Fam­ily pleads for less this hol­i­day sea­son Study prompts call to ex­am­ine flu vac­cine link to mis­car­riage



My hus­band and I have three beau­ti­ful chil­dren, ages 10, 3, and 1.

We are blessed with a large fam­ily on both sides. They are all in­cred­i­bly gen­er­ous, es­pe­cially at Christ­mas. They love to give gifts, and we are grate­ful for their gen­eros­ity. How­ever, like many fam­i­lies with sim­i­larly aged chil­dren, we have come to find lately that we have an over­abun­dance of, well ... stuff.

My hus­band and I have come to feel that we would like to stem the abun­dant flow of toys into our house, as our kids have far more than they could ever need or play with.

Not only that, but lit­tle ones just don’t have the at­ten­tion span to sit and open tons of presents. Last Christ­mas, it took my son three days to open all of the presents our fam­i­lies sent, even con­sid­er­ing that my hus­band and I only gave our kids one gift a piece.

This year, we would re­ally like to ask our fam­i­lies to avoid buy­ing toys al­to­gether. We would be fine with no gifts at all, but if our fam­i­lies in­sist, we would much rather the gift of ex­pe­ri­ence. For ex­am­ple, mem­ber­ships to lo­cal chil­dren’s mu­se­ums and zoos, con­tri­bu­tions to­ward sum­mer camps or ex­tracur­ric­u­lars, movie tick­ets, etc.

I know in gen­eral it is con­sid­ered rude to ask for spe­cific gifts. How­ever, I fear that if we don’t say some­thing soon, we will be over­whelmed with toys again. We ap­pre­ci­ate the thoughts, but we are at ca­pac­ity.

I would feel ter­ri­ble tak­ing toys im­me­di­ately to do­na­tion cen­ters, but I think that’s what will hap­pen. Is there any gen­tle way to make this re­quest with­out seem­ing greedy or un­grate­ful? — UP TO HERE WITH GIFTS

You should con­tact ev­ery­one on both sides of your fam­ily in (per­haps) a group email, and ex­press your grat­i­tude for their gen­eros­ity. Tell them that this year you are go­ing to try to cut down on the abun­dance of ma­te­rial gifts. Say, “We’d be happy to of­fer sug­ges­tions for al­ter­na­tives, such as mem­ber­ships to our lo­cal mu­seum or ex­tracur­ric­u­lars for the kids. It also might be fun for them to re­ceive ‘coupons’ for ex­pe­ri­ences from you, which they could cash in through­out the year. We cer­tainly don’t want to dic­tate your choices, but thought we would share this idea with you.”

I am not gen­er­ally the kind of per­son to seek out­side help like a ther­a­pist, but I love my wife dearly and we are strug­gling. Af­ter ini­tial hes­i­tancy, my wife, “Dahlia,” has agreed to at­tend mar­riage coun­sel­ing to­gether.

Dahlia has seen ther­a­pists in­di­vid­u­ally in the past, with vary­ing de­grees of satisfaction.

One of the spe­cial­ists in the area is some­one Dahlia has seen in­di­vid­u­ally and was pleased with.

I see the ben­e­fits of hav­ing a coun­selor who has some back­ground into our sit­u­a­tion al­ready and that I know has the right chem­istry with my wife.

But I also won­der if hav­ing heard only one side and hav­ing built a re­la­tion­ship with Dahlia and not me makes this ther­a­pist an un­wise choice for us.

Can you help guide us? What are your thoughts? — WON­DER­ING HUS­BAND

I would coun­sel against see­ing the same ther­a­pist your wife al­ready has a re­la­tion­ship with. One rea­son is that mar­i­tal ther­apy should be fu­ture fo­cused, while in­di­vid­ual ther­apy is of­ten rooted in the func­tions and dy­nam­ics of the fam­ily of ori­gin.

It seems log­i­cal that you should both start with a fresh story-slate.

NEW YORK — A puz­zling study of U.S. preg­nan­cies found that women who had mis­car­riages be­tween 2010 and 2012 were more likely to have had back-to­back an­nual flu shots that in­cluded pro­tec­tion against swine flu.

Vac­cine ex­perts think the re­sults may re­flect the older age and other mis­car­riage risks for the women, and not the flu shots. Health of­fi­cials say there is no rea­son to change the gov­ern­ment rec­om­men­da­tion that all preg­nant women be vac­ci­nated against the flu. They say the flu it­self is a much greater dan­ger to women and their fe­tuses.

The Cen­ters for Dis­ease Con­trol and Preven­tion has reached out to a doc­tor’s group, the Amer­i­can Con­gress of Ob­ste­tri­cians and Gyne­col­o­gists, to warn them the study is com­ing out and help them pre­pare for a po­ten­tial wave of worry from ex­pec­tant moms, CDC of­fi­cials said.

“I want the CDC and re­searchers to con­tinue to in­ves­ti­gate this,” said Dr. Laura Ri­ley, a Bos­ton-based ob­ste­tri­cian who leads a com­mit­tee on ma­ter­nal im­mu­niza­tion. “But as an ad­vo­cate for preg­nant women, what I hope doesn’t hap­pen is that peo­ple panic and stop get­ting vac­ci­nated.”

Past stud­ies have found flu vac­cines are safe dur­ing preg­nancy, though there’s been lit­tle re­search on im­pact of flu vac­ci­na­tions given in the first three months of preg­nancy.

This study fo­cused only on mis­car­riages, which oc­cur in the first 19 weeks of preg­nancy and are com­mon. As many as half of preg­nan­cies end in mis­car­riage, ac­cord­ing to a March of Dimes estimate that tries to in­clude in­stances in which the mis­car­riage oc­curs be­fore a women even re­al­izes she was preg­nant.

Flu and its com­pli­ca­tions kill thou­sands of Amer­i­cans every year. The el­derly, young chil­dren and preg­nant women are es­pe­cially at risk. When a new “swine flu” strain emerged in 2009, it killed 56 U.S. preg­nant women that year, ac­cord­ing to the CDC.

The study’s au­thors, two of whom are CDC re­searchers, saw a big dif­fer­ence when they looked at women who had mis­car­ried within 28 days of get­ting a shot that in­cluded pro­tec­tion against swine flu, but it was only when the women also had had a flu shot the pre­vi­ous sea­son.

They found 17 of 485 mis­car­riages they stud­ied in­volved women whose vac­ci­na­tions fol­lowed that pat­tern. Just four of a com­pa­ra­ble 485 healthy preg­nan­cies in­volved women who were vac­ci­nated that way.

The first group also had more women who were at higher risk for mis­car­riage, like older moms and smok­ers and those with di­a­betes. The re­searchers tried to make sta­tis­ti­cal ad­just­ments to level out some of those dif­fer­ences but some re­searchers don’t think they com­pletely suc­ceeded.

Other ex­perts said they don’t be­lieve a shot made from killed flu virus could trig­ger an im­mune sys­tem re­sponse se­vere enough to prompt a mis­car­riage. And the au­thors said they couldn’t rule out the pos­si­bil­ity that ex­po­sure to swine flu it­self was a fac­tor in some mis­car­riages.

Two other medical jour­nals re­jected the ar­ti­cle be­fore a third,

ac­cepted it. Dr. Gregory Poland, edi­tor-in-chief, said it was a well-de­signed study that raised a ques­tion that shouldn’t be ig­nored. But he doesn’t be­lieve flu shots caused the mis­car­riages. “Not at all,” said Poland, who also is di­rec­tor of vac­cine re­search at the Mayo Clinic.

Though this study may cause worry and con­fu­sion, it is ev­i­dence “of just how rig­or­ous and prin­ci­pled our vac­cine safety mon­i­tor­ing sys­tem is,” said Ja­son Schwartz, a Yale Uni­ver­sity vac­cine pol­icy expert.

Some of the same re­searchers are work­ing on a larger study look­ing at more re­cent data to see if a pos­si­ble link be­tween swine flu vac­cine and mis­car­riage holds up, said James Don­ahue, a study au­thor from the Wis­con­sin-based Marsh­field Clinic Re­search In­sti­tute. The re­sults aren’t ex­pected un­til next year at the ear­li­est, he said.

A nurse prac­ti­tioner pre­pares a flu vac­ci­na­tion in Rockville, Md. EVAN VUCCI/AP

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