[Editor's note: This is part three of an interview series between Science & Sensibility's Walker Karraa, and OBGYN Dr. Michael Lu. To read the series from the beginning, go here. For a list of resources pertaining to this interview series, go here: resources and bibliography_dr lu interview series. ]

Get Ready to Get Pregnant: Prenatal preparedness and childbirth educators

Walker Karraa: How could we begin to integrate preconception care issues into childbirth education?

Dr. Lu: I think there are so many things that childbirth educators can be doing that would really improve and maximize their impact on both the women's health as well as family health.

Given the current constraints I think childbirth educators could try to really expand the content of their education into, not only the immediate postpartum, but also the inter-conception. And if you think about it, for women that are going to have more babies, the postpartum care is really preconception [care] for the next. I think it would be a good first step. I think most health educators actually do a pretty good job in terms of talking about breast feeding. I don't think they do as good a job talking about family planning, at least I think its variable. I don't think they talk very much about postpartum weight retention, nutrition, physical activities. So we know that both gestational weight gain as well as postpartum weight retention are main drivers of the obesity epidemic that's going on in this country. What are childbirth educators doing about that?

I think childbirth educators can do a lot better in terms of talking about mental health, so that women and couples can be better prepared to recognize the signs and symptoms of postpartum depression, and feel comfortable talking about what options there are so that women don't feel like they have to go through this alone. But that's for women with the full DSM-IV diagnosis. What about the vast majority of women who are just completely stressed out after the baby is born? I've had so many patients who are literally crying out for help. They don't have a DSM-IV diagnosis but they are wiped out. They're tired; they're lonely, they're isolated, they're stressed out, they're looking for help - and they don't really get that much support. Shouldn't this be part of what childbirth educators can do to help both women and men prepare' again, not just for childbirth but beyond?

Walker Karraa: And inter-conception care contributes to healthier attachment, better outcomes with breastfeeding, etc.

Dr. Lu: Right. And there's finally some discussion, a movement in the country, in terms of re-engaging dad in pregnancy and childbirth, postpartum and so forth. I actually share this national commission on paternal involvement in pregnancy because we've been talking about how do we better involve dads?

We're talking about baby-friendly hospitals. What would a father-friendly hospital look like? What would father-friendly prenatal care look like? I think dads are changing. There are a lot of dads that really want to be involved but aren't very well supported to get involved. What's the role of the childbirth educator in terms of involving dads? There are things both during childbirth as well as after the baby's born in which dads can play a very important role. But I think like most obstetricians, most childbirth education really doesn't focus that much on dad's role in all of this.

Walker Karraa: And there is increasing literature coming out about the rates of postpartum depression and anxiety for dads.

Dr. Lu: Yeah, it's a stressful time. And I believe I mentioned in my book, like 20% of couples break up within the first year after the child's birth. We always think that childbirth is such an amazing, joyful time, but having a new baby is such a stressful time... if dads or moms aren't equipped, it disrupts the family unit. The situation created really doesn't optimize the child's life course or healthy development. When we think of epigenetics, some of this may have intergenerational impacts.

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From Dr. Lu's consumer-geared book, Get Ready to Get Pregnant: here is an example of the unique ways Dr. Lu presents prenatal education:

What is unique about this book?

First, this book is written to help prospective parents prepare for pregnancy. While there are plenty of good pregnancy books that teach prospective parents what to do once they are pregnant, there are very few pre-pregnancy books that teach them how to get ready for a pregnancy.

Second, this book is based on good science, which is more than I can say about many pre-pregnancy and pregnancy books out in the market today. Most haven't kept up with the latest advances in science and medicine. As a research scientist and a professor at UCLA, I can honestly say that this book summarizes the best of what we know today about preparing for pregnancy.

Third, this book gives the readers an action plan to get themselves ready for pregnancy:

• Ten steps to get yourself nutritionally ready
• Ten 'brain foods' you should eat more of, and ten 'toxic foods' to avoid
• Ten steps to strengthen your stress resilience
• Ten steps to give your immune system a good tune-up
• Ten steps to detoxify your environment
• Ten things to talk to your doctor about during the pre-pregnancy check-up
• Ten steps to get your man ready for fatherhood.

Each step is based on the best available scientific evidence as well as the most up-to-date clinical guidelines and public health recommendations. I believe I've put together in this book a state-of-the-art pregnancy preparedness program for readers. (Lu, 2008, p. 6-7)

[Editor's Note: In tomorrow's installment of this interview series, Dr. Lu and Walker Karraa discuss doulas and other aspects of labor support, and the sacred trust between women and their maternity care providers.]

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