Prevention and self-management
- Self-management of physical symptoms:
- Many health problems that occur during pregnancy can be managed at home using methods recommended by healthcare professionals.
- Constipation and hemorrhoids: One of the reasons for constipation may be changes produced in the digestive tract due to hormones slowing down the movement of food. Additionally, during the last trimester of pregnancy there is more pressure on the rectum from the uterus. To avoid these problems, healthcare professionals recommend drinking plenty of water and eating fruit and vegetables with a high fiber content, such as green, leafy vegetables. Some pregnant women experience relief drinking a glass of room temperature water before breakfast. Over-the-counter (OTC) stool softeners may be used, such as docusate sodium (Colace®). It is recommended to tell the doctor of any OCT medication or dietary supplement taken during pregnancy.
- Nausea: Nausea occurs due to metabolic changes. In the morning before getting up, eating crackers and standing up very slowly is recommended to decrease feelings of nausea. It is best to try to eat in small quantities every three hours (fractionated diet). During pregnancy, it is good to eat proteins (meat, eggs, beans) before going to bed at night.
- Heartburn: Heartburn can occur when stomach acid from digesting food is pushed into the esophagus. During pregnancy, all digestive processes are slowed down and the engrossed uterus presses up on the stomach. To avoid heartburn, eat in small quantities, several times a day. Avoiding spicy and greasy foods and not eating at least one hour before going bed is important. Some pregnant women experience relief resting at night by elevating their heads with two or three pillows.
- Fatigue: Pregnancy may stress a woman's body. It is important to try to sleep eight hours daily and if possible, take a nap during the day. Avoiding hard work and eating a balanced diet throughout pregnancy is recommended by healthcare professionals.
- Headaches: Headaches may develop during pregnancy. This may be in part due to stress or in some cases it is cased by the higher level of blood in the body during pregnancy. Relaxing in a dark room may help decrease the pain and length of a headache. It is recommended by healthcare professionals to not take medications for headaches while pregnant unless directed by a doctor.
- Frequent urination: During pregnancy, the uterus is pressing down on the bladder. Even if the bladder is almost empty, this pressure produces the same sensation as if it were full. Do not avoid the urge to urinate.
- Cramps: Cramps are due to circulatory problems associated with the weight gain as the individual progresses in pregnancy. Exercises can be recommended by a healthcare professional to alleviate these discomforts.
- Chloasma: Chloasmas are obscure marks in the skin caused by the hormones secreted during pregnancy. They tend to disappear after delivery. Common areas of chloasmas include the forehead, temples, cheeks, or upper lip. Avoiding sunlight on sensitive areas can help prevent chloasma.
- Stretch marks: Skin tissue that has to support extra weight causes these marks. They appear on the abdomen and breasts and in most cases slowly disappear after delivery. Creams that contain cocoa butter may be useful in preventing stretch marks.
- Varicose veins: Varicose veins are produced by the pressure of the uterus on the lower part of the abdomen that causes difficulty in circulation during the nine months of pregnancy. Varicose veins usually appear in the legs especially if the mother must stand or sit for long periods of time. Moving frequently helps improve circulation. Elevate the legs when possible or lie in bed with a pillow under the feet. While sitting, try to keep the feet up. Do not wear tight clothing. A doctor may recommend support stockings.
- Breathing difficulties: Breathing difficulties may happen during the third trimester of pregnancy because the fetus is occupying more space in the abdomen; breathe deeply several times a day but avoid hyperventilation. Sleep propped up and avoid crowded places and smoggy environments.
- Backaches: Backaches are a consequence of the growing of the abdomen and weight increase associated with pregnancy. If an individual is suffering from backaches, healthcare professionals recommend: to avoid wearing high-heeled shoes; try to keep the back straight; and avoid lifting heavy weights. It is good to practice some relaxation exercises that will help to lower the tension in the muscles.
- Swelling: Swelling can occur due to the retention of water in the tissues. Swelling has a high occurrence in the feet. Try to elevate the legs whenever possible and avoid tight clothes that bind the legs. It is important to notify a doctor if swelling is taking place in uncommon areas, such as the face, or if weight increases suddenly.
- Pregnancy prevention, family planning:
- Abstinence: Abstinence is a lack of sexual relations. There are many ways to prevent pregnancy, but only abstinence is 100% effective.
- Natural family planning (NFP): Researchers have found that a method of natural family planning that uses two indicators to identify the fertile phase in a woman's menstrual cycle is as effective as the contraceptive pill for avoiding unplanned pregnancies if used correctly. The study specifically investigated the efficacy and the acceptability of the symptothermal method (STM), a method that uses two indicators of fertility, temperature and cervical secretions observation. In the largest study of STM, the researchers found that if the couples either abstained from sex = during the fertile period, the rate of unplanned pregnancies per year was 0.4%. The study authors suggested that the effectiveness of STM is comparable to the effectiveness of modern contraceptive methods such as oral contraceptives, and is an effective and acceptable method of family planning.
- A number of fertility awareness based methods of family planning have been advocated over the years, but comparisons between different methods and studies of their effectiveness have been limited and hampered by problems such as differences in cultural backgrounds, different ways to measure the effectiveness of a FAB method, different ways of classifying unintended pregnancies and other study design problems. Researchers recommend that women or couples who want to learn the method should buy a book, attend an NFP course, or get some teaching by a qualified NFP teacher.
- Early studies have also suggested that couples who practice NFP: have a dramatically low (0.2%) divorce rate; experience happier marriages; are happier and more satisfied in their everyday lives; have considerably more marital relations; share a deeper intimacy with their spouse; and realize a deeper level of communication with their spouse. Further, more well-designed studies are needed.
- Sterilization: Sterilization in the male is termed vasectomy and in the female tubal ligation, or tubal sterilization.
- Tubal sterilization, or tubal ligation, is surgery to block a woman's fallopian tubes. Tubal sterilization is a permanent form of birth control. After this procedure, eggs cannot move from the ovary through the tubes (a woman has two fallopian tubes), and eventually to the uterus. Also, sperm cannot reach the egg in the fallopian tube after it is released by the ovary. Thus, pregnancy is prevented.
- Vasectomy is a procedure in which the two tubes that carry sperm from the testicles to the urinary tract are surgically altered so sperm cannot pass through and be released to fertilize a woman's egg during sexual intercourse. For couples who have made the decision not to have any further children, vasectomy is the safest and easiest form of surgical sterilization. While reversible in many cases, vasectomy should be considered a permanent form of birth control.
- Hormonal contraception: Hormonal contraception to prevent pregnancy includes birth control pills, birth control patches, and birth control vaginal rings.
- Birth control pills, also known as oral contraceptives, have been marketed in the United States since 1962. Over the past 40 years, the type of estrogen and progestin (hormones) used in the pills has changed and the amounts of those hormones has been lowered. Birth control pills today are designed to improve safety and reduce side effects. Lower doses of estrogen are associated with a decrease in side effects, such as weight gain, breast tenderness, and nausea.
- Over 30 different combinations of birth control pills are available in the United States. Most of the combinations of these pills have 21 hormonally active pills followed by seven pills containing no hormones. A woman begins taking a pill on the first day of her period or the first Sunday after her period has begun.
- If a dose of oral contraceptive is missed, the individual may not be protected from pregnancy. A backup method of birth control, such as condoms, may be used for seven days or until the end of the cycle. Every brand of oral contraceptives comes with specific directions to follow if one or more doses have been missed. It is recommended to call a doctor or pharmacist with questions regarding missed oral contraceptive dosages. It is recommended by healthcare professionals to continue to take the tablets as scheduled and use a backup method of birth control until the questions are answered. Advantages of using birth control pills include their use to treat irregular menstrual periods. Women can manipulate the cycle to avoid a period during certain events, such as vacations or weekends by extending the number of intake days of hormonally active pills or by skipping the non-active pill week. Birth control pills may help prevent certain conditions, such as benign breast disease, pelvic inflammatory disease (PID), and functional cysts. Functional cysts are reduced by the suppression of stimulation of the ovaries. Ectopic pregnancies are prevented by the cessation of ovulation. The relationship between birth control pills and certain types of cancer is still being studied.
- Disadvantages of birth control pills include nausea, breast tenderness, breakthrough bleeding, no periods, headaches, depression, anxiety, and lower sexual desire. Birth control pills do not provide protection from sexually transmitted diseases (STDs). Taking the pills daily and consistently (same time every day) is important. If a woman stops taking birth control pills, she may need a few months to get her normal ovulatory cycle back. After six months, her healthcare provider may need to examine her.
- Additional risks include blood clots (venous thrombosis). At particular risk are heavy smokers (especially those older than 35 years), women with high or abnormal blood lipids (cholesterol levels), and women with severe diabetes, high blood pressure, and obesity. The association of birth control pill use and breast cancer in women remains controversial.
- The relationship between birth control pill use and cervical cancer is also quite controversial. Important risk factors include early sexual intercourse and exposure to the human papillomavirus (HPV). Women who use birth control pills should have a periodic Pap test.
- Intra-uterine device (IUD): An intrauterine device (IUD) is a small T-shaped plastic device that is placed in the uterus to prevent pregnancy. A plastic string is attached to the end to ensure correct placement and for removal. IUDs are an easily reversible form of birth control, and they can be easily removed. However, an IUD should only be removed by a medical professional.
- Birth control barriers: Birth control barriers such as diaphragms, cervical caps, and condoms may also be used.
- Spermicides: Spermicides are chemical barriers to conception. They are a reversible method of birth control, meaning that when a woman stops using them, full fertility returns. Vaginal spermicides are available in forms such as foam, cream, jelly, film, suppository, or tablet. Spermicides are not as effective as many other forms of birth control when used alone. They are often used with barrier methods of birth control and are much more effective when used in this context.
- Emergency contraception: Plan B is the only emergency contraceptive pill ("morning after pill" or "day after pill") being sold in the United States today, although women can also use many kinds of daily birth control pills to prevent pregnancy after sex.
- Plan B contains the hormone progestin. Other options for emergency contraception include taking a different dose of daily birth control pills (most of which contain both progestin and estrogen, so they are called "combined" pills) or having a healthcare provider insert an IUD within five days after the birth control failed and having had sex without using contraception, or if the individual was forced to have sex. Preven®, the brand name of a combined emergency contraceptive pill that was approved for use in the United States, is no longer being sold here. Plan B is more effective and has fewer side effects than other emergency contraceptive pills.
- Emergency contraceptive pills are available without prescription to women and men 18 and older in the United States, though women 17 and under will still need a prescription from a healthcare provider to buy them. In some states, women of all ages can get emergency contraceptive pills directly from a pharmacist, without having to see a doctor first.
- Once pregnancy occurs, hormonal changes take place in the body of the woman. Also, development of the fetus in the womb produces many biochemical changes in the mother.
- There are signs associated with pregnancy. The most common is a missed menstrual period. However, since all women do not have regular menstrual cycles, it is important to watch for other pregnancy signs such as: breast tenderness, nausea, heartburn, extreme tiredness, and frequent urination. (see Heading:Diagnosis)
- Even if a woman has some or all symptoms it is important to reconfirm the diagnosis with a pregnancy test. This test will detect the presence of a hormone called chorionic gonadotropin, which is produced by the placenta and it is present in the blood and urine of the expecting woman.
- Pregnancy is typically broken into three periods, or trimesters, each of about three months. While there are no hard and fast rules, these distinctions are useful in describing the changes that take place over time.
- First trimester: Traditionally, doctors have measured pregnancy from a number of convenient points, including the day of last menstruation, ovulation, fertilization, implantation, and chemical detection. In medicine, pregnancy is often defined as beginning when the developing zygote becomes implanted into the endometrial lining of a woman's uterus to begin growth.
- Most pregnant women do not have any specific signs or symptoms of implantation, although it is not uncommon to experience light bleeding at implantation. In some cases where complications may have arisen, the fertilized egg might implant itself in the fallopian tubes or the cervix, causing an ectopic pregnancy. Some women will also experience cramping during their first trimester. This cramping is usually of no concern unless there is spotting or bleeding as well. The outer layers of the embryo grow and form a placenta, for the purpose of receiving essential nutrients through the uterine wall. The umbilical cord connects the unborn baby to the placenta. The developing embryo undergoes tremendous growth and changes during the process of embryonic and fetal development.
- Morning sickness afflicts about 70% of all pregnant women, typically only in the first trimester. Most miscarriages occur during this period.
- Second trimester: Months four through six of the pregnancy are called the second trimester. Most women feel more energized in this period than the first or third trimester and begin to put on weight as the symptoms of morning sickness subside and eventually fade away. Although the fetus begins moving and takes a recognizable human shape during the first trimester, it is not until the second trimester that movement of the fetus, often referred to as "quickening," can be felt. This typically happens by the fourth month. The teeth are now formed inside the unborn baby's gums and the reproductive organs can be recognized allowing a doctor to know the sex of the child.
- Third trimester: In the last or third trimester, final weight gain takes place and the fetus begins to move regularly. The mother's belly button will sometimes protrude due to her growing belly. This period of her pregnancy can be uncomfortable, causing symptoms such as weak bladder control and back-ache. Movement of the fetus becomes stronger and more frequent and the fetus prepares for viability outside the womb through improved brain, eye, and muscle function. The mother can feel the unborn baby moving and rolling, which may cause pain or discomfort around the mother's ribs.
- If a fetus is born early or prematurely in the third trimester, advanced medical technology can help the baby survive. In most systems of human pregnancy, prematurity is considered to occur when the baby is born sooner than 37 weeks after the beginning of the last menstrual period (LMP). The opposite condition, postmature birth, is defined as birth more than 42 weeks after the LMP.
- Prenatal care:
- Getting early and regular prenatal care is one of the best ways to promote a healthy pregnancy. Prenatal care is more than just healthcare. Prenatal care includes education and counseling about how to handle different aspects of pregnancy, such as nutrition and physical activity, what to expect from the birth itself, and basic skills for caring for the infant.
- Prenatal visits also give the woman and her family a chance to talk to a healthcare provider about any questions or concerns related to pregnancy, birth, or parenthood.
- Many healthcare providers recommend that a woman who is only thinking about getting pregnant see a healthcare provider about preconception health. Also, if the individual thinks they are pregnant she should also see a healthcare provider. There are steps she can take to reduce the risk of certain problems. The objective of prenatal care is to monitor the health of the pregnant mother and her unborn baby. It is important to visit the doctor as soon as an individual suspects they are pregnant. At each visit, a doctor will examine the individual and make sure that the baby and the mother are healthy. This examination includes: monitoring weight gain or loss, blood pressure, circumference of the abdomen, position of the fetus, and fetal heartbeat. Such variables are closely followed during the course of the pregnancy.
- A doctor may schedule monthly visits during the first two trimesters (from week one to week 28 of pregnancy), every two weeks from 28-36 of pregnancy, and weekly after week 36 (until the day of delivery that could be between week 38-40 weeks).
- Food and nutrition during pregnancy: It is important for an expectant mother to eat a healthy diet. Unless she has a specific health problem (such as diabetes mellitus or heart disease) common sense nutritional advice should be followed: balancing carbohydrates, fat, and proteins and eating a variety of foods, including dairy products and several fruits and vegetables, daily. A pregnant woman should consult her obstetrician for specific advice. Some specific nutritional needs for pregnancy include:
- Folic acid, also called folate or vitamin B9, is strongly recommended by healthcare professionals at the start of pregnancy and even before conception. Folic acid is needed for the closing of fetus' neural tube. The neural tube is the fetus's precursor to the brain and spinal cord. Folic acid thus helps prevent spina bifida, a very serious birth defect. Folates are abundant in spinach (fresh, frozen or canned) and are also found in green vegetables, salads, melon, and eggs. In the United States and Canada, most wheat products, such as flour or noodles, are supplemented with folic acid.
- Minerals, such as calcium and iron, are particularly needed by the rapidly growing fetus. Pregnant women should eat enough dairy products (for calcium) and red meat (for iron) if they are not lactose intolerant or vegetarian. Women who do not eat dairy or meat can obtain calcium and iron from fortified soy milk and juice, soybeans, and certain leafy greens. Calcium is effective only if women also obtain enough vitamin D. Vitamin D can be made in the body after exposure to ultraviolet rays from the sun or from food sources. Although milk is fortified with vitamin D, dairy products made from milk, such as cheese and ice creams, are generally not fortified with vitamin D. Cold water fish such as salmon, mackerel, tuna, and sardines also good sources of vitamin D.
- Healthcare providers may prescribe iron supplements if pregnant women develop anemia. Anemia, one of the more common blood disorders, occurs when the level of healthy red blood cells (RBCs) in the body becomes too low. RBCs contain hemoglobin, which carries oxygen to the body's tissues.
- Fluoride helps to build strong teeth by changing the nature of calcium crystals. If drinking water or table salt does not contain fluoride, it is recommended by healthcare professionals to take fluoride supplements at the end of pregnancy and during breastfeeding. However, high doses of fluoride are toxic. In many American cities, drinking water is supplemented with fluoride.
- Oils from salmon, trout, tuna, herring, sardine, mackerel, eggs, and some chicken contain omega-3 fatty acids that are needed to build brain tissue. Intake of omega-3 fatty acids during pregnancy may provide nutrition for proper brain and retina development of the fetus. However, large fish such as tuna and swordfish may contain high levels of mercury. Mercury can be toxic to the fetus and the mother. Eating omega-3 rich fish two or three times a week is recommended (no more than 12 ounces/week of low mercury fish should be consumed). Omega-3 fatty acids are also present in walnuts, flaxseed, and seaweed.
- Dangerous bacteria or parasites, particularly Listeria and Toxoplasma, may contaminate foods. To avoid those two hazards, hygiene rules should be strictly adhered to, including carefully washing of fruits and raw vegetables, cooking leftovers and meats appropriately, and avoiding raw-milk cheeses (due to Listeria). The label will state if the cheese is from raw milk. It is best to try to avoid contact with cat feces (due to Toxoplasma).
- It is best to maintain a healthy weight and diet and get regular physical activity before, during, and after pregnancy. It is recommended by healthcare professionals to avoid smoking, alcohol, or drug use before, during, and after pregnancy. These factors increase the chances of damage to the growing fetus.
- Labor and delivery:
- Labor and delivery, or childbirth, is the process by which an infant is born. When a baby is ready to be born, the mother will go through labor.
- Common signs of labor: A common sign that labor is near is lightening or when the baby "drops" or moves into position within the pelvis. Lightening may occur two to four weeks prior to labor in first-time mothers and often not until labor begins in mothers who have previously had children.
- The mother's abdomen usually appears lower and more protruding.
- The mother may experience a greater ease in breathing, relief from heartburn, and an ability to eat larger portions. However, the lower position of the baby together with its greater size can lead to: increased backache and sacroiliac (the two joints where the hip bones connect to the sacrum) discomfort; increased awkwardness in walking; and increased frequency of urination.
- Frequent bowel movements may be experienced within 48 hours of labor, cleansing the lower bowel in preparation for birth.
- Diarrhea or flu-like symptoms without fever may be felt before labor. Indigestion, nausea, or vomiting are common a day or so before labor begins.
- Increased vaginal discharge during the last few weeks of pregnancy as the body prepares for the passage of the baby through the birth canal may occur.
- Increased Braxton-Hicks contractions during the last weeks of pregnancy, which are "practice" contractions that prepare the uterus for labor and may cause some effacement and dilation (thinning and opening) of the cervix, may occur. These contractions do not ordinarily cause pain but may be sufficiently strong and regular to be confused with true labor. This is referred to as false labor.
- Possible "bloody show" or the release of slightly brown, pink, or blood-tinged mucus from effacement and dilation (the thinning and opening) of the cervix, causing the mucus plug to be released from the cervix, may occur.
- An initial sign of labor is when the "water breaks." The amniotic sac is a fluid-filled membrane that cushions the fetus in the uterus. The sac leaks or breaks releasing amniotic fluid before labor begins. If this happens, the individual may notice a trickle of fluid or a more obvious gush.
- Labor contractions are the periodic tightening and relaxing of the uterine muscle, the largest muscle in a woman's body. Contractions let the woman know labor is starting. Most doctors suggest going to a hospital when the contractions are five minutes apart and lasting 60 seconds and the individual has had this activity for about an hour. Contractions range from mild tightening to constant muscle spasms in the abdominal area. Contractions may be irregular at first but usually become regular. They get longer, stronger, and closer together as time progresses. Many mothers describe contractions that occur in early labor as similar to menstrual cramps, or as severe gas pains, which may be confused with flu symptoms or intestinal disorders. Walking usually makes the contractions stronger. Lying down does not make them go away. Often, the contractions begin in the back and move to the front.
- During the first stage of labor, the cervix slowly opens, or dilates, to about four inches wide. At the same time, the cervix becomes thinner. This is called effacement. The individual should not push until the uterus is fully effaced and dilated. As the cervix dilates, some individuals describe cramping and pressure, similar to what would be felt during menstruation. When is the cervix is completely dilated, the baby delivery stage starts. Crowning is when the baby's scalp comes into view. Shortly afterward, the baby is born. The placenta that nourished the baby follows. Mothers and babies are monitored closely during labor. Most women are healthy enough to have a baby through normal vaginal delivery, meaning that the baby comes down the birth canal without surgery.
- Pain in labor is a nearly universal experience for childbearing women giving birth naturally. Tears (rips) in the vagina during delivery will occur. In order to prevent these vaginal tears from occurring, doctors will often perform an episiotomy. In this procedure, an incision is made in the perineum, which is the area between the vagina and the anus. This incision allows the vaginal opening to enlarge, thereby giving the baby more space to emerge from.
- A typical labor for a first time mother is eight to 14 hours, and is usually shorter for a second or subsequent birth.
- Labor induction: Sometimes, if labor has not started on its own, doctors use medicines to make a woman's labor begin so that she can deliver the baby vaginally. This is called "labor induction" or induced labor. The most common reason for labor induction is that the pregnancy has gone two weeks or more past the due date. The baby may get too big if the mother carries it this far past the due date. The fetus may not be able to get enough food from inside the body. A doctor might also recommend labor induction if: the woman's water breaks before she goes into labor; she has high blood pressure; she has a serious infection; or if she has diabetes.
- There are several ways to induce labor. Toward the end of pregnancy, the cervix (the opening to the uterus, or womb) gets soft. It may even open up a little. A doctor will check to see if the cervix is getting soft and opening up. If it is not, a doctor may put a medicine, called oxytocin (Pitocin®), into the woman's vagina near the cervix. Oxytocin will soften and open the cervix up, helping to start the contractions and get them strong and regular. A doctor may also "break the water" or use a finger to separate the cervix from the membranes (tissues) around the baby's head. This often makes labor start. Sometimes it may take two to three days to induce labor, but this is rare.
- C-section: If labor will not start with medicine, a cesarean section (also called a "C" section) may be necessary. A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through the mother's abdomen. In the United States, about one in four women have their babies this way. Most C-sections are done when unexpected problems happen during delivery. These include: carrying more than one baby; health problems in the mother, such as diabetes or high blood pressure; the position of the baby; not enough room for the baby to go through the vagina; or signs of distress in the baby. The surgery is relatively safe for mother and baby. Still, it is major surgery and carries risks. It also takes longer to recover from a C-section than from vaginal birth. After healing, the incision may leave a weak spot in the wall of the uterus. This could cause problems with an attempted vaginal birth later. However, more than half of women who have a C-section can give vaginal birth later. Individuals can discuss options during childbirth before the due date in order to alleviate any added stress during labor and delivery.
Causes of pregnancy
- Pregnancy occurs with the fertilization of a woman's egg by a man's sperm, called conception. Fertility drugs, such as clomiphene (Clomid®), may improve a woman's odds of achieving pregnancy. Some of the most common causes of female infertility include polycystic ovarian syndrome, fibroids, and endometriosis. However, there are several other reasons why a woman may experience fertility problems, such as ovulatory disorders (like anovulation or the inability to ovulate), premature ovarian failure, and uterine factors. Egg quality also plays a role in infertility in many women. There are good and bad eggs from the very start in any female's body, but usually the number of eggs of superior quality are present at a higher volume at a younger age than after 30. Egg quality is also affected by external sources like radiation therapy, smoking, chemotherapy, and health conditions like endometriosis. Endometriosis is a condition in which the tissue that normally lines the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and possible infertility. In men, hormone disorders, illness, reproductive anatomy trauma and obstruction, and sexual dysfunction can temporarily or permanently affect sperm and prevent conception. Some disorders become more difficult to treat the longer they persist without treatment. According to the National Institutes of Health (NIH), male infertility is involved in approximately 40% of the 2.6 million infertile married couples in the United States. One-half of these men experience irreversible infertility and cannot father children, and a small number of these cases are caused by a treatable medical condition.
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.