Q. There is a history of sickle cell anemia in our family. Now my husband and I want to get pregnant. What do I need to know?

A. It's good that you're thinking about this issue now, before you become pregnant. I strongly suggest you ask your health care professional for a referral to a genetic counselor in your area, or find one yourself by going to www.nsgc.org. A genetic counselor will conduct an in-depth medical history of both of you and your families. The counselor may also recommend some genetic testing to see if either you or your husband carries the gene for the disease. If both of you carry the gene, your child has a one in four chance of having the disease. In that instance, your counselor may recommend options that could reduce that risk, such as a form of in vitro fertilization called pre-implantation genetic diagnosis, a donor egg or donor sperm.

Q. My husband thinks childbirth classes are a waste of time, and that I should be able to learn what I need from books and talking to my friends. Is he right?

A. I definitely do not think childbirth classes are a waste of time. Any education that a woman receives about her pending childbirth can be of value. I cannot tell you how many women over the years have told me how valuable they thought prenatal education was and how it empowered them by providing background knowledge they needed to make the informed decisions one needs to make in labor.

In addition, research finds that the more prepared a woman is for labor, the less fearful she is about the process. This, in turn, reduces production of stress hormones that can slow labor. By using breathing and relaxation techniques taught in a good childbirth class, a woman can take advantage of her body's endorphin release (natural pain-relieving substances), which will make her labor easier.

In looking for a childbirth class, it is important to check the credentials of the instructor. Make sure she/he is accredited by a recognized organization like Lamaze, ICEA (International Childbirth Educators of America) or Bradley. Too often, the only "credential" that the instructor has is that she is a staff nurse at the hospital where the class is held. Depending on her personal views of childbirth, you could get a very biased education on the finer points of childbirth.

It's also important to know what is covered in the class. If you're hoping for a birth with little medical intervention, but your class doesn't cover much on breathing or relaxation, you're going to be disappointed. Make sure the class has a well-rounded curriculum including breathing and relaxation training interspersed with informative topics like stages of labor, pain control options, baby care, cesarean birth and other topics.

And don't give up the reading! Two books I recommend to my patients are Active Birth by Janet Balaskis and Gentle Birth Choices by Barbara Harper. The key is to educate yourself so you feel you have all the information you need to make informed choices.
-- Michelle Collins
Certified Nurse Midwife and Clinical Faculty Member
Vanderbilt University
Nashville, TN

Q. I have a history of depression, and I'm worried about the risk of postpartum depression after my baby is born.

A. Although most women experience what we call the "baby blues" a few days after giving birth, postpartum depression is a far more serious issue. It is a form of major depression affecting between 10 and 18 percent of new mothers within the four to 12 weeks after childbirth, and it can occur up to two years after a birth.

While we don't know for sure what causes it, we do know of numerous contributing factors. These include a personal history of depression, a family history of depression, lack of social support, low income, stress in your family, relationship issues, having had a high-risk pregnancy or having a baby born with problems.

Being aware of these risk factors and talking to your health care professional before the baby is born can help insure prompt identification and treatment if and when postpartum depression develops. For instance, if you don't have any social support to help you with the baby (your mother, friends, a partner), your provider should try and facilitate something, like a visiting nurse or other support programs during the postpartum period. Many midwives, for instance, will do home visits to assess how an at-risk family is integrating the baby into the family.

You and your family should also be aware of the early signs of postpartum depression: a lack of interest in caring for yourself or the baby, weight loss and lack of interest in food, insomnia or sleeping all the time, decreased concentration and increased indecisiveness, feeling agitated and restless or, conversely, a lack of energy, feeling worthless or guilty and having recurring thoughts of death. Treatments vary with the individual woman, but include antidepressant therapy, counseling and the aforementioned home visits.
-- Heather Reynolds, CNM
Certified Nurse Midwife
Associate Professor
Yale Medical Center
New Haven, CT

Q. Yikes! I'm having twins. Can I expect a normal delivery?

A. While it is certainly possible in many cases to have a normal labor course and vaginal delivery in the case of twins, I caution that the incidence of cesarean section is increased with twins. When there is more than one baby, there are more problems that can arise that lead to cesarean section. Even before you get to the labor stage, there can be growth discrepancies or select problems with one twin that force the issue on delivery. And as for delivery, almost all practitioners require that at least the twin closest to the cervix be in proper position (i.e., head down) before vaginal delivery can be considered. Some doctors require that both babies be positioned head down before labor. During labor, when the fetal heart rates are monitored, both babies have to be doing well for normal labor to proceed.
-- Sidney Wu, MD
Attending Physician
New York Presbyterian Hospital
Manhattan, NY