Posts Tagged ‘metabolism’

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.

Sleepy-Time Smells
Smelling yourself to sleep seems like a pretty strange concept macrodantin doses . We have to admit that aromatherapy for insomnia seemed like a stretch to us, too metabolising caffeine . Most people are used to swallowing medicine, not smelling it nizoral anti-dandruff shampoo . Nevertheless, scientific research supports the idea that soothing smells may be relaxing and actually enhance sleep chronic daily headache tizanidine .69′ Lavender and jasmine are the two scents that seem to promote sleep half life of cymbalta . Sleep researchers at Wesleyan University in Middletown, Connecticut, found that lavender increased deep sleep in both men and women paroxetine formula . and they concluded that lavender aroma has sedative and sleep-promoting activity albuterol swollen epiglottis .691
Some people put a sachet u”dty their pillow is metformin a sulfonylureas . Others spray 1hle pillowcase with scented sandoz recall toprol . water metronidazole fish treatment .
Several friends and I have discovered a wonderful natural way to help insomnia zocor and muscle breakdown and pain . It is called “lavender and vanilla pillow mist” It can be purchased at the bath shops found in a shopping mall hyzaar astra zeneca .
When I first heard a friend tell me that she had been using sleeping pills for several years, and then did not need them once she discovered the lavender pillow mist, I originally thought it was all in her head using doxepin in treating ezema . But I gave it a try and found it most relaxing wall street journal zocor .
You just spray a little on the corners of your pillow, where your face will be isotretinoin substitutes . It even seemed to help my stopped-up nose!
To brag a little more, I sprayed some on my dog’s pillow, and she slept about an hour longer in the morning can viagra be taken with norvasc . I have been told that the Egyptians have used lavender for relaxing for more than 500 years mix bendryl claritin . Perhaps this will help those who are having insomnia and want a natural way to go to sleep amiodarone hcl wikipedia .
Those who don’t find lavender appealing may want to consider jasmine instead order cheap ranitidine . Researchers at Wheeling Jesuit University compared sleeping environments infused with jasmine, lavender, and no smell at all achat libre viagra . Twenty subjects were tested for 3 nights each and then given mental function tests price pseudoephedrine . Those who slept under the influence of jasmine woke up more refreshed and alert duloxetine torrent pharma . They scored better on the tests by responding more quickly and accurately grand mercure apartments allegra hervey bay . Lavender also seemed to help, but not as much as jasmine arava folic acid .69′ Scientists have found that both jasmine and lavender odors have measurable effects on nerve activity, mood, and heart rate caffeine addiction physical addiction . 693 A caller to our national radio show also reported that the scent of eucalyptus helped her sleep asprin asa classification .
Breaking the Vicious Pill Cycle
It may be difficult for people with chronic sleep problems to break out of the medication merry-go-round flomax litigation . Anyone who has relied on sleeping pills like diazepam (Valium), lorazeparn (Ativan), or temazepam (Restoril) will discover that stopping suddenly may lead to several sleepless nights topical ethynyl estradiol . Often, this sets in motion a vicious cycle in which the insomniac reverts to the medication just to get a little sleep but finds once again that when he or she stops the medicine, rebound insomnia kicks in how long diflucan stays in system .
It is not likely that natural sleep aids will be able to counteract this effect timing intercourse while taking clomid . Instead, you may need to discuss such a drug dependency problem with your physician to develop a withdrawal strategy buy promethazine . It may take several weeks (or longer) to wean yourself off a traditional sleeping pill habit wellbutrin overnight . Once “clean,” though, it may be possible to substitute an herb or a dietary supplement to get a decent night’s sleep without creating another vicious circle of rebound insomnia nutrients that lipitor diminishes . Because melatonin is a natural chemical created in the brain and is essential for normal sleep, it seems logical that taking melatonin in a pill would be helpful for insomnia synthroid or armour thyroid . Many peo- ple believe that melatonin is a wonderful natural sleep aid tadalafil no consultation . Unfortunately, the studies that have been done have produced mixed results comparison between effexor and lexapro . One careful review of clinical trials concluded, “There is evidence to suggest that melatonin is not effective in treating mostary sleep disorders with short-term use (4 weeks or less) azor olmesartan .”694
People taking melatonin did fall asleep more quickly-11 minutes on the average—not enough to write home about affect allegra d side . ‘Me authors concluded that melatonin appears to be safe, at least in the short term uses of triamcinolone acetonide . Another meta-analysis of 17 sleep studies reached a different conclusion diflucan works in 24 hours . Those investigators found that melatonin reduced the amount of time it took for people to fall asleep and increased the amount of time they spent sleeping flagyl avntis .’95
‘Me one condition for which melatonin appeared to work well is “delayed sleep phase insomnia aldactone and male pattern balding .” People with this problem go to bed very late (perhaps 3:00 or 4:00 a withdrawal schedule for prozac .m prandin percent compostion of carbon .) and get up late (around 10:30 a information on drug spironolactone .m does paxil raise cholesterol level . or later), haye trouble going to sleep at a normal time, and experience morning grogginess medicine called aleve . “Taking 5 milligrams of melatonin 3 to 4 hours before bedtime allowed such people to go to sleep more easily around midnight diflucan for diabetes .
** Melatonin
Taken 30 minutes before bedtime, melatonin may help a person get to sleep faster and improve sleep quality vermox contraindications . The dose is controversial 2d6 enzyme produce tamoxifen . As little as 1/3 milligram (300 micrograms) may be optimal (this dosage is available from Nature’s Bounty) crying while on alesse . Most supplements provide 3 Milligrams, which is DTDbably too much compare claretin and allegra .
Side effects: Tiredness, dizziness, headache orthostatic hypotension warfarin . Don’t mix with warfarin (Coumadin) demeclocycline for sale .
Downside: Finding 0 weight loss hair loss finasteride .3-milligram doses is hard online pharmacy soma no rx . You may have to split a 1-milligram tablet three ways low female testosterone .
Cost: Approximately $2 to $3 for a month’s supply
Melatonin
Acupressure
We never considered acupressure a viable sleep aid until we received a most unorthodox home remedy from one of our readers converting from coreg cr to coreg . He suggested taping a dried bean to the inside of the wrist between the two tendons risperdal law prolactin . He measured three finger-widths from the crease of the wrist lumiracoxib naproxen chan . The point he described is known in traditional acupuncture as the Inner Gate altace online . Pressing on it is supposed to relieve anxiety, slow the heart rate, and promote sleep cialis does it work for everyone .
I read in your column about an acupressure point on the inner arm to aid sleep viagra how long side effects . You suggested taping a kidney bean between the two tendons, three finger-widths from the wrist mefloquine and pregnancy .
My husband and I tried it, and it’s been amazing! The tape was uncomfortable on our skin, so we’re using plastic “marbles” (for arranging flowers in vases) instead of a kidney bean, and we secure it with an elastic hand cozaar hypotension at night . ft has improved our sleep tremendously, and we wanted to thank you ortho micronor birth control .
Other ingenious readers devised wristlets with buttons to exert pressure on the proper point what causes multiple pregnancies clomid . Apparently, though, the acupressure point our reader described is not the only one that could be used cipro hc otis dosage . A commercial product, 1st Choice Sleep Band, from the makers of Acuband, exerts pressure at a spot on the heart meridian (Ht7) metformin sodium . The manufacturer claims that wearing the bands on both wrists promotes restful sleep (for more information, go to www do robaxin and naprosyn contain aspirin .acuband mirtazapine dose sleep .com) taking zoloft and luvox together .
There is relatively little research to support acupressure for treating insomnia prednisone cancer pain . Not surprisingly, most of what there is has been done in places where people are familiar with the concepts behind acupuncture and acupressure cialis affiliate program . A Korean study found that acupuncture of the ear assisted elderly people in getting to sleep engles urso follmer .697 A Taiwanese study found that acupressure improved the quality of sleep in older people what is avodart side effects .698
Herbal Solutions
Compared to pharmaceuticals, herbs get no respect cocker spaniel skin yeast ketoconazole . Physicians think they are wimpy at best and ineffective and dangerous at worst ibuprofen combined with . This is despite the fact that the sleeping pills they have prescribed for decades carry substantial risks of their own abilify and adhd . More about sleeping pill problems in a moment,though suzanne sommers estrace 2mg . The question is whether it would even be worth trying an herbal approach to insomnia side effects of stopping prednisone .
VALERIAN (VALERIANA OFFICINALIS)
Do you remember the story of the Pied Piper of Hamlin? He used music to rid the town of a rat infestation diflucan dosage ringworm . Some herbal experts suggest that he may have used valerian as well arms ache on prednisone . It was popular in medieval times to flavor soups and stews blood pressure ibuprofen . Because dried valerian root smells like sweaty socks or stinky cheese, presumably the aroma would be appealing to rats wellbutrin xl 300mg generic . Some even suggest he could have given valerian to the town’s children to quell their fears before playing his pipe for them lithium 9v duracell . That would have made it easier for him to lure them away after the town fathers refused to pay him what they owed him for ridding the town of rats sides effects prozac .
Regardless of whether this legend has any basis in fact, the herb has long been used as a mild sedative prilosec compaired to aciphex . A number of small trials suggest that valerian reduces the amount of time it takes a person to fall asleep and may improve the quality of sleep how much does prozac cost .699 In one 6-week study, standardized valerian extract proved just as effective for mild insomnia as the Prescription sedative oxazepam (Serax) lithium’s alchemists symbol . Do not expect valerian to work instant magic amoxicillin clavulanic dose for pig . Unlike traditional sleeping pills, it appears that valerian is more effective when taken nightly for at least 2 weeks alprax caverta calcutta drug .
The biggest advantage of this herbal approach over antihistamines like diphenhydramine (Benadryl or Tylenol PM) and prescription sleeping pills like tema7epam (Restoril) is that va-
*** Valerian
Taken 30 minutes to 2 hours before bedtime for at least 2 weeks, valerian can help a person get to sleep faster ranitidine . It may also improve sleep quality drug interaction valium and prilosec . The dose is 300 to 600 milligrams daily neurontin for children . For tea, use 2 to 3 grams of dried root and steep for 10 to 15 minutes penicillin aqueous .
Side off ects: Digestive upset, rare headache muscle builders with testosterone . Don’t mix with prescription sedatives such as barbiturates or benzodiazepines discount viagra furthermore cheap adipex reviews .
Downside: Smells bad; quality variable
Cost: Approximately $8 to $12 for a month’s supply lerian does not affect coordination or make you woozy celebrex attorneys pennsylvania .100 This is critical if you wake up in the middle of the night to go to the bathroom ndc for toradol . Anyone who is a little unsteady could fall if taking standard sleeping pills discontinuing 300 mg tegretol .
OTHER SLEEPY-TIME HERBS
Other herbs that people have used to treat insomnia include hops, chamomile, lemon balm, passionflower, St withdrawal symptoms from effexor xl . John’s wort, kava, and fennel seeds hyzaar 50 12.5mg . There are, unfortunately, few large, randomized, controlled studies to verify the effectiveness of any of these natural prodUCt&70′ Kava works, but concerns have been raised that it might cause liver toxicity california discount pharmacy tramadol .This may have to do with how the kava is manufactured, but until this issue is resolved, we cannot recommend the long-term use of this herb purchase and viagra soft .
Chamomile tea is what Mrs lexapro cramps . Rabbit gave Peter to ease his tummyache and help him get to sleep after his mischief in Farmer MacGregor’s garden can i take reglan being pregnant . (In one of her other books, Beatrix Potter suggests that lettuce can make little rabbits sleepy, though she doesn’t find it affects her that way prozac reduce headaches .) Chamomile has traditionally been suggested to be a very gentle sedative, but there is hardly any evidence that it would have an effect in insomnia paxil ativan . On the other hand, a cup of chamomile tea might settle the stomach and be a nice way to calm down before climbing into bed wellbutrin for percocet withdrawl .
Sleeping Pills
Like Rip Van Winkle, the sleeping pill business is waking up after a long period of hibernation name of man who discovered penicillin . During the 1990s, sleeping pills fell out of favor coumadin activated . Triazolam (Halcion) was extremely popular after coming on the market in 1983 imipramine pm . Here was a sleeping pill that worked quickly to put people to sleep and would not leave a morning hangover like its predecessors (Dalmane finasteride and proscar cheap . Restoril, or Valium) does acai have caffeine . Since the, drug was rapidly eliminated from the body, it was believed to have no measurable effect the following day actress in viagra commercial . Halcion quickly became the market leader herbal med comparable to lasix .
Then odd reports started cropping up paxil treating delayed orgasm . Scientists taking Halcion to prevent jet lag while traveling to international conferences noted bizarre lapses in memory concerning events that happened the following day periactin to treat nausea . These people appeared normal to friends and relatives while they were giving speeches, recovering lost luggage, and sightseeing the day after taking Halcion amoxicillin with milk . But sometimes they later could not remember having done any of those things medical diagnosis for low testosterone . It was as if a piece of their memory had been erased, like words from a blackboard evista rod . There were also reports of depression associated with Halcion use and even some suggestions that it was linked to violent and aggressive
behavior advil versus aleve .
With all the bad press, Halcion in particular and sleeping pills in general fell into disfavor j-tube and prevacid . A lot of insomniacs worried about drug dependency, morning grogginess, and memory lapses buy aquazide esidrix online ezide hydrochlorothiazide . Instead, they chose to toss and turn rather than rely on benzodiazepines like estazolam, flurazepam, quazepam, temazepam, and triazolam order cheap viagra .
Then along came zolpidem (Amblen) in 1993 caffeine plant growth cafeine growth plant . It gradually captured the sleeping pill market cheep generic viagra . Eventually zaleplon (Sonata) showed up, but the real competition didn’t arrive until 2005 in the form Of eszopiclone (Lunesta) and ramelteon (Rozerem) how to shop for tadalafil online . Sleeping Pills were aggressively marketed directly to consumers wellbutrin xl sr . The Lunesta commercial featured a beautiful green Luna moth gently fluttering through a bedroom claritin and benadryl . But just because the ads are alluring doesn’t Mean a prescription is the best approach clomid when should we have intercourse .
An in-depth analysis indicated that for the elderly, at least some sleep medications are more likely to hurt than help zyrtec can be purchased from canada .7R The medications may help some older individuals fall asleep more quickly can boniva cause tooth pain . But the overview found that, for the most part, sleeping pills have only a modest effect zoloft at night .
The prospect of dangerous side effects is especially troubling depakote gain weight . Older people taking a sleeping pill were nearly five times more likely to become confused or forgetful as those taking an inactive placebo mg caffeine sparks .703 Dizziness that might lead to a fall and daytime drowsiness that could lead to an accident were also significantly more common singulair information . These risks should lead an older insomniac to ask lots of questions about possible problems if his physician offers a Prescription fenofibrate pictures . The, authors of the review suggested that Cognitive behavioral therapy or other nondrug treatment might be preferable for some elderly people with sleeping difficulties drug effectiveness wellbutrin and cymbalta . 704
As is so often the case, there are few head-to-head clinical trials comparing the effectiveness or safety of the newer sleep aid&705 As a result, ranking them requires a certain amount of guesswork and judgment abilify obesity . Here is our overview levaquin reaction symptoms .
** Lunesta (Eszopiclone)
Eszopliclone helps people fall asleep and stay asleep tricor 145mg directions . it probably lasts a little longer than Ambien but likely is comparable to Ambien CR lithium floride glow curve . Because the manufacturer submitted a 6- month study, Lunesta is approved for long-term use prednisone half-life .
Side effects: Unpleasant taste, headache, next-day drowsiness, dizziness, dry mouth, next-day memory impairment (anterograde amnesia), difficulty with coordination Downside: Possible memory difficulties new fda drug name acomplia . Sudden discontinuation can lead to worse insomnia during the first night or two minocycline calcium interraction . Lunesta can be very dangerous if taken in combination with alcohol or other sedatives nystagmus tremor celexa 40 mg . Avoid itraconazole (Sporanox), clarithromycin (Biaxin), and ritonavir (Norvir) cymbalta falling . Cost: Approximately $100 to $110 for 1 month (30 pills)
more than a few nights at a time, this labeling is likely to propel Lunesta to becoming the most successful sleeping pill in the United States tramadol hcl dosage . Whether it deserves this marketing edge remains to be seen info on celexa . Lunesta works in a manner similar to that of Ambien and Sonata, but it has a longer-lasting effect lamisil side effects .
One study suggested that Lunesta could be used for up to 6 months without losing its effectiveness or leading to dependence tamoxifen and lamisil . Nevertheless, the FDA classifies it as a Schedule IV controlled substance, which means “limited dependence liability ibuprofen kids .” When Lunesta is stopped, rebound insomnia is a distinct possibility flagyl and macrobid .
Rozerem (Ramelteon)
This is the first truly unique sleeping pill to come to market in years seroquel defined . It targets melatonin receptors to help people fall asleep nitrofurantoin macro . Unlike all other prescription sleeping pills, Rozerem is not classified as a “controlled substance prilosec and liver side effects .” That means there are no restrictions on the length of time it can be used and no fears about abuse or dependency caffeine at night symptoms .
On the surface, it might seem as if Rozerern represents a wonderful new solution to insomnia osmolite and warfarin . Unfortunately, we are not overly impressed with its effectiveness average cost per day risperdal . In clinical trials, it reduced the amount of time it took people to fall asleep by 8 to 16 minutes norvasc aleve . 707 That may be helpful for some, but Rozerem Rozerem I(Ramelte0qW cheapest viagra and regalis .
Ramelteon helps people fall asleep baclofen and tizanidine . It works differently from all other sleeping pills and poses no risk of dependency reglan without prescription . Take it 30 minutes before retiring and not with a high-fat
meal omeprazole drugs .
Side effects: Next-day drowsiness, dizziness, nausea, fatigue, and headache
Downside: Not safe for people with liver problems what is nifedipine used for . Avoid fluvoxamine (Luvox), fluconazole (Diflucan), and ketoconazole (Nizoral) crookd penis from levitra . Safety during pregnancy has not been determined herb zyrtec . Cost: Approximately $80 to $85 for 1 month (30 pills)
did not reduce nighttime awakenings or help people get back to sleep once they had awakened cyproheptadine anti-serotonin depression . In addition, there is one side effect that bothers us vioxx celebrex bextra . The manufacturer reports that this compound lowers testosterone levels and increases a hormone called prolactin sainsburys caffeine level . This change in hormone balance may be associated with reduced libido, infertility, and osteoporosis fluconazole infants stomachs .
Sonata (Zalepion)
Sonata is a very short-acting sleeping pill that works in a manner similar to that of Ambien and Lunesta actos lawsuits . Because its effects wear off quickly, it can be used when someone wakes up in the middle of the night and cannot get back to sleep asprin and vitamin e acne treatment . The only caution, though, is that you need at least 4 more hours of sleeping time for the effects to wear off charging cr2032 lithium . If you wake up at 5:00 a ultram withdrawal symptoms .m dangers of atenolol . amoxicillin long term use for kidneys . take a Sonata, and then expect to be able to hit the ground running at 7:00 a too much synthroid medication .m what is feldene drug ., you could be in trouble aciphex and hip fracture . If Sonata is taken at bedtime, it is less RV,6y than other sleeping pills to rwist morning hangover dr affect driving ability the next day coreg varices . The downside to this short effect is that some people may wake up early in the morning because the drug’s effect has worn off synthroid and antidepressant metabolism .
For people who wake up too early in the morning, there is another trick to try cialis dreampharmaceuticals online . Bright light exposure in the evening may help them reset their body clock so that they can sleep through the night zantac picture .” Those who cannot fall asleep until the wee hours may benefit from bright light in the morning robaxin damages .
Sonata (Zaleplon)
Zaleplon is a good choice for people who wake up in the middle of the night and cannot easily fall asleep again motrin dosa . At least 4 hours of sleep time are needed levitra duration . Do not take after a fatty (heavy) meal because the food will delay absorption citalopram and duloxetine .
Side effects: Headache, stomachache, dry mouth, constipation, back pain, and occasional next-day drowsiness Downside: Sonata’s very short effect may mean that the drug wears off during the night and results in early morning awakening viagra home made . People with liver problems should avoid Sonata aleve back and body . Cost: Approximately $100 per month
Diphenhydramine
This antihistamine, the active ingredientin Benadryl, is noto- rious for causing drowsiness japanes green tea caffeine . During the daytime, this side effect is a real liability if you want to drive or do anything that requires alertness does medicaid cover zoloft . But at bedtime, drowsiness might be a good thing prednisone horse dosage . ‘There are many over-the-counter sleeping pills that contain diphenhydramine (Nytol, Simply Sleep, Sominex, Unisom Sleepgels, etc lipitor radio control car .) zocor benefits side effects . The manufacturers of nighttime pain relievers like Alka-Seltzer PM, Exedrin PM, and Tylenol PM have been successful at getting consumers to buy into the need for a combination analgesic and sleep aid synthroid maintentance dose based on weight .
• • •
O diclofenac tabs . Several years ago I developed severe dry eyes celebrex pill photo . About a year later, my husband developed the same condition ivermectin liquid compounded . The only common denominator our doctors could find is that we were both taking Tylenol PM to sleep at night lexapro celexa .
The ingredient that helps one sleep in that product is an antihistamine, which can be drying premarin pronounced . Your readers should be told topamax warfare .
A prescription drugs lexapro . Diphenhydramine, which puts the PM in Tylenol PM and many other nighttime pain relievers, can dry out mucous membranes lariam side effects class action . Sensitive individuals could notice dry mouth benadryl with singulair . This is the first time we have heard that this antihistamine may also cause dry eyes clomid and follistim .
• • •
The main problem with diphenhydramine as a steep aid is that some people experience next-day grogginess 5 cheapest sildenafil citrate 56 . As a result, driving performance may be impaired; In addition, some peo- ple may experience dry mouth or difficulty with urination indian sildenafil without prescription . The sleep-inducing effect can wear off after a few days cytoxan metabolism speed .”O Older people may be especially vulnerable to side effects such as cognitive impairment viagra enhancements .
Conclusions
Getting a good night’s sleep is crucial for good health does medicare pay for viagra . We never cease to be amazed that health-conscious people who exercise, eat carefully, and take their vitamins often skimp on sleep lyme disease treatment with azithromycin . We hope you will make getting adequate sleep an important health priority doxycycline for rosacea . If you can find a psychologist who specializes in cognitive behavioral therapy for sleep disorders, this approach may be the safest and produce the longest-lasting benefits ultram er 300 mg .’”
Here is an overview of our other recommendations pre emptive analgesia etoricoxib .
• Practice good sleep hygiene itraconazole liver function tests . Try to go to bed at the same time each night social anxiety disorder celexa . Avoid alcohol and caffeine geodon anit-psychotic dangers . Keep the bedroom dark, and do not watch TV in the bedroom ths soma in the nervous system .
• Exercise during the day (not in the evening) and take a hot bath about an hour before bedtime zocor with chantix .
• A high-carb snack before bedtime may raise serotonin levels, helping you fall asleep levaquin tablet cost . Relax with soothing music or a relaxation CD tramadol vicodine taken together .
*Cognitive behavioral therapy is one of the most cost-effective approaches to insomnia azithromycin stomach flu . Finding a practitioner with experience will be your biggest challenge soma 78 restaurant tucson .
*Try magnesium supplements before bed rx board viagra . As long as your kidneys are healthy, 250 to 500 milligrams may help atorvastatin pravastatin simvastatin rosuvastatin lovastatin . If you develop diarrhea, reduce the dose glaucoma topamax .
• Aromatherapy may be helpful side effects of levora . The scents of jasmine or lavender can be relaxing and facilitate sleep buy cheap viagra prescription online .
• If a nondrug herbal approach appeals to you, valerian is our first choice buy online prilosec . We would recommend a standardized ex- tract of 300 to 600 milligrams before bed attack mefloquine panic . Several days to 2 weeks may be needed to see results lithium manganese battery 123a .
• If a sleeping pill is your last resort, we suggest zolpidem loperamide dose dogs . Because it is available as a generic, it will be the most cost-
effective citalopram side afects .

Care
Boundaries
Birth is an immense change for the baby. Her whole physiology changes fundamentally and she experiences a completely new environment. The boundaries of the womb are left behind and she enters a ‘boundless’ world. In the womb, the child was able to grow harmoniously, protected from the world.
This reveals that everything that is developing requires a protective environment. With a newborn baby, and actually throughout childhood, this protective environment is constantly provided to establish firm foundations for later life. Unconsciously, the child is constantly reminded of the situation in the womb, which is related to an experience of security, safety, protection and fundamental confidence.
Warmth
The womb not only protects the embryo from the world; it also surrounds it with an even temperature of 37°C (98.6°F). A ‘warm environment’ is provided in the best possible way.
After birth, a child has to learn to maintain her own body temperature at a constant level, at first with the help of adults. She must interrelate the warm and cold parts of the body. This is achieved by means of a sensitive metabolic process which generates heat.
Normal growth and the development of the normal physical processes are also dependent on this metabolism. All the heat which the baby does not have to produce herself in order to maintain her temperature at the right level will benefit growth.
It takes the child a long time to regulate her own temperature; the normal difference of PC (2°F). between the body temperature during the night and the day is achieved by most children between their fifth and ninth months. Up to that time they are extremely dependent on the extra warmth provided in the form of good physical care, clothes, and hot water bottles used to warm the cradle before they are placed in it.
The ability to distinguish whether something is hot or cold is learnt during the initial period. The better this ability has been developed by providing sufficient warmth in childhood, the better the child can use it at a later age.
Cold feet are an important sign that extra attention should be devoted to regulating the child’s temperature. A baby should have warm feet, warm legs, a warm body and warm arms.
Special attention to warmth also has another significance. A warm environment helps the child to ‘warm up’ for life on earth. However, our motto is not ‘the warmer, the better,’ because always being dressed in too many clothes or being covered up can actually make a child either drowsy or very restless, and overheating can be very dangerous. Detailed research has revealed that there is a relationship between overheating and cot death. Duvets and synthetic materials can especially cause overheating. Therefore we certainly advise against using these.
In our view, the important thing is to learn to observe the needs of the child with regard to warmth, and to read the signs when more or less warmth needs to be provided in the form of clothes, bedding or ambient heating. The body temperature of the child is the most important thermometer, and in a healthy baby, this fluctuates around 37°C (98.6°F). You can learn to take the baby’s temperature with your hands so that you can literally feel how the child is regulating its own temperature. In the first week or two after birth, take the baby’s temperature every day, as well as feeling how warm she is. Then start testing yourself: feel how warm the baby is, then predict her temperature and check with the thermometer for a few days. If your predictions are correct, you will only have to take the baby’s temperature when you are doubtful or if she is sick.
Impressions
Everything we do, feel and think around the child is assimilated by the child. She is still completely open and has a boundless trust in the environment. The buffer which
we have between ourselves and the world as adults is formed by recognising and understanding that world. A small child is not yet able to do this. Up to about the third year, the child identifies with the environment in which she is living in a very natural way. This is followed by a stage in which thinking gradually assumes set patterns, and the child leans to distinguish herself from the outside world. For the first time, she makes a distinction between her own individuality and the world which is perceived. In this light it is understandable that first memories only go back to the third year, and there are no, or very few, memories before this.
The child is one big sensory organ. Up to the third year, all impressions are assimilated in an uninhibited way and disappear into the subconscious. There they are combined with other physical processes, and a sort of print is made; it is as though the child models the influences of the environment in its own `clay.’ Therefore, it is important that we are aware of what ‘goes into’ the child — also for later on.
Example. A child in a boat on the water, experiences the swell, feels the sunlight on her skin and the wind in her hair, smells the odour of water and fish, is taking in healthy impressions which build up the whole organism. The situation is quite different for a child at a department store who is placed in a rotating ship, which goes round and round when a coin is placed in the machine. The child will enjoy both these experiences, but they affect the organism in significantly different ways. The ‘boat on the water’ situation sounds idyllic; this is usually a vacation experience. However, there are also impressions closer to home, which can be constructive and have the above-mentioned character
Positive, constructive impressions are those impressions in which the natural origin of materials, sounds etc, can be perceived by the child. For hearing, these are the sounds of people and animals, and natural sounds such as the rustling of the wind. For sight, they are natural colours. For the sense of touch, they are materials such as wool, cotton, silk, wood, sand and water.
Many domestic appliances such as vacuum cleaners, washing machines, radio, television and plastic toys were created as a result of human technical ingenuity. For children, these are actually an abstraction, lacking in natural connection.
Radio, television and plastic toys are things you can consciously choose to have or not to have in a small child’s immediate environment. With household appliances, you can take care to minimize the sound in the baby’s immediate environment. So-called ‘white noise’
from household appliances is not a good idea for the young child as it blocks out normal impressions. Autistic children can also become obsessed by white noise. Playing a lyre, humming or singing are better background sounds for the child.
Simple actions such as washing hands, or sweeping up with a dustpan and brush in the child’s presence show how things are done. These actions are enjoyable and you can invite children to imitate them.
The feelings of people around the child also have an effect. It is obvious that a child will thrive best in a genuine atmosphere of joy and warmth. This has a positive effect. But there is not a parent in the world that is always cheerful and relaxed at every moment of the day (and night). It is worth aiming to achieve these qualities, but at times when you do not succeed, you must take them for what they are — also real human emotions. In every family there are days when everything goes pear-shaped and the ideal image of a happy family seems a long way off. Humour is always a good remedy. It can be a relief if you can laugh about yourself and the situation.
The needs which were mentioned above — that is, the need for boundaries, warmth and positive impressions — make great demands on the environment. It means that parents must have clear insight and a good level of empathy to get things right: too cold or too warm, too many im-pressions or too quiet, well-protected or not enough room to breathe?
From this point of view, we would like to discuss a number of practical aspects of childcare.
Clothes
Clothes are like a second skin, which support the functions of the skin. The skin helps to regulate body temperature and protects us from infections. In addition, the skin is a sensory organ with which we perceive the environment. These three functions are most effectively supported with clothes made of wool, silk, cotton or hemp. These fibres are preferable as they provide sense impressions from a natural source via the skin, which help the child to build up its body. Other fibres are more alien, and even viscose, which is made from cotton or wood, is processed quite strongly, in a way which is now known to be quite polluting.
Wool
Sheep’s wool protects the sheep from heat and cold, rain and toxic waste. The curls trap the warm air around the sheep’s skin. The wool keeps out the rain, and waste products are absorbed and emitted through the wool via perspiration.
All these qualities are found in woollen clothes. The warmth of the wool protects the child from cooling down too quickly and supports her unstable heat regulation system which cannot yet retain body heat.
Its absorbent capacity (30 to 40%) ensures that the child remains comfortably dry. The quality of the wool depends on the age of the sheep, the animal’s diet and health, as well as the way in which the wool was turned into clothing.
Finely knitted woollen vests are available, which forma soft, flexible outer skin. Woollen jumpers and cardigans should be loose fitting so that they are easy to put on and take off. Woollen pants are wonderful to use over cotton nappies. They can be knitted easily, preferably from slightly greasy sheep’s wool, and are ideal for absorbing moisture and neutralizing the waste products in urine.
A woollen shawl will keep the baby warm when there are fluctuations in temperature. Woollen socks will also keep the feet nice and warm. Furthermore, wool does not attract dirt, and therefore woollen clothes do not have to washed as often as cotton clothes, though they do have to be aired regularly.
Silk
The silkworm spins its cocoon of silk thread, in which the worm is sealed off from any negative external influences. The silk is made under the influence of sunlight — at sunset, the silkworm stops spinning, and at sunrise, it starts work again.
If you use silk in clothes, you will feel its enclosing qualities. Furthermore, silk can absorb 30% of its weight in moisture without feeling damp. In addition, silk retains heat when it is cold and releases heat when it is warm. That is why silk is worn especially in summer. Silk and, in particular, knitted silk is an excellent basic material for vests, but it is advisable to put a woollen vest over the silk vest as well.
Children who are sensitive to wool against the skin, and children who are very sensitive to impressions and consequently become restless, will benefit from wearing a silk vest.
Cotton
Cotton is widely used nowadays for children’s clothes, especially as this material can be washed so easily in the washing machine. At the same time, it should be said that it actually has to be washed often because it attracts dirt easily. Cotton can absorb 20% of its own weight in moisture.
As cotton cannot absorb heat, this passes easily through the material to the outside air. Consequently, this material is not the best choice for a child’s underclothes throughout the year. Furthermore, the way in which cotton is grown is not particularly environmentally friendly, and chemical products are often used in the treatment of the material. Fortunately, there are several eco-cotton projects which now promote its environmentally-friendly cultivation and processing, and eco-cotton is becoming increasingly available in shops and over the internet.
We suggest dressing the baby in at least two layers of clothing, covering the whole body, including the arms, legs and feet. This produces a layer of air between the two layers which retains heat. In a temperate climate, a long-sleeved woollen vest — or a vest of wool and silk — can be worn for most of the year.
In practice, we regularly find that babies are not dressed warmly enough, and they are often restless and troubled by stomach cramps, or they are constantly crying. The simple remedy of dressing the child more warmly, in better fitting clothes, will do wonders for this.
Bonnets
Unfortunately, bonnets are no longer in fashion. In comparison with the rest of their bodies, little babies often have an enormous — and sometimes rather bald — head. The head is constantly losing heat, which should really be retained for the development of the brain and organs. On the one hand, a silk bonnet will retain the baby’s heat, and oil the other hand, it protects the head and the open fontanel from a restless environment. It is important for the forehead to be free, because this part of the body acts as a sort of thermostat for regulating body heat. Where it is often windy, it may also be necessary for the baby to wear a second bonnet made of wool. There are wonderful bonnets on sale, or they can be knitted in material which is so soft that it is like a second skin.

Bonnets can be removed when the child is in the cot as long as the baby is well protected.
Wraps and swaddling
Because of the need for boundaries, it is understandable why many babies, as well as older children, calm down and fall asleep easily when they are firmly tucked in, or if they are wrapped up or swaddled.
Usually, babies have a flannel sheet wrapped around them, during the postnatal period, but this often disappears, to be replaced by a babygro/sleepsuit. We recommend continning to use a swaddling cloth and wrapping it firmly around the babygro/sleepsuit before putting the baby to bed (see illustration). As the baby still lies with its arms and legs bent, it should be swaddled in this position, to increase the sense of security. The baby can now relax and will fall asleep warm and snug. However, you must make sure that the baby is not wrapped up too warmly (see p.25).
The woollen wrap can serve as a blanket outside the cot for when the baby is fed. When the woollen cloth is no longer sufficient, use a (woollen) baby sleeping bag for in bed.

Children who remain restless and have difficulty falling asleep despite being wrapped up, as well as babies who do not establish a good rhythm of drinking/sleeping, may benefit from the old-fashioned method of swaddling in which the arms are also wrapped up so that the child cannot flail about. Flailing is often a response to crying, cramps or fright, but because it is involuntary, it can cause new restlessness. Swaddling can help to break this vicious circle.
Many parents find it difficult to restrict their baby in this way; in our age of boundless freedom, it is not so easily accepted. However, parents usually overcome their resistance when they see how the baby responds to swaddling. For most babies, it results in a much greater sense of peace, and consequently they sleep well and establish a pattern of sleeping and feeding every few hours. Nowadays, two methods of swaddling are recommended: either ready-made swaddling blankets or swaddling wraps, or using the method shown at the back of this book (see p.108). (See also Blom, Crying and Restlessness in Babies.)
The cradle
The cradle is an important successor of the smallest home in which the baby lived before birth. You can opt for a basket cradle (Moses basket), a wooden (rocking) cradle or
a cot. For safety considerations, the baby’s feet should always be placed at the end of a cot, with its head halfway down. Tuck in the blanket in such a way that the head is free and the shoulders are covered. A hood or canopy over the cradle or cot makes the space more intimate, so that the child is not distracted by the environment and can sleep more peacefully.
For the canopy, it is best to use plain materials in soft colours. A canopy made of light blue silk combined with a layer of pink silk gives a very subtle calming colour.
The mattress must be absolutely flat, providing good support, and it must be well-ventilated and warm. Our preference is for a mattress of kapok, cotton or another natural material. A sheep’s fleece can be placed on the mattress. The fleece is soft and gives a beneficial warmth so that the newborn baby is protected from cooling down too quickly. Make sure that the fleece is not too large and lies on the mattress without any folds. Cover the fleece with a sheet. The bedding should be made of cotton and wool. Do not use synthetic materials. The sheets and blankets should be big enough to tuck the baby in quite firmly. The fleece and the mattress should be regularly aired. If you use a woollen wrap there are likely to be patches of damp under the mattress. If necessary, use a waterproof sheet. There are cotton sheets available that are impregnated with rubber and do not feel clammy. We do not recommend the use of duvets, even those made of wool, because of the risk of suffocation.
If the cradle is next to the window, watch out for overheating in the sun. A baby can easily become too hot in a heated room when the sun shines through the window.
The playpen
Up to the age of four months, it is not really necessary to have a playpen. Nevertheless, when the baby is downstairs, it is a good idea to have a safe place to place it. A wicker basket with a soft cover, or the bed of a pram, are quite suitable.
We do not recommend the frequent use of a baby seat or recliner, as the baby is stimulated by the ac-
tion of sitting in an upright position at a stage when he is still physically immature. The baby can only lie passively in a baby seat, which does not matter for a short period, but is harmful to physical development in the long term.
This objection does not apply so much to the use of a recliner, but there are other objections; when the baby discovers that he can bounce the recliner with one leg, he often finds it difficult to stop, even when he gets tired of the mechanical movement.
When the baby starts to reach out for things and becomes more active in its motor development, it is time for a playpen. Quite apart from the fact that this provides a safe place for the child to learn to sit and stand, it is often a favourite place for being quiet and for playing undisturbed. A cloth cover, like a curtain, along three sides of the playpen will increase the sense of security, and is not to be confused with cot bumpers, which are not recommended as they pose a suffocation risk for the young child. For motor development, it is important that the floor of the playpen is sturdy and not too smooth (for example, a cloth folded double), so that the child can roll over and can put pressure on it.
Walkers and baby bouncers
We emphatically advise against the use of walkers and baby bouncers. These are ‘aids’ which speed up the child’s motor development in an unnatural way. Children certainly like to use these things — especially if they can move around in them quickly — and want to use them more and more. However, it is much better for a child to learn to stand and walk at his own pace. In this sense, walkers and baby bouncers do not help healthy development in any way, and are actually more of a deterrent to healthy development.
Prams and baby carriers (slings)
The pram can be a safe and sheltered place in which the baby can sleep outside during the first few months. For walking, a baby carrier is often a better alternative because it means
that the baby moves in time with the pace at which the adult is walking, and is not shaken about so much as in a pram, as it goes up and down the pavement. The child is carried in a natural position in a baby carrier (sling), (see the illustration on p. 106).
However, at this point a warning should be given. It has been shown that babies can become too hot and stuffy, particularly if carried under a coat. Unfortunately, there are even a few cases, which resulted in a baby’s death. We recommend that you keep a careful eye on a baby in a baby carrier, and if possible carry it on top of a coat rather than underneath, with, if necessary, a woollen cloth around the baby.
The disadvantage of a baby carrier in which the baby is in a vertical position is that the baby did not take up this position itself. In this sense, the baby carrier is not for babies until they reach the age of nine months. A sling is preferable, as the whole back and head are supported, although it might be tiring for the mother to carry.
When a baby has reached the age for a pram, the best model is one in which the baby faces the parent. In this way, the baby constantly has the comforting face of its father or mother in front of it, and can find out from that face what is happening in the big wide world. A traditional pram has the advantage that the child lies flat, as at this age the baby’s head is still relatively heavy and the neck cannot keep the head in a stable position. We recommend a buggy only from the age when the child is able to sit unassisted.

What’s happening to my body?
how your body changes
I’m feeling like a beached whale and I’m only 16 weeks, what can I do?
Weight gain during pregnancy is not only due
to the baby, placenta, and amniotic fluid, but to a number of factors. Changes in your metabolism, the development of certain organs such as the uterus and breasts, and an increase in your blood supply causing more fluid retention and swelling,
all contribute to your weight. In addition, extra stores of fat are laid down as pregnancy requires more energy for the work involved in developing the fetus and coping with the demands of labour. Although most of this fat is stored in the first 30 weeks, weight gain is usually slower at the beginning of pregnancy and suddenly increases in the second half.
The average weight gain is 12 5kg (271b), 4.5kg (101b) of which is gained in the first 20 weeks, and the remainder thereafter. If you feel you have put on more than this, my advice is to eat healthy, smaller, more regular meals and take some gentle exercise.
People keep telling me I’m too small, but the midwife says everything is fine. Can you explain?
Tell them to mind their own business! If your midwife says she is not worried, then I would feel reassured -some women just hide a pregnancy very well! Your midwife starts to measure your tummy at around 26-28 weeks, as by then the major organs are more or less developed and your baby is concerned with growing and laying down fat supplies. Most units use personalized growth charts that are designed to take into account your individual traits such as your race and height, which influence how big your baby is likely to be By taking these factors into account, your midwife can predict more accurately the expected weight and measurements of your baby.
I’m 17 weeks and my breasts have changed - they’re painful and look different. Is that normal?
It’s perfectly normal and very common to
experience breast changes in pregnancy. These are caused by both an increased blood supply and a rise in pregnancy hormones, particularly in the
first 12 weeks. Before your pregnancy was confirmed you may have felt tingling sensations (especially in the nipple area) as the blood supply increased. As early as 6-8 weeks, breasts can get larger and more tender and may begin to look different on the surface, with threadlike veins starting to appear. At around 8-12 weeks, the nipples darken and can become more erect, and as early as 16 weeks, colostrum, the first milk, may be expressed.
Why am I getting more vaginal discharge since becoming pregnant?
In pregnancy, the layer of muscle in the vagina thickens and this, combined with an increase in the pregnancy hormone oestrogen, causes the cells in the vagina to multiply in preparation for childbirth. As a side effect, the extra cells mean that there is an increase in vaginal discharge, known as leucorrhoea.
If you feel sore or itchy and the discharge is anything other than cream or white, or smells, see your midwife or doctor so that a swab can be taken to rule out infection Some infections: such as thrush, cause an abnormal discharge They are common in pregnancy and are easily treated.
Dark patches have appeared on my face. What could they be?
The dark patches on your face are called “chloasma’ or `pregnancy mask” and these patches affect around half of pregnant women. Nearly all pregnant women notice some changes in skin colouring, with skin usually darkening from 12 weeks. This is due to an increase in the hormones that stimulate skin pigmentation, with darker-skinned women affected more. This darkening may be more apparent on certain areas, such as the nipples, perineum (skin between the vagina and anus), and naval, or areas that experience ”friction rubbing”, such as the inner thighs and armpits. You can reduce or prevent dark patches on your face by minimizing your exposure to the sun and using high-factor sun creams.
I’m a model and I’m worried I’ll get stretch marks. Is there anything I can do to avoid them?
I appreciate your concern, especially as looking good affects your work. Stretch marks, also called striae gravidarum, are thought to be connected to the collagen and elastin content of your skin rather than to how much your stomach expands They occur as the collagen layer of the skin stretches over areas of fat deposits on the breasts, abdomen, and thighs. Unfortunately, there are no pills, creams, or magic lotions that can influence whether or not you will get stretch marks or, if you do, how badly you will get them, although taking regular exercise can help you to maintain an ideal weight during pregnancy and so minimize your chances of developing stretch marks.
Take comfort from the fact that although the marks may be red and livid in pregnancy, in the months following the delivery they lose their colour, usually becoming silvery-white and less obvious.
My tummy is really itchy. Is it safe to use moisturizers on my skin in pregnancy?
As your abdomen grows it can become itchy as the skin stretches You can use moisturizers on your body in pregnancy, and these may relieve the discomfort. Choose non-perfumed lotions oils, or creams to avoid further irritation Rubbing almond oil, vitamin E, or wheatgerm oil over the abdomen may also help.
Eating a healthy diet with fruit and vegetables and drinking plenty of clear fluids to keep you well hydrated will also help the condition of your skin.
I can’t look in the mirror as I’m feeling so depressed about my size. Will things get better?
You are not alone in battling with your self-image in pregnancy For many women, their changing body shape can create very negative feelings Eating a healthy diet and taking some exercise helps to keep weight gain to a minimum, and exercise will help to lift your spirits and improve your sense of wellbeing. There is no set emotional response to pregnancy, but as well as coming to terms with a momentous life and body change, you are also under the influence of fluctuating hormones, all of which affect your moods and add to feelings of negativity.
Mild depression in pregnancy is often helped by reassurance and support from your partner, family, or friends. Talking over your fears and concerns with your partner, or with other pregnant women at antenatal classes, may help to relieve your anxieties -you will probably find that other pregnant women are experiencing the same feelings.
If your depression is very severe and you
feel desperate, consult your midwife or doctor as antenatal depression is now recognized as having an effect on pregnancy and birth outcomes, with studies showing a possible link between medication given to treat depression in pregnancy and a lower birth weight and increased risk of premature birth. Your doctor or midwife may refer you for counselling, and some areas hold group classes for pregnant women suffering from antenatal depression.
Why do people talk about the second trimester as the time when pregnant women “bloom”?
For many women, the second trimester is the most enjoyable part of pregnancy. As women find themselves released from the draining symptoms of early pregnancy, this can lead to an upsurge of energy and many find it easier to eat, sleep, and work. Many women also notice that their skin is glowing and their hair is glossier than usual. It is also around this time when you first feel your baby move and, as your baby grows, you start to notice a definite bump and begin to look pregnant - changes that can help you feel more positive and excited
However, not all women feel this way A sizeable minority of women don’t feel any better as the second trimester progresses, with nausea, tiredness, and other symptoms continuing unabated Some may find it hard to come to terms with physical changes such as weight gain, or skin and hair changes. If this is the case, it’s important to remind yourself that almost all of pregnancy’s downsides clear up as soon as the baby is born. If you’re feeling particularly down or low on energy it may be a sign of other problems, such as anaemia (see p 81) Speak to your midwife or doctor for further advice.
I’m worried that my husband doesn’t find me attractive any more. Am I being paranoid?
Self-image can be a big problem with pregnant women and many worry that they are unattractive to their partners in the latter stages of pregnancy This worry is usually unfounded and more to do with their own feelings about their increased size. Keeping anxieties bottled up can make them seem bigger than they actually are, so talk to your husband about your worries and explain how you are feeling. He may be completely unaware of what you are thinking
As your husband isn’t carrying the baby he cannot truly understand the physical demands of pregnancy. Informing him about the changes your body is going through can help him to understand the process of pregnancy and be better equipped to
provide support when you need it most Some men actually find their partners more attractive during pregnancy but you won’t know this unless you talk to each other about your changing shape.
If you are worried about gaining too much weight in pregnancy, focus on eating a healthy, balanced diet (see p 50) and take some light, daily exercise. Even if this is only a short walk or swim, it will help to keep you toned and supple, which will help your confidence as well as prepare you for childbirth
Can I wear high heels?
Although lots of pregnant women continue to wear the same footwear during pregnancy, it is advisable to avoid heels and opt for a flatter shoe, particularly as your pregnancy progresses.
Later in pregnancy, your posture and centre of balance changes, as your increased weight is now mainly at the front of your body. In addition to this, increased levels of hormones secreted during
pregnancy, such as relaxin, make the joints and muscles of the body more lax So wearing high heels can increase the strain on the lower back and pelvic
Looking good
Making the most of the pregiiar..cy “bloom”
Whether you are ecstatic about your body shape, or feeling like a beached whale, spending time pampering yourself will help you enjoy the new you. *Your hair may feel thicker and glossier o:- become more unmanageable. TYeat yourself to a new haircut to make the most of your pregnancy hair.
* Book yourself in for a massage to relax and chill out. Find a masseur experienced in dealing with pregnant women.
* If you’re feeling low about your size, splash out on some new maternity clothes, nowadays available in fabulous styles.
joints, oints, giving rise to aches and pains in those areas However, it’s alright once in a while to wear high heels, for example at a party, but it might be wise to take flat shoes to change into for walking home.
What shall I do about my pierced belly button?
If you are pregnant and your navel is pierced, your midwife will probably recommend that you remove any metal jewellery from your navel for the duration of your pregnancy Some women are happy with this advice, but a lot of women do not want to risk letting their piercing heal up, and then having to have it re-pierced after their baby is born, so they try to wear jewellery in their navel through their pregnancy
You can use something called a”pregnancy retainer” Due to the popularity of body piercing, these have been manufactured to help pregnant women maintain their piercing as their body shape changes. They are made up of a soft, flexible substance called PTFE (polytetrafluoroethylene) in the shape of a ”banana” bar that has two acrylic screw-on end balls. There is a wide range of sizes and styles for women to choose from. As a general rule, you should choose a retainer that is at least 4mm longer than the size of the jewellery you are currently wearing, although, as you can imagine, every tummy is different and will obviously change in size as your pregnancy progresses The important factor is that your pregnancy retainer should not pinch into your skin at any time - if you feel your retainer is causing you discomfort, then buy a larger size.
I don’t have much to spend on maternity clothes, any ideas?
Lots of women are faced with this predicament when they become pregnant, but you don’t need to spend a lot of money Most women’s clothes shops now stock selections of maternity wear at very reasonable prices. Invest in a couple of pairs of trousers or skirts that you will be able to adapt as your pregnancy progresses and then mix and match colours and styles with a few tops. The tops don’t have to be maternity wear - you could just buy ones a couple of sizes up from your normal size.
You could look in charity shops too, or loan maternity clothes from friends and family, as women wear maternity clothing for such a short period that it is often in good condition. Ebay is a good place to pick up a bargain, and local NCT (National Childbirth Trust) sales have plenty of items in excellent condition. Lastly, don’t forget your partner’s tops and jeans, which may be the perfect fit!
I’m 20 weeks’ pregnant and have noticed that I get short of breath very easily. Is this normal?
When you’re pregnant, your lungs have to work much harder to meet your body’s increased oxygen needs. To help you take in more air, your ribs flare out and your lung capacity increases dramatically This can make you feel breathless, particularly from mid-pregnancy onwards. In the last three months, most women find they get breathless even during mild exertion, which happens as the expanding uterus pushes up against the lungs. However, being breathless can also be a sign of anaemia, which may need to be treated (see below). Your breathing may start to get easier when your baby engages - moves down into your pelvis ready to be born.
My midwife has told me I’m anaemic. Can I improve my iron levels through my diet?
All pregnant women should be offered screening for anaemia, which is done early in pregnancy (at the first appointment), and again at 28 weeks. Generally,an iron-rich diet is advised in pregnancy and this
is enough to prevent or improve anaemia. Eat plenty of lean red meat, beans, dried fruits, dark green vegetables, fortified cereals, and bread Try including a vitamin C-enriched food or drink in your diet, as vitamin C helps the body to absorb iron more efficiently. Vegetarians need to eat plenty of eggs, pulses, beans and nuts to boost iron supplies. Iron tablets may be recommended depending on how low your iron levels have become.
I have developed a dark vertical line down the middle of my tummy. What is this?
A brown line down the centre of your stomach is known as the linea nigra This occurs due to changes in skin pigmentation, which are extremely common in pregnancy, affecting 90 per cent of all women in some way or another, and is often more noticeable if you are darker sl6nned. As well as the line on your tummy, you may also notice a darkening of the skin around your nipples and a darkening of freckles, moles, or birthmarks. A few women may also experience brown patches on their face called chloasma or ”pregnancy mask” (see p.105), These changes are caused by the extra amounts of the hormone oestrogen in pregnancy, which affects the melanin-producing cells of the skin - the cells that produce the pigment that darkens the skin. These colour changes are normal and will usually fade once the baby is born
I’m 32 weeks and my pelvis
is really aching now - what are the reasons for this?
Mild pelvic discomfort is a common symptom in pregnancy as your ligaments loosen due to the increased levels of the hormones relaxin and progesterone in pregnancy These changes in your pelvis prepare your body for the birth. This feeling is quite normal and happens to most pregnant women. If your pelvis continues to give you discomfort, you can try to adapt your day-to-day living to relieve the symptoms Keep your legs together and swing them
round when getting in and out of a car or bed. Think about your activities for the day and plan your movements ahead so as not to exacerbate any discomfort you have Avoid wearing high-heeled shoes and take a rest whenever the discomfort becomes more noticeable
If your pelvis is more than just uncomfortable, seek medical advice More extreme discomfort that causes chronic pain is a sign that there’s a dysfunction in the pelvic area, which may require treatment and support as pregnancy progresses The most common form of pelvic dysfunction is symphysis pubis dysfunction (SPD), which is caused by the pubic joint not working as it should (see p.82)
I’ve never looked better -why is that?
Hormone levels in early pregnancy can make for a miserable time for many women as they battle against morning sickness, tiredness, and sore breasts. However, at around 12-16 weeks, when pregnancy hormones begin to settle and these symptoms start to subside, many women feel that their skin and hair are in great condition and their energy levels are at a high. This is sometimes called ”blooming” (see p 108) and you may be lucky and find that this continues throughout your pregnancy.
If you are feeling particularly well, you may feel tempted to do too much, but you should exercise some caution as there will still be times when your body needs additional rest and you need to store up energy in preparation for labour and birth.
GETTING COMFORTABLE:
I’m 36 weeks and have noticed that I’m more comfortable and breathing more easily. Why is this?
It sounds like your baby has moved down into the pelvis. The baby’s head is ”engaged” when the widest part of the head has passed down into the pelvis. This means that when the midwife feels your abdomen, less than half of the head can be felt abdominally. Engagement is normally recorded in your antenatal notes in fifths, ranging from 1/5 to 5/5, so if the midwife has written ” 1/5 palpable” your baby’s head is deeply engaged in the pelvis, as this means that 4/5 of your baby is down within the pelvis The timing and significance of engagement depends on several factors. Women expecting their first baby tend to have firmer abdominal muscles, which gently ease the baby down into the pelvis during the last four weeks of pregnancy. This appears to be what your baby has done, and that is why you suddenly feel you can breathe a little easier as your lungs and rib cage are not so squashed A second or third baby may not become engaged until labour starts, as the abdominal muscles tend to be more lax.
What is perineal massage?
Perineal massage is the practice of massaging the perineum, the stretch of skin between the vagina and anus, to make it more flexible in preparation for childbirth. The intention is to prevent tearing of the perineum during birth, and the need for an episiotomy or an assisted (forceps or vacuum extraction) delivery, as the skin in this area may become more stretchy as a result of massage. Clinical trials indicate that perineal and vaginal massage can reduce the seriousness of tears and so some consider it beneficial.
Use a lubricant such as KY jelly cocoa butter, olive oil vitamin E oil, or pure vegetable oil on your thumbs and massage around the perineum Place your thumbs about 3-4cm (1-1%zin) inside your vagina and press downwards and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning, tingling, or stinging sensation. With your thumbs, hold the pressure steady for about two minutes, or until the area becomes a little numb and you don’t feel the tingling as much. As you keep pressing with your thumbs,slowly and gently massage back and forth over the lower half of your vagina, avoiding the urinary opening, and along your perineum, working the lubricant into the tissues for three to four minutes. This helps stretch the skin in much the same way that the baby’s head will stretch it during birth. Do this massage once or twice a day, starting around the 34th week of pregnancy. After about a week, you should notice an increase in flexibility
I’m 35 weeks and feeling as tired as I did in the first trimester. Is that normal?
Tiredness can cause real problems for women in the first and last trimesters and is often worse for women who are overweight or who have a multiple pregnancy In the early stages, you may feel tired
and lethargic due to hormonal changes, while later in pregnancy tiredness is caused by the extra demands on your body Rest is the best cure, though this may be difficult if you’re working or looking after children.
Boost your energy levels with regular, balanced meals. Late pregnancy is also the time to get your
partner, family, and friends to help out with things like shopping. chores around the house, and cooking
Severe tiredness in the last trimester may indicate that your iron levels are low, so it may be worth getting your iron levels checked
I’ve gone from an A cup to a size D - my husband hopes this will last forever, but it won’t will it?
Many women notice an increase in the size of their breasts in the second trimester and some maintain a bigger size after the birth, especially if they breastfeed. This is due to the effects of oestrogen, which causes fat to be deposited in the breasts. As your breasts enlarge, the veins become noticeable under the skin, the nipples and area around the nipples (areolae) become darker and larger, and bumps may appear on the areolae. Some women get stretch marks on their breasts, but these fade in time After the birth, your breasts may get even bigger when the milk comes in! They do reduce in size once you finish breastfeeding, although the majority of women report a permanent increase of some degree.

Maternity bras
Breast changes are one of the first signs of pregnancy, as from around 3-4 weeks’ gestation there is an increased blood flow, which increases tenderness. Some women notice a change in breast size early in pregnancy. while others may not notice any change until they breastfeed Nevertheless, it’s a good idea to get advice from a shop that stocks maternity bras with staff trained to measure and advise on what size you need. If your current bra fits well, wait until later in pregnancy to get measured when changes in cup size are more likely In the early days of feeding, you may experience some engorgement of your breasts, but don’t panic and send your partner out for a bigger size as this settles in a few days.

 
Weight gain in pregnancy
Monitoring your weight
The recommended weight gain in pregnancy depends on your pre-pregnancy weight. If your BMI was less than 19.8 you should aim for a gain of between 12.5-18kg (28-401b): between 19.8 and 26 you should aim for 11 5-16kg (25-351b); above 26 you should aim for 7-1 lkg (15-251b).
What if I gain too much or too little? There is a link between not putting on enough weight in pregnancy and low birth weight babies. If you gain too much weight, you are more likely to suffer from pre-eclampsia, high blood pressure, diabetes, backache, varicose veins, tiredness, shortness of breath, and to have a large baby
How do I maintain a healthy weight?
Take moderate exercise, eat healthily (see p.50), and follow a weight-reducing diet only under supervision. You need only 200-300 calories more per day so ”eating for two” is not a healthy option.