What Women Should Know/Chapter 9
Symptoms of Pregnancy.—The woman who is already a mother is seldom in any doubt about her condition when she becomes pregnant. There are certain signs and feelings, peculiar to herself, perhaps, which she cannot mistake. But the young wife, lacking this experience, may not always know whether she be pregnant or not.
Cessation of the Menses.—The first symptom of pregnancy is generally a cessation of the menses. In rare instances these may continue for a month or two after pregnancy has taken place. In still rarer cases they may continue through the whole period until delivery. The menses may disappear without any sign whatever; or they may seem to attempt to come on with all the usual symptoms, and with perhaps more than ordinary pain. Before they have made their appearance the woman will, perhaps, be seized with a severe chill. The non-appearance of her monthly courses she will be very apt to attribute to the chill, and will very naturally be led to resort to simple measures in order to restore the suspended menses.
Nausea.—A few days will probably undeceive her. She will soon be seized with that nausea called morning sickness, which is the usual accompaniment of pregnancy. It is possible that this nausea may have been already felt; or it may still delay in mak ing its appearance for a few weeks.
Enlargement of the Breasts.—The next symptoms will probably be darting pains through, and enlargement of, the breasts. These symptoms are not always present. Sometimes there is little change and no unpleasant sensations in the breasts during the whole period of gestation. The nipples and the circle around them become darker, the former more enlarged and more prominent, and little excrescences will present themselves on the surface of both.
Quickening.—The next probable symptom in the course of nature is quickening, the word by which we distinguish the first perceptible motion of the embryo.
Period of Quickening.—Physicians calculate the time of quickening—that is, the time when motion is first felt—to be about the middle of the period of gestation, though they allow that it may occur a few weeks either earlier or later. There is, indeed, no definite time. It is sometimes felt at the end of three months and again it has been delayed until the sixth month.
Sensations of Quickening.—The first motion felt is described by medical authorities as a fluttering like that of a bird. This is not so. The first motion which may be felt is so slight as to be passed unnoticed by the one feeling it for the first time. It is like a gentle tap, perhaps occurring but once, or, it may be, repeated at short intervals. The "fluttering" motion only comes after the fœtus has acquired considerable strength and muscular power.
Enlargement of the Abdomen.—At or about the beginning of the fourth month the womb rises above the rim of the pelvis, and then there begins a perceptible enlargement of the abdomen. There is no mistaking the form and feeling of the enlarged womb. The hand pressed upon the abdomen encounters a hard unyielding object which cannot be grasped. An accumulation of fat can be readily detected, as it can be grasped in the hand and its actual thickness measured.
Flatulence mistaken for Pregnancy.—There have been cases reported in which flatulence has been mistaken for pregnancy. Flatulency will cause the abdomen to be at one time hard and drum-like, and at another soft and yielding. In pregnancy it is invariably hard, solid and firm to the touch.
—In the early stages of pregnancy the navel is slightly depressed. As the pregnancy advances it gradually assumes a protruding appearance.
Other Symptoms of Pregnancy.—There are other accompaniments of pregnancy which may or may not be present. These are cramps, swelled feet, varicose veins, fainting fits, hysteria, longings, toothache and moth or blotches on the face.
These Symptoms to be ⟨Considered as⟩ Disorders.—Some women may experience only a portion of these last-mentioned symptoms; others may have them all while still others may be entirely free from them. I believe these should all be considered as diseases or evidences of disorder which, in a perfect state of health, will never show themselves.
Duration of Pregnancy.—The usual duration of pregnancy is about two hundred and eighty days. Delivery may sometimes occur a few days earlier or a few days or weeks later. I have known of its being delayed until the three hundredth day after conception. The child in this case weighed nearly eleven pounds, and presented, not only in size, but in strength and use of faculties, the appearance of a month-old babe. So it was not retarded development which delayed his birth. The laws of France recognize a child as legitimate whose birth dates within three hundred days from the death or absence of the husband. It does not deny the possibility of the time being longer, but allows it to be a matter for litigation. Physicians give what they consider well-attested cases of births not taking place until some weeks even after this period; but these cases are exceedingly rare.
Rule for Calculating Time of Delivery.—The best and safest rule for calculating a confinement is to count thirty-nine weeks from the time of the last menstrual flow. It will commonly take place at the end of the thirty-ninth or fortieth week.
Delivery Before the Proper Time.—If delivery takes place before the thirty-ninth week, it is called premature. If at less than the eighth month, it is miscarriage. A prematurely delivered child is not so liable to live as one who goes its full term, though it is not uncommon for seven months' children to survive. Life is even possible when delivery takes place at the end of six months, though such cases are rare.
I know a woman now full-grown and fully-developed who was born at six months. She was so exceedingly small at birth that a finger-ring would easily pass over her arm up to her shoulder. She was too small to be dressed, and lay wrapped in cotton wool until she had completed the third month of her life, or what would have been the full term of delivery. Up to this period she took as food but a single drop of milk at a time. After this period she became in size and appearance like an ordinary newborn infant, and was dressed and fed as such. I have never personally known of a case of birth at an earlier date than this, but I have read of a man who was born at five months and lived to reach an extreme and healthy old age. When birth takes place at but a short period before the proper time, it is considered the same as regular delivery, though its dangers are somewhat increased.
Abortion, or Miscarriage.—Abortion, or miscarriage, is usually attended with far more dangers than regular delivery. It is possible that abortion may occur at the end of the first or second month with little inconvenience to or even without the knowledge of the woman. There will be a profuse and prolonged menstrual flow, with some slight appearance of clots, which occasion little surprise and no alarm. Nevertheless, though the immediate trouble is slight, the occurrence should be considered disastrous in the extreme. For, abortion having once occurred, it is likely to occur again at the same period, and the woman may never be able to complete her full term.
Causes of Abortion.—The causes of abortion are manifold. They may be either of a physical or a mental nature. A woman who, previous to marriage, has been injudicious in her habits of living and dressing, and who has thus failed to establish the menstrual flow with regularity and freedom from pain, is more liable to miscarriage than one whose physical health is perfect.
Too severe physical exertion, running, lifting, sudden and excessive joy or sorrow—all of which a healthy woman ought to endure in perfect safety—will be sufficient to bring on abortion. A fall or blow sometimes produces the same result.
Women of strong passions, and those who indulge too frequently in marital pleasures, are more liable to abortions than others. Sometimes the same effect is produced by a like character and course of conduct on the husband's part, when the wife herself is blameless.
Excessive straining at stool, or severe and prolonged coughing, will occasionally produce the like result in those who are predisposed to this difficulty. A too idle and luxurious life, and one too laborious, are about equally capable of causing abortion.
Dangers of Abortion.—The dangers of abortion are greater far than those of mature delivery. There is the danger that the whole of the fœtus or the afterbirth may not pass away. A small portion remaining in the womb may bring much suffering, and even death, to the woman. Then, as nature is not ready for the act of delivery, she has made no preparations for it. The placenta or after-birth is connected with the womb by means of numerous minute blood vessels. When the term of gestation is complete, these separate of themselves from their points of adhesion, and the loss of blood is small. But in abortion these are forcibly torn away, leaving a myriad bleeding apertures; and thus severe and dangerous flooding is likely to ensue.
Flooding in Abortion.—Flooding is indeed the greatest danger attending abortion. The patient is liable to it for weeks, and even months, after she thinks she has recovered her health and strength For this reason she ought to retain her bed longer than after delivery at full term, in order to give the ruptured membranes time to heal. Upon the first symptoms of flooding the patient should lie down with the hips raised, and preserve the utmost quiet, and external applications of cold water should be made until the flooding is checked. If it does not show signs of stopping, a doctor should be at once sent for, or the patient may bleed to death.
Necessity for a Physician in Abortion.—The presence of a physician. is far more necessary in case of an abortion than in a regular delivery. The latter is an act of nature; and if there be nothing abnormal in the case, a woman of ordinary intelligence is perfectly competent to see it safely through. But abortion is not a natural act, and no one but an experienced physician can foresee and provide for its dangers.
Signs of Threatened Abortion.—The first sign of a threatened abortion is generally a flow of blood. As soon as this appears the patient must take to her bed and remain quiet. It is possible that this symptom may pass away without any unfavorable result. If, however, the flow of blood increases, and there are pains similar to labor pains, a doctor must be sent for. He will ascertain whether the fœtus be alive or dead. All information which the woman can give in regard to any circumstance which might possibly result in the death of the unborn child ought to be fully communicated. If the child is living, it is still possible, by the employment of proper means, to avert the abortion. But if it be dead, there is but one inevitable result, and it is the physician's business to make this as speedy and as safe as possible.
Abortion will usually take place at about the ninth day after the death of the fœtus, though there are cases on record where the dead fœtus has been retained for months before its expulsion. It is imperatively necessary that all the discharges of the patient and all the cloths used about her person should be subjected to the inspection of the physician, as he alone is qualified to judge of the nature of these discharges, and to know when the abortion is complete. An attendant may mistake a simple clot of blood as a portion of the after-birth or of the decomposed fœtus, and from this mistake serious consequences may ensue.
To Prevent Recurrence of Abortion.—As it is greatly to be desired that abortion should not become a habit, which it has a tendency to do, every means should be taken to prevent it. First of all, the husband should absent himself from his wife's bed for three months after its occurrence, that she may not too soon become pregnant again, before she has fully recovered from the shock to her physical system, which even the most painless abortion proves to be. Then, when the woman becomes again pregnant, sexual intercourse should not be indulged in until after the time at which abortion took place on the previous occasion. The cause of that abortion, if it was ascertained, should be carefully avoided, and the woman should, besides, be careful of all her habits of life, living plainly and sparingly, and, though indulging in moderate exercise, avoiding over-exertion. The greatest danger is at the period in pregnancy when the previous abortion took place. When that is safely passed, there is tolerable reason for hope that she will go safely to the end of her time.