University of Arizona Center for Integrative Medicine

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EXECUTIVE EDITOR:

Andrew Weil, MD

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Jessica Cerretani

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Before embarking on any health-related regimen, beginning any exercise program, taking any herbs, drugs, supplements or other health-related items, seek the care and advice of a qualified doctor or health professional.

The content in Dr. Andrew Weil’s Whole Life Health Advisor is intended to inform, not prescribe, and is not meant to be a substitute for the advice and care of a qualified health professional.

Dr. Andrew Weil, MD, is an internationally recognized leader in integrative medicine and expert in medical education, medical botany, and mind-body interactions. He earned an AB degree in biology (botany) from Harvard College and an MD from Harvard Medical School.

He is a best-selling author of books on health based in integrative medical philosophy, along with the popular Self Healing newsletter. Dr. Weil holds the Jones/Lovell Endowed Chair in Integrative Rheumatology at the University of Arizona College of Medicine, where he is also Clinical Professor of Medicine and Professor of Public Health. He is the founder and director of the Arizona Center for Integrative Medicine, a Center of Excellence at the University of Arizona.

In these pages, you’ll discover the latest information about living well throughout the many stages of life. Because the topic is lifelong and family health, this guide is designed to be meaningful to everyone, whether that’s a 40-year-old mother, her 75-year-old father, or her 10-year-old son. You might find yourself drawn to read the sections of this guide that are most applicable to you right now, or discover that you look ahead with the goal of staying healthy as you get older. However you use it, we hope that Dr. Andrew Weil’s Whole Life Health Advisor becomes a trusted resource in your home library for years to come.

AN INTERVIEW WITH DR. WEIL

In this exclusive interview, Dr. Weil shares why he’s passionate about helping everyone achieve optimal health, no matter their age.

Q. WHY FOCUS ON FAMILY HEALTH?

A. Families are the foundation of community, a concept interrelated not only with the health of individuals, but also with the health of the planet and a sense of purpose greater than ourselves. The goal is to create a healthy lifestyle that works for everyone and everything.

Q. WHAT ARE THE MOST IMPORTANT THINGS WE SHOULD DO TO STAY HEALTHY THROUGHOUT OUR LIVES?

A. I believe that everyone should understand the concept of health as its own state of vitality and not just the absence of disease. In general, you should learn the principles of healthy eating, get regular physical activity, learn and practice methods of neutralizing the harmful effects of stress, get adequate rest and sleep, cultivate emotional wellness, use preventive medical care judiciously, and learn to breathe properly. To foster optimal health in your family, it pays to teach these approaches to your loved ones, too. I cover all of these crucial areas in this guide.

Q. WHAT’S THE RELATIONSHIP BETWEEN FAMILY HEALTH AND INTEGRATIVE MEDICINE?

A. Integrative medicine views patients as whole persons who live in families and communities. It focuses on health promotion and disease prevention and pays attention to all aspects of lifestyle that influence health, including the support of family in times of illness and the stressors that can accompany family discord or crisis. Integrative medicine is appropriate for people of all ages.

Q. HOW HAS YOUR APPROACH TO YOUR OWN HEALTH CHANGED OVER THE YEARS?

A. I continually modify my diet and supplement regime as I learn new scientific findings. For example, as I’ve learned more about the importance of the microbiome, I’ve made more effort to eat fermented foods regularly. I’ve also modified my exercise routine to adapt to changes in my body.

Everyone’s definition of “family” is different, but for many people, the concept of family isn’t complete without children. For those who are able to conceive, pregnancy can be a busy and joyful time, full of plans for the future. In spite of its timelessness across generations, however, it’s likely you and your partner have a lot of questions about ensuring a healthy pregnancy and childbirth. Much of the information in this section of Whole Life Health Advisor comes from my colleague Victoria Maizes, MD, executive director of the University of Arizona Center for Integrative Medicine and author of Be Fruitful: The Essential Guide to Maximizing Fertility and Giving Birth to a Healthy Child.

Maximize Your Fertility

Unless you pursue in-vitro fertilization (IVF) or other fertility treatments, the process of conception is the same: Each month, in one of a woman’s two ovaries, a group of immature eggs begins to grow and become follicles. Typically, one of the follicles matures and suppresses the development of the others. The mature follicle releases its egg, a process known as ovulation that occurs about two weeks before a woman’s next menstrual period starts. Following ovulation, the follicle changes into the corpus luteum, and begins to produce progesterone and estrogen. Progesterone prepares the uterus for pregnancy by thickening the endometrium, the inner layer of the uterus where the egg will attach if it is fertilized. After the egg is released from the ovary, it travels through the fallopian tube where it remains for about 24 hours, and where it may or may not be conjoined with a sperm. When you’re trying to prevent pregnancy, you might worry that this process will occur all too easily. While it’s not uncommon for couples to get pregnant on the first try, others struggle with infertility for years. For most women under age 35, however, it’s normal for conception to take up to about six months of trying. Age is certainly a consideration: At 40, the average woman has a five percent chance of conceiving in any given month, compared to 20 percent at age 30. A variety of other factors also reduce fertility, including irregular ovulation, scarring of the female reproductive organs (from pelvic inflammatory disease, for example), and, in men, the number, shape, and movement (motility) of their sperm.

There are many other influences on the ability to become and stay pregnant, some of which are under your control. When you’re trying to conceive, the most important thing you can do to boost your fertility is to prepare for pregnancy by leading a healthy lifestyle. To improve the odds of conception, try the following natural fertility boosters.

Get to Know Your Body

First, start paying attention to your cycle so that you understand and can predict when your body has the conditions necessary to conceive. Determine when your next period is due to start and count back 12 to 16 days. This will give you a range of days when you will likely be ovulating. (For women with a 28-day cycle, the 14th day is often the one.) To use this method, you need to know the length of your cycle. The best way to find your most fertile time is to monitor your body closely and learn to recognize the signs that ovulation is imminent.

You will want to watch for three different signs of ovulation. The first is a change in cervical mucus. As your cycle progresses, this increases in volume and changes texture. The greater volume and changes in texture signify your body’s increasing levels of estrogen. You are considered most fertile when the mucus becomes clear, slippery, and stretchy, similar to a raw egg white. The role of mucus is to nourish, protect, and propel the sperm on its way up through the uterus and into the fallopian tubes to meet the egg.

A few days after ovulation, your body temperature can increase by 0.5 to 1.6 degrees. You won’t notice the difference, but you can detect it with a basal body temperature (BBT) thermometer. This temperature spike indicates that you have ovulated. (Release of an egg stimulates the production of progesterone, which raises body temperature.) You are most fertile in the two or three days before your temperature hits its high point. A few experts think you may have an additional half-day to one-day window of fertility after you first notice the temperature rise, but most say at that point it is too late to conceive. Fertility specialists advise charting your temperature every morning for a few months to detect a pattern and pinpoint your likely ovulatory date. Then you can plan to have sex during the two to three days preceding the day your temperature normally rises.

Approximately 20 percent of women actually feel ovulatory activity, which can range from mild achiness to twinges of pain The physical symptoms, called mittelschmerz, may last anywhere from a few minutes to a few hours.

You can streamline things by using an ovulation prediction kit. Available without a prescription, these kits detect the surge in luteinizing hormone (LH) just before ovulation. They are easier to use and often more accurate than the BBT method, and they can predict ovulation 24 to 36 hours in advance, and thus aid in increasing your chance of conception the very first month you use them. But they are not foolproof. They can measure LH (you get either a positive or a negative result, not a number to quantify it) but are not able to indicate whether you ovulate after a positive response; LH can surge with or without the release of an egg.

False LH surges can also take place before the real one. For maximum accuracy, follow the kit’s directions closely. (However, if the instructions say to test your first urine of the day, you may want to test your second catch instead. Overnight urine can be concentrated and might give you a false-positive result.)

Your cycle starts on the first day you have your period. If you have a 28-day cycle, begin the test on day 11 and use it for six days (or however many days the kit recommends). If your cycle is longer, for example 35 days, start on day 14 and test for nine days. If you have an irregular cycle, you may find that this is the least convenient way to detect ovulation, because you will have to buy multiple kits to use over a long period of time. If your cycle runs between 28 and 40 days, your ovulation may occur between days 14 and 26. Because the kits (which range in price from $20 to $50) usually provide only five to nine days’ worth of tests, you may need to buy two of them per month.

Clean Up Your Act

In the past, couples were less aware of the negative consequences of unhealthy behaviors such as using tobacco or drinking alcohol excessively while pregnant. Now, many expectant mothers view pregnancy as an opportunity to eliminate risky behaviors and commit to a healthy lifestyle. And these days, that goes beyond quitting smoking and taking prenatal vitamins, although those choices are certainly important. As we learn more and more about the effects of common chemicals on health, it pays to be mindful of your dayto-day exposures—even before you conceive.

There are several reasons to pay attention to your environment and, especially, chemical exposures when you’re planning a pregnancy, says Dr. Maizes. First, many such compounds are endocrine disruptors, which means that they affect levels and actions of estrogen and other hormones that play an integral role in both fertility and pregnancy. While more research is needed, there’s compelling evidence that exposure to endocrine disruptors may interfere with the ability to conceive. For example, studies suggest that bisphenol A (BPA)—a chemical found in some types of plastic, including food and beverage packaging—is associated with decreased fertility. One small study even found that high levels of BPA in women’s blood were linked to a 50 percent reduction in normal fertilization of eggs retrieved for in-vitro fertilization. (The good news: BPA is rapidly eliminated from the body if you avoid further exposure.)

If you do get pregnant, your baby will likely be exposed to a multitude of chemicals even before birth: One analysis detected an average of 232 chemicals in babies’ umbilical cord blood—possibly setting the stage for later problems like learning disabilities, reproductive abnormalities, cancer, heart disease, and diabetes. Those are good reasons to go green, but don’t despair if the idea of eliminating toxins seems overwhelming. Dr. Maizes recommends starting with some simple steps.

Get personal. Before anything else, assess your exposure to environmental toxins by asking yourself questions about your diet, home, and habits. For example, do you purchase organic produce? Do you use “natural” cleaning products? Are you exposed to chemicals at work? For a free selfassessment, visit victoriamaizesmd.com.

Target the big guys. It’s unrealistic to expect that you can completely clear your life of toxic chemicals. Instead, try to avoid those that you encounter most often. If you enjoy gardening, for example, use only nontoxic pesticides and herbicides. If you’re a cosmetics lover, check the labels of your products for questionable ingredients at the Environmental Working Group’s Skin Deep site (ewg.org/skindeep).

Clean the kitchen. Your kitchen is one of the easiest places to go green. Swap plastic storage containers for glass, make sure your water is free of contaminants, and use cookware that won’t leach chemicals into food.

Feed Your Fertility

Obviously, what you eat and drink can also be a source of unwanted toxins, so it makes sense to choose organic options when possible. But that’s only one aspect of the role that nutrition plays in your fertility. In fact, specific foods can help raise—or lower—your odds of getting pregnant.

Choose whole foods. Dr. Maizes recommends a diet rich in vegetables, fruits, eggs, vegetable-based protein, and omega-3 fatty acids in the form of low-mercury fish— like wild salmon and sardines—and low in processed foods, meat, and high-glycemic carbohydrates. The anti-inflammatory diet I recommend (outlined in Section Three of this magazine and described in detail in my books and newsletter) meets these requirements. So does the Mediterranean diet, which has been linked to a 40 percent reduction in the risk of infertility.

Go fish. Fears about mercury and other pollutants have led many women of childbearing age to reduce—and sometimes almost eliminate—fish from their diet. Yet oily, cold-water fish are excellent sources of omega-3 fats, which may benefit fertility and are critical for a growing fetus. Dr. Maizes recommends choosing fish that are high in omega-3s and low in mercury, such as wild salmon, sardines, herring, and trout. For more on selecting healthy seafood, check seafoodwatch.org.

Shun soda. Need another reason to ditch soft drinks? Research shows that the more soda a woman consumes, the longer it takes her to conceive. In general, carbohydrate foods that rate high on the glycemic index (a measure of how quickly they raise blood sugar) have been found to interfere with fertility.

Take a multi. There’s good evidence that taking a daily multivitamin can help boost fertility, protect against birth defects, lower the risk of miscarriage, and reduce the odds of having a child with autism or other learning disabilities. Dr. Maizes recommends that all women who are contemplating becoming pregnant supplement with a multivitamin that contains vitamins A, B12, D, and E, as well as iron, iodine, and at least 400 mcg of folic acid.

A Word About IVF

If you’re struggling with getting pregnant, there are other options for conceiving, including in-vitro fertilization (IVF), in which egg and sperm are combined in a laboratory petri dish and the resulting embryo implanted in the woman’s uterus. Success with this approach increases with the number of cycles attempted, up to four cycles. According to the American Society for Reproductive Medicine (ASRM), a woman under the age of 35 has a 25 percent chance of conceiving and having a baby via IVF as long as her male partner has no fertility problem. The odds are lower for women in their forties. To optimize your chances for success with IVF, I recommend consulting a traditional Chinese medicine specialist in fertility: Acupuncture may improve the blood supply to reproductive organs, decrease stress, and positively influence sperm quality and count in men. Mind/body techniques such as guided imagery or hypnosis may also help.

Should You Freeze Your Eggs?

Oocyte cryopreservation is the technical term for freezing a woman’s eggs for future fertilization. This procedure is available to women who want to have children eventually but worry that by the time they’re ready, the odds that they’ll be able to conceive will be low. After age 35, fertility declines, and a woman’s eggs become more susceptible to chromosomal abnormalities, increasing the risk of birth defects.

While oocyte cryopreservation can be appealing for some couples, there are significant drawbacks. First of all, in order to produce eggs that are to be frozen, women must take two weeks of treatment with drugs to stimulate the ovaries so that they’ll produce multiple mature eggs, rather than the one (or possibly two) released during the normal menstrual cycle. The drugs can cause very unpleasant side effects, including depression, hypertension, chest pain, thyroid abnormalities, night sweats, muscle pain, joint and bone pain, and loss of libido. Between 10 and 20 percent of women develop ovarianhyperstimulation syndrome, which in its mildest form causes nausea, vomiting, and diarrhea. More severe forms can be lifethreatening.

Once eggs have been produced, they’re removed via a needle inserted through the vaginal wall and then frozen. That’s not as simple as it sounds: Eggs are harder to freeze than either sperm or embryos. They contain a lot of water, which makes them vulnerable to formation of damaging ice crystals. Because of this, chances are low that eggs will survive freezing and eventual thawing. When a couple is ready for pregnancy, eggs are thawed and fertilized with the partner’s sperm. Fertilized eggs, if any, are then implanted into the uterus.

Apart from the unpleasantness and potential danger of the ovarian stimulation, oocyte preservation has another big downside: The ASRM warns that for every 100 eggs that are extracted and frozen, only two will survive the process, and these may or may not result in live births. And then there are the costs, upwards of $10,000 for the ovary stimulation and extraction procedure—and that doesn’t include annual egg storage fees. None of this is typically covered by insurance for healthy women. Given the dismal success rates of today’s oocyte cryopreservation and implantation, the odds of a woman conceiving in her thirties and even her forties actually seem much better with Mother Nature.

Can Your Diet Influence Baby’s Sex?

It’s been said that we are what we eat, but does what you eat help determine whether you’ll have a boy or a girl? Some research suggests that diet may indeed influence sex, but the impact seems weak at best. For example, one study showed that women who had the highest caloric intake before they got pregnant were more likely to have boys than women who consumed fewer calories. But the researchers found no link between food consumption after or during pregnancy and the babies’ sex.

Of course, these findings reflect the fact that the contribution of either an X or Y chromosome by the father’s sperm genetically determines the sex of the child. If the findings of this study hold true, the influence of diet would be to create conditions in the mother’s body prior to fertilization that favor sperm carrying a particular chromosome and successful development of one sex over the other. If you’re planning a pregnancy, be sure to eat a healthy, balanced diet and take folic acid before trying to conceive and during pregnancy, to lower the risk of certain birth defects. Your diet prior to pregnancy might influence whether you have a boy or girl, but I wouldn’t count on it.

A Healthy Pregnancy

If you’ve successfully conceived, congratulations! You’re about to embark on the exciting journey to parenthood. That said, you’ll want to do everything you can to ensure a healthy pregnancy. No woman who is, or may soon become, pregnant should be oblivious to potential hazards, but feeling overwhelmed by the impossible task of avoiding every health risk isn’t wise either. Pregnancy should, to the maximum extent possible, be a happy and relaxed period in a woman’s life. Make a few low-stress, prudent choices each day, and you’ll greatly increase the odds of enjoying a successful pregnancy and delivering a healthy baby.

Go Green for Baby’s Sake

Dr. Maizes points out that some 87,000 synthetic chemicals are registered for use with the Environmental Protection Agency (EPA), yet only about 200 have been studied for health effects on human beings in general, let alone on a developing fetus. Of those, only five have been removed from production. With such lax regulations, it’s no surprise that these chemicals, which range from pesticides in foods to plasticizers in packaging, are making their way into the womb. One study of 10 babies born in five states between December 2007 and June 2008 found an average of 232 different environmental chemicals in the babies’ umbilical blood. This is an important and sobering finding, because research clearly indicates that fetal exposure to toxins can raise risks that a child will suffer from learning disabilities, cancer, diabetes, and heart disease as he or she grows.

Fortunately, in 2013, the American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM) took an important step in raising awareness. They issued a Joint Committee Opinion stating, “Patient exposure to toxic environmental chemicals and other stressors is ubiquitous, and preconception and prenatal exposure to toxic environmental agents can have a profound and lasting effect on reproductive health across the life course.” The opinion goes on to assert that ACOG and ASRM “join leading scientists and other clinical practitioners in calling for timely action to identify and reduce exposure to toxic environmental agents while addressing the consequences of such exposure.” This frank recognition by mainstream physician groups of these potential hazards could provide much-needed leverage in creation of tougher environmental protection regulations. In the meantime, there are simple, practical steps nearly any woman can take to lower the chance that her fetus will suffer significant exposure. I recommend the following tips. Banish bad habits. If you smoke or drink alcohol on a regular basis, quit and do your best to stay away from secondhand smoke. Drink up. Test your home water supply and, if necessary, install a water filter that removes any harmful compounds present. Visit NSF International (nsf.org) for information about different types of waterfiltration systems.

Clear the air. Consider placing a highefficiency particulate air (HEPA) filter in your bedroom. Further limit your exposure to air pollution by observing air advisories; visit AirNow (airnow.gov) for air-quality reports.

Be picky about plastic. Avoid plastic-wrapped and canned foods; these can contain plasticizers and bisphenol A, respectively, which can leach into the food.

Shop around. Use the EWG’s Skin Deep database (ewg.org/skindeep) to find safer versions of shampoo, sunscreen, makeup, and other personal-care products. And employ nontoxic cleaners: Make your own, or buy environmentally friendly brands at natural-foods stores.

Make a fresh start. When you begin decorating, paint the baby’s room with low- or no-VOC (volatile organic compounds) paint, and use hardwood or washable area rugs instead of carpeting. For additional practical advice on avoiding toxic chemical exposures while pregnant, see Dr. Maizes’s website at victoriamaizesmd.com.

Eat for Two

Remember that what you put on your plate affects your growing baby, too. Focus on eating whole, unprocessed foods with minimal additives, as well as brightly colored vegetables and fruits, which are natural sources of antioxidants. Opt for organic or locally grown produce whenever possible. You can find guidance from the Environmental Working Group (ewg.org) on the foods you should always buy organic.

Fishing for advice. When it comes to fish consumption in pregnancy, confusion abounds. The dilemma: The omega-3 fatty acids in cold-water fish such as wild salmon, sardines, herring, and black cod are vital for healthy development of a baby’s brain and nervous system. At the same time, seafood can contain high levels of mercury and other harmful heavy metals. In my opinion, you certainly should eat fish while pregnant. Research now suggests that the benefit to a baby’s neurological health from omega-3s appears to far outweigh the potential for harm from small amounts of mercury that you might ingest.

For instance, one study compared the children of women who ate no fish in pregnancy to those who ate up to 12 ounces per week and to those who ate more than 12 ounces per week. Researchers found that the children whose mothers avoided fish had nearly double the risk of a low IQ at age eight. This was measured very carefully in tests designed to focus on the amount of fish in the mothers’ diets, not on their social or economic status or educational levels. The children who did the best in the IQ testing were those whose mothers ate more than 12 ounces of fish per week while pregnant.

That makes sense, since the benefits of the omega-3 fat docosahexaenoic acid (DHA) include improvements in visual, cognitive, motor, and behavioral skills in newborns that last into childhood and may impact lifelong health and mental capacity. Ocean fish, including salmon, herring, sardines, and mackerel, meet the need for DHA and another omega-3 fat known as eicosapentaenoic acid (EPA) in pregnancy. I suggest avoiding swordfish, marlin, shark, and bluefish because they’re more likely than other species to contain dangerous levels of toxins. I recommend albacore over other species of tuna. Use the Natural Resources Defense Council’s Consumer Guide to Mercury in Fish (nrdc.org/health/effects/mercury/guide.asp) to make wise seafood choices.

Considering caffeine. Many women wonder whether it’s safe to continue drinking coffee or tea while pregnant. The answer is yes, but not too much. The concern focuses on the potential adverse effects of caffeine. Researchers have found that consuming the amount of caffeine in five or more cups of coffee per day doubles the risk of miscarriage.

However, there’s no evidence that moderate caffeine consumption of 200 mg daily from coffee, green tea, or other beverages increases the risk of miscarriage. (One-and-one-half to two cups of brewed coffee contains about 200 mg of caffeine; you would get half that amount in two cups of brewed tea.) When estimating your daily caffeine intake, remember to add in other sources of caffeine in your diet, such as soft drinks and energy drinks. I suggest limiting your consumption of coffee or tea to one to two cups per day, especially during the first trimester. Fortunately, no studies have found any connections between caffeine and birth defects, low birth weight, or a baby’s motor development or intelligence. But because caffeine can enter breast milk, you’ll also need to watch your coffee and tea consumption if you plan to breastfeed your baby. In that case, limit your caffeine intake to 300 mg daily.

On the Move

Just because you’re pregnant doesn’t mean you can’t keep up a regular exercise routine. In fact, I recommend that you stay physically active during pregnancy as long as you’re in good health and your physician approves. Exercise can help you balance your mood, maintain a healthy weight, and speed your recovery after your baby is born. If you are accustomed to working out, you should be able to continue with your regular exercise program, providing that you have no complications. However, even early in pregnancy you may find that you tire more easily during exercise than you did previously.

Walking, low-impact aerobics, and yoga are good choices for pregnant women as long as they are comfortable. Indoor stationary cycling and aquatic exercises in a swimming pool are excellent nonweight-bearing exercises during pregnancy. (Riding a bike outdoors isn’t a good idea since pregnancy-related changes in weight distribution, balance, and coordination can increase your risk of falling.) The American College of Sports Medicine also recommends the following tips.

• Avoid exercising while lying down on your stomach or your back after the first trimester of pregnancy.

• Make sure that you are well hydrated and drink plenty of fluids before, during, and after exercise.

• Avoid high heat and humidity, especially during the first trimester when the fetus is undergoing its most important growth.

• Stop exercising if you’re fatigued, develop persistent pain, or experience any vaginal bleeding; check with your doctor if regular contractions occur more than 30 minutes after exercise (possibly a sign of preterm labor).

• Avoid heavy weightlifting and any activities that require straining.

• Avoid exposure to extremes of air pressure, as in high-altitude exercise (unless you’re accustomed to it) or scuba diving.

• Don’t increase the intensity of your workout beyond pregnancy levels.

• Eat small, frequent meals throughout the day. Sedentary pregnant women need about 3,000 calories per day during the second and third trimesters; if you’re physically active, your caloric needs will be higher to make up for the calories burned up during your workout.

Managing Morning Sickness

Nausea and vomiting can be unwelcome side effects of pregnancy in many women, particularly during the first trimester, and these symptoms aren’t just limited to the morning hours. Here are my top three recommendations for managing morning sickness. Be sure to discuss any changes in your supplement regimen with your physician first.

GINGER. This spice (Zingiber officinale) is very effective for morning sickness. In scientific studies, the amount of dried ginger used to quell the nausea of morning sickness was about 1,000 mg per day, taken in two to four divided doses. You can take up to 1,000 mg of ginger daily in any form, including tea, candied slices, pickled slices, powder, or capsules. If you take capsules of ginger, keep in mind that many of the ginger supplements on the market are highly concentrated extracts. With these products, when the label says 250 mg, it means 250 mg of the extract. The equivalent of dried ginger root could be anywhere from 2,500 to 5,000 mg.

ACUPRESSURE WRISTBANDS. These bands apply pressure to acupressure points on the inner surfaces of your wrists and have been found to help ease motion sickness and morning sickness. They are available at most drugstores and health-food retailers. Proper placement of the wristbands is critical. Follow the package directions carefully so you’ll know how to locate the pressure points.

EAT SOMETHING. The traditional advice to keep your stomach partially full is simple and effective. Eat crackers, dry toast, or dry cereal before you get out of bed in the morning, and snack on dry, starchy foods later in the day. You should also sip clear liquids between meals. You’re more likely to feel nauseous if your stomach is empty or full, so aim for in-between.

FCHILDBIRTH: SPECIAL DELIVERY rom hospitals to home births, expectant mothers run the gamut in their views on the ideal setting for childbirth. You should always discuss your birth plan with your partner and healthcare team, weighing the pros and cons of different options. Here are my thoughts on some frequently asked questions about childbirth and delivery.

Hospital or Home?

Out-of-hospital births, including home births, have been increasing slowly and steadily, but according to the U.S. Centers for Disease Control and Prevention (CDC), these deliveries still represented only 1.5 percent of all births in the United States in 2014, the last year for which the CDC’s National Center for Health Statistics National Vital Statistics System has data. Of all the out-of-hospital births, 63.8 percent were home births and 30.5 percent took place in birthing centers.

According to the American Pregnancy Association, home births can be an option for women who are experiencing healthy, low-risk pregnancies. On its website, the association lists conditions that argue against home births: women who are diabetic, those who have chronic high blood pressure or toxemia (also known as preeclampsia), and those who have experienced preterm labor in the past or are considered at risk of it. The association also rules out home births when a woman’s partner doesn’t support her desire for one.

As you might expect, there is a fair amount of controversy about out-of-hospital births. A study presented at the February 2014 meeting of the Society for Maternal-Fetal Medicine found that babies born at home with midwives in attendance have a risk of neonatal death four times higher than that seen in babies delivered by midwives in hospitals. The same study found that the risk increased to about sevenfold if the pregnancy was the mother’s first and by about tenfold in pregnancies beyond 41 weeks, now considered “late term.” For this study, neonatal deaths were defined as those that took place up to 28 days after delivery. The study authors said that obstetric practitioners have an ethical obligation to disclose the increased absolute and relative risks associated with planned home birth to expectant parents who express an interest and to recommend strongly against it.

That report was challenged, however, by the American College of Nurse-Midwives, which questioned the accuracy of the CDC data used in the study and maintained that the birth certificates the researchers relied upon in compiling their data are not always the most accurate source of information on home births. For example, you cannot learn from a birth certificate whether or not a woman planned to have her baby at home or in the hospital. Some may have intended to go to the hospital but gave birth at home unexpectedly, and some women who planned to give birth at home may have been transferred to the hospital if complications developed or if the midwife could not reach her in time.

The conventional medical community offers only grudging support for home births. The American Pediatric Association and the American College of Obstetricians and Gynecologists maintain that the safest settings