Things I wish
I knew.

The things that caught me off guard

Some of the hardest parts of pregnancy were the parts I didn't know to expect.

The waiting

I started bleeding at about six weeks, roughly two weeks after I found out I was pregnant. They did an ultrasound to look for a heartbeat. At that point it can be too early to see one, so not finding a heartbeat might not have told us whether I was miscarrying. We might have had to wait for another ultrasound once a heartbeat could be detected, or until it became clear that I was losing the pregnancy. They did find a heartbeat at my scan. I was relieved, but going in I knew I might have to leave without an answer.

Morning sickness doesn't check the clock

It happened at all hours. The name really did not prepare me.

The gestational diabetes test

I have a fear of needles, and the testing was harder for me than I expected. An elevated one-hour screening result is not by itself a gestational-diabetes diagnosis; the usual follow-up in a two-step approach is a diagnostic glucose-tolerance test. My doctor later told me that, in my situation, meeting with a nutritionist after that first screen might have been an option. I wish we'd talked through the alternatives sooner. If you're worried about the test, ask your clinician what follow-up is medically appropriate for you. Read the NIH testing overview ↗

Stretch marks, at the very end

I thought I'd escaped them. Then in the last month, the bottom half of my belly stretched and the marks arrived all at once. I love them now. At the time, I had complicated feelings about them, and that surprised me too.

Two things to prepare before delivery

Perineal massage: If this is your first child and you plan to deliver vaginally, start at week 34. Do it daily with Vitamin E (washed hands, short nails). Read the article I used ↗. I also asked for warm compresses while pushing; I've written more about that below in my delivery story.

Car seat: Install it around week 36 so it's ready before the baby arrives.

Classes: what was worth it for me

The birthing class helped, even with its gaps. The newborn care class at MGH wasn't worth the time or money for us. We got much of the same information in the hospital, and practicing a bath with a plastic doll wasn't as useful as the nurse showing us how to bathe our daughter. The class also missed a practical diaper tip: pull the outer ruffles out to help prevent blowouts. I wanted more on newborn hygiene and visitors, too. Johns Hopkins has a guide to newborn visitors ↗. Your hospital's classes may be different. Ask what they cover before paying.

I'd save the money on that newborn class. I also recommend this childbirth-class video ↗ for birth preparation.

Read the whole label, even when a doctor recommends it

Giant prenatal pills were hard for me to swallow. My doctor suggested chewable Flintstones vitamins and Slow Fe for my anemia. I looked up the ingredients and was surprised by what else was in them.

I am not an expert on additives, but I wanted to minimize my exposure to ingredients that concerned me if I could. Titanium dioxide, silicon dioxide, and artificial dyes were the ones that sent me looking for alternatives. I still needed prenatal vitamins and iron. I wanted a formulation I felt better about taking.

Colors and coatings I didn't ask for

Titanium dioxide caught my eye because the EU withdrew its authorization as a food additive after regulators could not rule out a concern about DNA damage. Medicines have different rules, but I found other products without it. Read EFSA's explanation ↗

I also looked at artificial dyes. In the UK, foods containing certain colors, including Allura Red (Red 40/E129) and Sunset Yellow (Yellow 6/E110), carry a warning about possible effects on children's activity and attention. That warning isn't a finding about pregnancy. With questions about dyes still on my mind, I chose to look for vitamins without them. See the warning requirements ↗

Silicon dioxide

The Flintstones chewables my doctor suggested listed silicon dioxide, an anti-caking ingredient. I read research on engineered silicon dioxide nanoparticles ↗ describing animal studies in which the particles crossed the placenta and affected offspring development. The Flintstones label didn't say whether its silicon dioxide was in nanoparticle form, and I didn't want to guess. I chose Ritual instead and pushed through swallowing regular prenatal pills.

What about heavy metals?

A label won't tell me whether a bottle contains lead, cadmium, or arsenic. That's why I paid attention to independent testing, including Lead Safe Mama's reports on samples of Ritual Essential Prenatal ↗, Thorne Prenatal DHA ↗, and SmartyPants Organic Prenatal Multi & Omegas ↗. Those reports helped me ask better questions about contaminants. They cover specific products and samples, not a permanent ranking of brands.

Reading labels and understanding ingredients is why I built Ingestible ↗. It can help you spot ingredients in vitamins that you may want to look into. It can't test a bottle for heavy metals.

Buy less. Ask for diapers.

Baby sizes on tags told us surprisingly little. Holding clothes up next to each other before organizing the drawers worked better than sorting by the printed age.

Two birth plans, not one perfect script

The useful part of a birth plan was talking through choices with my companion before I was exhausted and in pain.

Perineal Prep & Pushing

If this is your first child and you plan to deliver vaginally, start perineal massages at week 34. Do it daily with Vitamin E (washed hands, short nails). Here is a great article about it ↗. During pushing, ask for warm compresses. I had a first-degree perineal tear and a first-degree periurethral tear. The warm compresses could also have helped; I was very happy with that outcome. I highly recommend this video to prepare ↗.

Navigating Interventions: Pitocin & The Epidural

It is incredibly tricky to advocate for yourself in the moment. I had bleeding when my labor started and was told I needed Pitocin because of it. Pitocin made my contractions almost impossible to manage, and I decided on the epidural I had originally hoped to avoid. I asked them to stop the Pitocin during the epidural placement. The contractions became manageable, but by then I felt it was too late to backtrack. My gynecologist later thought they should have first seen whether my labor would progress without Pitocin, even with the bleeding.

Advocate for time: I wish I had asked if we could watch the progression of my labor first and use Pitocin only if highly necessary. A nurse was increasing the dose about every 30 minutes; when I questioned an increase, she said it was needed but could space them out. I wish I had spoken to a doctor about it then.

Epidural Dosages: After my epidural, I couldn't move one of my legs. They said my position was sending more anesthetic to that side. I could move the other leg and wasn't in pain on either side, so I felt the dose might be too high. I told them I hadn't pressed the button since the first time they had me press it. I repositioned myself and asked them to decrease the dose. After they did, I could move both legs and still had very good pain relief.

Pain Management Prep: Watch this video ↗ and read the documents given to you by your hospital regarding pain management options.

(Note: I also experienced an unexplained hemorrhage during labor. Always trust your gut, and don't be afraid to ask a lot of questions to other moms before you go in.)

Ask what they have. Then ask again.

At our hospital, the lactation consultants were generous, but we often had to ask where the other supplies were.

A nursing scare and the tips I wish I'd known

We went to the ER after our baby vomited blood. Later, I found a nipple crack nobody had seen. I wish I'd known about hidden cracks, feeding backups, and the gear that helped us at home.

The crack I couldn't see

Our baby began vomiting after feeds and then vomited blood. We went to the ER. The team examined her and my nipples, and nobody saw an obvious crack. Back home, after another feed, I pressed a white cloth against my nipple and saw blood. The crack was hidden in a fold of skin and only opened when she latched. I wish I'd known that could happen.

Feeding choices I would talk through sooner

I used a bottle occasionally while my nipples healed. Later we stopped offering it, and when I had to go to the ER, our daughter refused the bottle for hours. I'd discuss an occasional bottle and a backup feeding plan with a pediatrician or lactation consultant, especially if I wanted someone else to be able to feed her. Families have different feeding goals, and there is no magic six-week rule that fits everyone.

My doctor suggested using a nipple shield with my pump so I wouldn't have to buy smaller flanges. And for nursing clothes? Pajamas with a neckline I could actually move out of the way were the winner.

Finally, research safe co-sleeping. Most parents will end up co-sleeping at some point out of sheer exhaustion. It is extremely important to know how to do it safely, keeping in mind that most SIDS cases happen between months 2 and 4. Boston Children's has an overview of SIDS ↗. Be prepared, be educated, and trust yourself.