What is colic?

Colic is uncontrollable crying in a baby that has no known cause.

Symptoms of colic

Your baby may have colic if he or she cries excessively over several days. Although this crying can occur at any time, it usually gets worse in the late afternoon and evening. Colic usually appears in the first few weeks after birth and the cause isn’t known. It generally lasts for three to four months.

Although colic isn’t thought to be due to pain, your baby may look uncomfortable or appear to be in pain. Babies may lift their head, draw their legs up to their tummy, become red in the face and pass wind. Colic is not a serious condition. Research shows that babies with colic continue to eat and gain weight normally, despite the crying. If your baby doesn’t, you should see your health visitor or GP.

The main problem with the condition is the stress and anxiety it creates within the home. You may find it difficult to cope with the constant crying, so it’s important for you to have support and to take a break now and then.

Causes of colic

The cause of colic isn’t known. In the past it was thought to be related to the digestive system. Painful wind may contribute to colic, but there is little evidence to prove colic is linked to digestive problems. Intolerance of lactose has also been identified as a possible factor, but evidence is limited.

Another possible cause may be your baby’s temperament. This may make your baby highly sensitive to the environment, and he or she may react to normal stimulation or changes by crying. If you smoke, this may also be a factor.

Gastro-oesophageal reflux disease (GORD) is associated with excessive crying in some babies. GORD symptoms include being sick and difficulty sucking, these are not usual symptoms in babies with colic.

Diagnosis of colic

You may be worried about your baby’s crying and may want to get advice from your GP or health visitor to make sure there isn’t a serious problem.

Before visiting your GP, you should think about what other things may be causing your baby to cry. These could include:

• hunger
• tiredness
• lack of contact – some babies want to be cuddled all the time
• startling – due to jerky movements or sudden noise for example
• temperature – your baby may be too hot or too cold
• pain – there may be an identifiable source of pain, like a nappy rash

If none of these are causing your baby to cry, you may decide to see your GP or health visitor. They will examine your baby and will ask you about your baby’s behaviour. By telling them when your baby cries, eats, sleeps and their pattern of bowel movements, they may be able to find out the cause of the crying.

Treament of colic

There is no single medicine or proven cure for colic, but there are measures that may help. Different babies are comforted in different ways, and you may need to try a few methods to see what works.

Self-help

To soothe crying babies, the following techniques may be helpful.

• Carry your baby in a front sling or back pack.
• Keep your baby moving in a baby swing.
• Try to soothe your baby with continuous noise or vibrations from household appliances like the dishwasher, vacuum cleaner or washer-dryer.
• Take your baby for a car ride or a walk outside.
• Give your baby a dummy to suck on.
• Bathe your baby – the warm water may be comforting.

Elimination diets

There are some dietary changes that may help some babies, but none are proven to treat colic.

It’s thought that some babies may not be able to digest lactose very well, but this improves as they get older. If you put breast milk into a bottle or use formula feed containing cow’s milk, you could try adding lactase before feeds to see if this helps. This can be purchased from a pharmacist. Lactase breaks down lactose in the body and can improve symptoms in some babies in the first few months. Some mothers may find using low lactose milk formula useful. If, after a one week trial, either method helps your baby, you can carry on feeding them in this way until they are 12 weeks old. The baby should then be slowly weaned onto normal milk over a period of one week.

There are other methods that may help if a low or non-lactose diet doesn’t work for your baby. If you are breastfeeding, you could stop eating dairy products, or try feeding your baby a hypo-allergenic formula containing whey or casein hydrolysate which your baby shouldn’t be allergic to. If eliminating dairy from your diet or hypo-allergenic formulas feeds work, you should talk to your GP about a referral to a specialist as your child may have an intolerance to cow’s milk. However, there is limited evidence that non-dairy breast milk and hypo-allergenic formulas are effective at reducing colic.

A substance found in soya products called phytoeostrogen can affect the development of your child. Speak to your health visitor and GP before using soya-based formulas.

Medicines

There is limited evidence that simeticone (eg Infacol), may improve symptoms. This treatment is used to relieve trapped wind. You may also consider trying colic drops or gripe water, which are available without a prescription.

Complementary therapies

Chiropractic spinal manipulation therapy or cranial osteopathy may relieve symptoms. However there is limited evidence that these treatments are effective.

Aromatherapy and tummy massage using lavender oil may help relieve the symptoms of colic. Always ask the advice of a qualified practitioner as some herbal remedies can be harmful to babies.

Help and support

Caring for a baby with colic can be very stressful, frustrating and challenging for any parent or carer, particularly if it’s your first child. If you feel overwhelmed, you should take a break if at all possible. Ask a partner or friend to take over for a while, even for just an hour or two.

A baby who refuses to breastfeed and is not in the process of being weaned, is said to be on a “breastfeeding strike”. It is your baby’s way of telling you that something is wrong. It will take a little investigative work to identify the problem.

What is the most likely cause?

Some of the most common reasons for breast refusal include:

• Your baby is not latching on properly and cannot get a good enough mouthful of breast to feed effectively. Get help from a breastfeeding counsellor or infant feeding specialist to improve the situation.

• Mouth pain from teething, a cold sore or an infection (such as thrush).

• Your baby reacting to your shout of pain when she bites your breast.

• Your baby has an ear infection, which causes pressure or pain while breastfeeding.

• A cold or stuffy nose, which makes breathing difficult while breastfeeding.

• Supplementing with too many bottles of formula, resulting in reduced milk supply.

• Regular distractions, noise or interruptions while breastfeeding.

• Repeatedly letting your baby cry when she wants to feed.

• A major disruption in your baby’s routine, such as moving house or you returning to work.

• An unusually long separation from you.

Other less common causes include food or breast milk sensitivity or allergy, a cream or perfumed product applied on or near your breasts or a change in the taste of your milk. This could be caused by a drug, certain foods, the return of your periods, or if you become pregnant again while breastfeeding.

What can I do?

A nursing strike can challenge even the most dedicated breastfeeding mother. It can be a shocking experience for a baby to refuse the breast after some months of problem-free breastfeeding. By this time most mothers will have assumed that any difficulties were behind them. Whilst a mother is racking her brains to discover the reason for the strike, she may even (irrationally) feel that her baby doesn’t like her any more.

Although breast refusal can be a worrying and upsetting experience, it can be overcome, with patience and support.

While still encouraging your baby to breastfeed, you will need to express your milk by hand or pump every few hours (about as often as your baby had been breastfeeding). This will help prevent engorgement or mastitis and give your baby the milk that she needs.

Here are some ways to deal with it:

• Try offering the breast when your baby is asleep or very sleepy. Many babies who refuse to feed when they’re awake will do so when they are sleepy.

• Visit your doctor to rule out any medical causes (such as an ear infection or thrush).

• Try different feeding positions.

• Breastfeed on the move. Some babies are more likely to feed when you rock or walk them than when you’re sitting or standing still.

• Find a quiet room to feed in. It’s common for a six- to nine-month-old to go on a nursing strike as a result of his newfound discovery of the world. Babies of this age are easily distracted and often prefer to “snack” at the breast instead of settling down for a meal. Try using a dimly lit, quiet room, away from the sound of the radio or television.

• Give your baby lots of skin-to-skin contact (try breastfeeding without a shirt on or in a warm bath). A sling or carrier can help keep your baby close to you between feeding attempts.

It is easy to jump to the conclusion that a baby who doesn’t want to breastfeed is weaning himself. But it is unlikely that a baby under a year old who has been successfully breastfeeding is ready to give up.

Will it affect my baby?

Breast refusal can be upsetting for both mother and baby. Try to keep other elements of your baby’s routine as normal as possible during this time. Give her extra attention and physical contact. If you are worried that your baby isn’t getting enough food, keep track of her wet nappies. At least five to six wet disposable nappies per day – or six to eight non-disposables – indicate she is receiving enough fluid (disposable nappies are so absorbent that you may not notice every time she wees). Don’t hesitate to call the doctor if you are worried.

Can I still breastfeed?

Absolutely. It’s important to keep trying to breastfeed your baby. With patience and persistence you’ll get back on course.

• The letdown reflex

You may experience fleeting pain in your breasts when your milk “lets down”. The letdown reflex, also known as the milk ejection reflex, is caused by the action of the hormone, oxytocin. Oxytocin stimulates the muscles of the breast to squeeze out milk. In the first few days after the birth, the hormone is released in response to your baby suckling. Later, anything that makes you think about your baby, or feeding your baby, can trigger this hormone release. Some mothers find that their breasts leak when this happens.

The letdown reflex feels different to different mothers. Some feel a slight tingling, some feel immense amounts of pressure and slight pain or discomfort and others feel nothing at all.

Most mothers are unaware of the letdown reflex in the early days of breastfeeding, although they may be aware of “afterpains” – the pains experienced after birth as their womb contracts down to its pre-pregnancy size – which is caused by the same hormone. They may be more aware of the letdown when their baby is a few weeks old. As time goes by and breastfeeding becomes established, most mothers become less and less aware of it.

• Producing too much milk

Some women who produce an abundance of milk have painful twinges deep in the breast after feeds. Provided your baby latches on well each time he feeds, your milk supply should quickly step down to match your baby’s needs exactly.

• Thrush

If yeast enters the milk ducts, (as a result of thrush) it can make breastfeeding painful. Unlike letdown pain, which is short-lived, thrush pain persists throughout the feed and is usually even worse after feeds. However, thrush in the milk ducts is uncommon – read our article on thrush for more information.

• Engorgement

Engorgement can over-distend the milk-producing cells of the breast, making letdown difficult and sometimes painful.

• Mastitis or blocked ducts

Mastitis or blocked ducts can cause an area of the breast to become red, sore, hard and inflamed.

Other possible causes of breast pain are:

• poor breast pump usage. See our article on expressing for tips on how to do it.

• a badly-fitting bra. The side seams should be on your ribs, not your breast, and the cups should not compress your breasts. Go to a department store or old-fashioned lingerie shop and ask an assistant to measure you properly.

• premenstrual pain. If your periods have started again, you may experience premenstrual pain. This pain should go once your period begins and stays away for the next week or two. The pain then starts to build up again after ovulation. Most women will recognise this cyclical pattern if their breast pain is related to their menstrual cycle.

• fibrocystic breast pain. Some women have a condition called fibrocystic breast disease – lots of lumpy areas in their breasts which can fill with fluid and feel tender and painful. This is a benign (harmless) condition but if you suspect you have it, it’s important to see your doctor so that other causes can be ruled out.

What can I do?

If you learnt breathing or other relaxation techniques during your antenatal classes, try using them as you breastfeed. They may help you cope with discomfort during letdown. If your breasts are engorged, your baby may not be able to latch on well enough to remove the milk effectively. You may need to start off with gentle hand expressing or pumping until your baby is able to draw your breast in sufficiently.

If your pain is caused by excess milk, it may be difficult to latch your baby well to your over-full breast. When your baby starts to suckle, and triggers the strong letdown, he may come off coughing and spluttering. Try this technique: put your baby to your breast as usual. When you feel your milk first let down, gently break the suction and allow the initial spurt to spray into a towel. Let your baby latch on again, better, when the flow slows down a bit. The more often the baby latches on well, the more quickly your supply will settle down and you should be more comfortable.

So enjoy this period: once she’s mobile, travel becomes a far greater challenge.

Health and safety tips

• If travelling by air, feed your baby on take-off and landing to ease ear pain.

• Bring nappy rash cream, bags for dirty nappies, enough nappies for the trip and infant paracetamol for relieving pain and fever. You may also want to bring a colic treatment (ask your pharmacist to recommend one), saline nose drops for stuffy noses and teething gel if your baby is teething.

• Bring hats and sunscreen (with sun protection factor 15 or higher) for your baby. Babies under six months should be kept well out of the sun, and babies between six months and a year should have only very limited exposure, especially between 11am and 3pm on hot days.

• Get removable window shades for car windows to shield your baby’s skin and eyes from the sun.

• If travelling by car, babies should always travel in a rear-facing car seat, preferably in the back seat of the car. Never put your baby’s car seat in a front seat with a passenger air bag. Spend time before you leave to make sure the car seat is installed properly and that the belts on the car seat are threaded correctly. Make sure the harness fits your baby snugly and securely.

Food and comfort

• If you aren’t breastfeeding, remember to bring formula and add cooled boiled water as needed. You can buy convenient travel-sized packs of ready-made formula at most chemist shops. You may want to bring tins, jars and packets of baby food, but unless you’re travelling somewhere very exotic, baby food should be available at your holiday destination, too.

• Bring a plastic bib for your baby. They’re invaluable for containing pureed carrot and preventing several changes of clothing a day.

• Bring a baby blanket so you can stop in a park to let your baby have a kick or a nap.

• If your baby sleeps in a cot, reserve one when you make your room reservation or you may be out of luck when you arrive. Alternatively, bring along your own travel cot.

Entertaining your baby

Bring a bag containing a few of your baby’s favourite toys, plus a couple of new ones. Possibilities include anything shiny, babyproof mirrors, rattles, musical toys, soft animals, pop-up toys, plastic keys or teething rings.

Travel gear

A few well-chosen pieces of travel gear will help to smooth your journey and explore once you’ve arrived. For young babies, a complete travel system takes some of the hassle out of getting in and out of cars and airplanes. A lightweight buggy you can stash in your car boot or a plane’s overhead lockers makes sense for babies who can sit up (you can also drop off your buggy at the plane steps and have it waiting for you on arrival). For smaller babies a baby carrier may be useful. If you’re travelling somewhere hot, a baby sun pod is another great investment – the perfect way to keep your baby shielded from the sun’s harmful rays.

Chickenpox is caused by the varicella-zoster virus (VZV). Kids can be protected from VZV by getting the chickenpox (varicella) vaccine, usually between the ages of 12 to 15 months. In 2006, the Centers for Disease Control and Prevention (CDC) recommended a booster shot at 4 to 6 years old for further protection. The CDC also recommends that people 13 years of age and older who have never had chickenpox or received chickenpox vaccine get two doses of the vaccine at least 28 days apart.

A person usually has only one episode of chickenpox, but VZV can lie dormant within the body and cause a different type of skin eruption later in life called shingles (or herpes zoster). Getting the chickenpox vaccine significantly lowers your child’s chances of getting chickenpox, but he or she may still develop shingles later.

Symptoms of Chickenpox

Chickenpox causes a red, itchy rash on the skin that usually appears first on the abdomen or back and face, and then spreads to almost everywhere else on the body, including the scalp, mouth, nose, ears, and genitals.

The rash begins as multiple small, red bumps that look like pimples or insect bites. They develop into thin-walled blisters filled with clear fluid, which becomes cloudy. The blister wall breaks, leaving open sores, which finally crust over to become dry, brown scabs.

Chickenpox blisters are usually less than a quarter of an inch wide, have a reddish base, and appear in bouts over 2 to 4 days. The rash may be more extensive or severe in kids who have skin disorders such as eczema.

Some kids have a fever, abdominal pain, sore throat, headache, or a vague sick feeling a day or 2 before the rash appears. These symptoms may last for a few days, and fever stays in the range of 100°–102° Fahrenheit (37.7°–38.8° Celsius), though in rare cases may be higher. Younger kids often have milder symptoms and fewer blisters than older children or adults.

Typically, chickenpox is a mild illness, but can affect some infants, teens, adults, and people with weak immune systems more severely. Some people can develop serious bacterial infections involving the skin, lungs, bones, joints, and the brain (encephalitis). Even kids with normal immune systems can occasionally develop complications, most commonly a skin infection near the blisters.

Anyone who has had chickenpox (or the chickenpox vaccine) as a child is at risk for developing shingles later in life, and up to 20% do. After an infection, VZV can remain inactive in nerve cells near the spinal cord and reactivate later as shingles, which can cause tingling, itching, or pain followed by a rash with red bumps and blisters. Shingles is sometimes treated with antiviral drugs, steroids, and pain medications, and in May 2006 the Food and Drug Administration (FDA) approved a vaccine to prevent shingles in people 60 and older.

Contagiousness

Chickenpox is contagious from about 2 days before the rash appears and lasts until all the blisters are crusted over. A child with chickenpox should be kept out of school until all blisters have dried, usually about 1 week. If you’re unsure about whether your child is ready to return to school, ask your doctor.

Chickenpox is very contagious — most kids with a sibling who’s been infected will get it as well, showing symptoms about 2 weeks after the first child does. To help keep the virus from spreading, make sure your kids wash their hands frequently, particularly before eating and after using the bathroom. And keep a child with chickenpox away from unvaccinated siblings as much as possible.

People who haven’t had chickenpox also can catch it from someone with shingles, but they cannot catch shingles itself. That’s because shingles can only develop from a reactivation of VZV in someone who has previously had chickenpox.

Chickenpox and Pregnancy

Pregnant women and anyone with immune system problems should not be near a person with chickenpox. If a pregnant woman who hasn’t had chickenpox in the past contracts it (especially in the first 20 weeks of pregnancy), the fetus is at risk for birth defects and she is at risk for more health complications than if she’d been infected when she wasn’t pregnant. If she develops chickenpox just before or after the child is born, the newborn is at risk for serious health complications. There is no risk to the developing baby if the woman develops shingles during the pregnancy.

If a pregnant woman has had chickenpox before the pregnancy, the baby will be protected from infection for the first few months of life, since the mother’s immunity gets passed on to the baby through the placenta and breast milk.

Those at risk for severe disease or serious complications — such as newborns whose mothers had chickenpox at the time of delivery, patients with leukemia or immune deficiencies, and kids receiving drugs that suppress the immune system — may be given varicella zoster immune globulin after exposure to chickenpox to reduce its severity.

Preventing Chickenpox

Doctors recommend that kids receive the chickenpox vaccine when they are 12 to 15 months old and a booster shot at 4 to 6 years old. The vaccine is about 70% to 85% effective at preventing mild infection, and more than 95% effective in preventing moderate to severe forms of the infection. Although the vaccine works pretty well, some kids who are immunized still will get chickenpox. Those who do, though, will have much milder symptoms than those who haven’t had the vaccine and become infected.

Healthy children who have had chickenpox do not need the vaccine — they usually have lifelong protection against the illness.

Treating Chickenpox

A virus causes chickenpox, so the doctor won’t prescribe antibiotics. However, antibiotics may be required if the sores become infected by bacteria. This is pretty common among kids because they often scratch and pick at the blisters.

The antiviral medicine acyclovir may be prescribed for people with chickenpox who are at risk for complications. The drug, which can make the infection less severe, must be given within the first 24 hours after the rash appears. Acyclovir can have significant side effects, so it is only given when necessary. Your doctor can tell you if the medication is right for your child.

Dealing With the Discomfort of Chickenpox

You can help relieve the itchiness, fever, and discomfort of chickenpox by:

• Using cool wet compresses or giving baths in cool or lukewarm water every 3 to 4 hours for the first few days. Oatmeal baths, available at the supermarket or pharmacy, can help to relieve itching. (Baths do not spread chickenpox.)
• Patting (not rubbing) the body dry.
• Putting calamine lotion on itchy areas (but don’t use it on the face, especially near the eyes).
• Giving your child foods that are cold, soft, and bland because chickenpox in the mouth may make drinking or eating difficult. Avoid feeding your child anything highly acidic or especially salty, like orange juice or pretzels.
• Asking your doctor or pharmacist about pain-relieving creams to apply to sores in the genital area.
• Giving your child acetaminophen regularly to help relieve pain if your child has mouth blisters.
• Asking the doctor about using over-the-counter medication for itching.

Never use aspirin to reduce pain or fever in children with chickenpox because aspirin has been associated with the serious disease Reye syndrome, which can lead to liver failure and even death.

As much as possible, discourage kids from scratching. This can be difficult for them, so consider putting mittens or socks on your child’s hands to prevent scratching during sleep. In addition, trim fingernails and keep them clean to help lessen the effects of scratching, including broken blisters and infection.

Most chickenpox infections require no special medical treatment. But sometimes, there are problems. Call the doctor if your child:

• has fever that lasts for more than 4 days or rises above 102° Fahrenheit (38.8° Celsius)
• has a severe cough or trouble breathing
• has an area of rash that leaks pus (thick, discolored fluid) or becomes red, warm, swollen, or sore
• has a severe headache
• is unusually drowsy or has trouble waking up
• has trouble looking at bright lights
• has difficulty walking
• seems confused
• seems very ill or is vomiting
• has a stiff neck

Call your doctor if you think your child has chickenpox, if you have a question, or if you’re concerned about a possible complication. The doctor can guide you in watching for complications and in choosing medication to relieve itching. When taking your child to the doctor, let the office know in advance that your child might have chickenpox. It’s important to ensure that other kids in the office are not exposed — for some of them, a chickenpox infection could cause severe complications.

You can have a drug-free delivery in a traditional hospital setting, but it’s likely to be easier to labor naturally at a birth center or at home. Birth centers are designed to provide a natural, family-centered experience, and you can certainly arrange things as you like at home.

If you’re planning a natural childbirth at a hospital, you’ll need to discuss your wishes and goals explicitly with your caregiver, and find out which interventions are routine and how you might get around them. Certain interventions, such as having an IV and continuous electronic monitoring, make moving around more difficult. This tends to make it harder – though not impossible – to handle with the pain without medication.

Many women choose a midwife to guide them through natural childbirth. Midwives are trained to help you cope with the demands of a drug-free labor and often stay with you throughout labor, while doctors typically do not.

If you’re giving birth in a hospital, you’ll be assigned a labor and delivery nurse to care for you. Some nurses are very skilled in natural coping techniques, but you can’t predict which nurse you’re going to get. Nurses come and go in shifts, and the nurse may have other patients to care for as well.

If your practitioner won’t be by your side for the duration of your labor, hiring a doula to stay with you and coach you may be particularly valuable.

Find a childbirth educator with a strong focus on natural childbirth to teach you a variety of coping methods and help you understand what to expect during labor. Understanding what’s happening during each stage can allow you to appreciate and work with your body’s powerful performance.

Whether or not you plan to have a natural delivery, it’s a good idea to learn as much as you can ahead of time about both natural and medicinal pain management. Tension and fear tend to heighten the perception of pain, and anything you can do to ease your anxiety will help with the challenges ahead. Being less anxious may even help the progress of your labor, because high levels of stress hormones can affect your uterus’s ability to contract.

Also, if you’re planning a natural childbirth, it’s important to remember that no matter how well prepared, healthy, or confident you are, it’s always possible that nature will throw you a curveball. You might need medical interventions that make it more difficult to manage your pain naturally, or your labor may be much longer or more painful than you had anticipated.

Even if you feel strongly now about how you’d like to deal with labor pain, a willingness to roll with the reality of your own labor and birth as it unfolds may ultimately be your greatest strength – and will also help you avoid disappointment if you don’t have the “ideal” birth you’d imagined.

Beyond the resolve to give birth without medication, there are no special rules for a natural delivery, but here are a few of the more common natural coping techniques:

Breathing exercises and visualization

Most childbirth classes cover breathing and visualization techniques. You and your partner may be given specific breathing patterns to practice, and your instructor may coach you on using visualization (imagining a place that soothes you, for example, or the safe, easy birth of your baby) to help you work through the pain.

You might also learn techniques like progressive or controlled relaxation, in which you release tension by zeroing in on a particular muscle, tightening it up, and then letting it go until it’s as loose as possible.

These techniques draw on relaxation and partnership as a way to manage your contractions, and they may work especially well if your labor progresses as it should.

If you’ve ever studied yoga, a martial art, or meditation, you might already have the practice you need to breathe through your birth. You might find, too, that bringing something special to look at (a favorite photograph, for instance) and having soothing music helps you relax.

One-to-one labor support

Having someone at your side who’s committed to giving you emotional reassurance as well as helping you be as comfortable as possible can dramatically reduce your anxiety and stress level and help you get through the rigors of labor without drugs.

Research shows that women who have continuous professional support are less likely to need systemic pain medication or an epidural during labor, tend to have slightly shorter labors, and are more likely to have a normal vaginal birth than those who don’t have such support. This may be especially true when one of the people attending you is a specialist like a doula, who has no other responsibilities but to offer support in labor and minister to your comfort.

Positioning and movement

When you’re not medicated or tethered to a monitor, you can try a variety of positions during labor, including standing or leaning on your partner, sitting, and kneeling (either upright or on all fours).

You may find movement comforting, too, and can try walking or rocking in a chair or on a birth ball. Moving around can make you feel more in control, thus lessening your anxiety and pain. Some hospitals have wireless monitoring systems, so even if you have complications that require continuous monitoring you might still be able to move about freely.

During the pushing stage, an upright position may help your baby descend, and squatting or kneeling may help to open your pelvic outlet. That said, the differences aren’t that great – so feel free to try a variety of positions and settle on the ones that make you most comfortable.

Hypnosis

Some studies suggest that hypnosis may reduce your need for pain relief medication during labor, reduce the need for oxytocin, and make a normal vaginal birth more likely. To use self-hypnosis, you’ll need training and practice ahead of time so you can learn how to focus and relax your muscles during labor.

Massage, touch, and hot and cold therapy

Massage promotes relaxation, soothes tense muscles, and may reduce your perception of labor pain. You can get a massage from your doula or other support person, or from your partner – a loved one’s touch can be very reassuring if you’re feeling anxious. You may be comforted by light stroking, or you might prefer a stronger touch.

If you’re having back labor, you’ll probably want firm massage or steady counterpressure applied to your lower back. At times during your labor, though, you may find massage to be annoying and will need to communicate that to your support team.

Many women also swear by using warm compresses or a hot water bottle on an aching lower belly or back – or anywhere else they’re feeling discomfort – to help them relax and reduce pain. Some find cold packs more soothing, while others prefer alternating hot and cold. It’s worth giving each a try. Just be sure to protect your skin from direct contact with heat or cold.

Hydrotherapy

Hydrotherapy – using water to soothe and relax the body – can help ease the discomforts of labor.

Soaking in a bath at home appeals to some women during early labor. Most birth centers (and some hospitals) provide extra-large or Jacuzzi-style tubs for laboring women. And to prepare for giving birth at home, some women rent special portable tubs that are larger, deeper, and softer than a regular bathtub.

Like other drug-free options, hydrotherapy allows you to remain alert and in control. Immersing yourself in water relieves pressure on the body, promotes muscle relaxation, and may reduce pain, anxiety, and the need for medication. As many women who have been there will attest, a warm shower can also be soothing during labor.

If you choose to settle in for a soak, make sure the tub water is at body temperature (98.6 degrees Fahrenheit) or cooler. Anything higher can raise your temperature – and your baby’s temperature and heart rate.

Not all women are good candidates for water therapy during labor, of course. It’s clearly not an option if you have complications that necessitate continuous monitoring, for instance. And most caregivers advise against immersion if your water’s already broken, to avoid the risk of infection from bacteria lurking in the tub, water jets, or hosing. (A shower is fine, though.)

Acupuncture

Acupuncture, used for centuries in traditional Chinese medicine, involves inserting and manipulating fine needles at specific points on your body.

No one really knows for sure how acupuncture works to reduce pain. Two common theories are that the technique either blocks certain pain impulses to the brain or stimulates the release of natural pain relievers called endorphins. The acupuncture points commonly used in labor include spots on the hands, feet, and ears.

Though there aren’t a lot of good studies on the use of acupuncture in labor, available evidence suggests that it reduces the need for pain medication and possibly lowers the likelihood that you’ll need oxytocin to augment contractions.

The downside of this technique is that it requires a skilled practitioner, and few doctors or midwives are trained acupuncturists. If you’re interested in trying this method and are having your baby at a birth center or at home, you may be able to arrange for a certified acupuncturist to be on hand.

If you choose to go this route, you accept the potential for pain and discomfort as part and parcel of giving birth — an experience that includes working with complete awareness through each stage of labor. But with the right preparation and support, you’ll probably feel empowered and deeply satisfied by natural childbirth.

Here are the pros:

• Most natural childbirth techniques are not invasive, so there’s little potential for harm or side effects for you or your baby.

• Many women have a strong feeling of empowerment during labor and a sense of accomplishment afterward. And despite having to endure pain, many report that they’d want an unmedicated birth again the next time. For some women, being in charge helps lessen their perception of pain.

• There’s no loss of sensation or alertness. You’ll be awake and active during labor and birth — so you can move around more freely and find positions that help you stay comfortable during labor and remain able to aid the delivery process when it’s time to push your baby out.

• If you don’t need to be hooked up to an IV or a monitor, you can move around with ease

• You’re less likely than women who get epidurals to need interventions such as oxytocin (Pitocin) to make your contractions stronger, bladder catheterization, or a vacuum extraction or forceps delivery.

• Your partner will feel involved in the process as you work together to manage your pain.

• Breathing exercises, visualization, and self-hypnosis can be practiced ahead of time — and used again later. Many new mothers find themselves drawing on their relaxation techniques in the early days of breastfeeding, while coping with postpartum discomfort, or when caring for a newborn feels especially stressful.

What are the disadvantages of going without drugs?

Unlike an epidural, natural pain-reduction techniques don’t eliminate pain — so if you’re not willing to feel and work with the pain, you’ll be happier with an epidural. Also, natural approaches may not offer adequate pain management, particularly if you end up with a prolonged labor or a complicated labor that requires a lot of interventions.

How soon will I know?

The first signs of pregnancy

Periods are sometimes late and just missing one doesn’t necessarily mean you are pregnant. But if your breasts feel swollen and you feel nauseous particularly first thing in the morning, you would be advised to have a test.

When can I take a pregnancy test?

You can take the test any time you think you may be pregnant. However, you should know that conception takes place at the time of your ovulation – normally on the 14th day of your cycle (day one being the first day of your period). So if you take a pregnancy test on the day after sex, don’t think a negative result means you’re not pregnant; conception may take place a few days later!

When will baby be born?

The average pregnancy lasts 40 weeks and the starting point is day one of your last period – even though you hadn’t conceived then! You’ll find a calculator on another page which will give you a fairly accurate estimate when baby will arrive, and you will get another, probably more accurate, estimate when you have your ultrasound scan.

Does having sex in the missionary position determine whether you have a Boy or Girl?

No. There is no evidence to suggest that, nor are you likely to have a boy if you have sex standing up or when your partner enters from behind. Nor is there any evidence that lying on your back with your legs in the air after sex will improve your chance of conceiving – but if you want to try it make sure you close the curtains!

Are you more likely to have a boy if your partner has brothers?

No. Your partner’s sperm does determine the sex of the baby, but whether you have a boy or girl is a random process. Your eggs contain just a female or X chromosome, whereas a man’s sperm contains either a male, or Y, chromosome or an X. The sperm that gets to the egg first and fertilises it will determine the sex of the child. Female sperms are larger and swim slower than the males. So why don’t you always have boys? Well, when the male sperm arrives the egg may not have been released from the ovary and the sperm dies off. The female sperm arrives later by which time the egg has been released and fertilisation takes place. If you want a boy try having sex as close as possible to ovulation when the egg is released, or just after if you want a girl. You can buy an ovulation testing kit to help with timing.

If you already have two Boys or Girls, are you likely to have a third?

Yes. Although sex selection is random, some men have better quality X or Y chromosomes and have large families of just girls or boys. If you are desperate for a girl, get your partner to go scuba diving! Studies show that the more delicate Y chromosomes don’t survive the pressure experienced at depth.

If you have an orgasm, are you more likely to conceive a Boy?

No. The male sperm may swim towards the egg a bit faster, but it depends whether the egg has been released when it gets there.

It it easier to get pregnant a second time?

Yes. Which is surprising considering you’re so tired through looking after the first one! On average it takes couples with children six months to conceive, as opposed to twelve months for couples without kids.

Are Boys more likely if you conceive on odd days of the month?

No. Nor are there fairies at the bottom of your garden!

Can tight underpants harm sperm quality?

Yes. Sperm likes to be at slightly below normal body temperature, which is why the testicles are outside the body. Tight pants hold the testicles closely against the body consequently sperm quality can be reduced. Boxer shorts are more comfortable and more sperm-friendly.