in looking for an exercise to do for 10 minutes every day. “But the question is not what’s a good exercise,” she said. It’s more about how people move in every one of their daily activities, from getting out of bed to picking up mashed fruit off the floor to lifting babies out of their cribs. The proper way to pick up that mashed fruit or a baby in a car seat is to squat down, keeping your center of gravity over your hips and not tilting forward. Then exhale, engage your abs and straighten up using your leg muscles, not your back. 

  • Don’t put up with painful sex.

It’s common to feel discomfort or pain the first few times you have penetrative sex after childbirth, but after that, don’t put up with it. The first step is of course to go slowly and be gentle with yourself. Often ob-gyns will advise using an over-the-counter lubrication product, because breastfeeding suppresses estrogen production, and estrogen produces lubrication, explained Dr. Alison Stuebe, associate professor of obstetrics and gynecology and chair of the taskforce that wrote the newest American College of Obstetricians and Gynecologists guidelines for postpartum care. But lube is just a beginning, our experts all agreed.

In addition to dryness, pain during sex can be caused by pelvic floor dysfunction, other tight or stretched muscles or scar pain from a tear or episiotomy during a vaginal birth. Sex can hurt for patients who’ve had C-sections as well, because both C-sections and the process of pregnancy can stretch or tighten muscles. Ask your obstetric care provider for a referral to pelvic floor physical therapy.

Dr. Stuebe also directs patients to “The Parents’ Guide to Doing It,” an episode of “The Longest Shortest Time” podcast with sex advice columnist Dan Savage as a guest. Savage discusses types of sex other than penetration. Unfortunately, some women experience pain with any kind of sex, usually from increased nerve sensitivity, said Colussi.

  • Seek help if you feel pressure in your vagina.

Some women come to Colussi saying they feel pressure in their vagina, like something is obstructing their bowel movements, “or like a dry tampon is half falling out of me,” she said. Sensations like these could mean a pelvic organ prolapse, when an organ (uterus, bladder or urethra) shifts from its original position or presses against the vaginal wall. “Prolapse is probably the thing women are least prepared for,” said Colussi.

Severe prolapses can be fixed with surgery or alleviated with a pessary (a support in the vagina to prop up the prolapsing organ), but milder prolapses can be managed just by lying down more frequently and avoiding high levels of pressure in your abdomen, Colussi said. “Oftentimes for a woman it feels a lot worse than it actually is,” she said, but in other cases prolapse can be more severe than it feels, so it makes sense to see a health care provider. To better manage pressure levels in your abdomen, don’t bear down when pooping; and exhale instead of inhaling or holding your breath when you exert yourself. If you find yourself grunting and then holding your breath when you lift something heavy, try exhaling instead. 

  • Ask your doctor about scar pain.

If you feel pain in your C-section scar or scar from a tear or episiotomy, see your medical provider. A doctor may recommend scar massage or scar mobility treatments from a postpartum physical therapist. However, be aware, scientific data on the effectiveness of scar massage is limited because it has barely been studied, Dr. Stuebe said. A 2011 paper concluded that scar massage is “anecdotally effective” but found that surgical scar massage of any kind had only been studied in a tiny sample size of 30 patients. Scar pain is common. A year after giving birth, a study found, 18 percent of women who had C-sections still had pain at the incision site, and 10 percent of women who had vaginal births still felt pain in the vagina or perineum (the area between the vagina and the anus).

  • Learn to carry your baby on both sides.

Carrying a baby, lifting a baby and holding a baby while breastfeeding are hard physical work, especially for women who were pregnant. Your posture and movement habits change during pregnancy from carrying around extra weight in new places, and your body also produces the hormones relaxin and progesterone, which loosen your ligaments and joints.

Baby product design doesn’t help. “Car seats and cribs have changed drastically” in recent years, said Colussi. They’re carefully designed for infant safety, but not for parent ergonomic safety. Infant or “bucket” car seats are heavy, and usually parents carry them in their nondominant arm, causing muscle imbalances. She recommends that parents practice early and often carrying their babies on both sides equally. “Cribs are hard because the rails can’t go up and down anymore,” she said. Colussi recommends that parents, especially shorter ones, place a step aerobics stepper next to the crib.

If pain persists after making these changes, physical therapy is a good idea.

  • Use proper form for sitting up.

If you feel a gap in your abdominal muscles, you may have diastasis recti, in which all the layers of the abdominal muscles, the rectus abdominus, separate in the middle. This happens normally during the latter part of pregnancy to make room for the growing uterus, but if it persists at your six-week postpartum checkup, ask your provider, who may refer you to a physical therapist. To avoid putting too much pressure on these muscles, avoid crunches or sit-ups, and when you sit up, don’t sit straight up using just your abdominal muscles: Roll onto your side first and use your arms.

WHEN TO WORRY

  • If you have shortness of breath, pain in your chest or seizures, call 911.
  • If you have an incision that does not heal, a temperature above 100.4F, too much bleeding (soaking one pad per hour or a blood clot the size of an egg or larger), a red or swollen leg that feels painful or hot, or a headache that does not get better with medication or is accompanied by vision changes, call your medical provider.
  • If you had gestational diabetes, make sure you get screened for diabetes according to your medical provider’s advice.
  • If you had high blood pressure (pre-eclampsia) during pregnancy, make sure your blood pressure is monitored according to your medical provider’s advice. (You are still at risk for pre-eclampsia up to six weeks postpartum.)
  • If you quit or tapered smoking or other drugs during pregnancy, see your medical provider for a postpartum support plan. The stresses of life with a baby can lead to relapse. 

SOURCES

Debra Bingham, Dr.PH., R.N., professor of nursing at the University of Maryland and executive director of the Institute for Perinatal Quality Improvement, Aug. 23, 2018

Tamika Auguste, M.D., obstetrician-gynecologist at MedStar Washington Hospital Center, Aug. 27, 2018

Alison Colussi, D.P.T., physical therapist at Physical Therapy Center of Rocky Hill in Rocky Hill, Conn., Aug. 27, 2018

Alison Stuebe, M.D., M.Sc., associate professor of obstetrics and gynecology at the University of North Carolina School of Medicine, Aug. 27, 2018

Holly Herman, D.P.T., physical therapist at HealthyWomen HealthyMen Physical Therapy, Aug. 27, 2018 “Save Your Life: Get Care for These Post-birth Warning Signs,” the Association of Women’s Health, Obstetric, and Neonatal Nurses, 2016

How to Be a Supportive Partner During Pregnancy (and Beyond)

HOW TO BE A SUPPORTIVE PARTNER DURING PREGNANCY (AND BEYOND)

David Howard

THE GIST

  • Numerous studies have shown the benefits of having a partner who is supportive or perceived to be supportive. Conversely, having a partner who is perceived to be unsupportive is a predictor of depression and anxiety both before and after a child’s birth.
  • Start early. Being a supportive partner begins in the months before delivery, when an expectant mother’s anxiety levels may be rising about giving birth and the changes a baby brings.
  • Make a plan for your supportive role both during and after the baby’s arrival, but be flexible. There’s no script for how things are going to go.
  • New research indicates that supporters may need support of their own: They can feel isolated or rejected but question the legitimacy of their experiences.

If you’ve watched any movies with birth scenes, you may have noticed that the partner’s role often fits into one of two categories: He — and it’s always a he — is a comically inept second fiddle, fainting just when he’s needed most, or else absent entirely, inhaling a cigar in a nearby pub. 

These dated archetypes exist for a reason. What actually comprises a supportive partner has only come into focus in recent years, as fathers and same-sex partners have become more central to the birth and all that comes after. But the research is resoundingly clear: A strong mate makes a difference. Having a supportive partner is good for everyone involved, including the baby.

The scientific literature is less clear on what specific strategies best support pregnant women — it’s tough in a clinical setting to isolate the benefits of, say, a well-timed hug or a promise to handle 3 a.m. feedings. But the three researchers I spoke to distilled their studies into some real-world advice.

WHAT TO DO

  • Connect with each other well before the due date.

This should be even more of a priority than buying the right stroller. “The focus is so much on practical needs,” said Dr. Pam Pilkington, Ph.D., a perinatal psychologist who practices at the Centre for Perinatal Psychology in Melbourne, Australia, and founder of Partners to Parents, a resource site developed by a team of researchers and psychologists at Australian Catholic University to provide guidance for partners. “During pregnancy, people perhaps don’t focus on the couple relationship, or supporting each other emotionally as much as they could.”

In practical terms, this means talking often and openly about how you’re both feeling — anxious, excited, uncertain, whatever it is, Dr. Pilkington said — then validating each other, making sure you both feel heard and accepted. An example: After a month at home, a new mother might say, “I feel trapped here all day while you’re at work.” The supportive answer here is not, “I need to work so we can pay the bills. Why don’t you get your mother to come help?” Rather, a validating answer would be: “I’m sorry that you’re feeling pinned in place. It sounds like you’re missing seeing your friends at the office.” 

Trying to build mirroring-and-validating skills during the relative calm before your child’s arrival will help cement your bond for the challenges to come, Dr. Pilkington said.

  • Make your good intentions known.

Making yourself of service to another is what’s known in scientific vernacular as “offering social support.” Researchers call it a mysterious force that has tangible benefits. “There’s a magic about social support,” said Dr. Christine Dunkel Schetter, Ph.D., a professor of psychology and psychiatry at UCLA who has studied its effect on stressful situations, including pregnancies. “And the magic is that when it’s really working in these kinds of situations, it’s about things that take place between two people. And it’s about what one person says to the other, or does, that makes them feel better.”

Part of the magic of social support?Even when an expectant mother merely perceives that she has a supportive partner, she’s more likely to come through pregnancy happy and healthy, research shows. Studies have variously found that partner support is associated with better birth outcomes and lower levels of distress and depression among both mothers and infants.

But follow-up is key, too, said Dr. Dunkel Schetter. If you don’t actually come through on a promise to assume half of the diaper-changing duties, the benefits of perceived support quickly trail off.

Sometimes, supportive partners will learn that the best kinds of support are nonverbal — offering a hug during a low emotional ebb. And the support should be offered unconditionally. “The person giving it can’t say, ‘Now you owe me, you’re obligated, I’ve done so much for you,’ ” said Dr. Dunkel Schetter.

CenteringPregnancy, a program developed by the Yale School of Nursing, provides social support instruction, among other services, in a group setting for women and their partners; it’s now available in health-care facilities around the United States. (You can find a nearby location on the website.)

  • Take a birthing class — but be open-minded when the day arrives.

Classes like the Bradley Method, which teaches that childbirth can be managed through deep breathing and the support of a partner or labor coach, can be helpful in making you feel more prepared, and offering a sense of what to expect. But Dr. Pilkington pointed out that birth is not the same as being a cast member in a play. The baby sometimes rewrites the script. Things take unexpected turns, or the mother’s preferences before going into labor might change 12 hours in. The partner should avoid rigid thinking about how it was supposed to go, and instead help the mother roll with whatever’s happening and support her choices along the way, Dr. Pilkington said.

  • Have a plan for the weeks after the baby arrives…

Specifically, the partner can draw up an action plan in which he or she commits to executing certain helpful tasks. Maybe it’s late-night feedings if the mother is going to pump breast milk or your baby is on formula. Maybe it’s a daily break that the mom can count on, like taking the baby out for a walk so she can nap or take a bath, said Dr. Pilkington.

  • … But be flexible.

Planning to do those 3 a.m. feedings is one thing. The searing exhaustion that kicks in after four weeks of doing that is another. During your child’s early life, it’s best to expect some meltdowns. (The baby will cry sometimes, too.) Revisit the plan anytime based on whatever challenges you might face at each stage of your baby’s life. It’s O.K. to ask for extra support from friends and family, Dr. Pilkington said. Both parents can use a break in the first couple of months of their baby’s life.  

  • Know your role with feeding.

One task the mother generally handles alone is breastfeeding. But a 2015 studyled by the University of Ontario Institute of Technology suggested that a partner’s active involvement —learning how breastfeeding works and providing encouragement — leads to “significant improvements” in breastfeeding duration. Then think of simple, commonsense ways to step up: Helping the mother stay hydrated by offering a glass of water, bringing healthy snacks and providing a comfortable environment, Dr. Pilkington said.

For parents who can’t breastfeed or choose not to, Dr. Pilkington says it’s important to remember they haven’t failed. “How parents feed their infant is a personal choice that should be based on their specific situation,” she said. If the mother is pumping, you can help maintain the equipment and offer to bottle-feed using the milk. Parents feeding their baby with a bottle — whether it’s formula or breast milk — can split overnight duties, one taking the 9 p.m. to 2 a.m. shift, the other holding down the 2 a.m. to 7 a.m. slot, for example. Partners using formula can make sure there are adequate supplies on hand at all times and know how to mix it. Some formulas can be premixed and stored in the fridge for up to 24 hours, which could save an exhausted mom from having to drowsily scoop powder in the small hours of the night.

  • Expect that your sex life will change — for a while, at least.

This is a biological imperative, so expect the temperature to be dialed down in the marital bed post-birth (for a duration that depends on the circumstances of the delivery; consult a professional). And even after you’re medically cleared, that doesn’t mean you’ll feel the same or have much energy for sex early on. Make a point to seek out alternate forms of intimacy, like hand-holding and cuddling, Dr. Pilkington said. The key, again, is to maintain an emotional connection and strong lines of communication.

  • Look for signs of your own stress, and act on them.

The psychological effect on partners after a baby’s arrival is mostly a black hole in the scientific realm. Dr. Pilkington noted that only 19 of the 120 recent studies around pregnancy touched on outcomes for fathers or partners, and researchers openly acknowledge the need for more research. But the few studies that have been done show that fathers can struggle to navigate this interlude. Dr. Zoe Darwin, Ph.D., a lecturer in maternal health at the University of Leeds in the U.K. who has conducted some early inquiries in this area, found that men often feel stressed and detached but want to keep the spotlight on the mother and child. “The research that we’ve done,” she said, “found that although some of the men we spoke with felt excluded by maternity services, and had experienced significant stress in this period, they often questioned the legitimacy of their experiences and their entitlement to support.” If you feel yourself struggling, let your partner know, and consult a caregiver.


WHEN TO WORRY

If you’re struggling with depression or anxiety, you may need more than a hug or the sage words of a parenting class. Seek professional help from a counselor.

SOURCES

Dr. Pam Pilkington, Ph.D., perinatal psychologist who practices at the Centre for Perinatal Psychology in Melbourne, Australia.

Dr. Christine Dunkel Schetter, Ph.D., professor of psychology and psychiatry at UCLA, expert on stress processes in pregnancy

Dr. Zoe Darwin, Ph.D., lecturer in maternal health at the University of Leeds in the U.K. who specializes in mental health and wellbeing during and after pregnancy.

18 Brilliant Ways to Care For Your Pregnant Wife or Partner

Handsome man portrait gifting flowers to his pregnant girlfriend

18 BRILLIANT WAYS TO CARE FOR YOUR PREGNANT WIFE OR PARTNER

Parent Co

Pregnancy is, for many women, one of the most emotionally wrought and physically challenging experiences in life. Whether it’s her first or her fourth, the best thing you can do for your pregnant partner is show a little extra compassion during these 40ish weeks.

We’re offering 18 ideas here – all of which we’re confident would be appreciated – but the best thing for you to do is find the expressions of care that feel most genuine to you. Think about your partner as a person; her likes, dislikes, obsessions, and quirks. Many of those will follow her into pregnancy and then well into motherhood.

Showing that you understand and love her will help your partner feel cared for as she wades (or waddles) into the sometimes tumultuous waters of pregnancy.

Read more

Healing through infertility and miscarriage

HEALING THROUGH INFERTILITY AND MISCARRIAGE

Anne Banks

Every story has a happy ending but not every ending is the same.

I hadn’t struggled getting pregnant, we had just waited for what felt like the right time to try again. We were thrilled. We had a happy accident with our first pregnancy, meaning we weren’t really ready to be pregnant, but happy to have our baby. This time around, we wanted to be pregnant, we wanted this baby. I could barely contain my excitement.

If you haven’t guessed from the title of the post, and that preface, yes, I miscarried. I was heartbroken. I was already planning names, counting down to the gender ultrasound. I miscarried at 9 weeks. It was a very difficult time, right around the holidays. My doctor told me that about one in four pregnancies end with a miscarriage. I couldn’t believe the numbers were so high. Then I had friends who started to tell me about their experiences. It is a fairly common occurrence. And in most cases, it is heartbreaking for the mom. Dads may feel heartache as well, my husband had wanted the baby as much as me. It’s just different for women.

Read more

How to help when your wife has a miscarriage

HOW TO HELP WHEN YOUR WIFE HAS A MISCARRIAGE

Francia Benson

Having a miscarriage is one of the most painful events a woman can experience. There are no words to describe the hurt, anger and disappointment. If your wife has had a miscarriage, there are several things you can do to help her.

It was a dark, cloudy morning. My father carried the little wooden box in his hands. My siblings and I followed him ominously. Once he found the perfect spot he proceeded to bury my stillborn brother.

My mom was four months pregnant when she had the miscarriage. Despite my young age, I noticed and appreciated how my dad helped her go through that painful period in her life. He was there, physically and emotionally, for her and for each of us. Who knew that years later, it would be me who would be crying over the death of my own stillborn baby.

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6 symptoms that occur during your most fertile period

6 SYMPTOMS THAT OCCUR DURING YOUR MOST FERTILE PERIOD

Stael Ferreira Pedrosa
Do you dream of having a child? Or are you avoiding pregnancy, but not using birth control? Here’s the knowledge you need.
Whether you’re trying to get pregnant or trying to avoid it, knowing when you’re most fertile is vital information.
Here are six signs that you’re in your most fertile period of the month:
1. Increased libido
During this time, your progesterone (a hormone) levels increase. This causes your libido to spike more than normal. It’s also common to feel more hungry because of the hormone.

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