Everything I’m doing differently, section by section
My full plan for this pregnancy (spacing, records, providers, my body, birth, my village and postpartum) and what my first pregnancy taught me about each part.
Key points
- The American College of Obstetricians and Gynecologists (ACOG) advises avoiding pregnancy within six months of giving birth, and talking through the risks of a gap shorter than 18 months. Bring your operative report, the surgeon’s record of a past cesarean, to that conversation.
- If you’ve had preeclampsia, a serious blood pressure condition, ask about low-dose aspirin after 12 weeks. The U.S. Preventive Services Task Force recommends 81 mg a day for anyone with a high-risk factor.
- In a CDC review of pregnancy-related deaths from 36 states in 2017–2019, 53% of deaths with known timing occurred 7 to 365 days after pregnancy ended. Plan your postpartum care before you deliver.
If I could do it over, I would start preparing the support around me much earlier. Pregnancy brought medical questions, but it also brought questions about who was responsible for my care, how I would recover, how my baby would eat and sleep and what help would actually make life easier. This is the plan I’m working from now.
1. Before getting pregnant
Spacing
I started asking about a second baby in the months after my first birth: how close together two children could be after a cesarean, and how long to wait. ACOG’s guidance is a population recommendation, not a personal timetable, so I wanted the conversation grounded in my own history.
My records from last time
I requested my full records: prenatal, delivery, operative, anesthesia, inpatient and postpartum. The operative report matters most. It records the type of incision on my uterus, which helps decide whether labor after a cesarean is an option. Getting my records took months. (“Nine Months Later, I Was Still Asking What Happened in My Surgery”)
My scar
A few months after my first birth, I asked whether the keloids (raised, thickened scar tissue) on my cesarean scar meant there was scarring inside too. Nine months after the birth, a gynecologist examined a painful lump under my scar and started the process for a preconception consultation with maternal-fetal medicine, the high-risk pregnancy specialists.
2. Finding my providers
Hospital first
For this pregnancy, I compared hospitals, looking for outcome data, including results for Black patients where hospitals published them. I made a Level IV NICU, the highest level of newborn intensive care, a requirement. (“How to Choose a Hospital, Then a Doctor”)
The team I’m building
- My primary care doctor, whom I see about once a quarter, for testing, referrals and the practice’s maternity resources.
- An OB who is named as responsible for my pregnancy, in writing.
- Maternal-fetal medicine, because my history makes me high risk.
- Cardiology, for chest pain I’ve had since before I knew I was pregnant.
- A pelvic floor physical therapist.
- Possibly a midwife.
- A naturopath. Training and licensing vary by state, so I check credentials, and anything recommended goes on my medication list and back to my OB for approval.
When my care fell apart
This pregnancy, the day before my first scan, the high-risk practice that had cared for me in my first pregnancy cancelled all my appointments. For weeks I asked, in writing, for the name of the physician responsible for my pregnancy. In the end, I traveled out of state to see an OB before my screening window closed. (“Setting Up Your Care Structure”)
3. Preventing preeclampsia
I had preeclampsia with severe features after my first birth, which puts me in the high-risk group. With my clinician’s approval, I take low-dose aspirin. The orange-flavored chewable tablets made it easier for me to take my dose consistently. I log my blood pressure at home, with the thresholds for calling in writing. (“Preeclampsia: Know the Numbers”)
4. Managing symptoms and medications
This pregnancy so far:
- Chest pain. I found out I was pregnant in the ER, where I’d gone for a sharp pain in my chest. The pain has kept coming back, so my OB referred me to a cardiologist.
- Iron. When iron shots weren’t raising my levels, my OB referred me to hematology, the blood specialists, for infusions.
- Infections. When symptoms came back, I asked for a culture (a lab test that identifies the bacteria) and whether the antibiotic matched it. (“Urinary and Vaginal Infections in Pregnancy”)
- One medication list, updated every time something changes. (“Managing Conditions, Medications and Test Results”)
5. Preparing my body
Pelvic floor
I want an assessment from a pelvic floor physical therapist before birth, not exercises I guess at. (“Your Pelvic Floor After Birth”)
Movement and breathing
A trainer gave me a late-pregnancy movement and breathing plan. I’m bringing it to my clinicians to confirm what fits my history.
Rest
In my third trimester, I scheduled two hours and 45 minutes of rest a day, then had to admit it was rarely uninterrupted. Rest only happens when someone else has my child, the door and the phone.
6. Practicing for birth
Two birth plans
Last time, my family’s plan assumed a 24-hour induction, and it took three days. This time I’m writing two plans again, one for my care team and one for my family, and planning for the long version of an induction or a repeat cesarean. (“My Birth Story”)
My delivery questions
- Could there be a defect in my scar, adhesions (internal scar tissue) or other problems with no obvious symptoms, and could tests find them?
- Could a vaginal birth be possible for me this time?
- Could the IV fluids during my first induction have contributed to how swollen I was afterward?
Getting ready to go
The bag, pre-registration, the car seat and who to call are in “Getting Ready for the Hospital.”
Before I leave the hospital
I want my operative report and an explanation of my surgery before discharge, not nine months later.
7. Preparing my village
What I need covered
When I mapped out a normal week, the list was daily meals, housekeeping, deeper cleaning, childcare, evening and overnight support, household administration and backup for when someone leaves. Each one needs a name next to it. (“Preparing Your Village”)
Help at home
I’m looking for someone with newborn and toddler experience and infant CPR, and I want references I actually call and a paid trial first.
Boundaries
I’m planning for rest, practical support and clear expectations about how family and caregivers can help. (“Preparing Your Village”)
8. My postpartum plan
- Before delivery, I’m arranging the handoff: who manages my recovery, who sees an urgent wound concern and who my OB-GYN is once the high-risk specialists stop following me. ACOG recommends contact within three weeks of birth and a full visit by 12 weeks. (“What Postpartum Care Should Include”)
- A blood pressure check early. For high blood pressure in pregnancy, ACOG recommends a check within 7 to 10 days, and within 72 hours if it was severe.
- The recovery I didn’t keep up with last time: my pelvic floor, an abdominal binder and scar care. (“Healing After a Cesarean: My Nine-Month Recovery”)
- A lactation consultant’s number saved before the birth. (“Feeding Support Before You Need It”)
9. Gear for two
I looked into car seats for crash safety and flame-retardant chemicals, and thought through what it takes to travel with a carrier, a stroller, a backpack and a car seat. I’m still working out a stroller setup for my toddler and the new baby together.
What’s working, and what isn’t yet
Working: my blood pressure log, with the thresholds in writing. My own copies of my records. Asking for the responsible physician by name instead of waiting to be told.
Not working yet: rest, help at home and the boundaries with the people around us.
What I’m hoping for
I still want to research and participate in my care. I also need a doctor who notices what needs attention, explains the plan and follows through. I had that out of state. My OB there wasn’t the most personable, but genuinely listened, anticipated my needs, remembered details and took an interest in my overall health. I really enjoyed being there. When I needed to move back, I cried because I had to leave that practice. What I’m building now is a team where I can still bring my research without carrying every detail myself.
Take this back
To discuss with your care team: Given my history, what should we plan for before delivery? What does my operative report mean for how I deliver this time? Who manages my care after the birth?
To discuss with the people in your life: Which part of this list can you take off my plate entirely? If labor starts early, what’s your one job?
Next in the series: “How to Choose a Hospital, Then a Doctor”
