Sunday, 16 March 2008

Becoming a father : Reference Section

Summary of Nutrient Sources
The government recommendation is to eat five to nine servings of fruits and vegetables a day. Looking at the lists below this makes sense, though it is important to make sure it includes leafy green vegetables like spinach.
It is also important to east a fair amount of meat and fatty fish. This is clearly not an option for vegetarians, so they need to pay particular attention to making sure they get all the nutrients they need. It is possible to get all the nutrients on a vegetarian diet, though some are rather harder to absorb from vegetable sources. Also it is worth noting that unless they specifically say they are vegetarian many of the supplements are made with animal products.
Essentially what is required is not just a healthy diet, but also a varied diet. That said stress is not a good idea, so it may be worth considering supplements (see the next section). You will still want to try and eat a healthy selection of all the sources below, but supplements will help to prevent the need to worry about food. Food should be enjoyed, and with a healthy diet that can be very easy.

Folic Acid
Folate is commonly found in leafy greens, orange juice, legumes and fortified grain products. Spinach is a particularly good source.

EFAs
The best sources of EFAs within a healthy diet are:
• Fatty fish (herring, sardines, halibut, mackerel and blue fin tuna),
• Wild game (buffalo and venison)
• Vegetarian sources include canola oil, flaxseed, flaxseed oil, walnuts, and leafy green vegetables such as spinach
• Alternative sources include omega-3 enriched eggs and milk as well as enhanced breads

Vitamin B12
Liver, kidney, yogurt, dairy products, fish, clams, oysters, non-fat dried milk, salmon, sardines.

Vitamin C
Citrus fruits (especially kiwi fruit), berries, tomatoes, cauliflower, potatoes, green leafy vegetables, peppers.

Vitamin D
Milk, Salmon,

Vitamin E
Wheat germ oil, almonds, sunflower seeds and sunflower oil and to a lesser extent spinach and broccoli.

Calcium
Low-fat milk, yoghurt,

Selenium
Some good sources of selenium include red meat, tuna, chicken, and enriched pasta and whole grain breads.

Zinc• Meats (especially liver)
• Seafood (particularly Herring)
• Vegetarian sources include eggs, nuts, peas and beans


Pregnancy timetable
Baby Development from Period to Birth
A pregnancy lasts 266 days, though it is usually counted as 280 days as it is usual to count from the first day of the last period. It is important to understand that the following timetable is pretty approximate. Some things babies do during their development have fairly fixed occurrence dates, but that does not mean that the symptoms these produce will let themselves be bound by any schedule.

This is a guide to give you an understanding of what is going on, but if your partner gets sore breasts from week 3 this means she has sore breasts from week three. Do not try to read too much into it, just try and be supportive, making her feel loved and cherished.

Your partner will know what she is feeling where a guide can only tell you what she might be feeling. This is the person you have chosen to have a baby with, so listen to what she tells you and try to help where you can.

Weeks 1-4 Fertilisation and embedding in uterus. If you are watching carefully you may even be able to spot a fertilised egg at this stage (by the change in consistency of her vaginal secretions), but until it is a bit more firmly rooted in reality it is just as well to take this as a sign that whatever you are doing to conceive is the right thing, and not as a sign that you have caused conception. Your partner may experience some implantation bleeding 6-12 days after conception. Having said that she might get some bleeding from the embryo failing to implant too, so do not read too much into anything at this stage.

It is also worth noting that the first few weeks of a pregnancy do not actually involve your partner being pregnant. While taking vitamin supplements, not smoking and not drinking are still important there is no egg or sperm involved to start with, simply because it makes for easier timekeeping.


Week 5 Missed period. This is the time for a pregnancy test or two. If the first one is negative leave it a few days or even a week before trying the second if a period still does not turn up.


Week 6 The embryo is now officially a foetus. At this point it will be about the size of a baked bean. Spine and nervous system start to form. Time to see a GP or midwife. While you are there it is worth getting form FW8 which entitles your partner to free prescriptions. They will also give you a folder that needs to be taken to all appointments with your partner and a bunch of free stuff to advertise various baby related products.


Week 7 Lungs, jaw, nose, heart and palate have begun to form. The heart may even be detectable.

Morning sickness may start. Saying this in any one week is a bit silly. About 50%-80% of women get morning sickness and it can start anywhere from week 3 onwards. It can range in severity from a mild nausea (at any time of day) to full-on throwing up all day every day.

If it gets really bad contact the doctor. This is one of the times when you need to be in the forefront as many doctors will not realise how bad it is from listening to the woman concerned. If she is really not keeping enough food down it can be an issue and you will need to persuade the doctor that this is the case. Having said that, it may feel pretty awful from her point of view even if it does not look too bad. Try to be objective and if you feel she needs help go along and make sure she gets it. Arguing your case when feeling sick is not easy.

If she is not bad enough to need medical help (and few people are) then try taking over in the kitchen. If food makes her feel ill try to confine the times she has to deal with it to the minimum required for eating. She may find certain things make her feel better or worse. Find out what they are and try to help.

NB (note to self) following needs completing and ordering

8 First scan if history of miscarriages or if bleeding/spotting has been occurring.

9 about 50 mm long. Most major organs exist. Eyes and ears starting to form.

10-13 Dating scan.

11 Foetus looks real now. Umbilical cord now fully formed and supplying nourishment and removing wastes.

12 Risk of miscarriage now low and traditional time to tell people. Most likely week for dating scan.

13 Uterus starts coming up from behind pelvic bone, pregnancy more noticeable.

14 Sometimes referred to as 1/3rd of the way through though it makes little sense.

15 Blood tests for downs takes place somewhere between week 14 and week 16.

16 Toe and finger nails formed also eyelashes and eye brows. Around now the protective body hair coating that protects the baby in utero is formed.

17 Uterus still rising, and pregnancy more noticeable to people who did not know already. Baby able to hear external noises.

18 Foetus now big enough (110 mm or so) that movement can be felt. Actually this is a bit of a myth, mothers can usually start to feel their first baby anywhere from 16 weeks through to 20 weeks, and even then we are only talking ‘usually’. There is no hard and fast timetable for this one, you will just have to take your partner’s word. Some people claim that additional fat can make you less sensitive, but some mothers claim the reverse. It seems likely that skinnier women have a better chance of feeling it early, though one extremely skinny woman managed to go all the way to term without realising she was pregnant, so it can work either way.

19 Baby growing fast. It will finish the week at nearly 1/3rd of a kilo and around 200 mm. Tooth buds have formed inside gums.

20 Time for the next scan. This one may show the sex of the foetus if he opens his legs. It can also show the sex if she opens her legs, but if she is female it is a little harder to be certain.

21 Foetus growth now starting to impact on the mother’s lungs. Shortness of breath is quite common. Possible additional scan to check all the internal organs.

22 Foetus starts to be able to feel taste and touch sensations.

23 Skull bones start to harden (though they will not finish hardening until after the baby is born or there will be no way to fit the head through to get it out).

24 About the youngest a baby can be born and have a chance of survival though still less than 50%.

25 All organs now finished, just growing from here on. Better than 50% survive if born at this point. Pre-Eclampsia now a possibility.

26 Skin begins to become less transparent

27 Foetus is now up to around 340 mm and about 800g.

28 Routine test for Pre-eclampsia. Also time for an injection to protect future pregnancies if your partner has Rh negative blood and you have positive Rh (Blue baby syndrome).

29 We are in the third trimester now, so things like RLS may be showing up.

30 In all probability you will be able to feel the baby move by now (you may have been able to for literally months, but you may not until now).

Irregular painless squeezing sensations near the top of the uterus (Braxton Hicks contractions) may begin now. While they are irregular and painless do not worry as they are just preparation for labour. If they become painful or start to become more frequent (more than 3 times an hour) then assume they are the real thing and call a doctor or midwife.


31 The foetus can now tell if it is light outside, as enough light filters through the mother and the foetus’ eyelids to be recognised by the eyes which are now sensitive and able to feel it. Your partner’s breasts may start to produce the high calorie milk precursor (colostrum).

32 Time for another antenatal appointment.

33 Time for the baby to turn head down ready to match up with the pelvis, see week 36.

34 Uterus pressing on stomach may make eating proper meals harder for your partner. Small snacks will show affection and win brownie points. For some mothers, little and often, seems to be the only way they can eat from here on.

35 Time to discuss birth options.

36 Time for a first baby to move its head into a docking position with the pelvis. This is known as being “engaged”.

37 Lungs mature and able to breath unaided if born prematurely.

38 Babies born from now on are no longer premature. All that is left to do is put on more weight.

39 Another ante-natal appointment.

40 Birth might take place if baby is running dead on due date. Actually anywhere within a couple of weeks either way is pretty normal.
the conventional 40-week pregnancy length is completely arbitrary. It was established by a German obstetrician in the early 1800s. He decided that a pregnancy should last 10 moon months (40 weeks) each. However, when researchers in a 1990 study followed a group of healthy, white women, they discovered that the pregnancy in first-time mothers averaged 8 days longer than this, and the average was 3 days longer in women with prior births (Mittendorf et al. 1990). This means that first-time mothers are not only not "late" at 41 weeks, they haven’t even reached the average pregnancy length.

The following happen but I have not put them into the order yet (see not to self above)
Internal organs

Placenta attaches lowering miscarriage risk

Placenta starts fully filtering lowering toxoplasmosis and other disease related risks. Less care eating and drinking required.

Shedding protective body hair

Hearing

Eyes register light

Eyelids separate

Movement of foetus can be felt externally


Things that can go wrong
Problems conceiving
Problems during the gestation period
Miscarriages

Causes.
How to spot a potential miscarriage and what to do if you do notice in time.


Premature birth
Before I say anything else on this subject I should say that premature birth is not common. A baby born anywhere from 37 weeks onwards is not premature. A little early perhaps, but no worse off for that. I have included this section so that if a really premature birth does happen in your case you have some figures for reference to give you a grasp on what is going on and to try and understand it. It is not likely to happen. I do not recommend spending time on this section unless it is actually happening to you or someone you know. It is a horrendous thing to happen and will depress you unnecessarily. If it is happening to someone you know please give them quiet support as they will need it.

Why Are Some Babies Born Early?
This is not an area where the reasons are fully known. A number of known possible reasons are as follows.

• Infections in the mother

• Multiple babies. The uterus starts to contract when it is as stretched as it can cope with so most multiple births are born before 38 weeks, and quite a number are born a lot sooner.

• Weakness in the cervix.

• If you have a condition that affects your health or your baby's (such as severe pre-eclampsia) the medical staff might advise you to have an induction.
If your labour starts early by itself, you will either experience rupture of the membranes, or you will start to feel contractions. If you think you might be in labour, or if you are bleeding, call the hospital or the midwife immediately.
It may be possible to slow down or even stop a premature labour. Drugs that stop the contractions may give the baby more time in the uterus thus improving the chances of survival (see below). There are also treatments to prevent the baby being born with RDS which seriously affects breathing.

Again, when a baby is premature the realities are pretty harsh, but my feeling is that in that case it is better to know. If you do not feel the same, or if you are not sure, now is the time to skip past this to the glossary, or to go and look at some baby shopping catalogues elsewhere.

Will A Premature Baby Live?
Premature labour is usually defined as labour beginning before the 37th week of pregnancy. Over the last few years a premature baby’s chances of surviving without any long term problems have increased significantly. There are two hurdles for a premature birth:

1. Surviving the birth itself

2. Surviving from birth onwards.

Premature babies born before 24 weeks rarely survive more than a few days. The survival rate of live-born babies at 24 weeks is around 40% thereafter every week adds about another 10% to the survival rate up to 28 weeks where the rate is around 80%. After that the survival rate goes up more slowly (otherwise it would go beyond 100% after 30 weeks), but does continue to go up. The birth weight makes a significant difference. Being over 500g at birth seems to add almost another 10% to the chances of a premature baby.

By the time the pregnancy has reached week 35, the baby may need to spend some time in special care, but will probably be fine. Some premature babies that survive have long-term disabilities or conditions that affecting their health. This is something to talk to the doctors about when you are becoming more confident that your baby will live.

In general the prospects of a premature baby are determined by:

• The number of weeks gestation (the later, the better, see above)

• The baby's weight (heavier babies usually have a better chance of survival)

• Whether the baby has any birth defect (e.g. cleft palate, Down syndrome)

• The availability of specialist care (in the UK, Europe and the states this tends to be pretty good).

Problems with the birth itself

Problems with the child afterwards.


Warning signs to watch for.

These are a list of things that could indicate a problem with the health of the foetus, the health of your partner, or the progress of the pregnancy. If you see any of them it is worth calling the doctor. As I said in the disclaimer no book is ever going to be as good as having proper medical attention and this book is no exception. Most of these signs can happen and then go away with no explanation. Do not wait to see if they will go away, call and get help. Pregnancies can do all sorts of strange things, but when there is a warning it pays to take notice.

Weight warnings
Keep track of your partner’s weight. If you find she is doing any of the following it is worth calling a doctor or midwife as they can be indicative of a large variety of problems. Clearly you should discuss this with your partner before making the call.

• Gaining more than 3 pounds in any week between week 13 and week 27 (inclusive).

• Gaining more than 2 pounds in any week after week 27.

• Not gaining weight for more than two consecutive weeks from the 4th month through to the 8th month (inclusive).

• Gaining more weight then you expected while eating healthily.

NB The last point is a judgement call, so spend even more time discussing it with your partner before phoning the doctor.

Spotting or vaginal bleeding
If your partner talks about seeming to have a period, spotting or bleeding it is time to pay close attention. This is particularly so in the first three months when miscarriages are most likely. This is a good time to get the midwife in urgently to do a pelvic exam to see if the Uterus is open.

About 25% of women have some spotting during the first months, of these only about 50% stop bleeding and finish the pregnancy normally. The causes can be varied ranging from a hormone imbalance threatening a miscarriage through an ectopic pregnancy to a full miscarriage. Once again, if there is vaginal bleeding seek medical attention. If she also gets cramping, call urgently, do not wait for anything. Your partner may be the one in eight who gets the bleeding without problems, but if that is the case calling the doctor will have done no harm at all. If she is not you may have saved the pregnancy.

Pre-eclampsia or toxaemia
Symptoms include bad or continual headaches, visual disturbances (blurring or spots before the eyes usually), excessive weight gain , fluid retention, sudden swellings (typically hands, feet or ankles) and high blood pressure.

Pre-eclampsia/toxaemia, is a pretty serious condition causing danger to your partner as well as to the foetus, and can require your partner to be hospitalised. Toxemia can cause low weight babies (a danger to the child long term) premature birth and other forms of foetal trauma.

Excessive morning sickness
If your partner cannot keep enough fluids down because she is continually throwing up for a one or two days this can cause dehydration. Call the doctor; as well as being bad for the foetus this can be very bad for her, and may require her to go into hospital.

Fever, chills or hot and cold flushes
A fever, chills or hot and cold flushes are warning signs, particularly if she has no symptoms of a cold. A high temperature can be dangerous in itself, as well as possibly indicating problems, as it can cause her to go into labour prematurely. As with all the warning symptoms found here get medical advice.

A sudden gush of fluid from the vagina may be an indication of the premature rupture of the membranes in the last trimester of pregnancy. When this occurs, an infection known as amnionitis develops the symptoms of, which are fever, a discharge that gives off a bad smell and abdominal pain. This is potentially dangerous for the fetus.

Urinary tract infection
Sometimes pregnant women need to urinate frequently. They may also feel some discomfort during urination either as a burning sensation or a dull pain in the lower abdomen towards the end of urination. These are the symptoms of a urinary tract infection.

Abdominal pain
Sudden intense or continual abdominal pains early in the pregnancy could signify a miscarriage. These symptoms late in pregnancy could be a precursor for premature labour.

Rash
Possibly indicative of Rubella (German measles)

Lack of foetal movement
If a pregnant woman feels a marked decrease in foetal movement, you/she should consult the doctor immediately as this could indicate foetal distress.


Frequently asked questions
Why don’t I feel excited?
Why do I feel pushed out of everything?
What can I do to become more involved?
How will I support the baby?
Will we still have time for a relationship?
Will we ever sleep again?
Everyone keeps telling me this will be the end of sleeping, is this true?
How can I prepare?
Will it affect sex?
Why is she so irrational?
Is it mine?


Things she should avoid
See also the wallet card summaries included in the book. These can be put in your wallet and kept with you for easy reference.

Chemicals
o Pesticides.
It has been suggested that both garden and agricultural pesticides cause a greater risk of neural tube defects, oral clefts and heart or limb defects.
o Cleaning products and bleaches in enclosed poorly ventilated spaces. Cleaning products seem generally reasonably safe though it has been suggested that oven cleaning may be too poorly ventilated to be a good risk.
Foods she cannot eat
Meats
o Liver
o Pate
o Uncooked meats such as
Parma Ham, real Spanish sausage, etcetera
Dairy
o Blue cheeses
o Cheeses with mould based rinds like brie and goats cheese
o Uncooked Goats Cheese
o Unpasteurised cheeses
o Anything containing raw egg
Home made Mayonnaise, Mousses, poached or soft boiled eggs, etcetera
Seafood
o Marlin, Swordfish, Shark, much Tuna (canned is better than fresh).
o Pickled fish (it is generally raw)
o Semi or uncooked shellfish
Medications
o Anti Thrush pills
o Painkillers
o Almost any other medication.

Most medications seem to carry a risk for pregnant mothers. Always read the label, and if buying from a pharmacy consult the pharmacist. If being prescribed by a doctor consult the doctor.

Habits she should break
o Smoking
o Drinking
o Drugs
o Gardening
o Dog walking on the public highway
o Changing the litter tray


The law and your rights

Paternity leave
From 2003 men can take up to 2 weeks paternity leave at £100 pw
Men can take up to 13 weeks unpaid maternity leave

Eligibility
Employees must satisfy the following conditions in order to qualify for paternity leave. They must:
• have or expect to have responsibility for the child’s upbringing
• be the biological father of the child or the mother’s husband or partner
• have worked continuously for their employer for 26 weeks ending with the 15th week before the
baby is due



If there are any problems with your partner’s employers are handling her maternity leave you may wish to provide backup and to talk to them from a point of knowledge. Here are a few details about maternity leave:

Eligible employees can choose to take either one week or two consecutive weeks’ paternity leave (not odd days).
They can choose to start their leave:
• from the date of the child’s birth (whether this is earlier or later than expected), or
• from a chosen number of days or weeks after the date of the child’s birth (whether this is earlier
or later than expected), or
• from a chosen date later than the first day of the week in which the baby is expected to be born.
Leave can start on any day of the week on or following the child’s birth but must be completed:
• within 56 days of the actual date of birth of the child, or
• if the child is born early, within the period from the actual date of birth up to 56 days after the first
day of the expected week of birth.
Only one period of leave is available to employees irrespective of whether more than one child is born as the result of the same pregnancy.

Women have a statutory right to:
• Take time off work for antenatal care
• Right to work in a safe environment
• Claim unfair dismissal if dismissed because of pregnancy
• Take 18 weeks maternity leave
• Right to return to work after baby is born
In addition women may have right to maternity pay


Ensuring the child is registered as yours
Car seats and taking the baby home.
What they say about letting you leave
Taxi’s, buses, trains and other transport methods.



Pregnancy related books and web sitesBooks
For you
About becoming a parent: None (well that is why I wrote this)
Sex books Nancy Friday, Cosmo book or similar
Stress Books:

For her
Best friend book
Week by week book

For both of you
Penguin names book
What not to name your baby (’cos it is funny, not because they are not good names)


Web Sites
www.babycentre.co.uk
(note to self) add others and classify them by type.

Other media
Coupling series four DVD
(note to self include reference to a Good DVD of a birth to know what it is actually like, how much blood, gore, etc.)
Shops and web sites for baby related shopping


Glossary

Acidity/alkalinity
The property of being acid/alkali. Acidity in a mild form is sourness; acids eat away at a variety of substances including glass and metals. The acidity of the vagina is one of the factors that prevents sperm from living more than a short time. Alkalinity is the opposite of acidity and acids and alkali neutralise each other. Alkalinity can also be corrosive a good example of which is the almost painful heat from chilli peppers which is caused by the natural acidity of the plant.
Agglutination
Clumping together. This makes it more difficult for the sperm to swim, and so harder for them to reach the egg to actually fertilise it.

Androgenic hormones
Any steroid hormones that control the development and maintenance of masculine characteristics such as facial hair, deep voices, muscle development, sexual response and so forth.
Examples of androgenic hormones are testosterone and androsterone.

Androsterone
See androgenic hormones.

Blue baby syndrome
If you have Rh positive blood and your partner has Rh negative blood then your partner’s body body may produce antibodies that will cross the placenta and cause problems in the growing baby (erythroblastosis fatalis or "blue baby syndrome").
The remedy for this is simple and effective. An injection of Rh immune globulin at 28 weeks and another after the birth. This prevents the production of antibodies to the Rh factor and protects future pregnancies.

Bulbourethreal fluid
See Cowper’s fluid.

Campylobacteriosis
Campylobacter is a bacterium commonly found in animals and the environment. Infection can result form the same causes as for Toxoplasmosis as well as drinking non-chlorinated water.
The symptoms of Campylobacter infection are usually flu-like, followed by diarrhoea, abdominal pain, nausea, and vomiting. Miscarriage and premature labour can occur.

CDC
The United States Center for Disease Control.

Colostrum
Colostrum is the pre-milk produced in your partner’s breasts at the start of breastfeeding. This special milk is low in fat, and high in carbohydrates, protein, and antibodies to help keep a baby healthy. It is prefect for the first food the baby consumes as it is extremely easy to digest. It is small in quantity but highly concentrated nutrition for the newly born baby. Colostrum has a laxative effect on the baby. This laxative aids the excretion of the breakdown products from the blood that has sustained the baby until birth; it also helps prevent jaundice.

Cowper’s fluid
Also called ‘Bulbourethreal fluid’ or ‘pre-cum’ this is clear fluid is released during sexual arousal as well as in the semen. It is there to cancel out the effects of any urine that may still be in the urethra.

Ejaculate (verb)
To eject or discharge (semen) in orgasm. Colloquially ‘to come’.

Ejaculate (noun)
The fluid, semen, discharged during ejaculation.

Ejaculatory duct
Either of the paired ducts formed by the junction of the seminal ducts with the vas deferens, through which semen is ejaculated.

Episiotomy
A surgical incision to try to help the baby fit through the vagina. Colloquially “A Cut”.

Fallopian tubes
A tube, or duct, for the passage of ova from the ovary to uterus where further development takes place.

Female reproductive hormones
Any of various natural steroids secreted chiefly by the ovaries, placenta, adipose tissue, and testes, and that stimulate the development of female secondary sex characteristics and promote the growth and maintenance of the female reproductive system.
NB these, or rather the various synthetic or semi-synthetic steroids (such as ethinyl estradiol or norgestimate) that mimic the physiological effect of these natural hormones are what are used in ‘the pill’ to fool the female body into thinking it is pregnant and so stopping conception.

Folic acid (folacin, folate, vitamin bc)
A yellowish-orange compound of the vitamin B complex group. Found in green plants, fresh fruit, liver, many fortified grain products and yeast.
Deficiency of folic acid has been linked to such ailments as anemia and poor growth. See also Nutrients above.

Free radicals
An unstable and highly reactive atom or group of atoms. In animal tissues, free radicals can damage cells, cause chromosome breakage and are believed to accelerate the progression of cancer, cardiovascular disease, and age-related diseases.

Listeriosis
Listeria is a common bacterium found in many places including animal faeces, on plants, in soil and in water. Listeria can occur on raw food and even contaminate prepared food. Listeria can grow on food in the fridge.
Listeria infection usually shows as mild flu-like symptoms including fever and muscle aches.

Oestrogen
See Female Reproductive Hormones.

Ovum/ova
The egg/eggs, produced by your partner which your sperm should fertilise during conception.

Ovulation
The moving of a mature egg (ovum) from the ovaries to the fallopian tubes ready to be fertilised.

Post-natal depression

Pre-eclampsia
A toxic condition developing in late pregnancy that is characterized by a sudden rise in blood pressure, excessive gain weight gain, generalized swelling from accumulation of watery fluid in the tissues (Also known as dropsy), protein accumulations in the urine (which imply kidney problems), severe headache, and visual disturbances
NB This is dangerous both to the baby and to your partner. If it is even suspected take your partner to see a doctor immediately, or if you have a 24 hour number call the midwife. Just less than one in ten women (8%) get this in some form or other, though most at risk are first time pregnancies and older (over 40) pregnancies.

Progesterone
See Female Reproductive Hormones.

Prostaglandin
A significant amount of the semen is made up of Prostoglandins. They are any of a group of hormone-like substances produced in various tissues that are derived from amino acids. They mediate a range of physiological functions, such as metabolism, nerve transmission and smooth muscle action.
Drugs that lower prostaglandin levels inhibit the development of male sexual behaviour. Prostaglandin is also used for the induction of birth and early termination of pregnancy.

Prostate
Produces prostatic fluid used for lubrication of the urethra, and protection, nourishment, and mobility of the sperm in the normally acid environment of the female vagina. Prostatic fluid is full of a lot of the good things discussed under nutrition like calcium, zinc, and citric acid.

RDA (recommended daily amount)
The RDA is the amount (for each) of vitamins and minerals recommend for the average person. The U.S. federal government sets these levels through the FDA.
The RDA indicates the amount of vitamins and minerals needed to prevent common deficiency diseases (such as rickets or scurvy) for the average person.

RDS (respiratory distress syndrome)
A respiratory disease of newborn babies, especially premature babies, characterized by distressful breathing, cyanosis, and the formation of a glassy membrane over the alveoli of the lungs. Also called hyaline membrane disease

RLS (restless leg syndrome)
RLS is described as an unpleasant sensation (crawling, tingling, cramps or burning) in the legs when sitting or lying still. The pain experienced is usually felt in the calves or thighs and can be relieved temporarily walking around or stretching the muscles. The persistent need to stretch often leaves the sufferer unable to sleep.
This is sometimes experienced in the third trimester, which is a shame as you want to be sleeping well ready for what is to come.

Semen
A thick whitish fluid containing sperm and the secretions from a bunch of glands. The main glands that are involved are the seminal vesicles, the testes, prostate, and bulbourethral glands. Semen is also called ‘seminal fluid’.

Seminal vesicles
A pair of glands on each side of the (male) urinary bladder that secrete the fluid for semen and nourish the sperm. These glands also move the sperm through the urethra when you ejaculate.

Show
Show If you notice blood-tinged mucous ("bloody show") from the vagina, your partner may be losing the mucous plug that has sealed off the cervix up to this point. This is another sign that her body is preparing for labour

Spina bifida
A neural tube disorder of improper development of the spinal cord and back bones, occurring when the lower end of the neural tube fails to close. Spina bifida can cause a range of symptoms depending if any nerve damage takes place, and if so where. As the brain is in some sense the most important organ in the body the most severe effects are when it is damaged. The spine is next, and damage can cause paralysis or loss of feeling, or even, if damage is slight, no symptoms whatsoever. Many people have only discovered that they have some forms of spina bifida (literally divided spine) when they have been X-rayed for other conditions and the division has been noticed.
Related conditions include hydrocephalus (fluid on the brain), anacephaly (brain missing altogether) and encephalocele (a sac which exerts pressure on, and may damage the brain). All of these have a severe impact on the child and its parents. As consuming folic acid in the early stages can prevent this, it is clearly worth ensuring that you and your partner take it, or at least eat enough leafy vegetables.

Spinnbarkeit
From the German meaning the ability to be spun, this refers to the elastic stringiness of cervical mucus during ovulation. It could be used to refer to the same quality in something else, but I have never seen it. If anyone comes up with an appropriate use do let me know as it seems like a really fun word.
Testicles (testes)
The source of sperm and the steroid hormones, such as testosterone and androsterone that control masculine characteristics such as facial hair voice changes and sex drive.
Normally occurring paired in an external scrotum, these are the male reproductive glands that correspond to the female ovary.

Testosterone
See androgenic hormones.

Toxoplasmosis
A disease caused by infection with Toxoplasma gondii. The congenital form, apparently resulting from parasites in the infected mother being transmitted to the foetus, is characterized by lesions of the central nervous system that can cause blindness, deafness and brain damage.
Toxoplasma is commonly found in most sorts of animals, especially cats. Infection can result from contact with animal faeces or soil, eating undercooked meats or salami-type meats (which are usually uncooked), raw milk (not pasturised), and unwashed raw vegetables.

Uterus
The muscular hollow also known as the womb. The uterus is located in the pelvic cavity and is where the fertilized egg implants and develops.
Urethra
The channel through which urine flows when we urinate.

Vas deferens
The sperm-carrying duct, the vas deferens is a small but thick-walled tube about two feet (60cm) long. It is very convoluted as it runs from the epididymis, through the inguinal canal, and down into the pelvis where it joins the seminal vesicle to form the ejaculatory duct.

Womb
See Uterus


Index

Agglutination. See Sperm Agglutination
Breastfeeding, 146
Colostrum, 202, 203
CDC, 202
Complications
Blue Baby Syndrome, 176, 202
Pre-Eclampsia, 176, 206
Premature Birth, 182, 183
Toxoplasmosis, 119, 212
Egg/Ova, 44, 206
Ejaculatory Duct, 204
Fallopian tubes, 204
Female orgasm, 43, 69, 80
Folic Acid, 48, 96, 205
Free radicals, 56, 205
Hormones, 204, 205, 206, 207
Nutrition, 23, 42, 48, 49
Post Natal Depression, 53, 206
Prostaglandin, 207
Recommended Daily Amount, 46, 47, 48, 49, 57, 58, 208
Respiratory Distress Syndrome, 182, 209
Restless Leg Syndrome, 176, 209
Sex, 79
Anal Sex and conception, 82
Sperm
Agglutination, 44
Chromosome breakage, 56, 205
Count, 21, 23, 49, 51, 59, 74
Deformed, 43
Motility, 44, 59
Spina Bifida, 210
Vas Deferens, 213

Disclaimer

I am not responsible for any loss or damage that you may view as being caused by anything that you have seen or read in this book. While every effort has been made to ensure that the information in this handbook is accurate when written, and at time of going to press, I am not providing individual advice to the reader; no book can be a substitute for a qualified medical opinion. Anything that concerns the health of yourself, your partner or your baby is something that should be referred to a qualified professional. This disclaimer should be replaced by a boilerplate legal disclaimer for medical books, and should probably include the publisher and distributor as well.

Copyright Rufus Evison 2005-2008

Friday, 7 March 2008

Becoming a father Chapter 4 : Nutrition

Everyone seems to know that women should take folic acid while they are trying to conceive so that the baby’s brain develops properly. Many people even know that it makes conception that bit more likely. What no one mentions is that nutrition can have a major effect on men too. Below, after a quick explanation of why good nutrition matters for men I discuss the requirements for a man who is ‘trying’ and how to ensure that you fill those requirements. There are also a few asides on your partner’s nutrition and how to avoid this becoming andissue.

Nutrients, How Sperm Are Made And What Can Be Wrong.
A sperm takes around 100 days to make and is clearly important in the conception process. When the sperm enters your partner it has only around six hours in the vagina before the acidity there will kill it. It is important that it is a healthy sperm for it to even have a chance of getting to the egg, let alone being in a condition fertilize an egg upon arrival.

A sperm measures around 1/20th of a millimetre and swims at around 3mm an hour. That means each sperm is swimming around 60 times its own body length an hour, which does not seem that much until you think that it has to swish its tail around 8000 times to move only ten centimetres.

Fortunately a strong female orgasm can cause muscle contractions to suck the sperm to the safety of the more alkaline cervical mucus. This means that most sperm reach the fallopian tubes within an hour, rather than getting too damaged by the acidity.

Possible problems with sperm include:

• Cannot swim in a straight line.
Sperm can suffer from a tendency to zigzag or even to swim around in circles. Not good news if you are a sperm in a hurry to get out of an acid environment.

• Deformed heads. Sperm can suffer from the heads being too big, too small, the wrong shape or even from having more than one head. This can affect ability to swim as well as ability to conceive upon arrival at the egg.

• Deformed tails. Sperm tails are made of two central tails surrounded by two rings of nine fibrils. These must taper to give the sperm proper motility. Again sperm can have these poorly formed or even have two tails.

• Lethargic sperm. If the sperm are not whipping their well formed tails behind their well formed heads they are not going to be moving fast enough to survive the whole journey.

• Not enough sperm. As most sperm never make it close to an egg it is clearly essential to have enough sperm or there will be very little chance of a successful conception.

• Sperm not ‘motile’. If the sperm are stuck together (agglutinating) or otherwise not able to move properly they will not make it to the egg while they are still viable.

More About Sperm
Some sperm facts:

• When you orgasm you ejaculate around 2-5ml of sperm (up to around a heaped teaspoonful). This contains around 90 million sperm per millilitre. Depositing between 150 million and 500 million sperm.

• Sperm can survive for up to around 6 hours in the vagina though most will die within the first hour or less.

• Sperm can live for 3-5 days or even longer in your partner‘s cervix if there is fertile mucus there.

• When your partner is not in her fertile phase her mucus blocks entry to the cervix keeping the sperm out.
Sperm are therefore stuck in the vagina and killed by the acidity of the vaginal secretions.

• Around 8% of couples of who use anal sex as a method of birth control have pregnancies each year.

• Your testicles are always making sperm, so you are potentially fertile all the time, rather than in phases like your partner.

• The natural lubricant produced before orgasm, sometimes known as pre-come can contain sperm, and so can cause pregnancy even without ejaculation.


What Our Bodies Need
To make healthy sperm our bodies need a whole variety of nutrients. To protect the sperm during their journey from where they are made to where they are stored before sex they need other nutrients such as antioxidants. A variety of governmental and other organisations produce recommendations for how much of each nutrient a person need and these are listed on packaging in terms of the Recommended Daily Amount (RDA).

The RDA for vitamins and minerals references the average person. Talking about the average person assumes that you are a healthy adult below 60 with normal digestion, not overweight, leading a relatively stress-free life. It also assumes no medical problems and a good diet. Under this definition very few people are average.

Few adult men consume the RDA for zinc. Zinc is one of the major constituents of sperm. Fewer than 29% of people eat the recommended 5 fresh fruits and vegetables a day . With the way that vegetables have been watered down, in some cases literally, there are grave doubts as to whether the recommended 5 portions a day are still sufficient. If you want to conceive then a healthy diet is very important and supplementing it with one or two tablets is not a bad idea at all.

It should however be emphasised that taking vitamin tablets is never going to be a substitute for a healthy diet. Do make the effort to eat healthily while you are trying to conceive, and to help your partner to eat good food throughout the pregnancy and you may find it has more effect on your sex life, your relationship and your general happiness than you would have believed possible.
Where the symbol is used in the table it means that the given item can be bad under some circumstances, but under others can actively be helpful. Each of these is covered in more detail elsewhere in the book, but in summary Vitamin E is useful up to the RDA, but check with a doctor before going over. Caffeine is generally okay in moderation, but cutting out altogether may be better. The exception to this is that there are some possible good side effects on sperm straight before sex under the right circumstances.


Details of Individual Nutrients
Folic Acid RDA 400ug
Folic acid is a B vitamin found in many fruits and vegetables. Men do not need to take as much of it as women, but they should be consuming it during the 100 day run up to conception. A finding of the Western Human Nutrition Research Center with UC Berkley was published in the journal of Fertility and Sterility; it suggests that low levels of folic acid correlate with decreased sperm count and low sperm density.
Your folic acid could be in the form of green leafy vegetables like spinach or it could be in the form of vitamin pills, but you do need to make sure there is enough of it in your diet.

The same study suggests that where there is a lack of folic acid there is more likely to be chromosome damage in the sperm which may contribute to an increased risk of childhood cancer.

A supplement containing the RDA of 400 micrograms per day wouldn't hurt. While too little sperm may be caused by lack of folate, over-consumption will not cause men to produce excessively high amounts of sperm.

Folate is commonly found in leafy greens, orange juice, legumes and fortified grain products. In the UK there is currently investigation into the idea that all white sliced bread should be required to be enriched with folic acid to prevent birth defects. As of January 1998, all uncooked cereal grain products in the United States were fortified at a concentration of 140ug of folate per 100 g of grain for the same reason.
NB: Too much folate in the diet can hide the anaemia associated with a lack of vitamin B-12. If you are taking a supplement then this is unlikely to be a problem, but if you are not then you may want to be sure you are eating enough meat and dairy produce (see Vitamin B12 below)

Folic acid in women
Even though this book is aimed primarily at men I feel that this can make such a significant difference to the future of the child and hence to the whole family that it deserves a proper mention. The CDC estimates that two-thirds of women in the United States do not consume adequate amounts of folic acid. I have not been able to obtain good figures for the UK but I would expect that more than one third of us do get enough folate. While the UK as a country are probably doing better than the United States, it would be very surprising if overall either were consuming enough.

In women, too little folic acid has been found to correlate with a higher risk of having children with birth defects such as spina bifida Previous research has shown that it is important for a woman to have enough folic acid in her body both before and during pregnancy to ensure correct brain development.
Adequate amounts of the vitamin are very critical for women, particularly during the period before conception and during early foetal development (the first three months or so). Folic acid taken by the woman before conception is also supposed to improve the chances of successfully conceiving.

Essential Fatty Acids (EFAs) RDA not yet issued
Essential fatty acid supplements are a good idea because semen is rich in prostaglandins which are produced from these fats. Men with poor sperm quality, abnormal sperm, poor motility or low count, generally have inadequate levels of beneficial EFAs or prostaglandins.

In addition essential fats have a major effect on the reproductive system (along with every other system of the body) as they are crucial for healthy hormone functioning. Omega-3s are fatty acids which are particularly linked to brain development and preventing depression.

In terms of ensuring the welfare of your child their brain development is clearly important, and lack of the right ingredients in your sperm are believed to be able to make a significant difference. Like all these things it will not make as large a difference as a long term lack in your partner during pregnancy, so you will want to help her with her nutrition as soon as you are able to stop taking care of yours.


EFAs and Female Depression During Pregnancy

If your partner is not getting enough EFAs then the foetus will take the lion’s share of what she is consuming. This lack can cause depression in your partner. If your partner is suffering from depressive symptoms during pregnancy check she is getting enough EFAs.

NB while pregnancy depression should not be confused with ‘Post-natal Depression’ it is possible that the two may be related, so care should be taken. Post-natal depression is covered later in the section entitled ‘The Birth’.


The best sources of EFAs within a healthy diet are fish, wild game and Flaxseed. In fact Mahatma Ghandi is quoted as saying “Wherever flaxseed becomes a regular food item among the people, there will be better health”. While Ghandi was no nutritionist he seems to have been right on this one, which along with the other sources near the end of this section is good news for vegetarians or the more adventurous omnivores.

In terms of fish the more fatty the better, so cold water fish (who need the insulation fat supplies) are ideal. Good examples of these are herring, sardines, halibut, mackerel and blue fin tuna. Do not forget that your partner has to be careful about how much tuna she eats because of the heavy metals, so this may be one to have on your own.

Buffalo and venison are also good sources of EFAs and have at various times been sold in most major supermarket chains including Sainsbury and Tesco. Marks and Spencer quite often has venison in a variety of forms that can conveniently be put into sandwiches as well as the sausages and cold cuts you will usually find in most places. If you do have difficulty finding these they are also available mail order from

http://www.farm-direct.co.uk/farmers/direct/fmbd2dee.html (Buffalo)

and

http://www.realmeatco.sageweb.co.uk/catalog.htm (Venison)

For vegetarians canola oil, flaxseed, flaxseed oil, walnuts, and leafy green vegetables such as spinach are all good sources of alpha-linolenic acid (ALA or sometimes LNA). ALA is the plant-based omega-3. Weight for weight walnuts have about three times the ALA content of salmon, so being vegetarian is not an excuse to skimp on the fatty acids.

Some people find that fish oil supplements give them unpleasant fishy burps or indigestion. If you are not one of these people, or if you can cope with the burps, then the supplements are worth taking while trying to cause a conception. Other ways, for those who cannot cope with the more standard supplements include omega-3 enriched eggs and enhanced breads.

Anti-Oxidants
Some research has indicated that certain types of DNA damage in the sperm can make it difficult to conceive, and can cause an increased risk of miscarriage if conception does take place. If DNA is damaged, there may be a chromosomal problem in the baby, should the pregnancy proceed. It has been suggested that his sort of damage is linked to some childhood illnesses.

Whether or not DNA damage does have these effects has not been conclusively proven, but to my mind the research makes it seem likely. It certainly seems worth taking vitamin C and the other antioxidants just in case. The same is true for your partner. The good news is it is possible for you to get pretty much all you need out of one or maybe two tablets, or out of a careful, healthy diet. Of the two I have to recommend having the healthy diet, and adding supplements so that you do not have to spend time worrying about how healthy you have managed.

Selenium RDA 55ug
Selenium is an antioxidant that helps to protect your body, your sperm and your partner’s eggs from free radicals. Low selenium in the blood is associated with low sperm counts. By protecting against free radicals selenium can prevent chromosome breakage, which is known to be a cause of birth defects and miscarriages.

Some good sources of selenium include red meat, tuna, chicken, and enriched pasta and whole grain breads.

Vitamin B12 RDA 1000 µg = 1mg
Vitamin B12, also known as cobalamin (from cobalt vitamin) is a complex compound containing cobalt which is important in the synthesis of RNA and DNA. B12 deficiency has been linked with anaemia, low sperm count, malformed sperm leading to poor sperm motility and with a failure to absorb folic acid. B12 supplements are one of the things sometimes prescribed for men with fertility problems, so getting enough in a normal healthy diet can sometimes avoid having problems in the first place.

Good sources of b12 include liver and kidneys, yogurt and dairy products, fish, clams, oysters, non-fat dried milk, salmon, and sardines.

Vitamin E RDA 10mg
Vitamin E is another powerful antioxidant; it increases fertility for both men and women. It may make the sperm themselves more fertile. Vitamin E given to men who are going for IVF treatment with their partners causes a 10% rise in the couple’s overall fertility. It has been suggested that the antioxidant activity might be responsible for this rise, but no one really knows.

WARNING: Vitamin E should not be taken if you are using anticoagulants. Always check with a doctor before exceeding the RDA of Vitamin E.

Wheat germ oil, almonds, sunflower seeds and sunflower oil are all excellent sources of vitamin E. Some vitamin E can also be found in Broccoli and spinach.

Vitamin C RDA 60mg
Vitamin C is yet another antioxidant. Studies show that vitamin C enhances sperm quality, protecting sperm and the DNA within it from damage. Vitamin C also seems to keep sperm from agglutinating, making them more motile.

Good sources of Vitamin C include citrus fruits - especially kiwi fruit, berries, tomatoes, cauliflower, potatoes, green leafy vegetables, peppers.

Poisoning: Large doses can cause diarrhoea and nausea.
Vitamin C is relatively quite delicate and often destroyed during food preparation, so raw or lightly steamed is best. It is destroyed by: boiling food, too much chopping, light, smoking and heat.

Calcium RDA 100mg=1g / Vitamin D RDA 5ug
It is worth ensuring that you are getting enough Calcium and Vitamin D. I am classing them together because the one is absorbed better in conjunction with the other. Research suggests that 1g of calcium and 10 micrograms (ug) of vitamin D each day may together improve a men's fertility. Sources of calcium include low-fat milk (an average milk glass has about 400mg) and yoghurt (one individual pot has around 300 mg of calcium). You'll find vitamin D in milk (the same size glass has 2ug) and salmon (a 100g has just under 10ug)

Zinc RDA 18mg
Zinc has been the subject of a huge variety of studies in both men and women.
Lack of zinc can cause changes to your genetic material and the same is true for your partner. This is associated with a low sperm count in men as the sperm tails and their outer layer are heavily dependant on sufficient zinc. Excess zinc can interfere with Copper and Calcium absorption, so while it is imperative that you get enough zinc it is not a good thing to go to far in that direction.

Clearly as I have said before, the less sperm there are out there, the less chance of conception. As well as lower sperm counts zinc affects the motility of sperm. Even if low zinc does not prevent conception in a particular case it can have an effect on the health of the baby.

Zinc is equally important for your partner’s body to use oestrogen and progesterone. Lack of zinc in women can lead to reduced fertility and an increased risk of miscarriage.

Most meats are good sources, particularly liver, as are most types of seafood, particularly herring along with eggs, nuts, peas and beans. Grains contain a fair amount of zinc, but have been shown to contain acids which bind to zinc making it harder to absorb. It is possible to overdose on zinc, so do not take more tablets than are recommended on the packet. As most of our zinc comes from animal proteins vegetarians need to be particularly careful to ensure they eat enough.

Supplements
The first thing that has to be said here is that supplements are never a substitute for healthy eating. What supplements are good for is avoiding worrying about whether your healthy diet includes absolutely everything that it should. If you cannot guarantee to eat five fruit or vegetables and a sufficient quantity of each of the different nutrient sources then I would personally recommend two of the ‘Soft and Chewy’ multivitamins from Bassets. The Blackcurrant flavour does not contain any artificial sweeteners or other nasties and is actually very pleasant to eat (as you might imagine being made by Bassets). In addition to these I would suggest occasional zinc, selenium and vitamin C tablets. These need not be as regular. What I found was that a single Bassets would be juicy enough to swallow a zinc or selenium tablet, so I alternated which I took on a day and then followed up with the second bassets chewy vitamin. The Vitamin C tablets I took were interesting and high dose, but not so pleasant that I always remembered or bothered with them.

Are supplements expensive?
Supplements for men are not expensive as you can use standard supplements that are not specific to pregnancy. Supplements for women are expensive as they have to avoid vitamin A and so the supplement companies know it is pregnancy related. For leaving out that vitamin they charge a large premium. The excuse is that extracting it from the fish oils is a cost, but as vegetarian supplements are not made with fish oil I have my doubts. In any case pregnancy vitamins are expensive where normal ones are not. I have included a few sample costs below. They will be out of date by the time this goes to press, but they are good indications.

Sample costs
MumOmega, 90 capsules £12.99
ClearBlue Pregnancy
Vitamins 28 capsules £4.99

Folic Acid 360 tablets £3.95

Pregnacare, 90 capsules £10.69
Bassetts Soft & Chewy Multivitamins, 30 sweets £1.49


Are supplements worthwhile? I know all the doctors I have spoken to about it recommend them. I also know that the reassurance that her supplements provide for my partner, when the hormones try to make her worry needlessly, is worth the price. Are they worthwhile for you? I think they probably are, but it is a personal choice. I recommend them, but do not feel they are so necessary that if the cost is a big issue you should stress yourselves out to get them into the budget.

As this is not a book for women I do not have the difficult job of trying to evaluate all the different supplements that your partner might want to consider. Certainly I was happy for my pregnant wife to take Pregnacare and MumOmega, but there could have been a more efficient way that would have let her off with just one tablet. It was not a big problem for her to have both, just a mild inconvenience.

In terms of practicality the best time to take your supplements is when you will reliably remember to take them. That is the reason I had mine first thing, and used supplements I enjoyed taking. In terms of efficiency the best time to take supplement seems to be with your biggest meal as the food helps you to absorb the supplement and lowers the chances that they will upset your stomach. Don’t take lots of different supplements at the same time because they can interact with each other and be less effective, for example, zinc interferes with how copper and iron are absorbed.

Taking supplements discretely.
As stated elsewhere, if people realise you are trying they will inevitably put more pressure on you both. For this reason you may well want to decide to keep it quiet. As some of the supplements can be a give away discretion about taking them may be required. Men can offer round the bassets supplements as delicious and no one will think any more about it. Also being chewy and not needing water these can be shoved in with food without even noticing.

Your partners will be much more likely to generate suspicion that they are trying if they start taking them openly and you may want to offer advice and help. This is in part because the supplements for women, being restricted to avoiding vitamin A, are recognisable as pregnancy related and have names like MumOmega and Pregnacare. Using a pill box or similar for taking them with meals hides this as well as making the packet small enough to be a bit more discreet. Nipping off to the toilet during a communal meal is another way of avoiding anyone noticing your partner taking her supplements. Also as supplements are not strictly necessary she could skip them on the days when having a meal with the mother or whoever else needs to be kept in the dark.

If they are not taken properly, supplements are flushed through your body without being absorbed. Ladies pretty much need to take supplements with water at room temperature – hot or chilled drinks can damage them. They should not drink tea or coffee 15 minutes before or after taking supplements because they interfere with nutrient absorption. Make sure you read the label on the bottle, and that your partner takes supplements with or after food as directed.

What Our Bodies Do Not Need

Alcohol
Why to reduce your intake
While an occasional drink is generally considered safe, studies show that daily consumption of wine, beer or spirits can decrease testosterone levels and sperm counts and increase the number of abnormal sperm in semen. Cut out or cut back on alcohol.

The same is true of your partner as Danish research has shown that a woman's alcohol intake is associated with decreased fecundability even among women with a weekly alcohol intake corresponding to five or fewer drinks.

It is worth noting that your partner is going to be being careful about alcohol for a lot longer than you are, so making he know you are making every effort at the start is good for both of you in the long run. Earn your brownie points while they are easy to get.

Tips for reducing your intake
Much alcohol consumption is related to peer pressure. It is not easy to avoid having a Guinness on Saint Patrick ’s Day or a whisky on Burn’s Night. If you are not strong enough to say no, or if you do not want to give away the fact you are trying to have a child then there are still a few things you can do. These really come down to (1) avoiding situations where drinking will be expected, (2) having a good excuse ready, (3) pretending to drink without actually consuming much alcohol.

Avoiding situations where it is necessary to drink
This is really just about planning. Look at all invitations and see whether you will have to drink. If you will invent a prior engagement or arrange to go to a less alcoholic do at the same time. Most men seem to let their partners keep hold of the diary, so producing engagements you have to get to should not be hard.
Below are a few good reasons why you are not drinking.

• I am driving
• I have felt a little dodgy today
hates it when I come home smelling of alcohol, and she has been a bit down lately so I thought I would surprise her
• We are thinking of trying for a baby, so I thought I would see how long I could give up for. Once sees how hard it is/how much it would cost/other reason not to try it will probably come to nothing.
• My doctor told me to cut down for a while.
• I have had too much already.
• I had too much last night.

Tactics for appearing to drink without drinking

• Raise a wine glass (or any other glass) to your lips without drinking, so it never needs refilling. I have gone a whole evening without drinking anything by getting a big drink and any time I am offered saying “no thanks I was just bought one” as I show my full glass.
• Pick up the bottle and refill everyone yourself, so they do not notice your refill is only a splash.
• Gin and Tonic without the tonic, or better still mineral water masquerading as G&T.
• Alcohol free beer
• Virgin Mary
• Take your drink with you and pour it away when you are out of site.
• Iced coffee (with no milk) can look like dark spirits such as whisky
• Arrange to pour drinks for your partner and for her to pour for you. This can range from weak or completely alcohol free drinks to simply giving you stingy portions.
• Finally, tactic one of the list above can be supplemented by taking away the occasional full glass and ostentatiously replacing it with another big one.

It is worth noting that drinking and then throwing it up is not a good idea for a variety of reasons. The most important being that alcohol is absorbed through a variety of membranes from your tongue (mucus membrane) to your stomach wall, so even if you empty your stomach it may be too late to stop the alcohol getting into your system. Next most important is that your digestive juices which come up will not be good for you and their loss will be bad for your digestion.

Caffeine
There are good reasons for you to either give up caffeine or at least to reduce your intake. That said it is not always a bad thing for a man to have caffeine before conception. For women the only side effects are negative ones, for men the story is a little more complex. Below, as well as tips on cutting down I have included a brief explanation of the side effects as well as the myth that coffee wakes you up. Once you have read this you should have a reasonable idea of how much you want or need to cut down, and if you do need to then of how to do it.

The myth that coffee wakes you up.
Everyone thinks that coffee wakes you up, and most of us have even experienced it. Remember when you had your first cup of coffee? You suddenly felt very, very alert. The same for that evening when you discovered a local place that served double espressos. Well what you felt was not just the placebo affect, and yet coffee does not really wake you up. How can this be?

It is actually pretty simple. We know caffeine is addictive, that is why people are dying for their first cup to wake them up in the morning. Well the problem is that our body is not really designed to be hyper alert all the time but it is adaptable. After having coffee each day for a couple of days our body becomes accustomed to it. It puts you in a down state and the coffee brings you back to normal. You can think of it as coffee withdrawal symptoms. No coffee no alertness at all. Stop taking coffee for a few days, maybe a week, and your body starts waking up as normal. Suddenly you do not need coffee to wake you up, you have better mornings and are overall more alert.

It sounds odd but switching to decaf actually makes you more awake on average.

When caffeine is a good thing and when it is bad.
Strangely caffeine seems to have a similar effect on sperm to the effect it has on people. A cup shortly before sex that you want to result in conception gives the sperm a sort of undirected turbo charge. They move further and faster, though their sense of direction may not be as good. Clearly this only works if you have not been having coffee for a few days prior, otherwise the boost is gone, but the negative effects are still there. If your sperm are not suffering from a tendency to zigzag then abstinence followed by a cup of coffee at the strategic time can actually be beneficial. Taking coffee regularly will only have a small negative impact in most cases, certainly less than becoming very stressed by giving it up. I would suggest changing to decaf straight after the fertile time and sticking with it until she is fertile if you like the taste.

Reducing your caffeine intake
If rather than give up you simply want to reduce your caffeine intake there are a few ways you can try and do this:

• Substitute Decaf for every second cup. Try a blind test as if you get good coffee you will find decaf has a placebo effect just as good as the real thing. If you normally drink instant try buying single cup filters for the caffeine free drinks. This will mean you actually look forward to the better tasting coffee.
• Look at when you regularly have coffee and see if you can change the circumstances, e.g. if you have it with each meeting try and combine meetings to lower the number.
• Try different drinks such as water or tea when you might otherwise have coffee .
• Get your partner to help you, just as you will be helping her.

Rufus Evison