Getting Pregnant

What a 21st century midwife would like you to know.
By Susan Fekety RN, MSN, CNM


Have you noticed when an emotionally resonant topic is on the table, there’s suddenly a lot of busywork to do? You fuss and create distractions so the big feelings can be kept at a safe distance. You fall in love, and next thing you know, it’s all about invitations and table décor and gift registries. You think about making a baby, and it’s even worse.
When it comes to the precious leap of faith that is parenthood, it has become customary to obsess about gadgets, procedures, shopping lists, and ways to get the kind of baby you want. Is having a baby really a soul-obscuring major project involving scheduled sex, no more brie, no more sushi, no more Chardonnay, baby showers, nursery décor, and labor preparation classes? Or could it be humanity’s most unparalleled endeavor of committed love and complete surrender? How in the world does one prepare for that?

Twenty-five years of midwifery practice have convinced me that the fertility journey calls you forth to cultivate a closer connection with the earth, your body, your spirit, and the people you love. The rest is just fluff. If you’re already dedicated to a natural lifestyle and to living from your heart, your path to parenthood should be smooth, sweet, and unpredictable (in a very good way).
Couples who want a natural experience for baby making can easily feel like they’re trumped before they’ve even looked at their cards. Ten percent of women have trouble getting pregnant, and about a third of American babies are delivered surgically. It’s easy to forget that reproduction is your most ancient, finely tuned, heavily-insured biological activity (well, maybe it comes after eating), and that you have four million years of evolution in your back pocket. Baby making works amazingly well the vast majority of the time if we get out of the way and let it.
Before you start to fret about whether you’re going to have trouble getting pregnant, or whether you should save time by exploring in vitro fertilization now, consider that fertility can be powerfully enhanced by simple lifestyle changes. There are even natural methods that can help men, too, but we’ll focus on women in this article. Visualize yourself moving forward, supported by a companion we’ll call your 21st century midwife; scientifically informed, with ancient traditional skills and a steely confidence in your body’s ability to do what it was designed to do.
Use “The Secret”
Conception is exquisitely suited for techniques like visualization and affirmation, particularly if you suffer from negative self-talk about motherhood. For optimal fertility, your 21st century midwife would suggest that you act as if you are already pregnant, already mothering, and supremely confident in your body.
If you’re reading this thinking you’ll be ready “maybe in a few months” or just “someday,” go ahead and picture the outcome vividly in your mind: feel your body changing and ripening, feel yourself strong and accomplishing an ecstatic and easy birth, feel yourself cradling a sweet-smelling baby who has already arrived. Lean into the support of a loving partner, and throw in some tears of joy— whatever brings this picture most fully into your imagination— and remember to do this regularly.
Even if you are not a plan-ahead kind of person, it would be beneficial if you could find a midwife or a holistic doctor and start building a relationship now. Their job is to help you make a preconception wellness assessment, evaluating your risk for common prenatal-relevant diseases, and metabolic or hormonal disorders. Many pregnancy challenges can be remedied with a little lead-time, and it will be easier when you already like the person with whom you’ll be having your first appointment.
Acting as if you’re pregnant also means letting go of smoking, recreational drugs, caffeine, artificial sweeteners, and alcohol (of course); improving your nutritional pattern if it has gotten sloppy; and starting to take a quality prenatal vitamin. There is something emotionally significant about taking these steps, too: shopping for prenatal vitamins in particular can be a surprisingly profound affirmation of your intention.
So, You’re Older—So What?
I feel sad and angry when a mid-thirties patient bursts into tears in my office because she is convinced that her childbearing chances are fading away like dry leaves in autumn. I cannot fathom why society does this to women—sending messages that women have to have kids before age 35—unless it’s to keep them off-balance psychologically so they’re steady customers for fertility procedures they really don’t need.
It is true that by your mid-thirties you have fewer viable eggs than you did when you were twenty; but it only takes one to get pregnant. It may take a bit longer, but there are plenty of women in their late thirties and forties having babies today (many quite by surprise), and there’s no reason that you couldn’t be one of them. And although the older you are, the higher your chances are of having a baby with a genetic defect, even at the extremes of reproductive age there are many more normal babies conceived than abnormal ones. Give your body a chance to show its stuff!
The 21st century midwife LOVES working with older mothers because they’re wiser, know how to say what they need, and have accomplished things in life that support a positive self-image as successful mothers. If your care provider gives you a negative vibe about conception “at your age,” consider looking for a different provider.
Know Your Fertility Signals
The enormous variation in the length and regularity of women’s menstrual cycles means that the standard advice to have conception sex around day 14 may be wildly inaccurate. Ovulation-prediction kits or counting squares on a calendar can help you identify your fertile days more or less accurately, but it’s empowering (and even fun) to learn to identify your own fertility signals without disposing of a single piece of plastic. There’s no better way to connect with your body’s readiness to receive, and I guarantee that you’ll get to know your body even better. Many women even sense a distinct change in their eroticism at their most fertile time—it’s nature’s plan.
Your 21st century midwife will teach you how to check your basal body temperature daily, for a couple of cycles at least, and how to identify ovulatory cervical fluid as well. (And if you eventually feel like you need help with conception, let me promise you that your clinician will absolutely love you for coming to her office with a folder full of temperature charts.)
But if you’re older than 35, keep this in mind: In perimenopause (which can begin in your mid-thirties, when you are still quite fertile) the hormone signals can vary enough to make ovulation predictor kits less than perfect for timing conception sex. Your 21st century midwife will tell you that basal temperature charting could be more accurate for you. Explore your temperature and fluids, and spend that test-kit money on a massage, instead.
Enjoy Fabulous Food
Researchers in charge of the Harvard Nurses’ Health Study recently completed another big analysis of the dietary habits of thousands of women and demonstrated what 21st century midwives have known for years: what a woman eats before conception affects her ability to get pregnant. Calories count, but nutrient density and the way foods interact with your hormone system count more.
Your 21st century midwife recommends that you eat like your ancient sisters who lived, conceived, and gave birth in close connection to the Earth. This means eating lots of plant-based foods in season, whole and unprocessed foods with abundant micronutrients, fiber, vegetable, and animal protein, and including healthy natural fats (like olive oil). It also means very little sugar consumption, except what comes naturally in honey or whole fruit. In comparison, typical “nutrition for conception and pregnancy” guidelines recommend grains, fruit juices, and milk to excess, while deemphasizing whole foods, protein, and the healthy fats, which are crucial for hormone production and proper fetal brain development. Oops.
The 21st century midwife also suggests that your waist-to-hip ratio might be more relevant to your fertility than your actual weight on the scale. (To get your ratio: Divide your waist measurement at the level of your belly button into your hip measurement at its widest point. If the result is 0.8 or below, you have a pear-shape. If it is above, you have an appleshape.)
Having an apple body shape is a simple marker for two common fertility-thwarting hormone patterns: high insulin and high cortisol. Women who eat too many carbohydrates for their metabolism will make extra insulin, and women who are under a lot of stress or eat a nutrient-poor diet will make extra cortisol. Either of these hormones can cause you to store fat around your midsection instead of around your hips and can disrupt ovulation patterns by skewing the balance of estrogen, progesterone, and testosterone. Fortunately, you can change your body type with a more natural food plan and added exercise.
If you are a pre-pregnant apple, are already overweight, or have a family history of diabetes, it will be particularly important for you to have your 21st century midwife help you construct a modern, scientifically sound diet that does not make your underlying hormone imbalance worse. An ancient-looking modern diet is the single most powerful intervention for promoting optimal fertility and low-complication pregnancy in the 21st century midwife’s toolkit.
Move with Joy
Using your body inappropriately, either by pushing it too far or not pushing it far enough, can constitute a physical stress and disrupt your ovulation-hormone symphony. Surprisingly, I encounter almost as many women who need to slow down for optimal fertility as I do women who need to get moving. Women who are extremely active and/or extremely lean may have a body-fat percentage too low to permit normal hormone production and regular ovulation—a distinct conception disadvantage. I’d suggest stopping anything that doesn’t feel like play or that makes you grimace instead of smile.
If your periods are irregular, you already know you have a low body fat percentage, or even if you’re just a dedicated exerciser and having (what feels like to you) a hard time getting pregnant, stop everything except for recreational, daily walks for a few months and see if that makes a difference. (I know, this is a rather alarming recommendation from a 21st century midwife, but it really does seem to make a difference for some women.) Nobody gets to be a couch potato, though; if you are sedentary, commit to half an hour of some activity every day.
Learn to Surf
There is an old saying that you just need to relax to get pregnant, and this just happens to stress a lot of women out. Still, it is true that emotional or physical stress will show up in the body in various ways. The reproductive system manifests stress by shutting down. If you’re tense, driven, or scared, your adrenals send a powerful message to your body that “things are not safe here now” and “reproduction is not a priority.” In an ironic twist, pressure to conceive—a stressor—can interrupt your ability to do exactly that, and throw your libido into the basement. Not fair!
For many of us, handling emotional stress is a new skill. Stress reduction doesn’t mean you have to up and ditch the toxic influences in your life (though you may choose to do that); it’s about looking mindfully at your emotional challenges, cultivating non-attachment, and choosing love instead of fear.
A friend of mine who teaches meditation says, “you can’t control the waves, but you can learn to surf.” Practitioners at the Mind/Body Program for Infertility at Harvard have helped women with years of unexplained infertility to get pregnant by teaching them how to relax. Relaxation is also an essential motherhood skill; you might as well become an expert at it now.
Anything that helps you reconnect to your spirit or your highest self, even for as little as half an hour each day (listening to relaxation tapes, meditating, praying ,doing breathing exercises, yoga, etc.) takes the pressure off of your hormone system and primes your body to conceive. Plus, it’s essential for your soul and will improve all your relationships.
Wait, do I hear, “I’m too busy for that”? If so, your 21st century midwife lovingly suggests that making some space in your schedule for yourself is a great way to start making space for a new family member.
Lights Out at Night, On in the Day
Our bodies are designed to resonate with the diurnal cycle of light and dark, but we live in an artificially lighted, “constant-on” world. Normally, melatonin is produced during the dark of night—complete dark—and although you might be more familiar with it as a sleep aid, melatonin interacts with your reproductive hormone system, as well. Your natural biocycle, and the reproductive hormone signals which accompany it, can be disrupted by the dimly lit glow of a computer, the TV you fell asleep watching, the digital-numbers of your alarm clock by the bedside, or the bright lights you turn on during your midnight bathroom run.
Make an effort to sleep in a completely darkened room, keep the bathroom lights low, and if you must have a nightlight, make it any color but blue. Wouldn’t you know it, blue, the color of choice for many modern electronic displays, seems to have the greatest hormone disruptive effect. In the morning, get your face into the sunlight (maybe a short walk) as early as you can to reset your hormone system.

Know your D
Speaking of sunlight, your body was designed to spend the day naked in a bath of it. Unfortunately, so many of us spend the day indoors or slathered with sunscreen when we do go out, that vitamin D deficiency has become an epidemic.
Low vitamin D levels are associated with a lack of ovulation in animals and unsuccessful fertility treatments in humans. The evidence suggests that vitamin D deficiency could even be a factor in fertility restriction in 21st century women. Pre-conception, consider getting a blood test to know your vitamin D level so you can plan your supplementation program and sensible sunshine exposure accordingly. Though there is some bickering about the best number, the 21st century midwife suggests aiming for 50-60 ng/ml.
Checking Homocysteine
Our ancestors ate a lot of leaves, and we evolved with a diet that exposed our genes to a lot of B vitamins. B vitamins facilitate healthy processing of sex hormones, especially estrogen, and are also needed for gene synthesis and the replication of cells. Remember science-class movies about those little ladders of DNA, splitting and replicating like zippers? Every time that replication occurs, the process uses B vitamins to activate the chemical reactions that glue the new ladders together. Imagine how often those DNA molecules have to reproduce to correctly make all the cells of a fetus. Significant demand for these nutrients occurs before you know you’re pregnant, which is why folic acid is added to many processed foods these days—it helps prevent birth defects.
Because of a minor genetic variation, some people need significantly more B vitamins than others. Having high blood levels of homocysteine can be a tip-off to this, since homocysteine is an amino acid that’s normally cleared from your body through the actions of folate and vitamin B12. Women with the high levels of homocysteine have trouble getting pregnant and have more pregnancy complications. Your 21st century midwife might recommend that you have your blood homocysteine level tested before you welcome conception, just to be sure.
Feed Your Thyroid
Hypothyroidism is increasingly common in women, particularly those older than 35. There are a variety of reasons for this, including micronutrient deficiencies (primarily iodine and selenium), autoimmune disorders, and the effects of environmental chemicals. If your thyroid gland is not performing at its peak, you can develop irregular menstrual periods and have trouble getting and staying pregnant. In addition, the shortage of thyroid hormone circulating to your baby can result in abnormal development.
Low thyroid is pretty simple to remedy once it’s diagnosed, which is usually with a simple blood test. Your 21st century midwife can help get your thyroid function in top shape before you start trying to get pregnant. In the meantime, thyroid-nourishing behaviors include eating sea vegetables (for iodine), eating a Brazil nut every day (for selenium), and using iodized salt.
Rid Yourself of Toxins
The 21st century midwife has a deep respect for the impact of environmental chemicals on the body, especially the female hormone system. We now know that many plastics and cosmetic products contain substances that can disrupt your hormone functions (like parabens). In animals, one of the typical endpoints of this kind of chemical exposure is disrupted fertility.
In my practice, it is not uncommon to see a seemingly intractable hormone imbalance, such as heavy periods, resolve completely when a woman reduces her exposure to plastic wrap, bottles, and food containers. Seriously! Minimizing exposure to chemical toxins (primarily pesticides, plastics, solvents, and organochlorines) will almost undoubtedly support healthy reproductive function.
Put some energy into getting rid of the chemicals in your life, if you haven’t done that already. Check your cleaning products, your cosmetics, your dishes and storage containers. Go organic when you buy food, particularly with animal products and the “Dirty Dozen” vegetables (for more on this, check our blog at Move your food from plastic containers to metal or glass, don’t put anything on your skin or hair that you would not eat or can’t pronounce, and drink filtered water. Besides boosting your fertility, these simple actions can aid your overall health in many other ways.
Women often ask whether they should do a detox in preparation for pregnancy. A solid, healthy lifestyle and robust diet will maximize your natural detoxification mechanisms (sweat, urine, stool, and breath) every single day, but a brief, gentle-cleansing diet, undertaken with professional guidance, is fine if you are intuitively drawn to that. Since detoxification can temporarily liberate toxins into your system, though, I recommend that you don’t try to conceive during your cleansing time, and for a couple of menstrual cycles afterward.
Explore Acupuncture and Massage
Acupuncture, which works with the body’s energy to restore internal balance, can help women with hormone imbalances or ovulation issues in a variety of ways. In addition to the innate power of the modality itself, acupuncture encourages a profound relaxation: when you’re on a table with a bunch of needles poking out of your body, you really do not want to move.
Soothing effects aside, there is a growing body of medical evidence describing the benefits of acupuncture treatments for conception, both natural and assisted. If you haven’t considered this modality, your 21st century midwife should be able to recommend a good practitioner in your community.
Another approach to explore might be some specialized bodywork for fertility and conception. Maya Abdominal massage is a bodywork technique based on ancient Mayan healing practices, which has an anecdotally favorable track record and is non-invasive. Certified practitioners of this technique use external massage to reposition the internal organs, stimulating circulation and lymphatic flow while enhancing the normal function of the reproductive system. Even if you feel confident that your uterus is in the right place, consider seeking out a practitioner in your area. Just being in the company of someone who has an abiding faith in the capability of the female body can be inspiring and reassuring.
Your fertility journey can be the best thing that ever happened to you. Great food, great sex, big love, movement in the outdoors, and a strong, deep connection with your utterly amazing body are just some of the great side effects you will get when trying to conceive the natural way—not to mention you are about to bring a new life into this world.
SUSAN FEKETY, RN, MSN, CNM, is a Yale-educated Certified Nurse-Midwife in practice at the True North Center for Health and Healing, a multispecialty integrative medicine center in Falmouth, Maine. Visit her at