Raising Kids on a Shoestring

Pregnancy, Childbirth, & Postpartum Care

iStock_000008656922MediumPregnancy should be a joyous time, but expenses can cause worry and stress —and rob you of some of the happiness you deserve at this special time. Consider ways to hold down costs, without jeopardizing your health and safety. Make this an enjoyable challenge, and as always, check with your healthcare professional for the best advice for you and your baby.

According to the National Institutes of Health, many professionals agree that the best time to be sure you are in good health is before you are pregnant — whether or not you hope to conceive. Consult your physician about vaccinations. A good diet becomes especially important. Foods rich in folate, iron, calcium, and protein are easy to find. If you are planning to conceive, some experts advocate starting prenatal vitamins before pregnancy occurs.

Regardless whether you planned to conceive, as soon as you know you are pregnant, start taking appropriate vitamins. Both you and your baby will immediately benefit. The vitamins do not need to be official “prenatals.” A vitamin formula with 400 micrograms of folic acid, plus iron and Vitamin A (under 5,000 IU), is sufficient. Often, your doctor or clinic will provide free samples if you ask — so ask! Practice now being an advocate for yourself and your kid(s).

Stay away from preparations that contain herbs or additives; the Food and Drug Administration does not regulate dietary supplements like vitamins in the same way it does medications. Just because something is “natural” (an unregulated term) does not mean it is safe for you or your developing baby. Moreover, many herbs interact with common medications you might be taking. A good site to check to evaluate claims and research is www.fda.gov/Food/DietarySupplements/default.htm.

Eat well-balanced meals. Avoid raw fish and meat, as well as fish with high mercury levels (including shark, swordfish, king mackerel, and tilefish). Soft cheeses and ready-to-eat meats may contain listeria bacteria, so cook them until they’re steaming hot. Water is the best beverage. Alcohol and cigarettes don’t help the budget; worse, they harm you and your unborn or nursing child. Since you slow down toward the end of your pregnancy and the baby often rests up close against the intestines, constipation is common. Fiber becomes extra important, as do sufficient fluids. Cravings for non-foods, like chalk, mud, or starch, usually indicate a dietary deficiency and require medical attention.

If money is an issue, remember that all 50 states participate in the federal government’s Women, Infants and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) services. (See page 13 for more information on WIC and SNAP.) WIC provides food vouchers or debit cards for pregnant and nursing women, as well as children up to the age of five. To qualify, you must be nutritionally at risk. There are also residency and income requirements, which vary from state to state. Because WIC is not an entitlement program but has grant funding, waiting lists exist in some locales. WIC foods serve as a supplement to other wholesome foods, and the choice and variety are limited. For instance, cheese, eggs, peanut butter, and milk are on the list of foods, but most vegetables and meats are not. Depending on where you live, you can use vouchers or debit cards like money at a retail store or pick up food at a distribution center. In some locations, deliveries are possible.

Prenatal care is vital for you and your baby, so start it as soon as possible. Most pregnancy resource centers offer free testing, and those that are clinics often have a doctor who will perform a preliminary exam. While Medicaid varies greatly from state to state, it generally covers prenatal care, delivery, and up to 60 days of postpartum care. Processing takes as little as two weeks. Often, your baby will be eligible for one year of care, without a separate application. Most pregnancy resource centers keep lists of providers who take Medicaid in your area.

If you lack insurance and are not eligible for Medicaid, look into obtaining care at a free clinic, public hospital, or birthing center. Some private doctors will work out a payment plan for you, especially if you are already a patient of that practice. Also, remember that many tests during pregnancy are not necessary. If money is a concern, discuss this early and avoid unnecessary tests, such as unneeded ultrasounds.

As you increase in size, you’ll find that your once-comfortable clothing no longer is. Specially designed maternity clothes are nice, but simply buying pants or skirts with a larger and elastic waist works, too. Many women find large men’s shirts and tees just perfect, and you can supplement with an item or two from a friend. Try thrift and consignment stores, yard sales, and craigslist.org for inexpensive pieces. In this era of casual clothing and less emphasis on camouflaging a pregnancy, just about anything will work. If you plan to nurse your baby, consider separates, rather than dresses, so that you can lift the top to nurse.


iStock_000003858392MediumLabor and Delivery

Deciding who will deliver your baby and where you give birth can be limited by the options available in your area. If you have a choice, consider the less expensive alternative of a midwife. Women often choose midwives because of their well-deserved reputation for respecting childbirth as a natural process. Midwives also provide highly personal care with fewer interventions, like inductions and episiotomies. They are also less inclined to resort to routine electronic fetal monitoring, IVs, and other technology.

Midwives certified through the American College of Nurse Midwives (CM or CNM) are legal in all states. Those who are certified through the National Association of Certified Professional Midwives (CPM) are accepted only in certain areas. Your midwife need not be a nurse, but certification is essential. Choose someone whose professional skills inspire confidence and whose personality is a good fit with you and your partner. Check the physician and midwife backup rosters, so you know how scheduling will affect availability.

A home birth may be an option for healthy women with normal pregnancies. Many women enjoy the comfort and freedom of being at home while giving birth. Planning for a home birth requires the help of a midwife, doula, or physician. Your caregiver will help you prepare your home and any supplies you will need for the birth. A home birth is not recommended if you or your baby have any medical conditions or pregnancy complications. Even a routine home birth may require transfer to a hospital if complications arise during birth. Discuss a backup plan with your caregiver. Some insurance companies and HMOs will cover the costs of a home birth, but others will not. Knowing your insurance coverage in advance will relieve your stress and make your delivery easier.

Licensed birthing centers reduce costs and offer a homelike atmosphere for your prenatal care and delivery. Find out in advance what pain management options are available. Remember that with home birth and birth center options, insurance may cover much of the expense, but they are appropriate only for a healthy woman who anticipates a healthy child.

Childbirth education classes are important, especially for first-time parents. Knowledge helps you prepare for this momentous event, and it will also help quell anxiety. Free sessions are widely available. Have your labor coach (typically your spouse, partner, a family member, or friend) come along. Childbirth classes offer men an ideal opportunity to become active participants early in their children’s lives. They, too, need a chance to ask questions.

At delivery, nurses will help, but they may be caring for more than one patient. Every woman in labor needs someone to concentrate just on her. Doulas or coaches work with parents before, during, and after the birth. Doulas comfort and support the mother and her partner, try to enhance communication between the mother and medical professionals, decrease likelihood of unnecessary interventions, reduce negative feelings about the childbirth experience, etc. There are also doulas who help postpartum. Doulas do not provide any medical care and so do not need state licensing. Doulas of North America (www.dona.org) offers training and certification for birth and postpartum doulas; those in training often provide free services.

The length of your hospital or birthing center stay is a decision between you and the healthcare provider. Still, as long as you and the baby check out medically, the sooner the discharge, the better. Even the best hospital is noisy, somewhat rigid, and intended for sick patients. Don’t forget that every state has child automobile restraint laws, so come prepared with an infant car seat. Many hospitals provide free car seats as an incentive, and most will not discharge a baby to parents without one.

Try to have some help at home, even if it is a teenage neighbor to help with laundry or cooking. Childbirth is a wonderful but exhausting event, and recovery takes time. Newborns are notorious for their poor sleeping habits and demanding ways.


Fight the Feminization of Poverty

Marriage provides legal protection for you and your child, and most men love and support their children. If you are not married, establish paternity immediately. Hospital staff are prepared to help with this. Not only is it important to secure child support, it protects your child’s future should the father die or be unable to provide support. When there is no dispute, both parties declare themselves at the hospital, and the birth certificate reflects this. If there is not agreement, get help from your state’s child support enforcement agency, the Association for Children for Enforcement of Support (www.childsupport-aces.com) or your local Legal Aid organization. Paternity testing is simple (usually just a cheek swab), and in some cases, the costs may be waived. Get as much information about the father as you can, including his Social Security number, home address, work and home phone numbers, medical history, parents’ address(es), and mother’s maiden name. If the father does not cooperate, he can be found in default and might still be held accountable for child support. Fathers who are active in their children’s lives will find the rewards immeasurable.

Pregnancy and childbirth can be a wonderful time, even on a budget. Just remember there are many ways to economize without sacrificing essentials, and there is plenty of help available for the asking.

By Elizabeth Hanink