I didn’t agonize long over whether to immunize my family against swine flu. Earlier this year, I wrote about the flu’s deadly effects on pregnant women, and I want to make sure that my family and I didn’t contribute to the problem.

If the risks weren’t convincing enough, the moans and groans from other mothers whose families have contracted the flu are quite motivating. “Say good-bye to a month of your life,” they told me.

Our pediatrician also warned us of very high fevers (up to 106°!) , accompanied by a sore throat and cough. And the news from the Centers for Disease Control and Prevention (CDC) is not promising: The number of confirmed cases is rising.

According to the CDC, my family is a high-risk group—we “qualify” for the shot before others in our community. Not only are we caring for a baby under 6 months of age, but our two other children are under age 5.

So I should have no problem getting the vaccine, right? Not so fast. As it turns out, at least 25 city and county health agencies in California have received less than half of the vaccine doses they ordered, according to the Los Angeles Times. Here’s how my hunt for the vaccine went down.

No room at the pediatrician’s
So when I heard that the H1N1 vaccine had arrived in our community in California three weeks ago, I clicked my heels and called my pediatrician to make an appointment.

“We won’t have it until sometime in November,” his office told me.

So I called our urgent care clinic, and they did have some doses. “We can be there in 15 minutes,” I said.

“Hurry,” said the receptionist.

I pulled the baby from her high chair and loaded my pajama-clad children into the car, driving as fast as the law allowed. The waiting room was jammed, and the receptionist was crying.

“Sorry, sorry, sorry,” she was telling people. “If you’re not a current patient, we can’t vaccinate you.”

I am a current patient, but my kids are not, and they were only vaccinating children.

“Sorry, sorry, sorry,” she said through her tears, returning to the phone.

“Go to hospital across the street,” she finally told the assembled group of upset parents. “They have 40,000 doses arriving today. You can get in line after their staff.”

We headed there immediately, only to be told that the story was a complete fabrication. “We wish that were true,” the hospital operator chuckled when I asked her about it later. “I can’t get the vaccine either!”

Next page: Day 2

They could be the most annoying two words a couple can hear while trying to conceive: “Just relax!”

It feels like an impossible directive. Who can “relax” when she’s over 35, has miscarried twice, and is having a hard time getting pregnant again? I was wound tight as a drum, and I wanted to pull my hair out every time someone used the “R” word. When I finally came home pregnant after a trip to Paris, I dismissed any connection between my daughter’s conception and French wine.

But a Boston-area fertility clinic has released a study that may connect relaxation techniques with higher levels of IVF success. The results are compelling: Patients who took part in a stress-management program led by Dr. Alice Domar during their second round of IVF treatments had a 160% greater pregnancy rate than women who did not participate during their treatment.

A survey of the women in my area who struggled with infertility yielded some apocryphal data that bears this out.

“We were told to ‘just relax’ multiple times when we were trying to conceive,” Julianna Freed, a local mom told me. “In the moment, it is like someone telling you everything is fine while you are crying—obviously everything is not fine and being told it is is having your emotions completely discounted.”

Freed tried to conceive for two years, including IUI and IVF treatments. Instead of paying for another round of IVF, she and her husband spent the money on a long-delayed 10th anniversary trip. “Lo and behold, I came home from a two-week African safari with ‘jet lag’ that just wouldn’t quit for nine more months!” she says. ”So, yes, relaxing and letting it go probably did play a role [in conceiving our son].”

Several women had similar stories: Once they changed jobs (or husbands) or removed some other major stressor in their lives, they conceived their “miracle” babies.

But for every story like this, there are just as many women for whom “relaxing” was not the cure. One local mother told me, “That was the number-one piece of ‘advice’ I heard while struggling to conceive. It made me absolutely despair. It took six years of medical efforts to finally conceive my twins. We took six months off from trying to conceive in the middle of the six years. I needed a break. Needless to say, ‘just relaxing’ for six months did not help me conceive.

“When someone gave me this piece of advice,” she says, ”I would just walk away. If I said anything, I knew I would lose it and just sound like a crazy, unhinged woman anyway.”

I touched base with Hugh S. Taylor, MD, a professor and the chief of the Division of Reproductive Endocrinology and Infertility at Yale University School of Medicine.

“[Dr. Alice Domar's] program is far more than just telling people to relax,” Dr. Taylor says. “A comprehensive [mind-body] program such as this seems to have benefits.”

Dr. Taylor also recommends relaxation to his infertility patients. “However,” he cautions, ”it has never been proven to work as well as specific infertility treatments. It is difficult for someone with infertility to ‘just relax,’ as many psychological studies have demonstrated that the stress of this condition is on par with cancer.”

Dr. Domar also has a very helpful article about what to say—and not to say—to someone you know who is struggling with infertility.

So while there may now be evidence that a mind-body program may have a positive impact on the success of a fertility treatment, women need to hear this from their doctors—not from well-meaning friends and family.

Instead, how about offering an all-expenses-paid trip abroad, or at least one bottle of French wine?

Previous posts by Erica Kain:

Istockphoto

Create a will.
Without this legal document, your possessions and even your children may become subject to state law, which means the fate of your property and the custody of your kids could be left up to the state instead of you, Health money expert Lynnette Khalfani-Cox says. If you have a lawyer draft your will, the cost can range from $200 to $600. You also can create your own will on LegalZoom.com or BuildAWill.com for $70 or less.

Get life insurance.
“If you qualify, you can get an affordable 20-year plan for the price of a pizza every month,” Khalfani-Cox says. Basically, life insurance should provide 5 to 10 times the amount of your salary in the event that you die. Update beneficiary information every year.

Save now for college.
With the cost of college skyrocketing, saving what you can now is a good idea. One option: state-sponsored 529 plans, in which all the money invested is designated for higher education. The funds can be used for any school, not just an in-state college.

 
Related Links:

Laura Doss

Ah, family life. Dirty socks on the floor, that empty toilet paper roll (again!)—they can become sources of stress that build into real discontent. Add juggling your kids, parents, partner, and job—all during a recession—and it’s no wonder we’re short on fun. It doesn’t have to be that way, though. Our simple do-it-today steps will help you build a strong, happy, healthier family.

1. Eat, play, love
These easy ways to reconnect with your family can help create a really positive dynamic.

Fun up family meals. We know that eating together can boost achievement in children, lower the chance for eating disorders in girls, and lower depression rates in both girls and boys. But that doesn’t mean meals have to be serious, formal affairs. Simple, humorous rituals are what children remember as adults. Try a monthly “backward day,” serving breakfast for dinner and vice versa, or watch Saturday-morning cartoons together over breakfast. “Silly things that don’t cost a dime will bring you closer together,” says Michele Borba, EdD, author of The Big Book of Parenting Solutions.

Stay home, stay together. Tape a note to the telephone that says “No!” to remind you not to spread yourself too thin, especially during the holidays. It’s fine to make cupcakes for the school party, but do it with your child. And staying home for a night of reading Christmas books or watching movies may be a lot more meaningful to your family than a flurry of parties or caroling. “Reading aloud, in particular, is a great way to stimulate family conversation,” Borba says.

Be the cool parents. Creating a welcoming space for your kids and their friends is one of the smartest things you can do, so install a basketball goal and stock up on board and video games and healthy snacks. “As your kids get older, they tend to befriend others with similar values and interests,“ Borba says. “You can find out a lot about your child by who they hang with.”

Create (and uphold) boundaries. Families that set strict, clear expectations for their children are happier, according to Scott Haltzman, MD, author of The Secrets of Happy Families. “Kids may tell you they want to be free, but the idea is actually frightening to them,” he says. Make sure your children know and understand family rules.

Have an adventure. A vacation breaks down the traditional way of doing things. In fact, being in a new place increases dopamine (feel-good chemicals) in the brain, which helps bring everyone closer together, Dr. Haltzman says. Research also shows that people who give (time or money) are happier, he says: “It’s important that children learn that they are not the center of the universe and that they can have an impact on the world around them.” Volunteer at a local soup kitchen or shelter, Dr. Haltzman says. If time is tight, ask your children to donate a portion of their allowance to a charity of their choice, and tell them you’ll match it.

Celebrate your history. Sharing details from your family tree will help your kids feel like they belong to something greater than themselves and make them feel more grounded says David Niven, PhD, author of The 100 Simple Secrets of Happy Families. If your kids don’t have the opportunity to talk to their grandparents, look through old photo albums with them and share family memories, stories, and adventures.

Start texting. Although your first inkling may be to skip any technology you don’t quite know how to use (or that you think might get in the way of family closeness), there’s one trend you should jump on: texting. “It’s one of the best ways to stay plugged in to your kid’s life,” Borba says. “A simple, short ‘How are you?’ keeps you in their mind.” And it’s an easy way to say, “I love you” without embarrassment. It may not be the text your kid shows around to his or her friends, but this modern-day version of the note in the lunchbox can help keep your family connected.

Next page: Stop Fighting About Money, Honey

For the past five months I’ve used one excuse to deny myself absolutely nothing. An extra slice of pizza? My kids’ hot dogs? Halloween candy? “It’s OK,” I’ve said. “I’m nursing!”

I was under the impression that nursing was something like liposuction. With how much the baby is nursing, surely she’s sucking the fat cells from my body, right?

But recently I learned that nursing is no reason to go crazy at the buffet—quite the opposite, in fact. I need to make sure I’m filling up on the right kinds of foods in order to properly nourish the baby. And, to my chagrin, I learned that my ravenous appetite has nothing to do with the voluminous amounts of breast milk I’m producing.

For a nursing nutrition reality check, I connected with Frances Largeman-Roth, the senior food and nutrition editor at Health magazine, author of Feed the Belly: The Pregnant Mom’s Healthy Eating Guide, and, most famously (to me), the inventor of the Better Than Elvis milkshake. (My review of her book is here.)

As a nursing mother herself, Largeman-Roth sympathized with my ravenous appetite and gave some recommendations regarding my diet.

“If you’re breast-feeding exclusively, you’re burning up to 500 calories a day,” she says.

And what should I eat for those extra 500 calories? It turns out that pepperoni pizza and chocolate chip cookie dough didn’t make the cut. Go figure.

Next page: What I should be eating

With all of the recent news stories about the potential benefits of Vitamin D—namely strong teeth and bones, a reduced risk of cancer, and an improved mood—it should come as no surprise that the vitamin may be beneficial to pregnant women.

But I was blown away by a recent study that showed a connection between IVF success rates and Vitamin D.

Could upping my intake really help me conceive?

The study found that women with a higher vitamin D level in their serum and follicular fluid (the fluid in a developing ovarian follicle) are “significantly more likely to achieve clinical pregnancy” following an IVF-embryo transfer.

Lubna Pal, MBBS, an author of the study and director of the program for polycystic ovarian syndrome (PCOS) at the Yale Fertility Center, cautions that we don’t have enough data to definitively support the connection. However, she theorizes that Vitamin D affects the endometrium (the lining of the uterus), and research suggests that it may stimulate suppressor Th2 cells, which help the body maintain a pregnancy.

The potential correlation between Vitamin D deficiency and failed IVF cycles is a revelation that merits further study, and Dr. Pal says this may help explain why ethnic minorities have lower success rates in IVF. In particular, African American patients were found to have lower IVF success rates, and likewise, they were found to have lower levels of vitamin D. This particular deficiency is a well-known phenomenon, since people with darker skin who live far from the equator are particularly at risk for Vitamin D deficiency.

In the meantime, Dr. Pal warned that women of color aren’t the only ones that need to have their Vitamin D levels checked. According to her, 70-80% of the population are deficient in Vitamin D (which is a shame because there are so many non-skeletal benefits to the vitamin only now being discovered). She advises women to get plenty of Vitamin D when trying to conceive, and once they do conceive, use vitamin D to avert preeclampsia and gestational diabetes.

Next: The magic amount

When I asked my OB what I should do about prenatal vitamins—those revered nutritional supplements—he shocked me by reaching under his desk and pulling out the garbage can.

“Put them in here,” he said.

My doctor’s advice made my jaw drop.

On one hand, that was a huge relief, as the hyperemesis gravidarum (extreme morning sickness) that characterized all my pregnancies prevented me from swallowing almost any pill.

But I thought you were a bad mother if you didn’t take prenatal vitamins. In fact, before I became so ill, I purchased a jug of prenatal vitamins that included every possible herb that might benefit my brand new embryo. Because you’re better safe than sorry, right? Shouldn’t everyone take a multivitamin?

According to my doctor, that’s not right. And he’s not alone. In February, a study published in Archives of Internal Medicine showed that daily multivitamin use doesn’t ward off cancer or heart disease, even though a nutrient-rich diet does.

Charles Lockwood, MD, the chief of obstetrics and gynecology at Yale–New Haven Hospital, confirmed my doctor’s advice: “If you eat a balanced diet and are not iron deficient, it is not clear that prenatal vitamins result in any health benefits during pregnancy.”

My doctor then referred me to Williams Obstetrics, the essential source of information for ob-gyns. In the 17th edition, I discovered this passage:

“The practice of supplying vitamin supplements prenatally is a deeply ingrained habit of many obstetricians, even though scientific evidence to show that the usual vitamin supplements are of benefit to either the mother or her fetus is quite meager.”

Why doesn’t anyone know this? I read on to discover the Committee on Maternal Nutrition of the National Research Council pointed out that pregnancy supplements are of doubtful value, “except for iron and possibly folic acid.”

So we’re not completely off the hook—we still benefit from popping a few pills. But which pills, and how much? That seems to be quite a topic of debate. What does seem certain is that we’re better off taking our vitamins more discriminatingly, if we take them at all.

For example, if we take large doses of vitamin C, we could give our unborn babies scurvy, according to William Obstetrics. And supplementing iodine beyond our usual salt intake can “induce a sizeable goiter in the fetus.” Yikes!

I learned that the pills I should take while pregnant include the iron and folic acid mentioned in Williams Obstetrics, as well as the new darling of nutritional experts, vitamin D.

Next page: The trifecta of vitamins

Istockphoto

Who says partying in a parking lot has to be unhealthy and uncomfortable? Just add these finds. View the slideshow.

(Getty Images)

I just turned 38. Am I too old to contemplate one more pregnancy before I hang up my fallopian tubes?

After all of the drama I’ve endured with my last five pregnancies (and three births), I feel like I’ve gotten pregnancy down to an art. It seems unfair that I might be considered too old or too risky to bear another child.

So I wondered: Is there a perfect age to have kids? If so, how did I miss it?

First, I learned that I’m not the only one who got started late. According to an August 2009 report from the Centers for Disease Control and Prevention, the average age of first-time mothers in the United States jumped from 21.4 in 1970 to 25 in 2006. The number of first births for women 35 and older has increased nearly eight times since 1970.

Clearly I’m part of a fashionable trend, having had my babies at ages 34, 36, and 37. But is 39 a completely reckless proposition? How far am I from the “perfect age” at this point?

I consulted Ron Jaekle, MD, a professor of clinical obstetrics and gynecology at the University of Cincinnati College of Medicine, in Ohio.

“If you take maternal physical maturity, educational/financial readiness, medical wellness, and chromosomal risks into consideration, 25 to 30 would be optimal, with the five years on either side being almost as good,” Dr. Jaekle says.

But aren’t the odds of a chromosomally normal child for an older mother still very good? For example, if my child’s risk of Down syndrome is 1 in 100 (the risks are 1:1,400 for women in their 20s), then I still have a 99% chance of a healthy pregnancy, right?

Dr. Jaekle reminded me that those odds aren’t the only consideration. “Forty-year-olds have an increased risk for diabetes, hypertension, preterm labor, and preterm delivery, in addition to the chromosome risks,” he says.

I also learned that pregnancies between puberty and one’s mid-20s have surprising health risks, including premature labor, anemia, and high blood pressure. A study published by the University of Texas at Austin revealed that the best health outcomes for mother and child occur when the first pregnancy is in the late 20s or early 30s. According to the study, the ideal age for pregnancy and motherhood is sometime between ages 25 and 34.

So I moped around the house, wondering why I had waited so long. Why can’t I be the mom in Cheaper by the Dozen and have as many kids as I want?

Then I thought about who I was from age 25 to 30. I think wistfully of the nights in my 20s—I would stay up half the night dancing and then bounce into work the next morning, perky as ever. But I also had a mountain of debt left over from graduate school. And I didn’t meet the man of my dreams (and father of my future children) until I was 30. Then we spent a few years together before embarking on our parenthood adventure.

By age 34, we had a great marriage and well-established careers; plus, my debt was paid off. We bought a car and a house in the suburbs. So, for us, the perfect age to have kids was right at the outer edge of Dr. Jaekle’s recommendation. And we were probably smart to wait until we were financially stable. One child can cost more than $221,000, according to report by the Center for Nutrition Policy and Promotion.

Although our fertility is certainly not at its peak, this has been the right time to welcome babies into our arms.

Yes, my age was probably the reason we experienced two miscarriages after our first daughter was born, but now we are the best parents we can be, owing not just to our physical readiness, but also to the “educational/financial readiness” that Dr. Jaekle mentioned.

So I have to agree with him. If I’d only had my act together—romantically, financially, emotionally—during my mid-20s, I could have sailed through motherhood more easily. But it took me a few years to find an ideal place to nest and raise my brood. I may get crabby with anything less than eight hours of sleep and hear my knees crack when I play with my girls on the floor, but I also know I’m giving them a more stable environment than I could have in my 20s.

And as I mull my reproductive tardiness, I’m putting my baby’s outgrown clothes up in the attic. I’m not quite ready to let them—or my fallopian tubes—go just yet.

Previous posts by Erica Kain:

If I were pregnant now, I would be confused and somewhat scared by the news: Pregnant women infected with H1N1 (swine flu) have a higher rate of hospitalization and greater risk of death than the nonpregnant population.

Six pregnant women in the U.S. died of the virus between April 15 and June 16 (that’s 13% of the 45 deaths reported to the CDC). So why are pregnant women in danger?

“Pregnant women tend to be sicker when they have the flu, partly because of changes in the immune system, partly because the physiological stress of normal pregnancy pushes their heart and lungs to work harder, and partly because their lung blood vessels tend to be a bit ‘leaky’ anyway,” says Charles Lockwood, MD, the chief of obstetrics and gynecology at Yale–New Haven Hospital.

Changing lung anatomy may play a role as well. The flu symptom that pregnant women tend to suffer from disproportionately is “shortness of breath,” according to a report published by the CDC in The Lancet.

Most of the pregnant women who died were healthy before they contracted the flu, so it feels particularly insidious and frightening. Should women postpone pregnancy until this flu season is over? And should pregnant women freak out about catching this virus?

“While I would not postpone pregnancy, I would recommend that pregnant women be vaccinated as soon as a mass-produced, tested, safe, and efficacious vaccine is available,” Dr. Lockwood says.

Such a vaccine is due to be released this fall, with priority access for pregnant women.

I hope to get the vaccine, too, if there are enough to go around. I don’t want to be the one who passed H1N1 on to pregnant women, when it’s potentially lethal for them, and my baby won’t be old enough to receive the vaccine.

In the meantime, though, pregnant women should read the CDC’s guide of recommendations for preventing the H1N1 virus. But there is an upshot: If you are pregnant, and you may have H1N1, your best course of action is to take antiviral medication such as Tamiflu (oseltamivir) or Relenza (zanamivir), which keep germs from growing in the body within the first two days that your symptoms begin.

Treating the flu early seems to be the trick. The six women who died of H1N1 in the CDC’s study did not receive antiviral drugs until between 6 and 15 days from their symptom onset.

Unfortunately for those of us who are paranoid about medications we put into our pregnant bodies, these antiviral drugs are “Category C,” meaning that “clinical studies have not been done to assess the safety of their use during pregnancy,” according to this article on UpToDate.

Although no adverse side effects have been reported in women and their fetuses who have taken the antiviral medication, these drugs are not clinically proven to be safe. However,  if I were pregnant, I would consider popping those pills at the first sign of a fever.

Previous posts by Erica Kain: