PORTSMOUTH — The goal of a pregnant woman is to deliver a healthy baby, and simple steps prior to delivery can go a long way toward achieving that happy outcome.


Once a pregnancy test confirms the impending arrival, the first choices to be made are to pick the doctor or midwife and the medical facility where the child will be delivered. Visit both and begin making arrangements in advance so conditions will be ready when you are.

"The first thing that is so important is for the woman to understand going in that pregnancy can be enjoyable and fun," said Dr. Heidi Keup, who practices obstetrics and gynecology at Portsmouth Regional Hospital. "Having that mindset can make for a very positive experience."

That being said, Keup said pregnancy can be a time of high anxiety for some women, though they should not be hard on themselves if they have such periods because it's also normal.

"Pregnancy is a normal state of being," said Dr. Jane Kerr, an OB/GYN at Anna Jaques Hospital in Newburyport, Mass. "You need not make drastic changes, but you can continue all usual activity. Eat healthy and increase calories, but only by about 500 per day. You are not really eating for two as some women say. If you overeat, there will be excessive weight gain and it will be harder to lose after the baby is born."

Regular prenatal checkups will allow the doctor to monitor the progress of the fetus and determine if there is a problem requiring intervention. As an average guideline, a woman should plan to see her doctor once a month for the first 28 weeks, twice a month from 28-36 weeks, and weekly after that until she gives birth.

At a checkup, the physician will check the mother's heart rate and blood pressure and listen to the growing fetus' heart rate. Physicians will measure the mother's abdomen to track the growth of the child. Tests will be conducted to rule out and treat conditions such as anemia and gestational diabetes.

Amniocentesis and urine tests are used to watch for serious birth defects, Down syndrome and preeclampsia.

Prenatal vitamins are important to assist in "cooking" a healthy baby.

"If you are pregnant or ideally even thinking about being pregnant, you should be taking prenatal vitamins," Keup said. "One major difference from regular vitamin supplements is the high concentration of folic acid, necessary in helping to prevent neural tube defects like spina bifida."

Anyone who has taken these vitamins in the past will remember they are about the size of horse pills. For today's lucky moms, the pills now come in a tasty gummy version, Keup said.

"Take them at night because they can cause nausea," she said. "This way, you may be able to sleep right through that."

Pregnant women should avoid X-rays. They should tell their primary care doctor or dentist if they suspect they might be pregnant before submitting to the procedure.

Expectant moms also should take care to eat well-balanced meals. They should avoid the use of drugs or alcohol and should not smoke.

"In spite of what some people think, no amount of alcohol has been deemed safe," Kerr said. "Good studies show it can lead to fetal alcohol syndrome, which can be devastating. It may be linked to brain development and to conditions like autism. Just don't drink."

Even over-the-counter drugs should be avoided unless taken under the supervision of a physician.

Keup said Tylenol is the pain reliever of choice, advising against ibuprofen or naproxen, which could interfere with kidney development.

"As a rule of thumb, whatever you can avoid until after 14 weeks (the time of most development) do not take, and that includes herbal tinctures," Keup said.

Exercise is important. Overdoing it is not, so don't suddenly decide to run a marathon.

"This is not the time to begin a new rigorous regime if you have not been active," Keup said. Try to increase a bit. Take a walk every day. You will be in better shape for the delivery and after the birth."

Kerr said if you didn't do it before, don't do it now.

"Use common sense," she said.

Toxemia and listeria are food-borne illnesses that can impact a fetus.

"Avoid raw fish and eggs," Kerr said. Avoid artificial sweeteners and limit caffeinated beverages to 12 ounces a day. Mothers to be may want to avoid mercury-laden fish such as swordfish, king mackerel and shark, but shellfish is OK. Tuna in a can should be limited to one per week. Fruits and vegetables should be washed before consumption."

Kerr said the omega-3 oil found in fish is good but that supplements are available that are safer for pregnant women.

Anyone who might need free or reduced prenatal care can call their local health department. They can also call (800) 311-BABY (2229) to be connected to health-care services across the country.