Posts Tagged ‘blood’

WEIGHT LOSS
•    Find a diet plan that fits your style
•    Keep a dietary diary
•    Eat a high-protein breakfast
•    Use a pedometer to reach 10,000 steps
•    Try Alli (orlistat) for an OTC weight loss crutch
By now you are probably sick and tired of hearing about the obesity epidemic in America. You already know that bigger is not better and that a large waist size increases the risk of diabetes, high blood pressure, and heart disease. But shedding pounds—and keeping them off—is one of the great challenges of modern life.
It’s not that there is any shortage of advice. There are dozens of diet programs and probably hundreds of diet books available to help you shed pounds, preferably painlessly. Effortless weight loss seems to be the perennial American dream. Some of the diets keep popping up like perennials, as well.
One of them, misleadingly titled “the new mayo clinic diet,” has been circulating on the Internet for a decade. Even then, it was a resuscitation of the “old” mayo clinic diet that had been passed from person to person since the 1960s. The actual Mayo Clinic has disavowed this diet in any of its incarnations, but that doesn’t stop enthusiasts from claiming that you can achieve weight loss of 50 pounds in 2 months by following the plan. People are instructed to breakfast upon eggs, bacon, and grapefruit. Lunch consists of salad, meat, and the ubiquitous grapefruit. For dinner, the dieter has (you guessed it) half a grapefruit plus as much meat as he or she wants and a green or red vegetable cooked in butter. People are encouraged to eat until they are
full.
The sad and simple truth is that there are no shortcuts to the shape you want. Taking off pounds requires taking in less energy than you are using up.This equation has two parts: how much you eat and how much you exercise. Changing either part calls for more effort than many of us can muster in an environment that encourages us to eat more and exercise less. No doubt that’s why new diets have such appeal, even though they are often a familiar approach recycled with a new twist.
There are so many diet plans out there that we can’t possibly tell you about each one. Instead, we will stick to some general guidelines that may help you figure out the best approach for you. This is an arena in which one size does not fit all and, sadly enough, there is no magic bullet. Getting weight under control can be quite a challenge, but it is also a great Opportunity to improve your health.
Dietary Approaches
There is no question that diet is crucial to weight loss. You may not want, or even need, to count calories. But even if you take a diet pill, you can’t lose weight without paying attention to what you eat. Dietitians are fond of pointing out that losing weight is a simple matter of using up fewer calories than you take in. “Simple” it may be, but it isn’t easy, as too many of us know! For best results, of course, you need to work on both sides of the equation.
Pick a Plan
Which diet is best for weight loss? That is a difficult question to answer. Most of the popular diets have not been subjected to rigorous study. Even when they have been studied, few of them have gone head-to-head with others to determine the better or best one.
Scientists at Tufts University did undertake a comparison of four popular diets under “real world” conditions. They enrolled people in the trial and then assigned them randomly to the low-carbohydrate Atkins diet, the low-fat Ornish diet, the Weight Watchers diet plan, or the Zone diet. Although there were some interesting differences in the blood fats at the end of the stud
in terms of weight loss, the programs were about the same.People on the more extreme diets—the low-carb Atkins and the low-fat Ornish—lost a bit more weight than those on the more moderate diets. But more people dropped out of those diet groups as well, perhaps because the more extreme diets are harder to follow.
The main trick is to figure out what diet plan you prefer. We don’t mean “what you like to eat”; if you use a diet that focuses heavily on what you like to eat, it will be far too easy to eat too much. No, you need to ask yourself what you are willing to eat. If going without a single piece of cheese for a year will be a major deprivation, you might not want to adopt a super-low-fat approach. If your Italian soul can’t survive without pasta, an ultra-low-carb approach is probably out. But don’t fret too much. Either diet will work, if you stick with it. And so will a lot of the more moderate diet approaches. The social reinforcement built into the Weight Watchers plan can be very helpful for some people; it drives others nuts.
A meta-analysis of diet studies shows that both low-carbohydrate and low-fat diets are about equally effective for weight loss.831 The question is, Do you need to raise good HDL cholesterol and lower triglycerides as well? If so, choose a low-carb diet. But if you really need to get your total cholesterol and your bad LDL cholesterol under control, the low-fat diet is a better way to go.
We have a friend who has managed to lose and keep off about 30 pounds over the years. This weight loss has brought his total cholesterol down so well that he does not need a cholesterol-lowering drug. Mis surprised his doctor, who assumed that he would require a prescription for Lipitor (atorvastatin) or Zocor (simvastatin) sooner or later.
What impresses us is his persistence. He is always very careful about what he eats. We asked him how he manages to keep it up day after day, and he said he makes it like a game with himself. He actually shifts back and forth between a lowcmb pattern and a low-fat pattern, which helps him prevent boredom. But on any given day, he decides which diet he is following and challenges himself to see how closely he can adhere to it. We don’t know if he gives himself points or has a reward system set up. But playing the game of eating right has a lot of rewards built into it, not the least of which is weight control.
If you like the idea of a game, then we have a wonderful “diet” book to recommend: Eat, Drink, and Weigh Less, by the fabulous vegetarian cookbook author Mollie Katzen and the respected nutrition researcher Walter C. Willett, MD, DrPH, MPH. They devised a numeric concept, the body score, that makes it easy to measure how well you are eating and challenge yourself to do even better. 832
Write It Down
Aside from getting you to focus more on low-calorie, high-nutrient vegetables and fruits, calculating your bodV score brings another tool into play: the dietary diary. Even if you do nothing else in your weight loss efforts, do this. Get yourself a portable notebook. It can be as nice as you like, or as inexpensive as a little flip pad. But it does need to -be small, because you should take it with you everywhere you go and write down everything you eat. Not just the menus of your meals, though that is necessary and can be fun. You must also note every tidbit, every nut, every chocolate chip that you eat between meals.
***** Dietary Diary
No matter which diet you plan to follow, this allows you to track your progress. The simple act of writing it down can help you become more aware of what you are eating. You learn to ask yourself, Do I really want this?
In addition, you can analyze the information in your dietary diary to see what circumstances conspire against your sticking to your plan. Try to figure out other ways to deal with problems like having to rush from appointment to appointment and therefore missing lunch, then discovering that you are starving before dinner and gobbling down a bag of tortilla chips with nacho cheese, sauce.
Downside: Inconvenience. But if you stick with it, writing down what you eat and what else is happening can be a great way to reinforce your diet.
Cost: It’s up to you. You could spend as little as 69 cents on a small notebook or as much as $30 on an elegant bound diary.
And don’t forget to write down what you drink as well. Some of us get a lot of calories from sweetened beverages like soft drinks, fruit drinks, or sweet teas. In fact, this makes up 21 percent of our national calorie consumption. 833 Switching to water most of the time could make a substantial difference in energy intake for some people.
Eat Breakfast
It might seem like a good idea to save on calories—and time—by skipping breakfast. You’ve got enough trouble just trying to pull
get dressed, putogether everything you’ll need for the day, and get out the door. If you’re a parent, you may need to do all of that for your children, as well! It’s not easy. But going without breakfast, or grabbing just a cup of coffee and a piece of toast, is a bad idea. A study that has looked at people who have successfully lost weight and kept it off found that most of them make breakfast an important meal, or at least a reliable one.”"
There are probably some breakfast choices that might be worse for dieters than no breakfast at all. Coffee and a Danish pastry come to mind, so do orange juice and a big stack of pancakes dripping with butter and maple syrup. Foods like this are high in sugar and refined flour that are quickly absorbed and push blood sugar and insulin up rapidly. (This can be quantified in scientific terms as the glycemic index of a food, which compares the food’s effect on blood glucose to that of table sugar.) The result, though, may be that your blood sugar level will crash in 2 or 3 hours, resulting in fatigue and maybe even hunger. Instead of these high-glycemic-index treats that will send blood sugar and insulin on a roller-coaster ride—first way up, then down, way down—you want a meal that will carry you through until lunchtime. That way you have a better chance of resisting the midmorning siren call of cookies or pastry. Breakfast is especially important for children, who pay better attention in school with a little nutrition under their belts.
We like a light scramble made of mostly egg whites plus a whole egg. If that’s too much trouble, how about low-fat cottage cheese with some vegetables? Our quickest breakfast, a smoothie, still has a fair bit of protein in it: a frozen banana (peel it before you put it in the freezer!), a couple of scoops of powdered whey protein, a few teaspoons of powdered egg white, a cup or so of frozen fruit or berries, and about 3/4 cup of yogurt and just enough fruit juice to get the blender to work.
With the juice, you don’t need any sweetener; the whey and egg white are good protein, much better than yogurt alone’, and the berries offer all kinds of nutrients as well as fiber. Anyway, the point here is that you should find a breakfast that fits your tastes and lifestyle and satisfies you so you won’t need a snack before lunch.
Keep Moving
As we pointed out earlier, even the most rigorous diet is only half of the story. The other half is increasing your energy expenditure through physical activity. It needs to be tailored to your lifestyle just as carefully as your meal plan.
The majority of Americans just don’t use their muscles very much. If there were games or sports you enjoyed when you were younger, think about whether you might find the time to dust off the rust and go back to playing tennis, say, or dancing. Choosing something you love means you’ll want to do it frequently, and that is more important than the type of exercise. Gardening, swimming, martial arts, yoga, bicycling, or anything else that gets you moving is fair game. There is definitely some activity that will help you use your muscles; it is up to you to figure out what it is and go for it.
If you can’t think of anything else, consider walking. It’s
Pedometer
This gadget is a favorite at our house. It’s small and lightweight, so you can set it to 0, clip it on your belt, and wear it all day long just to see how many steps you take. Of course, if you have a favorite walking or running course, you can measure the distance in miles or kilometers by wearing the pedometer while you traverse it. The goal of taking 10,000 steps a day is definitely doable, but it provides a good challenge. Public health folks offer it as a starting point.
Downside: it can be tricky to figure out the best place to wear this gadget to get an accurate count. Setting the pedometer so it measures your stride is not as hard as programming a VCR, but it can be a challenge.
Cost: Approximately $25 to $30. You can spend more, but you don’t need to.
cheap and readily available, and it’s good exercise. All you need is a pair of decent shoes and about 20 minutes to spare. If you have been very sedentary, you don’t even want to start with 20 minutes. Begin with 5 minutes and gradually work your way up to longer walks. To give yourself something of an extra challenge, get a step-counting pedometer. Then strive for 10,000 steps a day. Write down your step count every night in your dietary diary. When you can get to 10,000 steps reliably, day after day, set yourself a new challenge.
Herbal Disappointment
Dozens of dietary supplements are promoted as weight loss aids, but the science supporting most of them is lacking. Even when a study is done, the difference between those who took the product and those who took placebo is generally quite modest, possibly just a few pounds over several months. So if someone tries to sell you an all-natural supplement from somewhere exotic—whether it’s the Amazon, Outer Mongolia, or the North Pole—be suspicious. If you are told that the agent will turn on your fat burners or turbocharge your metabolism, double your skepticism. People have been selling herbal diet pills for more than 30 years. If they really worked, we’d all be as thin as we’d like to be. In most cases, the only thing that will lose weight is your wallet.
The track record for herbal diet pills is frankly rather discouraging. For quite a while, ephedra (Ephedra sinica) was promoted as a natural weight loss aid. Companies producing ephedra products made a lot of money until, eventually, the FDA reviewed all the reports of problems with this herb. The agency determined that ephedra was associated with a number of strokes, heart attacks, and other serious complications and called for its removal from the market. Aside from being overweight, some of the people who suffered life-threatening or even fatal side effects were otherwise in good health. This Stimulant might have helped people shed pounds in the short term, but it was not safe enough to be used for the long haul.
Ephedra has stimulant properties, which probably account both for its ability to promote some weight loss and for its potential to trigger a dangerous reaction. A couple of other natural products with stimulant activity have beensu ested for use in weight loss. Green tea835 and yerba matAl
have been considered for this purpose, though the research so far is not impressive. Both contain caffeine, along with other compounds that might be relevant.
Another purported stimulant, Garcinia cambogia (hydroxycitric acid), has also been included in a number of herbal weight loss preparations. A 3-month randomized controlled diet did not demonstrate any weight loss benefit beyond that of placebo.837
Q. What is hoodia? I keep getting e-mail messages that this is a wonderful way to lose weight. Does it work? Is it safe?
A. Hoodia is a cactus that grows in the Kalahari Desert in southern Africa. It is being promoted as a marvelous weight loss agent, but there is very little clinical research to support the claims.
One small, unpublished study (18 obese patients) demonstrated some benefit, but we would need to see far more evidence before recommending this plant product. Questions have been raised about the quality control used in manufacturing hoodia products, and long-term safety has not been established.
Nonprescription Help
One of the reasons that ephedra became so popular was that there were only a few other choices available without a prescription. The most popular over-the-counter (OTC) weight loss ingredient was a decongestant called phenylpropanolamine, or PPA for short. In its heyday during the 1970s and 19805, Dexatrim was one of the most popular brands.
PPA was not as safe as most dieters assumed, however. As early as 1980, British researchers had raised a red flag. When they gave PPA to healthy young medical students, they noted side effects such as an alarming elevation in blood pressure along with dizziness, heart palpitations, headache, insomnia, anxiety, and restlessness. By 1990, doctors in the United States had reported 142 bad reactions to PPA, including bleeding stroke, seizure, and even death. But it took the FDA 10 years to make a move. It requested a study of PPNs safety, particularly with respect to bleeding stroke. Yale investigators found that women who took PPA for the first time in a cough or cold remedy tripled their risk of a stroke. Those using the drug as an appetite suppressant appeared to be at 16 times the stroke risk of a woman not taking
the drug. 8-38
Given these data, FDA staffers estimated that PPA might be responsible for 200 to 500 strokes in people under the age of 50 each year. Extrapolating over all the years it was on the market, PPA could have accounted for as many as 10.000 strokes in people who otherwise would not have been vulnerable to that problem. The agency announced in 2000 that OTC weight loss products would need to be reformulated without PPA.This meant that most dieters could no longer rely on a pill to help them. Ephedra had been taken off the market because it was too dangerous. And PPA was removed as well, also because it was not safe enough.
With the approval of orlistat (available by prescription as
Orlistat (Alli)
This weight loss medication is also available by prescription under the name Xenical. It appears to be one of the few weight loss drugs considered safe for long-term use. Orlistat is intended to be used in conjunction with a reduced-calorie, reduced-fat diet. The drug prevents the absorption of fat from the gastrointestinal tract. Nearly twice as many people on orlistat manage to lose 15 percent of their body weight in a year as people on diet restrictions alone.
Side effects: Most of the side effects are gastrointestinal. Because orlistat prevents the absorption of fat, fat is retained in the imeslines. This may result in stomachache, diarrhea, nausea, flatulence, rectal discharge, and fecal incontinence. Headache is also a possible side effect.
Downside: The drug may interfere with the absorption of fat-soluble vitamins. Take a multivitamin either 2 hours prior to or 2 hours after taking Alli.
Cost: Approximately $50 to $60 per month Xenical) to go over the counter under the name Alli, people finally have a tested do-it-yourself option. The company has chosen the name Alli to imply that it will work best if allied with a full program of dietary and behavior modification approaches. The FDA appears confident that this drug does not pose significant safety issues.
Orlistat is a compound that prevents the absorption of fat. It can help people lose weight, but there are some drawbacks. For one thing, there’s the underwear risk: spotting with oily stool. There also may be increased flatulence, sometimes with discharge. Orlistat doesn’t take you off the hook for eating carefully: The 5- to 6-pound weight loss advantage over placebo occurs only when people eat a reduced-calorie, low-fat diet. Unfortunately, once people stop the medication, they often gain back the weight they lost.
Perhaps Alli would be best used as a “jump start” by someone who’s having a hard time pulling together the pieces of a diet plan. Few people will want to take it year after year, although it does appear to be cost-effective.839
Prescription Weight-Loss Drugs
The history of prescription diet pills in the United States is full of woe and intrigue. Starting in the 1950s, millions of overweight Americans were prescribed amphetamines to help them shed a few extra pounds. Such stimulants were supposed to be taken for only a few months at a time, but they were extremely seductive. Many respectable housewives became dependent on “speed.” This made physicians a bit more cautious about prescribing such medications to help people lose weight.
During the 1990s doctors began to combine two diet pills that had been around for decades. The combination of fenfluramine and phentermine (”fen-phen”) seemed to work better than either drug trouble was, the combination led to heart valve complications. At about the same time, a new appetite suppressant, dexfenfluramine (Redux), was approved. It, too, was associated with heart problems and a potentially life-threatening condition called pulmonary hypertension.
In 1997, the FDA asked the manufacturer to withdraw Redux from the market, although it had been approved only the year before. Fenfluramine was also taken off the market. The fen-phen fiasco was certainly a spectacular disaster. Quite a number of people were left with damaged hearts just because they took drugs to help them lose weight.
Despite this uninspired track record, many people were hoping for the FDA to approve a new diet pill. The claims being made about rimonabant (Zimulti) are extraordinary. It is easy to understand why some people might be eager to try it, even if others are skeptical.
The manufacturer, Sanofi-Aventis, is being especially careful to downplay the cosmetic weight-reducing potential of Zimulti. Instead, they are highlighting other benefits, such as the improvement of lipid profiles. In three large clinical trials, Zimulti resulted in promising metabolic improvements.840,841,842
Good HDL cholesterol rose and bad triglycerides dropped. Insulin efficiency improved and blood sugar levels came down. The positive changes were twice what researchers would have anticipated from weight loss alone. Such metabolic effects may be especially beneficial for people with type 2 diabetes.
What really has millions of people excited, though, is rimonabant’s ability to lower weight. After 1 year on the drug, subjects lost approximately 15 pounds, significantly more than those on placebo. In the world of diet pills, such a loss is impressive.
The buzz surrounding Zimulti is enormous. Weight loss and
iW Rimonabant (Zimulti►
Acomplia is different from other prescription diet pills because it works on an entirely new mechanism. It blocks brain CB0) (cannabinoid 1) receptors that respond to natural marijuana-like compounds. It is more effective than any other medication for weight loss, helping people lose more than 15 pounds over the course of a year.
Acomplia also has beneficial effects on good HDL cholesterol, triglycerides, insulin efficiency, blood sugar level, and blood pressure.
Side effects: Nausea, diarrhea, dizziness, headache, sore throat or flu, anxiety, insomnia, and depression. Most of these were mild and transient, although depression is disconcerting and may lead to suicidal thoughts.
Downside: We don’t have much information on the long-term effects of this new medicine.
improvements in blood glucose, blood pressure, and lipids are certainly much needed. In addition, investigators are studying whether rimonabant may help people quit smoking. There is even some hope that the compound may help people deal effectively with other drug dependencies, including the most prevalent one, alcohol.”
The FDA has delayed approval of rimonabant due to worries about anxiety, depression and suicidal thoughts. It could take years to assess whether the drug is safe enough for longterm use.
Conclusions
Losing excess weight is notoriously difficult, but it can have a profound effect on health. Dropping pounds can help lower blood pressure and get cholesterol under control, as well as alleviating the strain on arthritic joints. Weight loss is probably approached best as a long-term change in lifestyle rather than a short-term goal. If Weight Watchers or a similar program that offers social support appeals to you, by all means try it out. Here are some other suggestions that may help.
•    Find a diet plan that appeals to you. The only program that will work is one that you can stick with long-term.
•    Keep a dietary diary. Write down every single morsel that you stick in your mouth and when. Most of the weight loss gurus that we have consulted over the last few decades emphasize that this one behavior is essential for lasting success.
•    Eat a high-protein breakfast. No more bagels and butter. Skip the orange juice and coffee. A low-glycemic-index meal will carry you through to lunch.
•    Find an exercise you like. Get a pedometer and strive for 10,000 steps a day. Plot your progress in your dietary diary or on a computer.
`If you need a pharmacological boost, consider Alli (orlistat). This fat Mocker may help you lose a few pounds, though the side effects might be embarrassing. Don’t forget to take your vitamins if you take this drug.
•    If all else fails, Acomplia (rimonabant) may provide the help you need to lose weight, improve your cardiometabolic risk factors, and quit smoking. Check with your doctor about the benefits and risks of this prescription drug.

NAIL FUNGUS
Over the last several years, nail fungus has garnered public attention completely out of proportion with its seriousness. The medical term, onychomycosis (oh-nick-o-my-CO-sis), is long and scary, but it just means fungal infection of the nail. Perhaps so many people are curious about this topic because nail fungus is very common. In addition, the development of
•    Soak your nails in a solution of one-third vinegar to two-thirds water
•    Prepare a cornmeal suspension and soak nails for an hour a week
•    Apply Listerine to infected nails daily
•    Coat the nails with Vicks VapoRub
•    Soak the nails in tea tree or vitamin E oil
•    Try Pau d’Arco tea soaks
•    Ask your MD about a prescription for urea paste 40 percent to remove the infected nail
•    Apply prescription Penlac (ciclopirox)
•    Consider the pros and cons of Lamisil (terbinafine) and Sporanox (itraconazole)
new antifungal drugs that can treat (dare we say cure?) nail fungus has encouraged the pharmaceutical industry to advertise in magazines, in newspapers, and on television.fbe popularity of sexy sandals as footwear may also have contributed to the interest in treating nail fungus.
For diabetics, nail fungus is a medical issue.fbey need to be extremely vigilant about foot care and attend promptly even to things that may seem minor. For the rest of us, though, thick, yellow toenails that are crumbly or hard to cut are more of a nuisance than a serious health concern. They look ugly, and if they get very thick, they may be uncomfortable as well. Sometimes they split, which can be quite painful.
In our opinion, though, it would be a mistake to put your life on the line to clear up your funny-looking nails. Mat’s why we have collected so many home remedies for this problem. They probably won’t work for everyone, but they shouldn’t be very risky, either.
Q. My husband took Lamisil to treat toenail fungus, The drug worked but was ultimately responsible for his death.
The fine print for this prescription drug noted that it might cause neutropenia. For my husband, it did. This led to MDS (myelodysplastic syndrome), which was followed thereafter by AML (acute myeloid leukemia) and his subsequent death.
He had suffered with periodic flare-ups of toenail fungus and athlete’s foot for most of his life. Neither condition was life threatening. The Lamisil was!
Even though serious side effects mentioned in prescription drug labels may affect only 1 percent of users, anyone could be in that I percent. People should ask themselves if it is worth taking that chancel
A. We are so sorry to hear of your husband’s tragic death. In rare cases, Lamisil may trigger serious blood disorders such as neutropenia, a lack of white blood cells. This drug can also damage the liver; there have been deaths associated with this problem. This is a high price to pay to cure toenail fungus.
Patients must always take into account not only common side effects but also the possibility of rare but deadly adverse reactions.
Home Remedies
It’s hard to say just where nail fungus comes from and why some people appear to be more susceptible than other-, Occasionally readers report that they first noticed nail fungus after going for a manicure or a pedicure. Presumably, it is possible to pass the organism that causes nail fungus from one person to another, and surely from one nail to another.To minimize that likelihood, we suggest that any tools such as scissors or clippers that have been used on a nail that might be infected be soaked in rubbing alcohol for 15 minutes before being used on an uninfected nail.
We think home remedies are the place to start for treating nail fungus, whether it affects the toenails or fingernails. (”This does not apply to people with diabetes, who should seek medical care for this problem.) Needless to say, some doctors are not fond of the idea of using home remedies for nail fungus.
Some time ago, we heard from a podiatrist who was very unhappy with our recommendations. “Home remedies hardly ever work,” he wrote. “The unproven treatments you mentioned are little more than urban legends. In 23 years of practice, I have never seen even one patient who responded favorably to Vicks VapoRub, dilute vinegar soaks, or vitamin E oil. Don’t make me waste time dispelling these myths.” He recommended that people take FDA-approved prescription drugs like Lamisil, Penlac, or Sporanox instead.
We certainly heard from readers who disagreed with him. One person who had success treating nail fungus with vinegar soaks expressed this opinion: “If a treatment is relatively harmless, as this is, and there’s even a chance it can work, I believe doctors should encourage alternative methods instead of high-priced medicines laden with potential side effects.”
A pharmacist also weighed in with some information on the effectiveness of the prescription medications:
I would like to point out some facts about the FDA-approved drugs the podiatrist prefers (Lamisil, Penlac, Sporanox). Does this doctor know that Penlac’s success rate for a complete cure, accord-ing to the manufacturer’s prescribing information, is only 5.5 to 8.5 percent after 48 weeks? When using Sporanox, the percentage of overall success rises to a dizzying 35 percent.
Also, does he know the costs of these medications? A bottle of Penlac costs $72.99. To reach 48 weeks of treatment once a day to a single affected nail, I conservatively estimate that the patient will need six bottles of the lacquer (one bottle approximately every other month), So Penlac will cost the patient, without insurance, 5437.94 to reach an outstanding 8.5 percent cure rate.
For Sporanox, one pulse-pak costs ME99. This is a 14-day supply. The manufacturer recommends 12 weeks of treatment, bringing the patient cost, without insurance, to $1,535.94! No wonder people are looking for alternatives to these medications.
Oral medicines such as Sporanox can occasionally trigger serious reactions as well. No wonder some people are willing to spend time and effort—but not much nioney—trying a low-risk home remedy.
I assumed toenail fungus was a fact of life forme. khad spread to five or six toenails when I finally saw a dermatologist The prescribed treatment was costly, and after it began, the dermatologist told me the odds of reinfection after treatment were about 50 percent
I had a nightmare reaction to the pills a week later I was in remote Finland, of all unlikely places, when I developed hives and severe itching. After 24 hours of nonstop, nonsleep itching, I got through to my doctor and was told to stop taking the pills.
When I got home, / decided to try the vinegar treatment I applied a drop of distilled white vinegar to my toenails with a cotton swab each time I got out of the shower As the nails grew out the fungus was completely gone, along with slight traces of athlete’s foot
Cost: under $ZOO over 9 months.
Side effects: none.
Effectiveness: 1019 percent (or 200 percent it you include the athlete’s foot).
Vinegar
One of our favorite home remedies is a vinegar soak. It is surely, one of the cheapest remedies for nail fungus. People who sit still to read, use the computer, or watch television could soak the foot with the affected toenails or hand with the affected  Vinegar
Use two parts of water to one part vinegar for a soaking solution. It does not seem to matter whether you use white vinegar or apple cider vinegar, so we suggest the cheaper
white vinegar.
Downside: Your toes may smell of vinegar.
Cost: $1.60 to $2 for 64 fluid ounces—enough for at least four treatments, and possibly eight
fingernails in a solution of one part white vinegar to two parts water. Vinegar is acidic, and acid makes the environment inhospitable to nail fungus. Because it is a home remedy, there is no “prescribed” method. Some people have had success soaking for an hour each week, all at one go; others soak once a day; and still others use the technique of daubing undiluted vinegar on the affected nail with a cotton swab every day. Persistence is needed with any home remedy. Nails grow slowly, especially toenails, and you need to give them time to grow out healthy and fungus free.
Cornmeal
Another natural fungus fighter may be cornmeal. We first learned of this approach from a public radio listener: “Put about an inch of cornmeal in a plastic dishpan. Pour in hot water, stir it so the cornmeal gets dissolved, and when it is cool enough not to hurt, soak your feet for an hour. If you do this regularly, it will get rid of the fungus.”
When examining me my doctor noticed that I had nail fungus affecting toes on each foot He recommended that) make a batter by mixing cornmeal and water in a shallow pan, let it sit for an hour, and then soak my feet for an hour He told me to do this once a week for a month. I did the cornmeal therapy for 3 weeks and the fungus was gone. I don’t know why it works, but it’s cheap, harmless, and it worked for me.
We haven’t found any scientific support for cornmeal as a nail fungus treatment, and fewer people have written us regard-Cornmeal
A footbath of cornmeal mush is neither expensive nor dangerous, and it takes just 1 hour a week. Put about an inch of cornmeal in a shallow pan and add enough hot water to dissolve it. Let it cool to a comfortable temperature and soak your tootsies for an hour.
Downside: This treatment could be somewhat messy. Don’t spill it on the carped
Cost: $2 to $4 for 5 pounds of cornmeal—enough for at least five treatments, and probably more
ing their success with cornmeal than with vinegar, but some have used it to eliminate their nail fungus.
Cornmeal does seem to be a popular home remedy in the garden, though. Gardeners claim that working some cornmeal into the soil around a rose bush will discourage black spot disease, a fungus that affects roses.
Vitamin E
We are always impressed by our readers’ ingenuity. We would never have thought of putting vitamin E oil on fungus-infected toenails, for example. We can’t think of a good reason why vitamin E in particular would be useful against fungus, and yet a number of people have tried this approach with some success.
I keep reading about treatments for toenail fungus so I thought I would pass on my solution. When I had this problem several years ago, I used a simple approach. I kept my toenail soaked with vitamin E oil and the fungus disappeared completely. I can’t recall exactly how long it took but it wasn’t too long.
As we understand the vitamin E tactic, a capsule that you would take as a vitamin—any dose will do—is pierced with a needle or a pin.’Iben the contents are squirted out all around the edge of the nail and particularly under the nail, between it and the skin. The key here, as with most nail fungus treatments, is patience and persistence.
Listerine
The old-fashioned mouthwash Listerine is one of America’s favorite all-purpose home remedies. (The other is Vicks VapoRub; more about it in just a bit.) Amber-colored original flavor Listerine contains a mixture of herbal extracts that can fight fungal pasties from dandruff to jock itch. Some people have also reported having good success with soaking infected nails in Listerine.
0. 1 cured my toenail fungus using a fifty-fifty mixture of vinegar and Listerine. I kept the mixture in a quart jar with a screw-on lid and used a clean paintbrush to apply the liquid to the affected toes morning and night. I wore socks to protect the bedsheets at night.
The fungus took about 3 months to clear up. It is slow growing but is also slow to cure. I hope this helps someone else.
A. You combined a couple of favorite remedies. Many people have reported success with soaking infected - nails in one part vinegar to two parts water. Others got good results soaking their toes in Listerine. Such remedies won’t work for everyone and take several months to produce results.
*** Listerine
This amber-colored mouthwash contains a fair amount of alcohol along with a mix of herbal oils including thymol, eucalyptol, methyl salicylate, and menthol. The thymol and the eucalyptol, at least, seem to have antifungal activity, and the other two may fight fungus as well. Soaking the nail in Listerine (original flavor) or daubing on a bit of Listerine after the daily bath has worked for some people.
Side effects: None known
Downside: Your nails may smell like Listerine. Cost: Approximately $5 for a liter  Vicks VapoRub
This ointment contains herbal oils such as camphor, menthol, thymol, eucalyptol, cedarleaf, nutmeg, and turpentine. Some of these have antifungal activity, and they may work synergistically. Apply Vicks VapoRub all around and under the affected nail or nails once or twice a day. Putting it on right after a shower or bath seems to help. If you apply it at night, wear socks to bed to protect the sheets. It may take 6 months to see results.
Side effects: Allergic rash is possible. In addition, we heard from a few people whose fungus-infected nails came off with this treatment. This might increase the effectiveness of the remedy, but it could be painful.
Downside: Inconvenience
Cost: Approximately $12 for 6 ounces. You could probably treat several toenails twice daily for 6 months with this much Vicks.
People have conjectured why Vicks seems to be beneficial against nail fungus. There is a compound in Vicks—thymol—that is now listed as an inactive ingredient.
When I was a premed student at UCLA in 1951, 1 met a mycologist (an expert on fungus). During World War It he devised a preparation to treat fungal infections that were common among the troops in the North African campaign. ft was an ointment that relied heavily on thymol as the most effective antifungal agent and reeked of thyme.
Vicks contains three active ingredients and 22 considered inactive. One or more of these might help thymol penetrate the tissues. I suspect that a pure preparation of diluted thymol, without other ingredients except a solvent, would be a good antifungal nail treatment
Vicks VapoRub certainly does not work for everyone. But we have heard from a great many people who have tried it and gotten a positive response. Some could see the results within a few weeks; others needed to keep applying it for month-s. Even prescription drugs take quite a while to clear toenail fungus, however, because the toenails grow so slowly. The infected nail must grow out completely and be replaced by uninvolved nail.
I had nail fungus fora long time. Medicines recommended by my doctor didn’t work. Then I read about using Vicks VapoRub. I applied it to the nail every day for about 5 months and now the fungus has disappeared. I’ve been cured.
Tea Tree Oil
Tea tree oil comes from an Australian tree, melaleuca. It has long been used to treat skin problems, particularly fungal infections. You don’t need to go to Australia to get it, though. It is marketed widely in stores and on the Internet in the United States. Applying tea tree oil to the infected nails daily can overcome some cases of nail fungus. Some people do develop allergic rashes in response to tea tree oil, however, so be alert for any itching or redness.
Q. Some years ago I was diagnosed with a fungal infection on one toenail. The intense throbbing pain made it difficult to wear a shoe.
My podiatrist said the only way to treat the toenail was to remove it. I had several more months of pain while the toe healed.
After the surgery I was alarmed when another toe showed signs of fungus. I asked about a natural treatment at the health-food store and was told to try tea tree oil.
I applied it liberally several times that day. Within 10 hours, the pain had diminished. I continued using tea tree oil on the nail daily for a few months. The base of the nail grew in pink and healthy.
I am angry that my podiatrist chose to operate on my toenail rather tha” recommend a natural, pain-free tMMYnent.
A. Tea tree oil (derived from the Australian melaleuca tree) has antifungal activity. It has long been used to combat skin and nail problems. Your podiatrist may not know about this herbal product, however.
Pau d’Arco Tea
The lure of the exotic can be seen not only in tea tree oil but also in Pau d’Arco, also called taheebo. This product is the inner bark of a South American tree that has been used medicinally by the natives of Brazil. Argentina, and Paraguay. It contains at least one compound with antifungal activity. Some readers report that using an infusion of Pau d’Arco to soak toenails, much as one would use vinegar or Listerine, can help clear the infection.
Oregano Oil
Oregano oil doesn’t come from a tropical rain forest, but it is hardly a common household staple. Nonetheless, some people have used it topically for fighting athlete’s foot, and others have reported success in using it against nail fungus. Like Listerine and Vicks VapoRub, oregano oil contains thymol. It also contains carvacrol. These two herbal oils together seem to have some antifungal action. Some people are allergic to oregano oil. Anyone who has experienced a reaction to basil, sage, lavender, marjoram, or mint probably should steer clear of oregano oil.
Can you stand another toenail fungus cure? I have found one that works for me, and I have tried them all, including prescription Lamisil pills.
I read somewhere that oil of oregano will kill anything, so tried putting a drop down between the nail and the skin every day. Slowly but surely the toenail is growing out normally! I hope someone else can benefit from this as well.
Lemon
Some years ago, we heard from a reader who maintained that sleeping with a lemon attached to the toe for 3 nights running would clear up toenail fungus. Only a few others have tried this -and reported back to us. It did not work for at least one person, though it seemed to help another.
0 0 *
0. Many people write to you about toenail fungus, but you have never mentioned a remedy I learned from an elderly lady in South Carolina. This remedy requires three fresh lemons. At night cut a hole in the top of one and scoop out a hollow just large enough for the toe.
My mother had a great toenail so thick and hard that she could hardly wear a shoe on that foot. I used duct tape to hold the lemon on Mother’s foot, and put a sandwich bag over it to protect the bed. Do this for 3 nights in a row. The toenail becomes so soft that it can be peeled right off, and the new nail that grows in is normal. It worked for my mother!
A. We have been collecting nail fungus remedies for years, but this is the most unusual. Fungus doesn’t thrive in an acidic environment, which may be why dilute vinegar soaks are so effective. The citric acid in the lemon may work in a similar manner.
Prolonged exposure to pure lemon might be irritating for some people, so we suggest that anyone who wants to try such an approach test it first. Removing a
toenail should be done only with medical supervision,
because there is a risk of infection.
* 0 0
Prescription Treatments
Unlike home remedies, prescription medications for nail fungus have been scientifically tested and have performed better than placebo. That is the criterion applied by the FDA before approving any prescription product. Don’t expect too much from these medicines, though: They don’t work for everyone, even though they might be more effective than home remedies. Before beginning a prescription medicine for nail fungus, make sure you understand the risks.
Urea Passe
One treatment for toenail fungus is to remove the nail surgically and then treat the underlying skin with an antifungal cream while the nail grows back without fungus. Many people are understandably reluctant to undergo surgery for nail fungus. Infection is always a risk. We hate it when the cure is worse than the condition it’s intended for.
Dermatologists have studied a different approach that is Urea Paste
The high-strength 40 percent urea paste that dissolves infected nails is available only by prescription. Its use should be supervised by a physician who is familiar with the treatment.
Side effects: Irritation, itching, or burning
Downside: Many doctors are not familiar with this approach. Cost: Approximately $75 for an 85-gram tube
far less traumatic. Urea paste at a 40 percent concentration will dissolve infected nail and leave healthy nail alone. It is essential to work together with the prescribing physician, however, as removing a nail is not a trivial issue. Please do not do this at home by yourself.
0. 1 have ugly, thick, yellow toenails that are hard to clip. My doctor says they are infected with fungus but he doesn’t want to prescribe Sporanox because it could interact with other medicine.
I have tried home remedies, including Vicks VapoRub, and none has worked. The podiatrist wants to remove the nails surgically. I know you have written about urea paste to dissolve away the infected nail. Where do I get it and how do I use it?
A. Surgical removal of nails can be painful and there is a risk of infection. Stanford dermatologist Eugene Farber, MD, discovered the urea treatment many years ago while traveling in Russia. 761 Urea (40 percent) is available only by prescription (Ureacin-40, Carmol 40, Gordon’s Urea 40). Your doctor should supervise the treatment.
Penlac
A lot of people are reluctant to take an oral antifungal drug. Some worry about side effects, others are concerned about potential interactions with other drugs they take. Both are valid concerns.
One manufacturer came up with a topical prescription antifungal medicine that is applied like nail polish. Penlac (ciclopirox) was approved by the FDA for the treatment of mild to moderate nail fungus. Like most of the home remedies we’ve already discussed, Penlac requires a lot of persistence. It needs to be applied to the affected nail, including between the nail and the skin, every day. It can cause redness or irritation, and it may take up to 6 months to produce results.
When people use Penlac, they need to see a health-care professional on a regular basis to have any unattached, infected nail removed so it won’t continue to spread the infection. We have no way of comparing Penlac’s effectiveness to that of other treatments. Presumably it is as good as most of the untested home remedies, but it is not really too astonishing. About 12 percent of the patients treated with Penlac in clinical trials were able to clear their toenails of fungus. One of the biggest differences between Penlac and a home remedy is the cost. A little bottle (6.6 milliliters) costs $130 or more.
Sporanox or Lamisil
The heavy artillery for treating nail fungus is an oral antifungal medication. If it is crucial to eliminate the infection, the physician will prescribe a drug such as itraconazole (Sporanox) or terbinafine (Lamisi)). (You may have seen magazine or television ads for Lamisil that feature a cartoon character, Digger the Dermatophyte.)
In a long-term head-to-head study, patients with toenail fungus were given either terbinafine or itraconazole according to the recommended dosing procedure for 3 to 4 months. 762 At the end of that time, 46 percent of the people who had taken Lamisil and 13 percent of those who had taken Sporanox had no detectable fungus in their nails. The follow-up extended for another 4 years or so. The investigators (some of whom worked for the maker of Lamisfl) found that relapse rates were significantly higher among those who had taken Sporanox.
An analysis of cost-effectiveness found that terbinafine is the most cost-effective treatment a doctor can prescribe. 761 Penlac was judged to be at least three times more expensive than the others, considering cost per cure. This analysis did not take any of the home remedies into account. If there were scientific data on them, they might well demonstrate low effec-tiveness, but because they are cheap, their cost-effectiveness might compare well to some of the standard treatments.
Another advantage of home remedies is the low likelihood of serious side effects. Lamisil is considered fairly safe, even for children and the elderly.764 Nonetheless some people taking Lamisil have developed liver failure.’W~ People who already have liver problems should not be given this drug. Other people taking Lamisil have come down with a very serious skin reaction, so anyone who develops a rash should get in touch with the doctor promptly. People who have lupus could get worse while taking Lamisil, so it’s generally not recommended for them.
As we mentioned at the beginning of this discussion, Lamisil occasionally can lower white blood cell counts to dangerous levels. Usually, the count comes back up once the person stops the drug. This drug may interact with other prescription medicines, including antidepressants. beta-blockers, and certain other medications that regulate the heart’s rhythm. By now, we hope we have convinced you to stay in very close touch with the doctor who prescribes Lamisil for your toenail fungus. It’ll probably run you more than $800 for the 12 weeks of treatment, but because it works so well, it is quite cost-effective.
Conclusions
Nail fungus, particularly toenail fungus, is usually more of a nuisance than a serious medical problem. (For diabetics, however, nail fungus or any other foot problem qualifies as serious and requires medical care.) As a result, we feel comfortable in recommending that most people try home remedies first. We don’t have any data on how well they work, but the testimonials we have received indicate that they do work for some people. In addition, they are inexpensive and don’t cause dangerous interactions or reactions.
A palm) who needs a higher likelihood of cure may need a prescription for Lamisil. It is the most cost-effective of the prescription nail fungus drugs. Even so, it does not work for everyone, and it is not always appropriate. Some people may be taking other medicines that could interact with Lamisil. Others may be at risk of liver problems or complications such as lupus. Most of the time, nail fungus is a problem you can live with; some of the rare side effects could be deadly.
•Toenails grow slowly. It takes a year to a year and a half for them to grow out completely, so be very patient and persistent.
•    After cutting fungus-infected nails, soak the clippers or scissors you used in alcohol for 15 to 20 minutes so you don’t spread the infection.
•    Soak your feet in a footbath of one part vinegar to two parts water for 20 minutes a day.
•    Mix cornmeal with hot water, allow it to cool to a comfortable temperature, and soak the affected nails for 1 hour once a week for at least a month.
•    Squeeze vitamin E oil or tea tree oil around the cuticle and under the nail once or twice a day.
•    Soak the feet in original Listerine or apply it daily to the affected nails.
•    Smear Vicks VapoRub around and under the nail every day.
•    Brew an infusion of Pau d’Arco for soaking the affected nails every day.
•    Stick your toe in a lemon overnight to soften the infected nail for removal.
•    If the nail needs to come off, ask your doctor about prescribing urea paste (40 percent).
•    Lamisil is the most effective prescription pill for fighting nail fungus.

INSOMNIA
• Avoid late-night TV, alcohol, and caffeine
• Exercise during the day
• Take a hot bath 1 hour before bedtime
• Listen to soothing music or a relaxation CD
• Seek cognitive behavioral sleep therapy ***
• Eat a high-carb snack before bedtime
• Take magnesium before bedtime ***
• Scent your bedroom with lavender or jasmine
• Try melatonin
• Use acupressure
• Consider valerian ***
• Ask your doctor about Ambien CR (zolpidem) **
• Check with your doctor about Lunesta (eszopiclone) **
• Inquire about Rozerem (ramelteon)
• Ask your doctor about Sonata (zaleplon)
Whoever coined the phrase “sleeping like a baby” must have been childless makita 18v cordless drill lithium . No parent who has ever walked the floor for hours with a fussy infant or gotten up for numerous nighttime feedings would imagine that babies sleep well zocor and mlik thistle .
At the other end of the life span, sleep problems are just as common side effects plavix . Older people frequently have trouble getting to sleep wellbutrin xl effecacy . Another common complaint is that they wake up far too early nabumetone arthritis medicine . Some have to get up to visit the bathroom and then have diffi-culty falling back to sleep tizanidine vs lorazepam for muscle spasm . Others find that they are wide-awake at 3:00 a bactrim ds package insert .m coumadin risks for taking . and toss and turn until mornin~ i Up to half of all elderly people report trouble with insomnia
Babies and senior citizens are not the only ones who suffer aripiprazole product monograph . The number of people who have intermittent or chronic sleep problems is enormous, perhaps as many as 70 million 672 That means that one in five of us is all too familiar with sleeplessness chloresterol drug tricor . 673
Perhaps people slept better in past centuries st johns wort metformin . Back before Thomas Edison invented the electric lightbulb, even adults slept an average of 10 hours a night raleigh lithium bicycle . But average sleep time has been dropping ever since chemistry and penicillin . A poll in 2002 showed that the average American gets fewer than 7 hours of shut-eye on weeknights pepcid drug guide . And the deficit can’t all be made up on weekends or holidays albert glyburide .
Think about a sleep debt as you would a financial debt omeprazole is the generic for .The more it grows, the harder it is to pay oft Eventually your body rebels nexium blood sugar . Chronic sleep deprivation is associated with high blood pressure, weight gain, diabetes, reduced immunity, daytime drowsiness, poor performance, traffic accidents, falls, memory problems, and cognitive impairment sustention testosterone despo . But lying awake in bed worrying about these possible consequences won’t help parlodel treatment in ivg .
NIGHT LIGHT
Epidemiologists have found that too much light at night may increase a woman’s risk of breast cancer discount vardenafil hydrochloride .”‘ Light
suppresses the production of a natural brain hormone called melatonin xenical acne . Blood levels of this hormone naturally rise at night purchase celecoxib on the net . When you are exposed to a computer screen or bright light at night, the body cannot make enough melatonin metformin 500 mg half . A low level of melatonin is associated with cancers of the prostate, lung, stomach, and breast ivf protocol estrace mid-cycle .675 To minimize disruption of melatonin, body-clock researcher William Hrushesky suggests the following sensible guidelines:
• Have a consistent bedtime generic mestinon .
• Darken your bedroom remeron tab .
• Get regular exercise during the day alternative health caffeine .
• Abstain from alcohol before bed (it blocks melatonin) prothombin time coumadin .
Inviting Sleep
Have you ever climbed into bed exhausted after a stressful day, only to discover that your brain won’t slow down? The events of the day just keep replaying like an endless movie perscription drug stores ultram tramadol . Figuring out how to let go of those worries can be challenging preventive treatment doxycycline . Watching the clock tick off the minutes or the hours just makes things worse glimepiride allergy sulfonamide . The later it gets, the more anxious you become, especially if you are concerned about being fresh the next day evista benefits com .
It’s hardly any wonder that so many people get into the habit of reaching for a sleeping pill “just in case generic allegra online .” They assume they will have difficulty falling asleep and pop a pill to prevent trouble cyclophosphamide and pulmonary hypertension and denton . Of course, this leads to an endless cycle keyword prozac controversy . Without the sleeping pill, they have rebound insomnia, which reinforces the fear of not being able to fall asleep, which triggers another round of pills zanax and buspar . What else can you do to avoid tossing and turning for hours?
Cut Out Caffeine
Most people know that caffeine is a stimulant that can keep them awake maker of flomax . They avoid that evening cup of coffee, thinking that will solve the problem diflucan over . But some people are so sensitive to the effects of caffeine that they should stay away from coffee, tea, and caffeinated soft drinks at any time in the afternoon discontinuation of bupropion . And don’t assume that decaffeinated coffee is the solution to your insomnia problems evista cod . If heartburn is contributing to your nighttime sleep woes, the culprit could be decal coffee, which can trigger acid reflux that may wake you up ic tramadol hlc .
Beware Drugs That Can Keep You Awake
Caffeine is not the only drug that can interfere with aood night’s sleep lithium polymer batteries uk . A surprising number of prescription and
over-
the-counter medications can contribute to nightmares, insomnia, or disrupted sleep using hibiclens while on accutane . Many of these drugs would not necessarily be expected to cause problems crestor vs zocor . Beta-blockers such as atenolol, metoprolol, and propranolol, which are prescribed for high blood pressure or heart trouble, may cause nightmares and insomnia lipitor child labor . The osteoporosis medicine Actonel (risedronate) can interfere with sleep vitamin b 12 deficiency nexium . So can many antidepressants, such as Effexor (venlafaxine), Prozac (fluoxetine), Wellbutrin (bupropion), Zoloft (sertraline), and others, and allergy medicines that contain decongestants such as phenylephrine and pseudoephedrine long term luvox use .
The list of drugs that can cause sleeplessness is so long that we cannot possibly include it in its entirety here guarana seed caffeine content . If you suspect that your medication may be interfering with restful sleep, discuss this issue with your pharmacist and your physician what is a cyclosporine challenge test . There may be alternatives avalide while pregnant .
Forgo the Nightcap
And don’t forget alcohol getting a tattoo on penicillin . An evening glass of wine or a nightcap may seem relaxing and even make you drowsy solubility cefuroxime acetone . But alcohol can affect melatonin levels and interfere with dreaming sleep ship free viagra sample . Waking too early is a common consequence of having an evening cocktail dristan sinus pain with ibuprofen .677 If you’re having trouble sleeping, don’t drink after dinner meloxicam for tendonitis .
Exercise
Exercise is not only good for the heart and bones, it is also a great stress reliever will prednisone make blood sugar elevate . If you can take a brisk walk, play a couple of sets of tennis, or play a round of golf (without the golf cart), you will find that your level of anxiety will diminish allergic reactin prednisone . Do it in the afternoon and you may get some sun on your face sore leg muscles and lipitor . Bright light combined with exercise can relieve depression and insomnia buy soma online usa .678 The sun exposure can also affect melatonin levels that have an impact on sleep quality and could reduce the risk of breast cancer in women tried both diflucan and vaginally . 79
Tai chi is an ancient Chinese exercise program can you get preganant taking provera . This gentle form of activity is actually quite beautiful to watch risperdal zoloft interaction . Researchers at the Oregon Research Institute in Eugene recruited 118 men and women over 60 years old importation viagra . Half were taught tai chi and the other half had a low-impact exercise session tramadol apap opinion . The tai chi students reported that after 6 months, it took them less time to fall asleep (18 minutes less on average) and they slept longer (48 minutes longer) ivermectin injection scabies .’
Timing is everything when it comes to exercise and sleep aleve drug interaction . If you exercise in the morning or early in the day, you should have less trouble sleeping amoxicillin bloating side effect . But if you exercise in the evening, just before bedtime, you’re likely to have more trouble sleeping clavulanic acid ampicillin oral dose .681
Hot Bath
Another simple, inexpensive, and pleasant way to ward off insomnia is to take a hot bath viagra us drugs stors . Here again, though, timing is critical clindamycin for prostatitis . A hot bath or shower just before bedtime could be counterproductive naproxen complications . The trick is to schedule it about an hour before you plan to go to bed risperdal children anger .(’82 A hot bath raises the core body temperature viagra after prostrate surgery . As it drops, the signal that goes to the brain is “sleepy time dipyridamole shortage .” Body temperature normally drops in the first part of a night’s sleep, so pushing it up with a 30-minute soak, then allowing it to fall tricks the body into thinking it may already be asleep zoloft versus efflexor side effects . Combined with a regular bedtime ritual, this can really help monohydrate in cephalexin .
Winding Down
Turning off the internal dialogue is especially hard for some folks cabergoline studies . “If only” is a dangerous game effects imitrex side . People who replay the day’s events, complaining to themselves that they should have done things differently, are destined to toss and turn lamictal side effects in children . How can you stop obsessing? One way is to set aside time specifically for worrying much earlier in the day lipitor and diarrea . It sounds odd, but some people find that it helps tavist smiley atlanta .
Another way to quiet your mind at bedtime is to keep the television out of the bedroom viagra berocca cocktail . Not only will this make it easier to get to sleep, it might improve your love life liquid femara . According to an Italian researcher, Serenella Salomoni, -if there’s no television in the bedroom, the frequency (of sexual intercourse) doubles viagra slump .”683 Satisfying sex can lead to deep relaxation and make it easier to fall asleep order propecia propecia .
If your bedroom clock has a bright face that allows you to watch the minutes tick past, turn it away from the bed buy lasix from a us pharmacy . Watching the time go by is a recipe for staying awake and increasing your anxiety about falling asleep generic versions of tramadol .
Another way to relax is to listen to gentle music or guided imagery depo provera hormones . Our favorites are by Emmett Miller, MD boards clomid message . Dr herbal alternatives to paxil . Miller is one of the founding fathers of the mind-body movement caffeine effects on the bodys tissue . He is a poet, a philosopher, a musician, and a healing, caring physician is prednisone otc . Nis voice, is so soothing and reassuring that you will find yourself relaxing without even trying medlineplus cozaar . To find out more about his CDs and tapes, visit www nash trial pioglitazone .drmiller does fluconazole treat chlamydia .com or call 800528-2737 lithium quartz tumbled brazil min . Our Dr warfarin and priapism . Miller Eaves are Easing into Sleep, Letting Go of Stress, 10-Minute Stress Manager, Healing Journey, and Rainbow Butterfly slur word speech celebrex .
Lest you think this is all touchy-feely New Age nonsense, we promise you that there is actual research to support these nondrug approaches disulfiram implants visotskij . One study offered insomniacs a selection of soothing music to be played for 45 minutes at bedtime low testosterone level boys . 684 The participants selected the music they preferred and were instructed to relax in bed while listening to it gene amplification dihydrofolate reductase methotrexate . Measurements showed that they had less trouble getting to sleep, fell asleep more quickly, and had better sleep quality buy zanaflex no prescription .
Another study compared progressive relaxation to anxiety management training for 9 weeks prozac and ecstasy . Both groups of insomniacs benefited side effects remeron rare . They fell asleep faster and slept more soundly keflex and blood clotting . 685 Such behavioral training can be a little pricey, which is why we like Dr kytril billing . Miller’s CDs norm shealy lithium oxalate .
Cognitive Behavioral Therapy
People who have persistent problems with insomnia may find it well worth their while to consult a counselor who offers cognitive behavioral therapy (CBT) genetic viagra mastercard . A study compared this nondrug approach to a sleeping pill similar to Lunesta (eszopiclone) that is commonly used in Europe motrin coupon . Investigators found that CBT was more effective than either the placebo or the sleeping pill mucinex vs claritin .’ The intervention included instruction on using the bedroom only for sex and sleeping, sticking to a regular schedule for rising and retiring, avoiding naps during the day, progressive relaxation, and discussion of beliefs and fears about sleep loss recurrent utis and macrobid .

Cognitive Behavievai ‘Therapy
In a study, learning about sleep ‘hygiene, sleep restriction, and progressive relaxation and discussing fears about losing sleep worked better than a sleeping pill against insomnia how much caffeine can cause miscarriage .
Downside: It is difficult to find a trained counselor testosterone raw powder suppliers .
Cost: Approximately $125 to $140 per session is alli the same as xenical . Six sessions should last a lifetime actonel appetite suppression .
are big fans of a low-carb approach for weight loss and blood sugar control, this principle does not hold in the evening albuterol side effect erdicaria . Protein can be energizing, which is the last thing you need before bed atazanavir omeprazole interaction . Instead testosterone levels determine facial hair growth . we would recommend eating carbohydratess septra bactrim side effects . According to Judith Wurtman, PhD, a research scientist at Massachusetts Institute of Technology, “If you eat carbohydrates when your internal clock wants you to sleep, the food will act like a sleeping pill shipping lithium ion battery .”687
Relaxation foods include caramel-coated rice cakes, Cheerios with frozen fruit and honey, toasted waffles with maple syrup and half a banana, a handful of pretzels, graham crackers, fig bars, and a blueberry muffin singulair and skin test . We would never recommend this dietary approach for someone with blood sugar problems (diabetes or prediabetes) low testosterone and erectile dysfunction . And it obviously is not for someone who is trying to lose weight testosterone at home test . But such high-carbohydrate foods can boost serotonin levels in the brain and make it easier for you to relax and fall asleep when you consume them 15 to 30 minutes before bedtime pnuemonia and cephalexin .
Magnesium
A simple mineral may be just the ticket for a good night’s sleep research study risperdal conduct disorder . Magnesium is essential for good health, but often it is in short supply in the American diet ketoconazole rx . One reason many people are deficient is because of their medicine depo provera side effect . Diuretics that deplete the body of potassium also can eliminate magnesium celexa 40 mg 30 pills . Although physicians are usually good about monitoring the blood’s potassium level, they may be less diligent when it comes to magnesium estrace cream pregnant .
Several years ago, we began hearing from readers of our newspaper column that magnesium is helpful for insomniacs pravastatin muscle pain . With some searching, we discovered that there is at least a
Magnesium
This mineral is helpful for bones, nerves, muscles, and brain function evista test . The recommended dose ranges from 250 to 500 milligrams daily tetracycline calcium . If you develop loose stools, reduce the dose mixing tadalafil and sildenafil citrate .
Side effects: Diarrhea
Downside: Not safe for people with poor kidney function Cost: Approximately $2 to $3 per month little scientific basis for this benefit 6m Magnesium appears to be especially helpful for those who suffer from restless leg syndrome breastfeeding and aleve .”Mis condition can make it hard to fall asleep or can awaken you once you are sleeping sweetly caffeine and dpression .
0 caffeine nut . 1 have suffered from episodes of insomnia for years nimotop online purchase . Cutting down on caffeine didn’t work cafergot tablet . Over-the-counter sleep aids such as Benadryl made me groggy the next day prior to the introduction of penicillin . Even prescription drugs like Ambien didn’t help how to stop taking wellbutrin xl .
Then a friend suggested I try taking magnesium at bedtime levaquin lev pack . I started taking magnesium (250 milligrams) at night lithium ion battery components . Magnesium has helped my insomnia more than anything else I’ve ever tried tardive kenesis caused by lithium carbonate .
A imitrex half life . Magnesium is essential for good health effects of low testosterone on conception . This mineral plays a role in more than 300 biochemical reactions in the body and is crucial for the proper functioning of nerves, muscles, bones, and blood vessels thyroid synthroid .
Magnesium is used in some laxatives (milk of magnesia) and antacids (Maalox, Mylanta, etc fluconazole lactation .) wellbutrin side effects achole effects . This nutrient may also be helpful in preventing osteoporosis and migraines and alleviating premenstrual symptoms strattera weight loss . We’ve not heard of magnesium being used to treat insomnia, however dosges liquid cialis . We’d be interested to learn if anyone else finds this mineral helpful against insomnia interaction between acetyl l-carnitine and warfarin .
* 0 0
In response, we heard from several readers wellbutrin arthritis . Some found that they could eliminate over-the-counter sleeping pills M-,eistarting magnesium supplements tetracycline treatment of acne . One reported, “I started takiIlg Citracal Plus with Magnesium at bedtime natural alternative for coumadin . Ever since, I’ve been sleeping like a baby (a lazy one, mind you, not the colicky kind) lamictal directions .” But here is a cautionary tale cipro prescribed for what infection . Timing is everything:
* 0 0
0 tired on famvir shingles . You asked if anyone has had success taking magnesium for insomnia ketoconazole gel . Years ago I was visiting my sister, who urged my husband and me to start taking magnesium in addition to vitamins dosges liquid cialis . We took the first dose the
morning we left for home nervous testosterone .
We usually split the driving side effects elavil . I drive in the evening, when I am most alert, and my husband drives in the daytime while I drowse risperdal educational video . That trip neither of us could keep our eyes open clomid succcess . We nearly pulled into a rest stop to steep, but somehow we managed to get home imigran inhalt sumatriptan .
I told my sister, who responded, “Sleepiness is a side effect amoxicillin for dental infection . We take magnesium at night boost natural testosterone levels .” I’ve used it for insomnia ever since msds samsung lithium ion batteries .
A brethine preterm labor law firm . You’ve confirmed what some other readers noted: Magnesium makes them sleepy altace pdr . Magnesium can cause diarrhea, usually at doses above 350 milligrams daily allegra medicine . People with kidney problems must avoid magnesium, because it could be harmful dizziness coumadin .
• • •

Practical Advice for
Birth to Three Months
Q
Psychomotor development
During the course of the first three months, the child gradually learns to control his head myopothy from prednisone . In the first month lie learns to focus, for example, on his father or mother albuterol nebulizer treatment for pneumonia . He also learns to follow an object, first with his eyes, and in the second month by rotating the head along with the eyes penicillin vk .
In the second month, the baby is able to hold up his head independently methamazole and albuterol .
The baby starts to laugh at about six weeks, which is a real milestone for the baby and its parents cephalexin liquid .
In the second and third months, the baby learns to raise his chest as well as his head, when lying on his stomach side effects to lasix .
Sleeping and waking
During the first three months, the baby is only really awake at the times that he is being fed online buspar . Adding LIP the time it takes to change the baby, this lasts from 45 minutes to up to one hour every time avandia bmj . By the end of these three months these periods may already be longer prednisolone eye treatment . If the baby’s pattern of sleeping and waking is very different, for example,
because he cries a lot and sleeps for short periods, or because he is difficult to wake, you should discuss this with the baby clinic pet tavist .
Crying
Many babies cry quite regularly in the first three months levitra without a presription . This is because they are getting used to a new life, and their intestines are still developing and usually cannot perform their functions straightaway watson brand carisoprodol . This can lead to hours of restlessness every day, as well as periods of crying prilosec pros and cons . In general, restlessness or crying for two or three hours a day is quite normal cycle length on clomid . This does not mean to say that a restless or crying baby is easy to live with; it takes you over completely wellbutrin and regular blood tests .
First of all, it is important to learn to distinguish different types of crying buy lithium carbonate . If the baby grizzles while he is falling asleep, this can be ignored for a while because it often stops automatically normal dosage of furosemide day . If the baby is crying because he is cross and cannot settle, this also often stops after a while lithium containing foods . Sometimes the baby will turn red bupropion fatigue . There are many children who fall asleep this way menopause and testosterone . However, there are some babies who cry so much that you simply have to console them because they cannot settle on their own cipro medication for bacteria .
Over the course of the first three weeks, the parent will start to hear whether the baby is crying because he has wind, or is troubled by a dirty nappy (diaper), or because he
is hungry nizoral loprox . Obviously something has to be done about this safety triamcinolone acetonide cream pregnancy .
The most common cause of crying mentioned by parents is cramp buspar constipation . You cannot always tell from the baby’s position — curled up with his legs tucked up — because all babies lie like this when they cry a lot zocor leg pain . The way in which he cries —vehemently, often alternating with short periods of silence — can tell you more, particularly it’ the crying is accompanied by a hard and swollen stomach and a lot of wind diovan long term results . At the baby clinic you can discuss whether to make any changes if you are breastfeeding caffeine msds . If the baby is bottle fed it is best not to change to a different sort of formula milk straightaway if the baby has cramp; changes in feeding can exacerbate cramps zyrtec or claritin . There are a number of ways that can help with crying babies detrol la prescribing information . Again it is important not to try everything out on one day, but to try out one thing for a few days to see whether it helps venlafaxine fordogs .
The method of feeding
In the case of breastfeeding, problems can arise if the baby has developed the wrong technique for drinking; for example, if the baby drinks too greedily and messily, so that he sucks in air coumadin prothrombin levels . It often helps to hold the baby in a more vertical position sleep disorders zocor . If the baby drinks too greedily, it can be helpful to express some milk before feeding can adderall be taken with zyprexa . The baby can then drink more calmly order diflucan online .
If the baby is fed too often once breastfeeding has started, and does not empty either of the breasts fully, he may be getting too much fore milk exelon transdermal . This is rich in carbohydrate, in contrast with the hind milk, which contains more fat manufacturer of altace . If the baby is proportionally drinking more fore milk than hind milk, this can lead to fermentation in the intestines luvox lead investigator .
In the case of bottle-feeding, the hole in the teat may be too large, so that the baby gets a lot of food in a short time buy generic carisoprodol . Look at the quantity: is the baby getting too much or too little (see Feeding Table on p methotrexate and medcation errors .1 14) metformin 500mg picture . Swaddling is an effective procedure for restless and crying babies
crying
(see also p lamictal combine other anti-depressants .108)
It also makes a big difference if you are able to deal with crying in a fairly relaxed way side effects if tetracycline . If you are able to communicate a feeling of calm and tranquillity and establish a pattern in your behaviour, this will also calm down the child buy propecia in canada .
Page 99 describes a number of household remedies, which may help for stomach cramps 7 proscar and hair loss .
If you are worried about the crying and think that something is really wrong with the baby, contact your doctor or the baby clinic zovirax tablets .
Care
Bathing and washing
Bathing the baby daily is not really necessary and is actually inadvisa-
ble in the first few weeks after birth methylphenidate zoloft . Once or twice a week is usually sufficient guinea pig ivermectin overdose . In fact, the baby loses a great deal of warmth when bathed, and not all babies feel comfortable when they are completely undressed to have a bath li-10b lithium battery . Furthermore, the layer of sebum, which is of enormous importance to the baby for the first few days after birth because it feeds and protects the skin, will soak off when the baby is bathed cheapest prices carisoprodol online . If you do not bath the baby, you should obviously give him a wash every day instead zoloft and naseau .
Bathing
Bathing the baby safely and efficiently is quite an art, which is usually learnt with the help of a health professional just after the baby is born cognitive psychopathologic response rivastigmine . It is important for the room in which the baby is bathed to be well heated, and to wrap the clean clothes and towel around a hot water bottle beforehand generic famvir . An extra hot water bottle should also be placed in the cot so that the bedding remains warm therapuetic level of trileptal . This should be removed before the baby is placed in the cot cialis now .
Do not leave the baby in the bath too long minocycline dosage for arthritis . Pat the baby dry all over and dress him quickly unexplained infertility and clomid . As bathing is tiring, the baby will often fall asleep straightaway after he has had a bath and been fed albuterol alternatives .
Washing
When you wash the baby, do not undress him completely, but undress him bit by bit to prevent him from cooling down cialis forum cialis pharmacy . Only those parts of the body that really need it are washed; the rest can be cleaned when the baby is bathed zoloft and blood sugar . Wash the face, ears, folds of the neck, armpits and diaper (nappy) area carefully with water, pat dry and apply calendula baby oil or another hypoallergenic product, as it provides a protective film on the skin salt and lithium . Do not clean inside the ears propecia hair loss treatment php .
There is no need to use soap, because it removes too much oil from the skin wellbutrin as a weight loss aid . The diaper area, armpits and folds of the neck can also be cleaned with some cotton wool and baby oil (see above) caffeine llc alex . Ready-to-use baby wipes sometimes cause irritation to the baby’s bottom dilantin dreyfus .
Nails
In the first few weeks it is only necessary to cut the baby’s nails if he scratches himself tribulus testosterone . Cut the nails straight and not too short with a special pair of baby scissors or baby nail clippers side affects of lovastatin . Do this at a moment when the baby is quiet or asleep north china beijing time syphilis cialis .
Foreskin
In little boys, the foreskin does not usually move freely yet children’s motrin dosing . Nothing has to be done about this; until the age of six, simply wash and pat dry albuterol safer than salmeterol .
Umbilical cord
In general, the umbilical cord drops off between the fourth and fourteenth day clomid in women who already ovulate . By six weeks, the navel is usually dry over the counter pyridium . In principle, you do not have to do anything apart from
keeping the navel as dry and clean as possible cymbalta maoi . In order to help it dry up, it is possible to use some Weleda Wecesin powder in the navel several times a day bosch replacement lithium ion batteries . Continue to use this, even after the umbilical cord has dropped off, until the skin of the navel is dry and looks clean cellcept and shingles . Make sure that the baby does not breathe in the powder when you are applying it buy citrate online sildenafil .
Taking the baby’s temperature
During the first few days after the birth, take the baby’s temperature every day low testosterone levels treatment . The temperature should be about 37°C (98 proscar is .6°F) lithium techno . Taking the baby’s temperature during the first few days is important because it takes a while for the baby to start to regulate his own body temperature, and one blanket or one hot water bottle (not in the cot with the child) more or less will have an immediate influence on its temperature testosterone imbalance .
After this, you should get to know the baby so well that it is only necessary to take his temperature when he is ill (see p methotrexate by myla .24f) picture of ziac . Observing the baby closely is important, because each child is different, and because the weather can change the baby’s temperature very rapidly stomach side effects from zocor .
If the baby really feels the cold, an extra bonnet, even in the cradle, sometimes works better than an extra blanket, because much warmth can be lost from the baby’s relatively large head cardura and cialis .
Diapers (nappies)
For parents who like to use cotton nappies (because cotton is good for the skin, or for the sake of the environment), but cannot cope with the mountains of washing, there are nappy services available risks and benefits of coumadin . These organizations collect the dirty cotton nappies from your home and bring clean ones in their place interaction mechanism digoxin fibre .
Wrap the baby up in a woollen wrap over the cotton nappy, or put knitted woollen overpants over the cotton nappy zithromax and side effects . These keep the baby warm and let very little moisture through, although they do breathe online generic viagra overnight .
In the cot
During the first two weeks, it is important to put the baby alternately on one side, then on the other side, then on his back alcohol cialis . The effects of gravity, to which the baby is now exposed for the first time, can affect the shape of his head, as well as the relationship between his trunk and pelvis canada launch biaxin xl history . By changing the baby’s position, you can avoid too much pressure on one side triamcinolone and ezcema .
Since the first results were published in the Netherlands in 1989 about the link between placing babies on their stomach and cot death, all baby clinics advise against this position male testosterone levels and frequent ejaculation . Infant mortality rates have clearly fallen as a result medrol dose pack and pentasa . After the age of two to three weeks, it is not advisable to place a baby on his side, because he can then roll onto his stomach tadalafil lesions . It is therefore advis-
CARE 51
able to place him on his back at this stage toxic dose of ibuprofen . Since this advice has been given, there have been an increasing number of babies with flattened heads doxycycline hyc 100mg via feeding tube . This does not do any damage to the brain risperidone wiki . As regards the appearance: as soon as the baby starts to play lying on his stomach in the playpen and starts to sit up, the shape of the skull will change back to some extent lexapro patient feedback . Any flatness that remains will not be so noticeable once the hair grows estradiol blood levels .
Some children develop a preference for lying on their back with their head to one side venlafaxine antidepressant effexor . This can result in the back of the head not only becoming flat, but also slightly crooked affects of caffeine on toddlers . It is possible to take a number of measures to prevent this clomiphene humans . Turn the cot around; the changing light and the new direction from which adults approach the cot can sometimes have a corrective influence metformin period pcos . When you change the baby, place him directly in front of you instead of at an angle to emphasize symmetry celebrex new vioxx york . These measures may not always be successful chemical properties prednisolone . Discuss the problem with the doctor if you are worried pravachol coupon .
As a preventative measure to safeguard against cot death, it is advisable for the baby to sleep in his own cot, not in his parents’ bed viagra koop belgie . Many parents like the baby to sleep in their room, especially for the first few weeks or months medicine terbinafine hcl . This feels safe and is easy if the baby is still having night feeds evista side efects . The time at which the baby moves into his own room (if there is one) to sleep will depend on the parents’ needs and on the baby’s sleeping pattern (also see Night feeds, p orlistat meds .56) chlorzoxazone tablet . During the day, the baby should be allowed to sleep in a quiet room generic viagra caverta generic viagra pillshoprxcom . It does not have to be absolutely silent, because children generally sleep well in a room where household sounds can penetrate to some extent lithium battery explosion . However, it should be somewhere where the baby can be quiet, without being constantly stimulated, thus preventing it from sleeping acyclovir and drinking alcohol . Therefore, a bedroom is much more suitable for sleeping than the living room, particularly for babies who are awake a lot or easily stimulated at is diclofenac . At first it may seem that the baby is rather a long way away, but experience has shown that you can still feel the connection with your baby at a distance accutane lab tests .
Many parents use a baby monitor at home to feel secure lexapro user . The disadvantage of this is that you respond to every sound the child makes contradictions lexapro pregnancy . Babies make all sorts of sounds while they are asleep, and these may seem rather alarming through a baby monitor hyzaar astra zeneca . This means that many parents take the baby out of the cot to calm him down, but this can actually make him restless and stop him from learning to solve minor problems for himself different mg of atenolol .
The room where the baby sleeps should be thoroughly aired at least once a day siadh and declomycin . Apart from this, the temperature of the room should be
between 18°C and 20°C (64°-68°F) keflex 750 mg capsule . If the baby is able to keep himself warm and is growing well, the temperature of the room can drop to about 15°C (60°F) depakote reactions . During this stage, it is often necessary to pre-warm the cot with hot water bottles fluoxetine hot sweats .
Going outside
For the first few weeks after the birth, there is no need for the baby to go outside cox-2 and warfarin . When he laughs for the first time, it shows that he is starting to feel at home here on earth prilosec cost . This may be the moment at which the baby can gradually get used to going outside lithium online . A baby does not need direct sunlight, not even to prevent rickets (see p prostatitis flomax .84) fenofibrate rebate . Too much sunlight on the skin can be dangerous, leading to sunburn and dehydration in the short term, and permanent damage to the skin in the long term prednisone versus methylpred .
The best place when the baby is outside in the pram in the shade under a blue sky; but if it is overcast, a baby can still come into contact with light and air allegra d experiences high . Light and air are essential for the baby’s development, first, held in his parent’s arms, and then in the pram in good weather indications for plavix . If you have a garden, the baby can sleep outside in the pram recreational viagra use . In summer it is important to ensure that the baby does not become overheated under the hood of the pram is toprol a selective beta blocker . If this is the case, place the pram in the shade childe and buspar . Take the way in which the wind is blowing into account atenolol potassium levels . In general, children sleep very well outside doxycycline hyclate 100mg for acne .
Always stay nearby, because warm prams are very attractive to cats, and use a cat net soma experience .
If you take the baby outside in winter, it is important to dress him warmly difficulty quitting celexa .
Thumb sucking and dummies
Between the age of six weeks and three months, many babies discover their thumb and start sucking it tramadol great buy . When the baby sucks his thumb, this helps him to make contact with himself, and withdraw into a dreamy inner world success with celexa . Thumb sucking can be a consolation and have a calming influence prescription drugs altace .
In the first few weeks, babies often cry, sometimes a great deal, because entering a new life is by no means easy nexium delayed release oral suspension . A thumb could be a great consolation but the baby has to find his thumb himself, and this often takes a long time drug interactions celexa and mucinex d .
A dummy can serve as an alternative to the thumb wyoming zyprexa lawyer . We would like to briefly outline the advantages and disadvantages bio-identical hormones testosterone levels .
Thumb sucking
A child always has his thumb with him, and can put it in his mouth when he feels the need to do so methocarbamol for goth . Dentists have different views about the negative effects which frequent thumb sucking could have on the jaw pregnancy or clomid . A child has to learn to stop sucking his thumb by himself, preferably before the permanent teeth come through, and this can be quite difficult pravachol risks pain .
If thumb sucking is linked with a cuddly toy or doll, it could be limited by only having the toy in the cot buy 1 cialis .
Dummies
The great disadvantage of dummies is that the child is dependent on his parents nexium uses . If the baby loses the dummy in the cot, he will not be able to find it by himself isosorbide mononitrate er generic name . Crying is the only way of letting the parents know, and this may happen several times a night depakote discount . If the baby uses the dummy a lot when he is not in the cot, this can affect the healthy motor development of the mouth and speech lyrica used with effexor xr . Do not give the baby a dummy if he has not become used to the breast and has not really mastered the sucking technique long term use doxycycline . By sucking on the dummy in this situation, the baby can learn the wrong sucking technique dangers of methyl-1 testosterone . If you give the baby a dummy, the flat, broad variety is preferable to the round, cherry-shaped model in connection with the development of the jaw diovan hct 12.5 . It should definitely be removed when children start to speak as they might develop a lisp on line soma .
Hiccups
There can be different causes for the hiccups saw palmetto or finasteride . Too much food all at once, or food that is too cold can cause hiccups, but so can stress or too much excitement g postmessage propecia subject forum . Copper ointment can be a good remedy if the hiccups lead to a great deal of restlessness paxil rosacea . Apply some copper ointment to the stomach with a warm hand, and at the same height on the back amaryl for diabetes .
Toys and playing
The child learns to explore the world through direct sensory contact — with his ears, nose, mouth, eyes, skin and hands, he assimilates everything difference between glipizide and metformin . During these months these are his toys flagyl for bv daily dosage . For example, the baby will discover his own hands and will practise endlessly bringing them together cheap generic propecia finasteride .
The parent’s face is also fascinating to look at or touch; the nose, hair, and mouth snort toradol 100mg . If you make sounds, recite a nursery rhyme or sing softly, the child will watch and listen intently molar absorptivity acetazolamide .
When the baby is outside in the pram he can look at the rustling leaves in the tree testosterone in females . He will see shadows and light and feel warm or cool air on his skin interaction mechanism digoxin fibre . His pleasure can be further increased by an attractive ribbon on the branch of a tree or shrub, or a bell to play with lecuona prozac .
Safety
The most common accidents during this period are caused by bums, falls and suffocation thioridazine mellaril australia . Take the following precautions:
Burns
Always check the hot water bottle and make sure that is it never in
direct contact with the baby side affects from actos . It is best to place the hot water bottle between two blankets at the foot of the cot, and remove before placing the baby in the cot 25mg spironolactone side affects .
Make sure that the bath water is at body temperature aleve interaction with casodex .
Falls
Never leave the baby alone, even for just a moment on the dressing table, or on a bed without a rail ultram lead investigator .
Use a changing mat with a raised edge on the dressing table weight loss side effects with ibuprofen .
When you walk around holding the baby, make sure that there are no articles left lying around on the floor or the stairs that you may trip over trazodone and eye irritation .
Suffocation or strangling
Make sure that there are no small objects left around the baby, such as loose drawstrings on clothes or hats, or, for example, electric cable near the cot; any drawstrings on the clothes should be well secured seroquel side effect .
When you use a bonnet, check that the bonnet encloses the head properly, and the cord is securely fastened uses for nizoral . It is better to tie it firmly with a short drawstring than to have a loose knot zoloft causes suicidal thoughts .
Also make sure that the lining of the cot is properly secured, and do not use a duvet high liver count due to lipitor .
In the first few years, it is not advisable to use a pillow in the cot, from the point of view of safety pseudoephedrine manufacturers in china .
Feeding
Breastfeeding
Breastfeeding is the art of giving, an art which you learn particularly in the first few weeks all uses of synthroid . In order to be able to give, the mother must be relaxed, or the reflex which releases the milk from the supply behind the nipple will not occur satisfactorily recent accutane stories .
A quiet environment contributes to a relaxed feeling, both for yourself and for the baby lithium indications for use . Try to feed the baby in the room where he sleeps as much as possible, particularly in the beginning, without household noises around you and without any visitors generic viagra vega . A relaxed position is also very important when you are feeding the baby carisoprodol product .
The position for feeding
Lying down: Place your shoulder on the mattress and your head on the pillow exelon chemical structure . Draw up your upper leg and support your knee with the mattress stop smoking bupropion . Make sure that you both feel comfortably warm, and if necessary take another blanket or duvet bupropion and half life .
Sitting down: Place apillow on your lap or under your arm for the baby to lie on so that you do not have to carry him in your arms all the time; a foot rest means that you do not have to cross your legs to keep the baby at the right height generic lansoprazole . Make sure that when you are feeding the baby, his head and body are in a straight line
FEEDING 55
or that his stomach is lying against you ibuprofen and platelets . If his head is turned away from the body, it is much more difficult to swallow metformin how it works .
The rhythm of feeding Breastfeeding is a matter of supply and demand caffeine and low carb dieting . The more often you feed the baby, the more milk will be produced diovan hct 25mg . It usually takes a few weeks before supply and demand are interrelated metformin and arm pain . Insisting on a rhythm too rigidly during this period, with not enough times when the baby can feed, could prevent the pattern for breastfeeding from developing satisfactorily drug interaction between claritin and pepcid . The baby’s own feeding rhythm starts to emerge after the first few weeks wellbutrin sr tinnitus . This is often approximately every three or four hours, but hardly ever at exact intervals sulfamethoxazole trimethoprin . For example, a pattern may emerge with three and a half or four hours between every feed in the morning, and three hours in the afternoon low price caduet . This is the baby’s own rhythm exelon patches . If there is a clear pattern, use this as a starting point for the next few weeks and try to keep to the routine as far as possible dell inspiron lithium ion battery .
A good routine creates a peaceful, calm atmosphere; parents often say that their children flourish better with a clear routine than with feeding on demand kitchen towel calan . This rhythm may be as follows: five to six times during the day, that is, every three or four hours, and another feed during the night if the baby wakes up for it effexor withdrawal dreams .

The Baby Clinic
When a mother is expecting a child, this is the beginning of an exciting period; a time of ‘expectation,’ followed by the birth and the baby’s first year. It is a special event every time, but particularly with a first child. Parenthood is `born’ along with the child, bringing all sorts of new tasks and experiences with it.
Baby clinics are located at health centres in virtually every town, and have the important task of monitoring the children and helping parents to look after their young children. In addition to ordinary baby clinics, there are also some clinics based on the approach used in anthroposophical medicine. In general, these are linked to anthroposophical medical practices.
All the work of these clinics is concerned with providing preventative care for children from birth to the age of four or five years. In general, this means providing help and support for parents to promote their child’s health.
The doctor and nursing staff at the clinic devote their attention to the physical and psychological development of your child. They ask questions and examine the child to check for certain disorders: for example, growth or psychomotor disorders; disorders or malfunctions of the cardiovascular system, lungs, kidneys and reproductive organs; ear, nose and throat disorders-, disorders of the abdomen, arms and legs; disorders of the teeth, and visual and hearing disorders.
At anthroposophical baby clinics, the constitutional characteristics of the child are also examined, and the personal characteristics and features, which might indicate a particular approach for medical and/or educational measures, are considered. After all, no child develops in accordance with the statistical norm. It is only by examining the individual developmental opportunities and problems of a child that it is possible to give appropriate advice. This is not so much a matter of preventing disorders, but of helping to ensure that the various developmental stages of the child follow each other in an appropriate way.
In addition, the baby clinic is an important place for parents to ask questions, as advice is offered on different subjects, including feeding and growth, upbringing and looking after the baby, physical and psychological development and the issue of inoculations.

The advice on children from birth to one year which you will find in this book is in line with the care provided by anthroposophical baby clinics, and may differ from the advice given by ordinary clinics, and is related to the views held by the doctor and nursing staff regarding the developing child. In Chapter 2 of this book you will find the viewpoints which form the background for the practical advice. This may be helpful when you want to make your own decision in a particular situation. However, this book serves to supplement rather than replace the supervision of the baby clinic. Whichever clinic you choose, it is important that you discuss any concerns you have, and express what you want, at the clinic.
We hope that the various subjects discussed will encourage a conscious approach to parenting and be helpful with regard to understanding, and living with, a developing child.

Pregnancy
Dufing pregnancy, the mother-tobe is in a very special condition, both physically and psychologically. There are all sorts of indications of a reduction in her level of consciousness, which may be manifested by drowsiness, diminished powers of concentration, dizziness, light-headedness and a floating sensation. At a physical level, there is a loss of muscular strength and a loss of tension in all the involuntary muscles. For example, the intestines work less effectively, which can result in constipation. There may also be changes in the action of the kidneys, blood pressure and pulse.
In a way, this whole condition resembles sleep. You could say that a pregnant woman floats between a waking and sleeping state and feels dreamier than she did before. Nevertheless, many women feel very well and active at the same time.
Pregnancy can be divided into three terms, each of roughly three months’ duration.
In the first three months, the woman’s organism has to be ‘transformed’ into a pregnant condition, or, as described above, the organism has to achieve a state between waking and sleeping. The fact that this is an intensive change is clear from the fact that the first three months of pregnancy are usually accompanied by nausea, vomiting and tiredness. It is during these months that the egg is fertilized, becomes embedded in the womb and the foetus starts to develop. It is a relatively vulnerable period of pregnancy in which miscarriages are fairly common (10%). See p.102 folic acid.
The second three-month term is usually the easiest. The pregnant woman becomes used to her condition, can do all sorts of things and does not experience much physical discomfort from the foetus. The foetus has become ‘firmly established,’ as is shown by the small number of problems during this period.
During the third stage, the physical manifestation of the child becomes increasingly clear, with a large stomach being the first sign of this. The discomfort which a pregnant woman experiences when bending down, urinating, feeling full after a meal, being unable to move, run, laugh and sit, reveals that the child has a clear physical presence. The foetus now becomes more vulnerable again. There may be bleeding or even a premature birth. At the end of this period, birth is often experienced as a real release.
When the woman has given birth, all the symptoms of the condition between waking and sleeping gradually disappear again. Only if she breastfeeds will this process be slightly postponed.
An overview of pregnancy reveals that the pregnant woman achieves a condition where she ‘makes way’ for the child to come; in which the child establishes a place on the way to birth. In a way, the expectant mother becomes less ‘earthly,’ while the child becomes increasingly ‘earthbound.’ From this perspective it is, therefore, not surprising that expectant mothers experience moments of contact with their unborn child. After all, both are in an ‘interim state;’ a state between the earthly world and the world that the child is coming from.
If we try to approach the woman’s pregnancy in this manner — taking the idea of ‘making way’ seriously — it is clearly understandable that during pregnancy a woman often finds it difficult to tolerate direct
confrontation with the world around her, and even tries to avoid it altogether. ‘Listening’ to her inner self is the best guideline.
It obviously goes without saying that alcohol and smoking should be avoided because they are known to affect the development and growth of the unborn child, and medicines should only be taken after consultation with the doctor. In addition, a natural, healthy and varied diet is clearly important for both mother and child.
To prepare for breastfeeding, it is a good idea to apply Weleda iris jelly to the nipples every day to prevent the skin cracking during breastfeeding. Stretch marks are largely dependant on genetic factors. However, it makes sense to keep the skin, particularly around the stomach and thighs, supple during pregnancy, by rubbing the skin twice daily with Weleda arnica massage oil. If there is a sensitivity to arnica, it is possible to use Weleda calendula massage oil.
The birth
Experiencing the birth of a child is one of the most intimate experiences in life. Feelings of astonishment, joy, anxiety, fear and fulfilment are experienced to extremes during the birth. Obviously these are most intense for the woman who is having the baby, but the family members and obstetric staff attending her fully share in the intensity of feeling.

It starts with the excitement and anticipation of what will happen when the waters break or the first contractions start. Getting everything ready, the support and help of the midwife during contractions, the constant question of how far the process has advanced — these are all part of the active and busy atmosphere of birth. However, sometimes there are also moments of near serenity and tranquillity; an atmosphere of relaxation, trust and complete surrender to what is to come.
The birth takes place in these recurrent and alternating periods of intense activity and intense tranquillity. Everyone attending the birth finds that a unique atmosphere develops as a result of these alternate emotions, which can go on for many hours. It is an incomparable atmosphere, evoking feelings of deep wonder and awe.
The focal point of everything that is going on is the mother-to-be. She is in touch with the deepest natural forces in her body, and is in danger of being overwhelmed by these natural forces, with an intensity which rarely occurs in life. She may also feel that she does not have the strength to give birth on her own, and may be very grateful to accept the instructions of the obstetric staff, so that the sense of impotence can make way for a sense of trust in the successful end of the birth.
When the cervix is fully dilated, the moment arrives when she can
THE BIRTH    15
use all her strength to help the child to be born by pushing it out. Just before this moment, it is quite common for the woman’s consciousness to be almost overwhelmed, and then return quite vivdly with the first push. This stage of pushing the baby out is extremely hard work, even though sometimes it only requires one big contraction.
From the moment that the baby’s head emerges, the atmosphere changes immediately. All attention is focused on the delivery of the rest of the baby, who eventually experiences light, air and gravity for the first time, is placed on its mother’s stomach and swaddled in warm nappies (diapers). If not giving birth at home, you should check with your midwife or consultant to see if it is possible to have a warm cloth to swaddle the baby in. All eyes are on the baby; the noises, movements, eyes and hair. Everyone feels an urge to touch the baby and stroke it.
Then the obstetrician focuses on the last part of the delivery: cutting the umbilical cord and delivering the placenta.
The whole birth is only really complete when the mother has been washed and cleaned up, and is holding the pink, warm, swaddled baby in her arms, and is surrounded by everyone who was present at the birth. The whole spectrum of emotions is experienced, together with a sense of satisfaction, gratitude and respect for the forces that play a role in the birth process.

The birth described above is probably the birth every parent dreams of. And yet, no two births are the same. The life of every person starts with a unique event; the delivery. Some children have a difficult start, for example, if the birth was induced too early, the baby was born prematurely, or if the delivery involved a great deal of medical intervention. In the UK most babies are now born in hospital, but it is possible to discuss your birth plan beforehand with your midwife or consultant.
For parents, the fear about the baby’s health or being overwhelmed by a premature birth can obstruct the feelings of wonder and gratitude described above. Sometimes it may be a while before you can start to love your child in a relaxed way and feel an obvious connection with it, particularly if you feel unsure or anxious. This takes time, so you must try and take the time that is needed. If you were admitted to hospital, you can organize a sort of second birth experience, so that when the baby comes home, you can get used to each other, feel each other, and build up a new life together. Many parents have described that this helped them to recognise the healthy aspects of the child and his lust for life.
Parenthood
The birth of a child is an intense experience for the parents, particularly
the birth of their first child. In fact, it brings about many changes. Before the birth the parents had a relationship with each other, and after the birth they have suddenly become parents and formed a family. Obviously, they still have a relationship, but the partners no longer relate exclusively to each other. In particular, the mother focuses body and soul on her child. After the birth it may be a very long time, sometimes as long as a year, before she feels her old self. Consequently, owing to the new situation in which they find themselves, parents have to redefine the way in which they relate to each other.
This process is extremely demanding because the father and mother are involved with the child in very different ways during pregnancy and birth, and during the initial period after birth. The father may have a tendency to continue his old life with some modifications, while the mother has a deep sense that everything has changed. It may be a while before the partners find a new way of relating to each other on the basis of these two different worlds of experience. It is important to take time for this process and talk about it together from time to time.
What was described above applies particularly for the situation in which mother, father and child(ren) form the family. Where there is a one-parent family from birth, this process will particularly concern the mother.

After the birth, another process starts as well in that all parents discover themselves in a new way. They experience new positive feelings, although they can also have a negative character. A child brings happiness and joy, but there are also moments when irritation reaches unimagined heights.
In the whole range of emotions evoked by a child, feelings of anxiety have a special place, giving rise to questions such as: Am I doing it right’? Will anything happen to my child or me? Will everything be okay?
Every step in the child’s development is another step out into the world. From the age of three, the child even ventures beyond the horizons of the parents; he walks around the block or goes to school for the first time.
Some people are more sensitive to these anxieties than others, but since this anxiety is fruitless — and can really make life difficult for a child — something should be found to counterbalance it. Sometimes gaining an insight into the situation helps to diminish the anxiety, but often this is not enough. In order to tackle the anxiety in a structured way, it may be necessary to work on strengthening the parents’ confidence. Obviously this does not mean blind faith that ‘everything will probably be alright.’ It is not as simple as that. It means that it is possible to work on the confidence about the direction in which the
PARENTHOOD    17
child is moving, even though unexpected and undesired events may play a role. White anxiety is often ,our own problem,’ confidence can become a strength, which allows the child to flourish; having confidence in someone gives them the strength to grow.
In addition, a child often gives us a new sense of self-awareness: with his behaviour and imitations, he holds up a mirror to his parents. From the age of a few months you will see that a child assimilates the world by imitating it. The child copies everything he encounters, both internally and externally. For parents, this means that what they do and how they do things is important. Whether we do things hastily or with care, whether we do things unwillingly or with joy; all these aspects permeate the actions we perform and are unconsciously assimilated and imitated by the child. This also applies to what we say. Long before the child can understand our words, he will be aware of our intentions. Experiencing this, and occasionally having the things which we do and say, and how we do and say them, reflected by a child will lead to self-awareness, and possibly to a change in our way of being and doing things.
In positive terms, a child stimulates us to develop ourselves as well. There is also a third process. By experiencing the development of a small child and feeling co-responsible for him, it is possible to focus on your own childhood. Some things from your own childhood can lead to the feeling that ‘I want to do things for my children like that as well,’ while at other moments, you feel that ‘I want to spare my children this or that.’ Sometimes this encounter with your own past can be quite intense. It’s good to know that it is not unusual.
Just as we re-examine our own past, we also start to have a different
view of the future; in a sense looking to the future through the child. The future shines through the small child and urges us to determine the structure for that future.
Above, we have highlighted a number of the issues which will confront every parent; the redefinition of the relationship with their partner and other members of the family, a redefinition of themselves, and a new view of the past and the future.

Your body after the birth
I’ve heard about “afterpains”, but what exactly are they?
The term “afterpains” refers to the discomfort felt after the birth as the uterus starts to contract back down  to its normal, pre-pregnancy size. These pains are often described as feeling similar to period pains. So times, women having their first baby may not notice any afterpains, or they are fairly mild; they are more commonly felt by women having their second or subsequent baby. due to the fact that the uterus has to work harder to regain its usual size after being stretched on more than one occasion. who are    also tend to be felt more in women
are breastfeeding their babies, as breastfeeding stim ates the release of the hormone oxytoch which in turn triggers the uterine contractions that are I elt as afterpains.
Getting enough rest
helping  your body to X recover
0    Whether you had a vaginal or
Caesarean birth, you are likely to feel exhausted in the first few weeks. It’s important that you don’t take on too much and give yourself time to recover. * Rather than try and catch up on chores while your baby sleeps, have a nap to catch up on sleep lost through interrupted nights.
•    Avoid heavy lifting as much as possible.
•    It’s fine to stay indoors at first and take things at your own pace while you get used to life with your new baby.
* Don’t feel you have to entertain visitors — 13k them to make you a cup of tea!
If you experience particularly uncomfortable afterpains, it is perfectly safe to take a mild analgesic or a painkiller such as paracetamol. You should find that the discomfort disappears after a few days. Taking warm baths can also be soothing.
I’m still bleeding heavily. How long will this last?
The bleeding you experience after birth is known
as lochia, which is a heavy, bloody vaginal discharge made up of blood and tissues from the uterus and from the site where the placenta was attached to the wall of the uterus. This is how your body gets rid of I he lining of the uterus that supported your baby. Most women find that the bleeding looks initially
like a “period” type of blood loss, and then gradually turns to a brownish or pinkish, watery discharge. The final colour may be yellowish and the discharge quite scanty This bleeding can last for anything from two to six weeks after giving birth. If you are breastfeeding it may finish sooner as the let-down reflex stimulates oxytocin, which in turn triggers uterine contractions.
Is it safe to use tampons while I’m bleeding?
It is not advised to use tampons for around six weeks after giving birth. This is because you are more vulnerable to contracting an infection during this period, so it is important to pay close attention to personal hygiene at this time to keep your vaginal area free from any bacteria, which can be introduced through the use of a tampon. So you should avoid using tampons while you have the post-pregnancy bleed known as lochia.
You can start to use tampons again for your first period after the birth, as long as this occurs at least six weeks after the birth.

LABOUR AND BIRTH
A NEW LIFE
Ouch! My stitches are really uncomfortable. What’s the best way to ease the pain?
Stitches do cause discomfort fora few days after giving birth, so keep the area as clean as possible as this will help prevent infection and minimize your discomfort. You should wash the area with warm water several times a day and make sue you change your pad frequently. Many women find the following techniques for reducing discomfort helpful: * Using a cold pad. You can use a cooling gel pad that has been specially designed for the purpose of soothing the discomfort caused by stitches in the perine area. These have been demonstrated to effectively reduce swelling, briusing, and pain. Or make y:)ur own cool pad by placing crushed ice in a pla tic bag and wrapping this in a dry flannel. * Taking the homeopathic remedy arnica, which is thou ht to help reduce bruising.
* Having a warm bath with a few drops of lavender or camomile essential oil.
* Taking painkillers such as paracetamol or ibuprof n. Ask your doctor or midwife for advice.
take a f w months or more. whichever category you fall to, it is important not to adopt a strict diet during e early weeks and months of parenthood, especi y if you are breastfeeding. However, it is sensib14 to eat a healthy, balanced diet and take some e ercise.You should aim to lose your “baby weight” ,gradually as this will ensure that you are receiv’ g enough nutrition in the postnatal period, and wi give your tummy more time to adjust its shape. eome women do attend professional sessions such as Weight %Vatchers, but it is important that you inform , e trainer or person in charge that you have recentl had a baby.
Coping with constipation Helping your bowels ‘Lo work after the birth
It’s common for bowel movements to be fairly sluggish after giving birth as your abdominal muscles have been stretched during the pregnancy and so exert less pressure, which slows down the movement of faeces through the bowels causing constipation.
You may also feel uncomfortable after the birth and be anxious that opening your bowels, and possibly straining, could damage stitches if you had any However, this is extremely unlikely. The best way to avoid constipation is to drink plenty of fluids each day, preferably water (also important if you are breastfeeding), and to eat tots of fibre-rich foods, such as fresh and dried fruits, cereals, and other wholegrain foods. Once you have recovered from the birth, gentle exercise that tones the abdominal muscles may also help your bowels to become more efficient (see pp.268-269).
How can I get rid of my stretchmarks?
Unfortunately, there is no magic way to get rid of stretchmarks, which affect a large number of pregnant women and seem to be influenced by genes as they often run in families. You will find that the marks fade over time from bright red to a paler pink, and then to a silvery colour that blends in with your skin tone. Massaging a natural oil into your skin may help them to fade.
If, after time, your stretchmarks are still troubling you, you could discuss treatment options with your doctor, which include Laser treatments to reduce the redness of stretchmarks. However, you should be warned that treatments for getting rid of
stretchmarks are often not completely effective and simply speed up the natural fading process rather than eradicate the stretchmarks altogether. Also you would have to pay for these treatments privately
varies widely.
How quickly will I lose the weight I put on during pregnancy?

I’m losing weight fast, but my tummy is really flabby - how can I tighten it up?
This i . a common problem after giving birth. The flabb i ess you are experiencing is caused by the muse :-s and skin having stretched to accommodate your bregnancy and baby After the birth, these muse  es relax and have lost their tone. However, you shoule find that the muscle tone gradually returns, altho gh it may never be quite the same as it was befor’ your pregnancy.
Yo u can try some gentle toning exercises (see pp.2t8-269) as soon as you feel able to after the birth,although you should wait for at least six weeks if yo ‘have had a Caesarean. Your midwife will be able io give you more information about what is safe to do land what is not. If you do go to a professional exert se class or gym, make sure you inform the train4 that you have recently given birth and what type of birth you had so he or she can give you appropriate advice and guidance.
I’ve still got a huge appetite - is this because I’m breastfeeding? Ho much should I be eating now?
This ould be because you are breastfeeding, which requi es an extra 500 calories each day However. this iay not equate to as much food as you think -it wo s out at about two slices of toast with baked bean ! Your big appetite therefore isn’t a problem
in itself, but how you satisfy it can be! As long as you are eating a healthy, balanced diet. you shouldn’t find that ou gain weight (and you definitely shouldn’t be tryinsi to diet while you are breastfeeding). Ensure
that our diet is providing sufficient quantities of prole and carbohydrates and plenty of fresh fruit and –getables. Also avoid filling up on “empty calor es” such as sweets, biscuits, and crisps, and insle.: d try to snack on foods such as fruit, nuts, and seed.. This will ensure that you receive the best nutri on during such an important time, which will bene it you and your baby, and will also help you to lose ..ny extra weight you have gained during the co -e of your pregnancy.
I’ve heard that breastfeeding helps you to lose the weight quicker. Is this true?
Breastfeeding can help you to lose weight moi e quickly after the birth as your body is using up energy to provide an adequate milk supply for
your baby. Some of the 500 extra calories a day you need may be taken from fat supplies deposited in pregnancy Often, extra fat laid down on the hips and thighs in pregnancy is lost first, providing the “fuel” required to make milk and breastfeed your baby. Gentle exercise such as walking and swimming will also help to shift the pregnancy pounds.
I’m not breastfeeding my baby at all - when will my periods start again?
If you are not breastfeeding, you can expect your first period to arrive any time from four weeks after the birth. Most women find that the first period is a little different from normal. It may be heavier or Lighter and it may last for longer or shorter than usual. A more regular pattern should establish itself over the next few months.

THE SIDE EFFECTS OF PREGNANCY

Why does pregnancy make you feel so sick?
Although no one is really clear about the cause of sickness in pregnancy it is thought to be due partly to the hormone human chorionic gonadotrophin (hCG), released early in pregnancy. For most women, symptoms are mild and begin to ease at 12 weeks. For some, the sickness may last throughout the day and continue beyond this time. A small percentage of women experience severe nausea and vomiting, known as hyperemesis gravidarum (see p 92).
There are practical measures you can take to relieve nausea and sickness (see p 82).
I’m two months’ pregnant and feel incredibly tired all the time. Is this normal?
Yes tiredness is a common complaint in pregnancy with most women feeling a sudden loss of energy in the early stages as their body gets used to the changes caused by pregnancy. This often lasts throughout the first trimester, but after about week 13 you should start to feel a bit more energized When you’re not resting, try to stay active and take some gentle exercise.
Another cause of tiredness is anaemia, a common condition in pregnancy that needs to be monitored. Although it’s more likely that your tiredness is due to the pregnancy itself, when you see your midwife you will be offered a blood test to check your iron levels, and if these are found to be low you will be offered supplements. To avoid anaemia, eat iron-rich foods, such as dark green leafy vegetables, red meat, wholegrain cereals, pulses, and prune juice. Vitamin C helps your body to absorb more iron from your diet, so try drinking fresh orange juice with meals, and limit your tea and coffee intake, as caffeine inhibits iron absorption.
I often feel faint - what could be causing this?
Feeling faint or having a dizzy spell is quite common in pregnancy as pregnancy hormones cause your blood vessels to relax and widen Although this improves the blood flow to the baby it also has the effect of slowing down the flow of blood around your body which can lead to low blood pressure, known as hypotension. Although this is unlikely to be a risk in itself, it can cause feelings of faintness, most commonly when you stand up too fast from a sitting or lying position.
Other causes of faintness include lying on your back (as this can put pressure on several large blood vessels involved in returning blood back to your heart, which can cause low blood pressure and in turn make you feel dizzy and faint); a lack of food or drink: getting overheated; and fast breathing (hyperventilating).
Sometimes, feeling faint can be more serious. If the feeling does not pass by eating, drinking water, cooling down, or taking things slowly as you stand up, it may need investigating further and you should seek the advice of your midwife or doctor as this could be due to anaemia (see above) and you may need treatment in the form of iron tablets.
Is it normal to have pelvic pain in early pregnancy?
Pelvic pain is associated with the soft area supporting your pelvis, the symphysis pubic joint. This can swell or separate causing considerable pain, termed symphysis pubis dysfunction, or SPD This is thought to be caused by pregnancy hormones and is quite common in late pregnancy, but can occur earlier. Many women feel most pain when walking or lying Wear comfortable shoes; use pillows to support the hips and legs in bed; keep your legs together when getting out of bed; avoid breast stroke; and get lots of rest. Some women find sitting on a birthing ball helps You may be referred to an obstetric physiotherapist and advised to wear a support belt. In severe cases, crutches may be needed. Most cases resolve after the birth.
I’m embarrassed because I think I’ve got piles. I don’t want to go to the doctor - what can I do?
Haemorrhoids (piles) are swollen veins at or near the anus that can be very uncomfortable, especially during pregnancy. Piles area common feature in
pregnancy, with many women experiencing them at some stage, so your doctor will not be at all surprised You could also speak to your midwife about the problem if this is easier Your doctor or midwife will be able to recommend a treatment, such as a cream or a cooling maternity gel pad.
As piles often develop as a result of straining due to constipation, increasing your fibre and fluid intake may help you to have regular bowel motions, which in turn may help to relieve the problem Eat fresh fruit and vegetables and drink lots of water If you are very constipated, you could ask your doctor to prescribe suppositories I know you may feel embarrassed, but it is best to approach someone rather than to suffer alone.
I’ve been getting regular headaches since becoming pregnant - should I be worried?
Headaches in the early stages of pregnancy are quite normal and are thought to be related to the effects of pregnancy hormones. Headaches can also be caused by other factors such as dehydration, low
blood sugar, a stuffy environment, tiredness, and lack of sleep. Try increasing your intake of water, aiming to drink at least eight glasses of water a day, and have small regular meals to maintain your blood sugar. If you feel a headache coming on, drink two glasses of water and have a rest for 30 minutes. Taking a lose dose of paracetamol is considered safe, although it is best to avoid this if possible
If you are suffering with headaches at around
28 weeks or more, you should inform your doctor or midwife of these, especially if your headaches are accompanied by blurred vision, an inability to focus, or flashing lights, as this may be a sign of pregnancy-induced hypertension (high blood pressure), which could indicate pre-eclampsia (see p.89). Try not to worry, as even though many women complain of headaches and some will have high blood pressure in pregnancy, few go on to develop pre-eclampsia. It is thought that the incidence is somewhere between two and five per cent of all pregnancies.
My gums have started bleeding since I’ve been pregnant -why is this?
It is very common for gums to bleed in pregnancy The pregnancy hormone progesterone causes areas of tissue that connect muscles and ligaments to soften and become stretchier so that your body can make room for the growing baby However, this can affect tissue in other parts of the body, such as in the gums, making them softer and more prone to bleed.
Also, some women crave sweet foods in pregnancy, an excess of which can affect the gums, causing them to become tender, swollen, and more likely to bleed, and increasing the chances of developing gingivitis, a gum infection. Pregnant woman are encouraged to see a dentist early in pregnancy for a checkup (dental care is free up until the baby’s first birthday)
It is important to brush your teeth more than usual and floss regularly when pregnant to minimize the risk of an infection Unlikely as it may sound, it has been suggested that there is a link between premature birth and gum disease
Whenever I sneeze, I leak - is that going to last for ever?
Many women suffer from stress incontinence during pregnancy, which means a leakage of urine when you cough or sneeze The leaks are caused by the loosening of muscles in the pelvic floor - a group of muscles and ligaments that support the pelvic organs - due to pregnancy hormones. Also, as the growing baby puts more pressure on the bladder stress incontinence becomes more likely,
It is recommended that you carry out pelvic floor exercises (see p.57) to reduce the likelihood of leakage. These can be started at any stage of pregnancy, but the earlier you begin the better; once you get the technique right they are simple. As these are such discreet exercises it is easy to practise without anyone else realizing what you are doing
Stress incontinence should improve following the birth, although it can take up to six weeks There is some suggestion that the problem can persist longer depending on the type of birth you have, with a natural vaginal birth more likely to cause ongoing problems than a Caesarean delivery.
I’ve been getting nosebleeds for the first time in my life. Why is this?
It’s not unusual for nosebleeds to occur in pregnancy due to the increased blood supply in the body Nosebleeds are not serious, but if the bleeds are severe, you can ask your doctor for a spray to help the blood to clot. If your nosebleeds are frequent, a simple surgical procedure can cauterize the vessel
When you have a nosebleed, sit for a few minutes with your head upright and apply pressure to the bridge of the nose. To avoid further nosebleeds, make sure you blow your nose gently, drink plenty of fluids to avoid dehydration, use vaseline on dry nostrils, avoid smoky environments, and open your mouth when you sneeze to relieve nasal pressure
I’m 30 weeks’ pregnant and have persistent backache - is there anything that can help?
The weight of your baby and the fact that joints and ligaments soften in pregnancy can cause backache Sometimes sciatica occurs, a sharp pain that travels down the back and leg when the sciatic nerve is
trapped in a joint in the lower back
For lower backache warm baths and a warm compress can help, and gentle massage done by an experienced practitioner Exercise, such as yoga, pilates, or aquanatal classes (see p.55), strengthens back muscles, but check with your doctor before embarking on a new exercise regime. Watch your posture, making sure that you sit upright - you could try using a birthing ball - and wear flat shoes.
If you have sciatica, ask your doctor or midwife to refer you to a physiotherapist to assess your condition and teach you exercises to help relieve the pain and minimize a reoccurrence. Some women have a maternity girdle or back brace fitted.
Little moles are appearing on my skin. Why is this happening?
Skin changes occur frequently in pregnancy due to the effect of pregnancy hormones However, some changes, such as new moles and freckles appearing,
although not usually serious, should be discussed with your midwife or doctor, particularly if new or existing moles seem to change shape, are red or tender or start to bleed
In general, skin either becomes quite oily in pregnancy due to an increase in the production of the skin’s natural oil, sebum or, if skin is prone to dryness, it may become even drier and more sensitive. Many women experience a darkening of the skin, while others notice a pattern on their face that looks like a patchy sun tan, called chloasma (see p. 105). If your skin is sensitive, avoid scented creams and oils, and perfume. Regular cleansing of the skin and avoiding oil-based products may also help
My mum had varicose veins -am I likely to get them in pregnancy?
Around a third of women suffer from varicose veins in pregnancy to some degree (see p.86). These occur because increased levels of the hormone progesterone cause the walls of the veins to become more relaxed; there is also increased pressure within the veins as a result of the enlarged uterus pressing on major veins in the pelvis A family history of varicose veins does increase the possibility of them occurring, but there are several things that you can do to reduce the risk or severity of varicose veins.
If varicose veins do appear during pregnancy, they usually improve within three months of giving birth although unfortunately in subsequent pregnancies they are likely to recur.
My feet are swollen and tight; can I do anything about it?
Swollen feet and ankles, known as oedema, are due to excessive fluid seeping into the tissues because of the increased volume of blood By late pregnancy as blood volume continues to rise, this is a common problem. The swelling is usually worse later in the day and when the weather is warmer There are steps you can to take to help reduce the swelling, such as elevating your legs when sitting, rotating your feet, and lying on the floor with your feet up the wall. Wearing support tights or stockings also improves circulation in the legs. Make sure that you drink plenty of fluids, particularly water, as this improves the kidney function and reduces water retention. Gentle exercise, such as swimming or aquanatal exercises, also increases the efficiency of the circulatory system. There is evidence that reflexology from a registered practitioner may help.
If you also have swelling in your hands or face it is worth having a blood pressure check to rule out pre-eclampsia (see p,89) Most women find that the swelling gradually disappears after they give birth
My fingers are tingling and my midwife said it might be carpal tunnel syndrome - what is this?
Carpal tunnel syndrome occurs when swollen tissues in the wrist compress the nerves and cause pins and needles and numbness. Other symptoms include difficulty grasping with fingers and thumb and a general weakness in the hands. This is common in pregnancy due to the increased volume of blood, which can cause fluid retention
There are ways to reduce the symptoms, such as circling and stretching exercises to improve circulation and increase wrist mobility Wearing wrist splints and elevating your hands on a pillow at night can also help. There is some inconclusive evidence that ultrasound treatment may help in mild cases
I’m 35 weeks and get terrible leg cramp. What can I do?
Leg cramp, where the leg muscles go into a painful spasm, is common in pregnancy, particularly at night, which may be due to the pressure of the uterus on pelvic nerves This usually resolves itself once you are out of bed and using the muscle. However, if the pain doesn’t recede and there is any reddening or swelling in one leg, you should seek medical advice urgently to eliminate the possibility of a clot.
To reduce the incidence of cramp or its severity; drink lots of water to prevent dehydration and try leg stretches and ankle exercises, circling your heel first and then wiggling your toes, before going to bed. Gentle exercise, such as walking or swimming, can also help and getting your partner, friend, or relative to massage your legs, particularly the calf muscle, can improve circulation Some research suggests that taking magnesium supplements reduces the incidence of cramps but further studies are needed.
I’m itching to the point where I’m bleeding. What can I do?
Most itching in pregnancy, especially on your tummy, is due to stretching of the skin, hormonal changes, and heat. However, if you have significant itching, see your midwife or doctor to determine whether you have a condition called obstetric cholestasis, a serious but rare condition that affects the liver and occurs in about one per cent of pregnancies (see p 90) - a blood test can rule out this condition
Using a non-perfumed moisturizing lotion or emoillient cream daily after washing may help, and avoid bathing in very hot water Try not to scratch, as broken skin is vulnerable to infection; wearing cotton gloves at night may stop you scratching in your sleep After 28 weeks, five drops of essential lavender oil in a bath helps to soothe the skin. Antihistamine creams or tablets may be prescribed by your doctor if the itching is severe and other measures aren’t working.
My breasts keep “leaking”. Should this be happening now?
In pregnancy, your body prepares for breastfeeding and some women find that they leak colostrum, the first watery, yellowish milk. as early as 16 weeks Some leak large amounts, some small amounts, and some not at all. The amount you leak has no bearing on the amount of milk produced after the birth or your ability to breastfeed. If you are self-conscious,wear breast pads to protect clothing You may leak more when sexually aroused as oxytocin, one of the hormones responsible for the “let-down” reflex in the breasts, is released at this time.
I’ve got terrible indigestion -why is this?
Progesterone, the hormone that relaxes smooth muscle (muscle that controls unconscious actions) in pregnancy, has the unfortunate side effect of relaxing all smooth muscle in the body, including the whole of the digestive tract. This slows digestion and the ring of muscles called a sphincter at each end of the stomach become less effective, which can cause heartburn and indigestion as acidic juices from the stomach leak back into the oesophagus. In addition, your growing baby is squashing your stomach so that you have a smaller space to digest food.
To relieve indigestion, eat little and often, eat slowly, don’t eat late at night, and cut down on fatty or spicy foods. Rather than lie flat, prop yourself up with pillows Talk to your midwife, doctor, or pharmacist about remedies that are safe to use in pregnancy.

Varicose veins
how can I avoid them
Self-help measures to avoid the risk of varicose veins include:
* Wearing support hosiery - this is one of the best ways to avoid varicose veins All pregnant women are entitled to two free pairs of compression tights
* Doing regular ankle and foot exercises to reduce swelling and cramp
• Avoiding standing for long periods.
• Raising your legs when sitting down
• Getting up to take regular walks if you have to sit for long periods.
* Avoiding high-heeled shoes, which reduce the work done by the calf muscles, to maintain blood flow in the legs.
Sleeplessness
You are often very sleepy at the beginning and end of pregnancy, and towards the end of pregnancy you may find it increasingly difficult to sleep restfully in the night as your bump makes it hard to find a comfortable position, pressure on your bladder causes you to get up frequently to use the toilet and your baby may not share the same sleeping pattern as you and wakes you frequently with his kicking. Coupled with the fact that your body is working extremely hard, a poor night’s sleep adds to your general levels of fatigue. If possible. try to compensate for broken night-time sleep by catnapping in the day, or find time to sit down and put your feet up

Coping with morning sickness
To alleviate feelings of nausea and sickness in pregnancy, try eating little and often, and sip water continually during the day Some women find ginger helps, so you could try nibbling ginger biscuits, perhaps before you get out of bed. Acupressure bands worn on the wrists and available from most chemists are also thought to relieve the symptoms.
Fatigue

One of the most cited complaints in pregnancy, particularly in the first trimester, is extreme tiredness as your body deals with its extra workload. Accepting this and adapting your routine accordingly can help you cope. * Slow down and take a break, or even a catnap, whenever possible.
* Eat small, healthy snacks throughout the day and drink plenty of fluids to maintain energy levels
• Whenever possible go to bed earlier.
• Take regular, gentle exercise to relieve stress and improve your fitness and stamina.

Not Getting Pregnant FAQs.

We’re not getting pregnant what do we do now?
We’ve been trying to conceive for 12 months - can the doctor identify the problem?
There are many factors that can increase or decrease your chances of becoming pregnant, but if you have been trying for a year, it would be sensible to contact your doctor. After an initial assessment of your general health and lifestyle, your doctor will offer your partner a sperm test (see below) and you will be offered tests to see if you are producing eggs and check whether or not your Fallopian tubes are blocked. Blood tests will be carried out to check your iron levels, your red and white blood cell count, and to check how organs such as your liver and kidneys are functioning In addition, couples are asked to agree to a sexual health screening to check for previous or current STls, such as HIV and syphilis.

My wife has been tested and has the all clear - how can I tell if I’m causing our fertility problem?
You will be offered a semen analysis to determine your sperm quantity and quality — how sperm move (motility) and whether they are a normal form. A healthy sperm count should have a concentration of 20 million spermatozoa per millilitre of semen, with
75 per cent of these alive and 50 per cent of these ‘motile”, or moving as well as possible Differences can occur over time in both the quality and quantity of sperm, so if your first sample is poor, you will probably be tested again a couple of months later.
You are also likely to be advised to give up smoking, reduce alcohol intake to 1-2 units once or twice a week, and to wear loose-fitting underwear to avoid overheating the testes If a problem is found, you will be referred to a specialist for a consultation Try to avoid becoming stressed as this can also affect fertility Learning relaxation techniques with your partner and practising these regularly will help.

We can’t conceive naturally - what do we do now?
Assisted conception; or assisted reproduction, is the term used when women are helped to conceive without having intercourse There are five main procedures available, listed below. Your consultant will go through each one with you, and together you can make a decision about which is most suitable depending on your problem. You can also contact the National Institute for Health and Clinical Excellence (NICE) for more information (see p.310)
* Ovarian Stimulation (OS), or Super Ovulation (SO), involves injections of fertility hormones to boost egg production This is followed by intrauterine insemination (IUI) of sperm, whereby sperm are collected and sorted so that only the strongest remain and these are then artifically placed inside the uterus via a catheter. This is ideal for couples when the man’s sperm is “slow” or the woman has problems ovulating, or there is a combination of both. * Gamete Intra-Fallopian Transfer (GIFT). This is suitable for couples for whom no cause for infertility has been found. It involves stimulating the ovaries to produce eggs, which are removed, mixed withsperm and replaced directly into the Fallopian tubes, allowing conception to occur inside the body.
* In Vitro Fertilization (IVF). This is the most widely used treatment and involves a seven-step process (see below and p.30) This is ideal for most problems including blocked tubes
* Intra-Cytoplasmic Sperm Injection (ICSI). This is used if the man’s sperm count is low, the motility of the sperm is very poor, or the woman is allergic to her partner’s sperm. The treatment involves injecting just one viable sperm into an egg (see box right). * Artificial Insemination by Donor (AID). This is simply the injection of donated sperm into the cervix This is used when a man is unable to maintain an erection or is sterile Similarly, women may require an egg donation if they are unable to produce their own eggs, although this is more complicated.
Whatever treatment is provided, it is important that you and your partner are treated as a couple rather than separate patients. It is also essential that you are kept informed throughout the process and given information on any risks and benefits.

What does IVF involve?
IVF, or In Vitro Fertilization, involves the surgical removal of an egg which is then mixed with sperm in a laboratory dish to fertilize and produce an embryo outside of the womb (see p.30).
IVF treatment occurs in cycles, as there are various stages that must be completed for it to be successful. Initially, a drug is used in the form of a nasal spray or injection to switch off the woman’s natural cycle of egg production in the ovaries, known as ”clown-regulation”. Fertility drugs are then given to stimulate the ovaries to produce more than one egg (ovulation induction). Mature eggs are collected from the ovaries using a fine needle guided by ultrasound. The procedure is usually uncomfortable rather than painful. On the same day, the partner’s sperm is collected and then the eggs and sperm are mixed in a dish. Within a few days, one or sometimes two embryos are transferred into the womb. If an embryo successfully attaches to the inside of the womb and continues to grow, a pregnancy results.

ICSI

This procedure may be used when it is thought that the quality of the partner’s sperm may be responsible for fertility problems. If the sperm count is low or movement is poor, sperm may be ”assisted” in fertilizing the egg. An individual sperm is injected directly into the egg and, if fertilization takes place, the resulting embryo is placed in the uterus.
What are the success rates of fertility treatments?
Success rates for treatments vary, depending on the treatments used and the health of the couple If you want to know the success rates of individual clinics, you can ask for their ratio of “live-births-per-cyclestarted”. This information is available from each clinic, but there are currently no nationally held data
Overall, couples have a better success rate if the woman is aged 23-39 years, has been pregnant or has had a baby, and has a normal body weight (a body mass index between 19 and 24). The older a woman is, the less likely she is to get pregnant
Figures show that for every 100 women who are 23 to 35 years, more than 20 will get pregnant after one PVT cycle; from 36 to 38 years around 15 will get pregnant at 39, around 10 will get pregnant; and in women over 40, around 6 will get pregnant

IVF is so expensive - can we get help with funding?
Since April 2005, women between the ages of 23 and 39 are entitled to one free IVF cycle on the NHS. However, you must meet the eligibility criteria set by your local Primary Care Trust (PCT), which varies across the country and depends on factors such as your marital status, weight, and whether you or your partner smoke Couples who can afford to, or who may have had one unsuccessful cycle already, often opt for a private clinic Although these are regulated by the Human Fertilisation and Embryology Authority (HFEA), this cannot set costs, and a private course of IVF can cost from E4,000 to £10,000
My partner is worried about producing his sperm sample. How can I reassure him?
As fertility problems affect 1 in 7 couples in the UK reassuring your partner that this is not an unusual situation is always a good start. You could try leaving out a leaflet on fertility problems for him to read for more information Try to empathize with him as much as possible by sharing your experiences and the tests you have undergone.
Your partner may be worried about ejaculating at the required time when he is already feeling anxious and is in a clinical environment Some men require a sex toy, magazines, or video clips to help. For others, restraining from sexual intercourse for a few days can make ejaculation easier If you live fairly close to the clinic, your partner may be able to produce the sample at home and deliver it.
Sometimes a medical condition such as diabetes prevents a man ejaculating If this is the case, sperm can be obtained through ‘’sperm recovery”, whereby a small needle is passed through the skin of the scrotum into the testes and sperm is withdrawn.

The drugs I’m taking for IVF are giving me terrible mood swings. Is this normal?
The drugs used in IVF treatment are female hormones (see p.30) to stimulate your ovaries to mature more than one egg at a time, and progesterone, which helps to sustain a pregnancy. Different levels of hormones can result in mood swings, as any woman who suffers with premenstrual tension (PMT) can testify, and this is also a common side effect of IVF treatment It’s worth considering too that couples undergoing IVF are under incredible stress, which has been linked to an increased risk of developing depression, so it’s important to decide whether you are feeling ”hormonal” or are in fact depressed. Your doctor can advise you and refer you if necessary.
My partner has a low sperm count - can you tell us what help is available for us?
Usually, two or three semen samples are taken to work out the average sperm count and to see if there are abnormal sperm present. A healthy semen sample of 2-5ml contains more than 20 million sperm per ml; a count below this is considered low If your partner has abnormal sperm, further testing may be necessary Lifestyle changes can boost sperm (see below). There are also hormonal treatments to improve sperm count and surgery to remove blockages You may be reassured to know that even poor-quality semen can be used to fertilize an egg with IVF or with ICSI (see p.29).
Can lifestyle changes really improve sperm?
Poor quality sperm has been linked to excessive drinking (more than three or four units of alcohol per day), smoking, and to wearing tight-fitting underwear,
which overheats the testicles and can affect their efficiency Excessive stress and a poor diet are also thought to affect sperm So yes, it is worth reviewing your lifestyle to see if improvements can be made Jobs that may expose you to harmful agents, such as pesticides, may also affect sperm, so if you think your partner’s job may pose a risk, it’s worth investigating.
I’m pregnant using a donor -what happens if my child wants to trace her biological dad?
From April 2005, children who were conceived using donor sperm have had a right when they reach 18 years of age to find out their parent’s identity. This also applies to children conceived using donor eggs and embryos. This right applies only to children conceived after this date and not retrospectively. Prior to this date, children had the right to know at 18 years of age if they were conceived using donor sperm, eggs, or embryos and to find out if they were related to someone they wanted to marry. The reason for this change in the law is that children conceived in this way are being given the same rights as adopted children regarding information on their genetic parents. However, some fertility experts fear that this will deter potential donors.
Is surrogacy allowed in the UK?
Currently, surrogacy is legal in the UK, although it is illegal to advertise it as a service However, the law does not recognize surrogacy
as a fixed agreement, which means that a surrogate can change her mind about the arrangement during the pregnancy and up to six weeks after the birth. It is usual for a surrogate to receive ”reasonable expenses”, although there is no definition of what is deemed as reasonable. Usually, this includes costs incurred by the surrogate relating to her pregnancy, If the father of the child is named on the birth certificate, this gives him equal rights to the child. If this is not the case, then six weeks after the birth the new parents can apply for a parental order that gives them full parental status At this point, the surrogate gives up any parental rights to the child.

Conception problems

There are a range of reasons why a couple may have difficulty in conceiving. Investigations and tests may uncover specific conditions, which may be treatable, or you may be offered help to conceive.
What can affect a man’s fertility? A semen analysis may reveal various reasons why sperm have difficulty in fertilizing an egg The sperm count may be low (less than 20 million sperm per ml); the motility of the sperm (how they move) may be poor, and there may be a high percentage of abnormally formed sperm Some men experience a failure to ejaculate at orgasm There may also be damage to the tubes that connect the testicles to the seminal vesicles where sperm are produced, and this may have been present from birth or caused by a later infection
What can affect a woman’s fertility? Conditions such as polycystic ovary syndrome
(a hormonal imbalance that causes ovarian cysts) and endometriosis (see p 19) can disrupt fertility. Other hormonal imbalances, such as low levels of FSH and LH, can affect ovulation; or levels of progesterone may be too low to sustain a fertilized egg. Damaged Fallopian tubes, caused by an ectopic pregnancy (see p 25), surgery endometriosis, or pelvic inflammatory disease, which may be caused by an infection such as chlamydia, can prevent conception. Damage to the ovaries can occur from scarring as a result of surgery or infection, or the supply of eggs may be low Some women have an abnormally shaped uterus, or have uterine scarring, that can prevent the successful implantation of an egg.

IVF treatment

In vitro fertilization or IVF, is a complex procedure with several stages, from the stimulation and harvesting of your eggs to the successful fertilization of the eggs, development of embryos and transfer of the embryos into the womb for implantation. Undergoing IVF can be a stressful and time-consuming undertaking, but knowing in advance how the procedure works and what you can expect at each stage can reduce anxiety and help you and your partner to cope.
What happens first? To optimize the chances of success with IVF more than one egg at a time is removed for fertilization Normally, your body produces one egg each month. In rVF, you will inject yourself with drugs, such as clomiphene and hMG (human menopausal gonadotrophin) to stimulate your ovaries to produce several eggs. While you are undergoing this treatment, you will need to visit your clinic every one to two days over one or two weeks to monitor the development of the eggs. Once it is thought that the eggs are mature, you will be given a blood test to measure your levels of oestrogen, which is released around ovulation.

What happens next? Once your follicles are ripe and ready for ovulation, your eggs will be collected at the clinic using ultrasound or laparoscopy to guide a probe. Once the eggs have been collected, they will be mixed with your partner’s sperm in a Petri dish in a laboratory ready for fertilization Your partner needs to produce the sperm on the same day as the egg collection. He can either do this at home, or come into the clinic with you and produce the sperm while you are undergoing the egg collection procedure.What happens in the laboratory? Once the egg and the sperm have been mixed, they are placed in the laboratory and monitored closely for the next few days. They will first be inspected around 18 hours later to see how many of the eggs have been fertilized and the clinic will usually pass this information on to you the day after the procedure It’s quite common for not all of the eggs to be fertilized and for only two or three to develop into embryos. The fertilized eggs are incubated in the laboratory over the next couple of days and their progress measured. The laboratory technician watches cell division under a microscope, waiting for the eggs to divide into two or more cells on their journey to becoming a blastocyst (see p.21).
If one or more fertilized eggs develop in the laboratory, you will be called back in for the embryo transfer, This is done by injecting eggs through a catheter into the uterus. No more than two eggs will be transferred and you will have the option to freeze any remaining embryos.

Surrogacy
A surrogate mother is a woman who reaches an agreement to carry a baby on behalf of another woman. She can either conceive the baby with the partner’s sperm, in which case she is the maternal mother, or the infertile couple may fertilize their own egg through fertility treatment, which is then transferred into the uterus of the surrogate mother for her to carry the baby through pregnancy and deliver at birth. This process can be beset with problems: such as the conflicting emotions of both the surrogate mother and the receiving couple, or legal issues if, for example, the surrogate mother has a change of heart after the birth and wishes to keep the baby, For this reason, it is important that all parties entering into the agreement have carefully considered the implications and are confident and happy in their roles.

Miscarriage FAQs. I’ve had a miscarriage why did it happen to me?

What is a miscarriage?
A miscarriage is the spontaneous loss of a baby at any time up until the 24th week of pregnancy After 24 weeks the loss is referred to as a stillbirth. The signs of a miscarriage are vaginal bleeding and period-like cramps. As not all miscarriages follow the same pattern, there are various terms to describe what occurs:
* A threatened miscarriage occurs when there is bleeding and possibly pain, but the fetus survives. * An inevitable miscarriage occurs when there is bleeding and pain due to contractions in the uterus, the cervix opens, and the fetus is expelled.
* A missed miscarriage occurs when the fetus dies but remains in the womb and either is expelled naturally later or removed in an operation

I’ve recently miscarried - why did this happen?
Miscarriage occurs in 10-20 per cent of pregnancies In the vast majority of these the cause is never identified, but it’s unlikely to be related to anything you did or didn’t do. There are thought to be several reasons why miscarriages occur (see p 25) There may be a genetic problem, in which the baby or placenta doesn’t develop normally, levels of the pregnancy hormone progesterone may be low; there may be an immune disorder m which the mother 3 immune system reacts against the pregnancy; an infection may be present; or there may be problems with the uterus or cervix. Miscarriages tend to be more common in older women.
The Miscarriage Association (see p.310) offers support and up-to-date advice and information about miscarriage. You may feel comforted to know that, statistically, any future pregnancy you have is likely to progress normally.
My period was late and now I’m bleeding really heavily -could I be having a miscarriage?
In the absence of a positive pregnancy test or a pregnancy confirmed by an ultrasound scan, it is difficult to know whether or not you were pregnant If you have had unprotected intercourse in the time since your last period, it is possible that you could have been pregnant and this is a miscarriage The lateness of your period may give a clue, but won’t confirm one way or another. If you have any other symptoms of pregnancy it might be worth doing a pregnancy test as sometimes, even when there has been bleeding, a viable pregnancy is discovered
However, it could also be a late period for no other reason than that this happens on occasion to everyone. A delayed period can be caused by  weight loss or gain, stress, or if you have been taking the oral contraceptive Pill but missed a dose.
Talk to your doctor if the bleeding continues:
you feel faint or experience palpitations; your period lasts for longer than seven days; you have more than six well-soaked pads a day; or if you have any severe abdominal pain Your doctor can carry out a blood
test to check your iron levels and possibly determine if you have been pregnant, in which case an incomplete miscarriage or ectopic pregnancy will need to be ruled out (see p.25)

I’m 10 weeks pregnant and getting cramping pains. Do I need to rest to avoid a miscarriage?
Cramping pains on their own without vaginal bleeding or spotting can occur at this stage of pregnancy. Sometimes pain can be felt as the ligaments stretch when the baby and -your uterus grows. There are also other possible causes for the pain aside from miscarriage, such as constipation or a urinary tract infection
Many doctors advise rest to avoid a ”threatened” miscarriage, but there is no strong evidence that this makes any difference to the outcome of a pregnancy If you feel like resting because you are in discomfort from the cramping pains then do rest, but if you feel happy continuing as normal then that may be the best option for you Soaking in a warm bath and practising relaxation techniques may ease the intensity of the pain If the pain increases or you get any bleeding or spotting, contact your doctor.
Does bleeding in pregnancy mean that miscarriage is inevitable?
No, many women experience bleeding in early pregnancy and then proceed to have a healthy pregnancy and baby. Indeed, some women have intermittent bleeding throughout pregnancy, Despite this, any bleeding should be investigated. This is usually done with a scan to determine if the pregnancy is viable (going to continue) and to identify if there is any indication of where the
bleeding is coming from. In very early pregnancy, it can be hard to see the pregnancy on a scan and a blood test to measure levels of the pregnancy hormone human chorionic gonadotrophin (hCG) may be done, mainly to rule out the possibility of an ectopic pregnancy (see p.25) Unfortunately for you this is a time of waiting; the timing of any further scans is usually determined by the findings of the initial scan and blood tests and the symptoms you are experiencing.

I’ve had three miscarriages before and I’m scared of trying again - is there anything I can do?
It is understandable given your experiences that trying to get pregnant again is a scary proposition. Following a third miscarriage, it is usual for your doctor to offer you a number of investigative tests
to see if a reason for the miscarriages can be found. In some cases, a cause is identified and treatment can be offered to help improve the outcome for subsequent pregnancies.
You are likely to be given a number of blood tests. These are to look for antibodies (proteins in the blood that fight any substance they recognize as foreign to your body), chromosomal abnormalities, and infection. You may also have a vaginal examination and swab and an ultrasound scan to check your womb and tubes. If a chromosomal abnormality is found, genetic counselling should be offered to discuss the implications for future pregnancies. The levels of the hormones progesterone and prolactin may also be checked as these can play a role in miscarriage. Sometimes, the cervix is found to be weakened and likely to open early If this is the case, you may be offered a cervical stitch that acts like a drawstring on the cervix and hopefully prevents future miscarriage or premature delivery
If you haven’t already been offered these tests, talk to your doctor about them before trying to get pregnant again so that you can begin any recommended treatment as soon as possible
My mum had two miscarriages -does that mean I am more likely to miscarry?
Ask your mum if she was given any particular reason for her miscarriages If for example, she knows that they were due to a chromosomal abnormality, such as sickle-cell disease, or if she had a medical condition such as heart disease, then there is a possibility that the condition is hereditary and the risk of miscarriage may be the same for you too.
However, it’s most likely that your mother’s miscarriages were unfortunate chance occurrences for which no reason was found If this is the case, then you are at no more risk of experiencing a miscarriage than any other woman your age. However, if you do become pregnant, it would be worth mentioning your mother’s pregnancy history at your initial antenatal appointment, as your family medical history is an important part of your medical notes during pregnancy.

I’ve had several miscarriages and my doctor has referred me to a genetic counsellor - why?
A genetic counsellor is a highly trained professional who supports families before and after conception. Quite often a miscarriage is caused by a genetic abnormality in the fertilized egg or embryo. This is usually a one-off and can affect any woman. However, if a woman has recurrent miscarriages, it may be that she is carrying a genetic condition
Women and their partners are referred to a genetic counsellor if either partner has a condition that can affect future children or the chances of becoming pregnant or continuing with a pregnancy (as they may be more likely to miscarry or be offered a termination) For example if there is a history of sickle-cell disease, a blood disorder that causes chronic anaemia and increases the risk of a preterm birth and health problems in the baby, it may be that either or both couples are carrying a gene that can affect a baby.
A genetic counsellor helps you understand how your genes could affect conception and pregnancy and about the tests available to determine if a fetus is affected. The counsellor will discuss a range of
issues, including the moral and ethical issues related to genetic testing, as it is common for couples to feel stress, guilt, and confusion in this type of situation.

I lost my baby, but I want to get on and try again - is this OK?
Although there are no hard rules about when to try for another baby, it is important that you allow yourself time to grieve and your body to recover before trying to conceive again. Some women feel able to try again within a month, while others may not feel ready for at least a year. Whatever you feel, it’s wise to let your hormones and body settle down after a miscarriage before considering another pregnancy. The usual advice is to wait for at least three months before trying to conceive again so that you feel both emotionally and physically prepared for another pregnancy. Your partner also needs to feel that the time is right for you both to try again.

We had a miscarriage at 20 weeks. Will the doctors find the cause so that we can move on?
Coping with the loss of a baby well into pregnancy is difficult and upsetting. Many women ask themselves why a miscarriage happened and feel unable to move on until that important question is answered. Unfortunately, unless this was a recurrent
miscarriage of three or more, there may not be an investigation, although it may be suggested that you have a cervical stitch in future pregnancies to stop the cervix dilating too early (see p 24)
It may be worth talking to a counsellor who
is trained to support women and families through such difficult times, your doctor or midwife may be able to refer you. You may find that discussing your miscarriage directly with a health professional helps to answer any concerns you or your partner have, and by communicating in this way you will have started to move forward and may begin to feel able to consider planning another pregnancy

My partner had a miscarriage. I’m being supportive, but I’m devastated too. What should I do?
Dealing with a miscarriage is very difficult for both women and men, but often far more attention is given to a woman, and a man’s feelings are simply ignored However, it’s important that you don’t internalize your loss and do acknowledge your feelings, which may range from feeling scared, disappointed, and out of control, to blaming yourself for not being supportive enough and mourning the loss of your identity as a father. Although you want to support your partner, you also need to recognize your own need to grieve, as working through your emotions can help you to come to terms with your loss more quickly
A good support network is important for both of you and it can help to find a sympathetic listener outside of your relationship. Initially, you may find discussing your feelings with another male easier than talking to your partner. You could also talk to your doctor, the midwife, or a counsellor, or contact the Miscarraige Association helpline.

What is a “D and C”?
D and C stands for dilation and curettage, a surgical procedure in which the opening to the uterus, called the cervix, is stretched (dilatation) and the tissue that lines the uterus is scraped away or removed (curettage). This procedure is sometimes carried out after a miscarriage to ensure that any of the remaining products of the conception and pregnancy have been removed
There are advantages and disadvantages to consider before having a D and C. The procedure is usually completed within two hours and most women resume their usual activities within a week. However, the need for routine surgical evacuation, or a D and C, following a miscarriage has been questioned because of potential complications, such as bleeding and infection. Ask your doctor for advice There are less invasive options than a D and C for dealing with a miscarriage. One method is simply to watch and wait to see if the uterus will spontaneously expel any remaining products of conception. Another option is a drug treatment that works by stimulating the uterus to contract and naturally expel pregnancy tissues.

The risk of miscarriage
There are several factors that can increase your risk of miscarriage.
Older women have an increased risk of having a miscarriage. It is thought that this is largely due to the fact that older women are more likely to have babies with chromosomal abnormalities, which may have problems developing and miscarry Some underlying medical conditions can also increase your chances of miscarriage, such as polycystic ovary syndrome or fibroids. Other factors that can increase your risk are if you are particularly underweight or overweight, smoke drink heavily, or take recreational drugs.
Miscarriages are also more likely the more pregnancies you have had.

Talking to others
Losing a baby during pregnancy can be devastating, leading to feelings of grief such as anger, depression, guilt, and anxiety. Talking to others can help you to work through your feelings.
* Ask your midwife or doctor to put you in touch with a counsellor who specializes in pregnancy loss
* Let close friends and family members know how you are feeling
* The Miscarriage Association is a great source of support and advice (see p.310). * Talk to your doctor or midwife about why the miscarriage may have happened.

Possible causes of miscarriage

About 1 in 4 first pregnancies ends in miscarriage, generally within the first 12 weeks. Often no cause is identified and it may not be investigated unless a woman has had three or more miscarriages in a row, known as ‘recurrent miscarriages”
Why has it happened? Some miscarriages occur because of a one-off genetic problem (caused by a faulty chromosome) when the baby does not develop properly. Genetic problems account for 60 per cent of early miscarriages If you think this may have been the cause, you can request tissue tests from the baby. Based on these results, you may be able to receive specialist counselling to discuss the risk of it happening again (see p.24). After 12 weeks, the chances of you losing your baby because of a chromosomal disorder reduce to about 10 per cent: however, if
Ectopic pregnancy
you are over 35, this risk is higher. Other less common causes of miscarriage include fibroids (non-cancerous growths), infection, problems with the uterus, hormonal imbalances, and immune system disorders. An ectopic pregnancy. below, occurs when the embryo implants in a Fallopian tube and needs to be removed
What can cause late pregnancy loss? A late pregnancy loss (referred to as a stillbirth after 24 weeks) can be due to the cervix being weak (or ‘incompetent’), causing the cervix to dilate too early. This accounts for 15 per cent of repeated miscarriages. In future pregnancies, a stitch around the cervix can strengthen this muscle and prevent it opening early Another cause of a late miscarriage can be if the placenta does not function properly and affects the baby’s growth.
fertilized egg implants in tube

Glossary
Abruption The detachment of part of the placenta from the wall of the uterus during late pregnancy, which may result in bleeding. Accelerated labour The artificial augmentation of contractions, after the cervix has started to dilate, by the injection of oxytocin through an intravenous drip Often used to speed up a long labour. Active birth An approach to childbirth that involves upright positions and movements during labour.
Active management of labour The constant monitoring and technical control of labour to monitor its duration
Alphafetoprotein (AFP) A substance produced by the embryonic yolk sac, and later by the fetal liver, which enters the mother’s bloodstream during pregnancy Alveoli Milk glands in the breasts, which produce a flow of milk when they are stimulated by prolactin and the baby’s sucking.
Amniocentesis The surgical extraction of a small amount of amniotic fluid through the pregnant woman’s abdomen. This procedure is usually carried out as a test for fetal abnormalities.
Amniotic fluid The fluid that surrounds the fetus in the uterus. Ultrasound scans may be done in late pregnancy to ensure that enough is present
Ammotomy The surgical rupture of the amniotic sac, often done to speed up labour This is referred to as ARM (artificial rupture of the membranes).
Anaemia A condition in which there is an abnormally low percentage of haemoglobin in the red blood cells, it is treated by iron supplements
Anaesthetic Medication that produces partial or complete insensibility to pain Anaesthetic, general Anaesthetic that affects the whole body, with temporary loss of consciousness.
Anaesthetic, local Anaesthetic that affects a limited part of the body
Analgesics Painkilling agents not inducing unconsciousness
Antenatal Before the birth
Anterior position See Occipital anterior Antibiotics Substances capable of
destroying or limiting the growth of micro-organisms, especially bacteria Antibodies Protein produced naturally
by the body to combat any foreign bodies, germs or bacteria
Anti-D An injection of antibodies given to women who have a Rhesus negative blood group if it is thought they may have been exposed to Rhesus positive fetal blood cells
Antihistamines Tranquillizers that are used in the treatment of nausea vomiting and certain allergies.
Apgar scale A general test of the baby’s wellbeing given shortly after the birth to assess the heart rate and tone respiration blood circulation, and nerve responses. Areola The pigmented circle of skin surrounding the nipple.
ARM See Ammotorny
Bile pigment See Bilirubin.
Bilirubin Broken-down haemoglobin, normally converted to nontoxic substances by the liver. Some newborn babies have levels of bilirubin too high for their livers to cope with See also Jaundice, neonatal. Birth canal See Vagina
Blastocyst An early stage of the developing egg when it has divided into a group of cells. Braxton Hicks contractions Practise contractions of the uterus that occur throughout pregnancy, but which may not be noticed until towards the end. Breast pump A device for drawing milk from the breasts.
Breech presentation When the position of the baby in the uterus is bottom down rather than head down
Caesarean section The delivery of the baby through an incision in the abdominal and uterine walls
Candida See Thrush,
Cardiotocograph (CTG) An electronic monitor that is used to measure the progress of the mother’s contractions and the baby’s heartbeat during labour.
Carpal tunnel syndrome Numbness and tingling of the hands arising from pressure on the nerves of the wrist In pregnancy it is caused by the body’s accumulation of fluids
Catheter A thin plastic tube that is inserted into the body through a natural channel to withdraw fluid from, or introduce fluid into, a particular part of the body This can be used to draw off urine from the bladder after an operation, or to maintain a constant input of fluids into a vein, or to introduce anaesthetic into the epidural space.
Cephalic presentation (Vertex presentation) The position of a baby who is head down in the uterus The most common presentation. Cephalopelvic disproportion A state in which the head of the fetus is larger than the cavity of the mother’s pelvis Delivery must therefore be by Caesarean section
Cervical dilatation See Dilatation.
Cervical incompetence A disorder of the cervix, usually arising after a previous mid-pregnancy termination or damage to the cervix during a previous labour, in which the cervix opens up too soon, resulting in repeated mid-pregnancy miscarriages. It is sometimes treated by suturing to hold the cervix closed. Cervix The lower entrance to the uterus, or neck of the womb
Chloasma Skin discolouration during pregnancy, often facial.
Chorion The outer membranous tissue that envelops the fetus and placenta
Chorionic gonadotrophin See Human chorionic gonadotrophin (HCG).
Chorionic villus sampling A method of screening for genetic handicap by analysis of tissue from the small protrusions on the outer membrane enveloping the embryo that later form the placenta.
Chromosomes Rod-like structures containing genes occurring in pairs within the nucleus of every cell. Human cells each contain 23 pairs. See also Gene
Cleft palate A congenital abnormality of the roof of the mouth
Club foot A congenital abnormality in which the foot is painlessly twisted out of shape. Colostrum A kind of milk, rich in proteins, formed and secreted by the breasts in late pregnancy and gradually changing to mature milk some days after delivery
Conception The fertilization of the ripened egg by the sperm and its implantation in the uterine wall.

Congenital abnormality An abnormality or deformity existing from birth, usually arising from a damaged gene, the adverse effect of certain drugs or the effect of some diseases during pregnancy
Contractions The regular tightening of the uterine muscles as they work to dilate the cervix in labour and press the baby down e birth canal
Cordocentesis A fine needle is passed trough the mother’s abdomen into the fetal –vein in the umbilical cord. The technique allows fetal blood to be tested, facilitates intra-urine blood transfusions, and enables drugs to be injected directly into the baby Corpus lutuem A glandular mass that forms n- the ovary after fertilization It produces progesterone. which helps to form the placenta, and is active for the first 14 weeks of pregnancy
Crowning The moment when the baby’s head appears in the vagina and does not slip back again.
CVS See Chorionic villus sampling.
D and C The surgical dilatation (opening) of the cervix, and curettage (removal of the contents) of the uterus
Dehydration A physical condition caused by the loss of an excessive amount of water from the body, often resulting from severe vomiting or diarrohea
Depression, respiratory Breathing difficulties in the newborn baby
Diabetes Failure of the system to metabolize glucose, traced by excess sugar in the blood and urine.
Diamorphine A narcotic opium derivative used as an analgesic.
Dilatation The progressive opening of the cervix caused by uterine contractions during labour.
Distress See Fetal distress
Dizygotic See Twins
Domino scheme A scheme operated by some hospitals in which community midwives provide antenatal care and are present at hospital for the delivery.
Doppler A method of using ultrasound vibrations to listen to the fetal heart
Doula A supportive woman helper who provides physical and emotional support during childbirth
Down’s syndrome A severe congenital abnormality caused by an incorrect number
of chromosomes that produces physical abnormalities and reduced intelligence. Drip See Intravenous drip.
Eclampsia The severe form of pre-eclampsia, which is characterized by extremely high blood pressure, headaches, visual distortion, flashes, convulsions and, in the worst cases. coma and death The condition is now rare since the symptoms of pre-eclampsia are treated immediately See also Pre-eclampsia.
Ectopic (Tubal pregnancy) A pregnancy that develops outside the uterus, usually in one of the Fallopian tubes. The mother has severe pain low down on one side in her
abdomen at any time from the 6th to 12th week of pregnancy. The pregnancy must be surgically terminated.
EDD The estimated date of delivery Electrode A small electrical conductor used obstetrically for monitoring the fetal heartbeat during labour.
Electronic fetal monitoring The continuous monitoring of the fetal heart by a transducer placed on the mother’s abdomen over the area of the fetal heart, or by an electrode inserted through the cervix and clipped to the baby’s scalp
Embryo The developing organism in pregnancy from about the 10th day after fertilization until about the 12th week of pregnancy, when it is termed a fetus Endometrium The inner lining of the uterus. Engaged (Eng/E) The baby is engaged when it has settled with its presenting part deep in the pelvic cavity. This often happens in the last month of pregnancy
Engorgement The over congestion of the breasts with milk. If long periods are left between feeds, or the baby is not well latched on painful engorgement can occur. This can be relieved by putting the baby to the breast or expressing the excess milk Entonox A mixture of 50 per cent oxygen and 50 per cent nitrous oxygen, breathed in through a mask during tabour, that gives pain relief as contractions peak
Epidural (Lumbar epidural block) Regional anaesthesia used during labour and for Caesarean sections, in which an anaesthetic is injected through a catheter into the epidural space in the lower spine. Episiotomy A surgical cut in the perineum to enlarge the entrance to the vagina.
External version (External cephalic
version, or ECV) The manipulation by gentle pressure of the fetus into the cephalic position This may be done by an obstetrician at the end of pregnancy if the baby is breech or transverse
Fallopian tube The tube into which a ripe egg (ovum) is wafted along after its expulsion from the ovary along which it travels on its way to the uterus
False labour Braxton Hicks (rehearsal) contractions, which are so strong and regular that they are mistaken for the contractions of the first stage of labour,
Fertilization The meeting of the sperm with the ovum or egg to form a new life See also
Conception.
Fetal distress A shortage in the flow of oxygen to the fetus, which can arise from numerous causes
Fetus The developing child in the uterus, from the end of the embryonic stage at about the 12th week of pregnancy until birth FH Fetal heart.
Fibroid A benign (non-cancerous) muscle growth in the uterus.
Forceps Metal tong-like instruments placed either side of the baby’s head during labour to help deliver the baby
Hormone A chemical messenger in
the blood that stimulates various organs to action.
Human chorionic gonadotrophin (HCC) A hormone released into the woman’s bloodstream by the developing placenta from about six days after the last period was due. Its presence in the urine means that she is pregnant
Hyperemesis gravidarum Almost continuous vomiting during pregnancy Hypertension (High blood pressure) During pregnancy this can reduce the fetal blood supply.
Hypnosis A state of mental passivity with a special susceptibility to suggestion. This can be used as an anaesthetic, and can be self-induced.
Hypotension Low blood pressure.
Identical twins See Twins
Implantation The embedding of the fertilized ovum or egg within the wall of the uterus
Induction The process of artificially starting off labour and keeping it going.

Insulin A hormone produced by the pancreas that regulates the level of carbohydrates and amino acids in the system. It may be used as a means of controlling the effects of diabetes.
See also Diabetes.
Internal monitoring See Electronic fetal monitoring
Intravenous drip The infusion of fluids directly into the bloodstream by means of a fine catheter introduced into a vein Intravenous injection An injection into a vein
Invasive techniques Any medical technique that intrudes into the body
In vitro fertilization (IVT) A type of assisted conception where fertilization occurs outside of the womb and fertilized embryos are tranferred back into the womb.
Jaundice, neonatal A common complaint in newborn babies which is caused by the inability of the liver to break down successfully an excess of red blood cells See also Bilirubin
Lanugo The fine soft body hair of the fetus Lateral position Transverse lie or horizontal position of a fetus in the uterus (sometimes occurring if the mother has a large pelvis), where the presenting part is either a shoulder or the side of the head
Let-down reflex The flow of breast milk into the nipple.
Lie The position of the fetus within the uterus Linea nigra A line of dark skin that appears down the centre of the abdomen over the rectus muscle in some women during pregnancy
Lochia Postnatal vaginal discharge Longitudinal lie The position of the fetus in the uterus in which the spines of the fetus and the mother are parallel
Low-birthweight baby A baby who weighs below 2,5 kg (57 lb) at birth.
Meconium The first contents of the bowel, present in the fetus before birth and passed during the first few days after birth The presence of meconium in the amniotic fluid before delivery is usually taken as a sign of fetal distress
Miscarriage The spontaneous loss of a baby before 24 weeks of pregnancy
Monitoring See Electronic fetal monitoring Monozygotic See Twins.
Morula A stage in the growth of the fertilized
egg when it has developed into 32 cells. Moulding The shaping of the bones of the baby’s skull, which overlap to allow the baby to pass through the birth canal.
Mucus A sticky secretion.
Multigravida A woman in her second or subsequent pregnancy
Multiple pregnancy The development of two or more babies, See also Twins Mutation A damaged genetic cell. This can occur naturally or more commonly as an effect of outside agents, such as radiation. Neural tube defects Abnormalities of the central nervous system See also
Anencephaly, Hydrocephalus Spina bifida. Nicotine A highly poisonous substance that is present in tobacco During pregnancy this can enter the bloodstream of a woman who smokes and may affect the efficiency of the placenta, which often results in a lowbirthweight baby
Nucleus The central part or core of a cell, containing genetic information.
Occipital anterior The position of the baby in the uterus when the back of its head (the crown or occiput) is towards the mother’s front (anterior)
Occipital posterior The position of the baby in the uterus when the back of its head (the crown or occiput) is towards the mother’s back (posterior)
Oedema Fluid retention, which causes the body tissues to be puffed out.
Oestriol A form of oestrogen.
Oestrogen A hormone produced by the ovary
Opioids (Narcotics) Painkilling drugs that induce drowsiness and stupor,
Ovary One of the two female glands, set at the entrance of the Fallopian tubes, which regularly produce eggs until the menopause Ovulation The production of a ripe ovum or egg by the ovary
Oxytocin A hormone secreted by the pituitary gland that stimulates uterine contractions during labour and stimulates milk glands in the breasts to produce milk Palpation Feeling the parts of the baby through the mother’s abdominal wall. Pelvic floor The springy muscular
structure set within the pelvis that
supports the bladder and the uterus, and through which the baby descends during tabour,
Pelvis The pelvis is a solid ring of bone at the base of the abdomen: it shields the bladder and portions of the genital tract. Perinatal The period from the 24th week of gestation to one week following delivery Perineum The area of soft tissues surrounding the vagina and between the vagina and the rectum.
Pethidine See Analgesics
Phototherapy Treatment by exposure
to light, which may he used when a baby has jaundice
Pituitary gland A gland set just below the brain that among other functions, secretes various hormones controlling the menstrual cycle. In late pregnancy it releases a hormone, oxytocin, into the bloodstream, which stimulates uterine contractions and also the milk glands.
Placenta The organ that develops on the inner wall of the uterus and supplies the fetus with all its life-supporting requirements and carries waste products to the mother’s system.
Placental insufficiency A condition in which the placenta provides inadequate life support for the fetus, often after 40 weeks, resulting in a baby at special risk.
Placenta praevia A condition in
which the placenta lies over the cervix at the end of pregnancy. This part of the uterus stretches in the last few weeks of pregnancy, but the placenta cannot stretch, so it may separate, the result is bleeding during late pregnancy, A woman with a complete placenta praevia is delivered by Caesarean section
Posterior See Occipito posterior
Postnatal After the birth.
Postpartum After delivery.
Post-traumatic stress disorder Panic and anxiety experienced by some women after traumatic and disempowering childbirth Pre-eclampsia (Pre-eclamptic toxaemia or PET) An illness in which a woman has high blood pressure, oedema, protein in the urine, and often sudden excessive weight gain See also Eclampsia.
Premature A baby born before the 37th week of pregnancy and weighing less than 2.5 Ing (5 lb)
Presentation The position of the fetus in the uterus before and during labour,

lying directly over the cervix
Preterm See Premature
Primigravida A woman having her first pregnancy.
Progesterone A hormone produced by the corpus luteum and then by the placenta Progestogen A synthetic variety of the hormone progesterone used in oral contraceptives.
Prolactin A hormone that stimulates milk production for breastfeeding Prostaglandins Natural substances that stimulate the onset of labour contractions. Prostaglandin gel may be used to soften the cervix and induce labour
Proteinuria The presence of protein in the urine, which may be a sign of pre-eclampsia. See also Pre-eclampsia
PTSD See Post-traumatic stress disorder Pubis The bones forming the front of the lower pelvis.
Quickening The first noticeable movements of the fetus felt by the mother.
Respiratory depression See Depression, respiratory.
Rhesus factor A distinguishing characteristic of the red blood corpuscles. All human beings have either Rhesus positive or Rhesus negative blood If the mother is Rhesus negative and the fetus Rhesus positive, severe complications and Rhesus disease (the destruction of the red corpuscles by antibodies) may occur, unless prevented by anti-D gamma globulin.
Rooting The baby’s instinctive searching for the breast
Rubella (German measles) A mild virus that may cause congenital abnormalities in the fetus if it is contracted by a woman during the first 12 weeks of pregnancy
Scan (Screen) A way of building up a picture of an object by bouncing high-frequency soundwaves off it. The sonar or ultrasound scan is used during pregnancy to show the development of the fetus in the uterus. See also Transducer.
Show A vaginal discharge of bloodstained mucus occurring before labour, resulting from the onset of cervical dilatation. A sign that labour is starting
Small-for-dates Babies who are born at the right time but who for a range of reasons have not flourished in the uterus. See also
Placental insufficiency
Sperm (Spermatozoon) The male reproductive cell that fertilizes the female ovum or egg.
Spina bifida A congenital neural tube defect in which the fetal spinal cord forms incorrectly, outside the spinal column Spinal anaesthesia An injection of local anaesthetic around the spinal cord.
Steroids Drugs used in the treatment of skin disorders, asthma, hay fever, rheumatism, and arthritis. Because they alter the chemical balance of the metabolism they may very rarely cause fetal abnormalities if used extensively during pregnancy
Stillbirth The delivery of a dead baby after the 24th week of pregnancy
Streptomycin A broad-spectrum antibiotic that should not be taken in pregnancy See also Antibiotics
Stretch marks Silvery lines that sometimes appear on the skin after it has been stretched during pregnancy
Supplementary feeding Additional bottles given to a breastfed baby.
Surfactant A creamy fluid that reduces the surface tension of the lungs so that they do not stick together when deflated. Preterm babies may have breathing difficulties if surfactant has not developed sufficiently Suture The stitching together of a tear or a surgical incision.
Syntocinon A synthetic form of
oxytocin, which is used to induce or accelerate labour.
TENS machine See Transcutaneous electronic nerve stimulation
Term The end of pregnancy this is measured at 38-42 weeks from the first day of the last menstrual period. Tetracycline A wide-spectrum class of antibiotic that should be avoided during pregnancy. because it can affect the development of the fetal teeth and hones See also Antibiotics.
Thrombosis A blood clot in the heart or blood vessels.
Thrush A yeast infection that can form in the mucous membranes of the month, genitals, or nipples.
Toxoplasmosis, congenital A parasitic disease that is spread by cat faeces. If it crosses the placenta during pregnancy, it can cause eye or central nervous system damage in the baby
Transcutaneous electronic nerve stimulation A method of pain relief that uses electrical impulses to block pain messages to the brain.
Transducer An instrument that translates echoes of very high-frequency soundwaves bounced off the developing fetus in the uterus to build up an ultrasound image on a monitor. See also Scan.
Transition A phase between the first and second stages of labour when the cervix is dilating to between 7 and 10 cm
Trial of labour A situation in which, although a Caesarean section may be necessary, the mother labours in order to see if a vaginal delivery is possible
Twins The simultaneous development of two babies in the uterus, either after two eggs are fertilized independently by two sperm - dizygotic or fraternal twins - or, more rarely, after one fertilized egg divides to produce monozygotic or identical twins.
Ultrasound See Scan, Transducer.
Umbilical cord The cord connecting the fetus to the placenta
Uterus (Womb) The hollow muscular organ in which the fertilized egg becomes embedded, where it develops into the embryo and then the fetus
Vacuum extractor An instrument, used as an alternative to forceps which adheres to the baby’s scalp by suction and with the help of the mother’s bearing down, can be used to guide the baby out of the vagina
Vagina The canal between the uterus and the external genitals It receives the penis during intercourse and is the passage through which the baby is delivered
VE Vaginal examination.
Vernix A creamy substance that often covers the fetus in the uterus
Vertex presentation (VX) See Cephalic presentation.
Vulva The external part of the female reproductive organs, that includes the labia and the clitoris
Water birth Birth of a baby under water.