It’s come to my attention that I’ve been throwing this term around without explaining it! Oops. Simply put, it’s the preparation you do before trying to have a baby. It can take many forms, depending on your situation, gender, family type, & and if you or a partner will be carrying the child or if you’re approaching parenthood via surrogacy, adoption, or another means. Some folks have surprise pregnancies and shuffle the pre-conception care side of things into the pregnancy or early years. Some folks find conception very challenging and the pre conception stage can go from exciting to agonising. Everyone puts their own emphasis on the areas that are important to them, and completely skip other areas they don’t feel are necessary, or don’t think about, or are too overwhelmed by. Here’s some rough areas people may work on during pre-conception care:

Physical Health

Your health impacts everything – your chances of conception, rates of miscarriage, how tough you might find labour to be (birth mums and everyone else in the room!), attachment to the baby, managing sleep deprivation with a wailing person in the house, and keeping up with small terrors who have something like 10 times your energy levels. 🙂 Rose and I have been working a lot on health, particularly as we both have diagnosed fertility issues so the scales are already tipped against us. In our case, we’re working on improving our diet to be primarily home cooked, with a focus on fresh fruit and veg and good intake of red meat. We’re spending more than we used to on food to make sure there’s healthy snacks and things to take for lunches, we’ve moved to low fat dairy products and we’re trying to avoid transfats. We’re doing this very carefully as there’s a lot of vulnerability around food and body image. There’s no point at all in losing weight at the cost of physical and emotional health.

I’m doing a lot of work around exercise, and I’ve taken up walking as regularly as I can manage. The key is being gentle, building up gradually, not pushing myself to walk when I’m just not well enough, and for me – tracking my progress because that makes me feel awesome. 😉 On my good days I’m building capacity. My longest walk so far is 3.6km. I’ve walked a total of 41.7km over the last 8 weeks. Whoo!

Health is also about things like – reducing or eliminating risky habits such as smoking. Finding alternative meds for those you need but that aren’t safe to use in pregnancy. Getting fertility issues properly assessed and if needed, treated. Getting on top of chronic issues as best you can. I’m still waiting for my sinus op, and I won’t be trying to get pregnant until it’s happened, because there’s no way I want to risk bad liver reactions to anaesthetics and pain relief when I have a baby on board.

In my case, this is also about looking at pregnancy and parenting through the lens of disability. One example is that my fibro leaves me vulnerable to higher levels of pain and fatigue in doing certain things. (this is different for everyone with fibro, and good days vs bad days are also different) In my case I recover much more quickly from an hour of gentle walking than an hour bending and digging and weeding in my garden. Something I’ve noticed from looking after my gorgeous goddaughter is that the lift/bend/twist action of putting a child into a child seat in the back of a car is hard on me. 2 door cars are way worse than 4 door, and seats by the edge are harder than seats in the middle (where I can rest on a knee on the seat). So with this in mind, Rose and I are working on fixing up and selling my car so we can buy a 4 door. This consideration is also guiding our choices around housing, bedding, choice of a nursing chair, and so on.

Mental Health

All the risks that poor physical health can increase also apply to your mental health. Some people have to figure out the risk/benefit ratios of psych meds that increase miscarriage rates. Sometimes they can swap to a less harmful med, sometimes they can taper their dose, sometimes they can get off the med entirely, sometimes they stay on it and deal with the consequences. I’m personally not only any psych meds so I don’t have anything to worry about here.

Do you have good supports and resources if someone struggles with post partum depression or other challenges? Are you able to recognise problems developing early and communicate about them? Is anyone likely to be struggling with complex responses to a pregnancy or baby – such as, people who have previously suffered pregnancy loss, are currently grieving a dead or terminal friend or person, were abused as a child and are likely to find some trauma things resurfacing, have existing relationships with abusive people, or are facing other major life challenges in the domains of health, housing, employment, poverty and so on? Giving some thought and preparation time to this can be the difference between a challenge met well and a quietly unfolding crisis, kept secret through shame.

In my case personally, there’s been a lot of hard work to build the kind of life stability I want and need. Housing is secure, income is low but safe, I’m building a business, my disability is well managed, my relationship is solid, and my mental health is in a good place for the massive amount of dedication and devotion needed to care for a child. This isn’t a guarantee that things won’t change! We’re all vulnerable to bad luck and difficult circumstances, none of us are beyond the reach of tragedy. But I’ve done what I can to set myself up.

Household

Babies have profoundly different needs from adults! Some won’t become apparent for awhile while others are really important to have ready before they arrive – like making sure your pets are child safe. Transport, location, house layout, safety, and extra resources can all also be given some thought to early. Rose and I have a pretty awesome collection of baby clothes, baby wearing wraps and carriers, we’re travelling out country shortly to buy a baby hammock, and we’re starting to keep an eye on key furniture in second hand shops and over eBay.

Structure

Every family is different! Time to talk about how you want to do things can help you to think more creatively and not just do what ‘everyone else’ does whether it suits you or not. How are you going to divide household tasks? Keep income happening? Do you have good routines for maintaining a home? Do you have any experience with children or babies? Do you communicate well? Are you going to involve anyone else? eg extended family members or friends who will live with you or nearby or offer support on an emergency or regular basis. Do you have enough skills to keep things running if something goes wrong? Can you adapt when things don’t go to plan? Can you support each other through grief? Are there good support people around you that you’re both comfortable with? You’re a team! Who’s on your team? How does this team work? What’s important to you, what don’t you care about, what skills do you need to develop more?

Family

If you don’t already think of yourselves as a family, planning for a child shifts all that. In our case, Rose and I are making a lifelong commitment to each other as co-parents, whatever might happen within our romantic relationship. We are building a family in which our devotion to this/these children is the foundation, our commitment to set up a safe, fun, loving little culture, to the best of our abilities. Our family is not just an extension of our romance, it’s separate from it. That doesn’t mean we don’t expect to stay together or that we don’t think having love and affection are important – we’ve been inspired by families where parents have changed their relationship dramatically but maintained their parent role with devotion, such as parents who split up but stayed living in the same house with the kids, and down the track each had their own other partners who visited but the family home remained intact. Others who bought a unit and the parent who wasn’t working with the kids that day would move to the unit, instead of the kids moving between houses. There are many aspects to my relationship with Rose, we’re friends, lovers, sometimes carers for each other, and soon, hopefully, co-parents. Each of these domains can shift and change with life, without destroying that last one.

Setting up a new family can benefit from some reflection at every step of the process. Each family has its own culture – values, rituals, norms. Preconception care can be about starting to define your own family culture. This can be about discussing family of origin and childhood experiences… what were the best parts? The worst? What do you want to replicate? What are you scared of replicating? Part of this process can also be your current relationships with friends and family. For troubled families, you need as much time as possible to start working on healthier dynamics. If there are big problems around abuse, distance, or power issues, it’s often more effective to start early and make gentle changes than suddenly try and change how you respond once a baby is here. If you want to build some more closeness with someone important to you, start now before you’re tired and need all your attention for a baby. If you need to set up some better boundaries and practice some communication and conflict resolution skills, ditto.

You all need to talk about safety and make sure children are never going to be left unattended with anyone either of you know is likely to harm them. That might sound obvious, but in complex families it can start WW3 to privately decide that you’re not going to leave a baby unattended with grandma because you have some bad memories about her when you were young that you’ve never shared with anyone else. For some families, the idea that you have the right to restrict power over or access to yourself or your children is a new and explosive idea. Of course, especially when there have been issues in the past this can also work the other way, and people can be terribly distressed when an over protective new parent cuts out loving people they suddenly see as a threat. It helps to start having these conversations early and often, and being very honest with your partner or co-parent in them. A baby can change everything, and things you have been tolerating or ignoring for years can suddenly become important to manage when you realise they will impact a tiny person who has no say about any of it. Safety is one of the most basic rights a baby should be able to expect.

In our case, another aspect of this is navigating a relationship with a known donor, making sure that we have sound legal advice, that we are open about our hopes and circumstances with them, that neither we nor the donor are in a vulnerable place where someone can be exploited, and that there’s a clear understanding of how this new family will be set up. 🙂 Whoot!

So there you have it. Pre-conception care can be as broad or narrow as you need it to be. As a general rule, those of us with fertility issues or in same-sex relationships put more time into this, and that can be a wonderful thing. It can also shift your whole life into a state of perpetual readiness that can turn into agony if a child takes a long time to come or never comes at all. For some of us, facing grief, loss, heartsick longing, and insensitive people can be a critical and deeply challenging part of pre-conception care. But nothing is wasted. All efforts to build healthy families are valuable, and it is not children who make a family but love. Any people who love each other are family. If you’re on this path, best wishes! And wish us luck, we’re exited and hopeful and anxious and positively quivering with anticipation. 🙂