-This is the state of a women from the time of conception to the time of delivery. The duration of the period is 280 days. If it terminates before this period,and yet late enough for a living child to be born, the birth is spoken of as premature. If the birth occurs earlier than this it is called a miscarriage,and if within the first three months it is generally spoken of as an abortion. Before birth the child is called the embryo,or foetus.
Calculation of the Date of Delivery.- The duration of pregnancy is,as has just been stated,280 days, or forty weeks. The best way of calculating is to take the last day of the last menstrual period,and calculate from that nine calendar months. To this add one week. On the previous page will be found the full obstetric table.
Quickening is the name given to the first occasion on which the mother becomes conscious of the independent movements of the child. This is felt about the fifteenth week after conception. It is often accompanied by fainting on the part of the mother,especially if it is the first pregnancy.
The Signs of pregnancy are chiefly these:-Stopping of the periods,increase in the size of the body,morning nausea,vomiting,increase in size of breasts,and darker appearance of the areolae round the nipples. But it should be borne in mind that all these symptoms may occur in connection with diseases of the womb,without there being any child. The only absolute sign is the child’s heart-beat,which a practised ear can hear on listening over the woman’s abdomen in the later months of pregnancy.
General Management of pregnancy.-Some women experience better health during the period of pregnancy than at any other time, but it is more general for women to suffer various inconveniences, if not actual disease, during some part or other of the term. Every woman should regard the care of her health as of the utmost importance, as any indiscretion will be visited not on herself alone,but on her child. There is no need for her to be idle and consider herself an invalid, but excesses of all kinds she must avoid-fatiguing and violent exercise, heavy lifting,indulgence in the pleasures of the table.
Diet.-This should be of a plain,wholesome,and nourishing kind,all alcoholic stimulants being avoided; also strong tea,coffee,spices,high seasoning,rich food,sweets,and pastry. It should be taken at regular times. Oatmeal porridge,whole-meal bred,and other bone producing foods should be taken with milk.
Sleep.-It is highly important that the woman should have plenty of sleep. She requires more than when in an ordinary state. She should retire early;the bedroom should be well-ventilated,should not have very much furniture,and the bed should have no hanging. Then the woman must be allowed to sleep as long as she feels the necessity,and rise when she wakes naturally.
Bath.-She may do as she usually does about bathing; the morning cold bath or sponge down,if she is hardly and used to it,will do good, but she must beware of straining herself on getting into or out of the bath
Dress.-This is a matter of the greatest importance. Stays must be either of a special kind,which give free play to the movements of the ribs,or must be discarded altogether. This is necessary for many reasons. The mother has to do a double amount of breathing- for herself and her child-and it is therefore important that there must be nothing to hamper the movements of the chest-wall and the diaphragm to diminish the breathing space. Nature made the ribs movable,from the first to the last,and also the abdominal walls movable and muscular. Stays have the effect of fixing the lower ribs,limiting the breathing space,and crowding the abdominal organs into half their natural space. Stays are accountable for weak backs (Which ought to be strong enough to hold themselves up)and a multitude of other ailments,among them all kinds of displacements,constipation,and piles.
I am aware the great difficulty is how to fit on the clothes is stays are discarded. They must be hung from the shoulders and from the hips. The shoulders may bear the upper half of the garment,and the hips-not the soft part above the hip-bones,but the hip-bones themselves-by a broad belt made to fit to the bones,or the skirts themselves may be made to fit them. From the hip-bones down to the hip-joints the bones spread outwards,so as to bear any amount of weight. On no part of the body should the clothes press tightly. Garters must give place to suspenders. The clothes must be suited to the season, and warm enough to guard against chills. A great weight of clothes is objectionable.
Disorders of.-It is not often that a woman passes all through the period of pregnancy without some of the ailments incident to the state. Morning sickness is the best known. Vertigo,headache,fainting,toothache,and a number of others may become serious enough to require special treatment. They are discussed under this heading,but reference may also be made to the several diseases under their own special headings.
Bladder Irritation.-This is a frequent accompaniment of pregnancy. The patient experiences a constant desire to pass water, more troublesome during the day than at night. It is due to pressure of the uterus on the neck of the bladder. As soon as the womb gets to a certain size it rises out of the pelvis(the lowest part of the abdominal cavity,closed in by walls of bone, which make a kind of basin),and then the irritation passes away of itself if it come on in the earlier months. When it comes on during the later months it is due to pressure on the bladder itself.
General Treatment.-The patient must lie down as much as possible on her back.
Medicines.-(Every two hours.)
-This will usually allay the irritability.
Breasts Painful.-Pain in the breasts is very common during pregnancy. If it becomes severe give Bryonia 3 every few hours.
Cramps.-The pressure of the uterus on the great nerves of the lower limbs often gives rise to cramps.
General Treatment.-Keep the lower limbs warm,and let the patient lie on the back a great part of the day when not exercising.
-If the limbs are very cold.
-In general; When there is constipation.
Digestive Disorders. – Toothache.- Some women “lose a tooth” with each pregnancy. In general, the cause of this is improper dieting. The child must have bone salts for its teeth, and if the mother does not supply it out of the food she takes, her own bones and teeth must go short of their proper amount. Whole wheat-meal and bread made of it, groats and coarse oatmeal, are excellent foods, and will save many a tooth if women will only persuade themselves to eat them in preference to white bread, sweets, and pastry.
Medicines.-(Every hour while it lasts)
Kreosotum3 -If the tooth is decayed.
-When the pain is unendurable, worse at night and from warmth.
-Great nervous excitability.
-If there is no decay.
Salivation.-Incessant flow of saliva is a very common accompaniment of pregnancy,and a very annoying one.
Medicines.-(Every four hours)
-This will suffice in most cases.
-After Mercurius, if insufficient.
Heartburn.-Many women have heartburn during the whole time they are pregnant.
General Treatment.-They must avoid all sweet food and drinks, and anything likely to create acid.
Medicines.-(Every four hours)
-When there is much acidity.
Pulsatilla3 -In fair, quick-tempered women.
-When there is not much acidity.
Morning Sickness.-This is the most characteristic and most troublesome of all the disorders incident to pregnancy. It generally occurs in the morning, but by no means always. There may be all degrees of it, from simple nausea, which never goes on to vomiting,to vomiting after every morsel of food taken. Sickness lasts, as a rule, ten weeks-from the fifth or sixth week to the sixteenth. The sickness usually comes on immediately on rising from bed, and continues for an hour or two. It may recur less severely in the evening or it may last all day.
General Treatment.-Food must be taken frequently in small quantities medicines must be given a quarter of an hour before food. The Patient should endeavour to take some nourishment- milk, beef-tea, chicken tea, or solid food if she prefers it- immediately after vomiting. Koumiss(or fermented milk) will sometimes be retained when nothing else will.
Medicines.-(A quarter of an hour before each meal, until amelioration has taken place: then two or three times a day)
-Nausea and vomiting, with great uneasiness in the stomach;vomiting of drink and undigested food; bilious vomiting and tendency to ulceration off the bowels.
-Nausea and vomiting, chiefly in the morning while eating, or immediately after eating, or immediately after eating or drinking; acid and bitter eructations and regurgitations; violent hiccough, waterbrash, pain and sensation of weight in the pit of the stomach; constipation and irritable temper.
-Nausea after eating; vomiting of food; heart-burn eructations, acid, bitter, or with taste of food; craving for acids, whitish-coated tongue; persons of mild disposition.
-When the nausea is constant; vomiting of food.
Constipation.- This is a common accompaniment of pregnancy, and often arises from a mechanical cause, pressure of the uterus on the lower bowel.
General Treatment.-Active open-air exercise is the best remedy in general. The patient should drink freely of cold water, and eat fruit, ripe or cooked.
Medicines.-See under CONSTIPATION, especially Nux v., Bryonia, Lycopodium, Opium, and Sulph.
Diarrhoea is an occasional occurrence, but is much less frequent than constipation.
General Treatment.-Whilst it continues, hot drinks, beef-tea, fruit, or vegetables must be avoided. Milk with or without lime- water, white of egg beat up, arrow-root and farinaceous diet must be adhered to For Medicines, see indications under DIARRHOEA.
False Pains.-When the uterus begins to have contractions before the proper time comes, these are called “False pains,” to distinguish them from the real labour pains, which do the work of expelling the child. It is only when they come several weeks before the term that they are morbid. For a week or two before the birth there may be contractions (or “pains, ” as they are called) which are really preparatory to the final effort. IT is only when they are severe, and interfere with rest, that they require treatment.
Medicines.-(Every few hour)
-In fair, gentle dispositioned women.
-When they are accompanied with severe headache.
Headache and Vertigo.-About the fourth or fifth week of pregnancy it is common for women to have giddiness, fulness, or pain in the head. With the headache there is weight at the top and back of the head, and down the neck, palpitation of the heart, nervousness, trembling. The symptoms are usually worse in the morning.
Medicines.-(Every two or three hours until relieved)
-Plethoric women of florid complexion; giddiness, as if intoxicated, on rising from a seat; faintness and blindness on rising form a recumbent position; determination of blood to the head.
-Congestion to the head, vertigo, staggering, trembling, intolerance of noise; heaviness and pressure, pain on the top of the head, or in the forehead over the eyes; sense of expansion of the neck, palpitation, throbbing of the arteries of the neck;red face; sparks before the eyes; objects appear double.
-Sedentary women of hasty temper, addicted to wine or coffee. Symptoms worse in the morning, better in the open air. Giddiness with feeling of confusion in the head; sight cloudy;buzzing in the ears; pains tearing, drawing, or jerking, or periodical pains; constipation; insipid, acid, bitter or putrid taste.
-Women of mild disposition. Giddiness worse after stooping, with momentary blindness and staggering, shuddering and shooting pains in the head; one-sided headaches;headaches every other day. Sometimes there is numbness, worse in the afternoon and evenings.
-Congestion of blood to the head;beating pains and heat in the head. Vertigo and staggering, especially when seated or after meals, with nausea, Fainting, weakness, and bleeding from the nose; confusion of the head, worse morning and evening One sided headache, headache at the top of the head, back of the head, forehead, over the eyes, with dim sight. Sinking sensation, with flushes of heat to the heat;cold feet. Pains worse by movement, walking in the open air, and by meditation.
Inching or Pruritus.-This is a not uncommon affection, and very distressing; it affects the mucous membrane of the parts. At times it occurs without an eruption, at times there is an eruption like thrush in infants; sometimes there is oozing of a thin watery secretion.
General Treatment.- Wash the parts frequently with warm water. To the water may be added a little borax(a teaspoonful to the pint) or a little lemon juice.
Medicines.-(Two or three times a day)
-In women of the pulsatilla type, fair, or mild disposition, and easily moved to tears.
Lycopodium6. -When there is constipation, flatulence, and sandy urine.
-When there is a thrush-like eruption.
-In obstinate cases, patient subject to eruptions.
Mental Disturbance.-It is not uncommon for women to become altered in temper and disposition during the pregnant state. They are frequently affected with low spirits and despondency, and are certain they will never get over their labour. When the time comes they forget all about it, and it does not come back after delivery.
General Treatment.-The woman ought to have cheerful surroundings and plenty of fresh air and exercise.
Medicines.-(Every few hours)
-If a fright has been the occasion of it, and if fear of death is the most pre-eminent symptom.
-Great agitation and restlessness at night; fear of ghosts; fear and disposition to run away and hide; involuntary laughter;disposition to laugh or sing or fall into a passion and rave; frightful visions.
-Depression, with sadness and weeping, and uneasiness in the pit of the stomach: sleeplessness; she imagines herself to be oppressed with a multitude of cares; dislike to conversation; headache and heart-burn.
-Low spirits, great anxiety on the subject of religion;despair of eternal salvation;forgetfulness of proper names, and of words when about to speak them; disposition to get angry.
Miscarriage- A pregnancy may terminate at any period short of the proper term, and then it is called a “miscarriage” or “abortion,” though the latter term is usually employed only in those cases which occur within the first three months. “Miscarriage” is used when it occurs at any part of the term before the period when the child may possibly be born alive and live-that is, within seven months. In medical language it is sometimes, but not always, restricted to the period between the third and the seventh months. A delivery after the middle of the seventh month, and before the proper time, is called a “premature birth.”These terms are purely arbitrary, and have no inherent significance, and I shall speak of all premature terminations of pregnancy under the term “miscarriage.” The period at which miscarriage most commonly occurs is form the eight to the twelfth week. It is usually accompanied with a great deal of pain and loss, but is not in itself dangerous unless it recurs often. Late miscarriages are more serious. The most common of all causes of miscarriage are sudden straining, falls blows, or over-exertion of some kind.
Next after the mechanical cause are sudden emotions-frights and starts. Then come over-indulgence in improper articles of diet, stimulating food and drink, and the abuse of purgative drugs. Criminal interference with pregnancy must not be forgotten.
Symptoms.-A miscarriage is generally preceded by bearing-down pains, severe pains in the body and back, discharge of mucus and blood; with this discharge the foetus and its membranes pass away.
Women who have miscarried once are very liable to do so again, every fresh miscarriage tending to increase the liability.
General Treatment.-All attempts to interfere with the normal progress of pregnancy, except for medical or surgical considerations and under expert advice, are strongly to be reprehended. In cases where the mother is in a state of health, as from heart-disease, making child-bearing a danger to life, the pregnancy may be terminated under proper surgical precautions. The woman who doses herself with strong drugs, or allows other means to be used is in great danger of bringing on herself lifelong pain, discomfort, and loss of health, if not loss of life.
In all cases of threatened miscarriage the patient should immediately lie down, and remain lying down until the danger is past. If the miscarriage has taken place she must still keep lying down to allow the womb to return to its natural size, and to prevent further bleeding from its surface. The neglect of this is the cause of endless trouble in the way of displacements and all their attendant miseries. If there is much bleeding, all warm drinks must be stopped until it has ceased. The general diet will be as advised under CHILDBIRTH.
Medicines.-(When used as prophylactic, two or three times a day; when used whilst the miscarriage is actually threatening, every half-hour.) When the miscarriage is inevitable suitable medicines will assuage the pains and favour the natural process. In the next pregnancy the patient must be extremely careful at the corresponding period, lying down continually, if necessary, and must take the medicine most suited to her general state.
-When symptoms arise from a blow, fall, strain, or mechanical injury of any kind.
-Valuable after the miscarriage, when there is much dark blood and few pains; useful in debilitated persons.
-Spasms, faintness, nausea, vomiting;profuse discharge of bright-red blood, downward pressure,cutting pains round the navel.
-Labour-like pains, each followed by a discharge of dark, clotted blood or blood and mucus;violent pains in the bowels, extending round the sides, with feeling as if about to have a motion or pass water; coldness, shivering, and thirst.
Croc. 3 -Dark, clotted blood, increased by the least exertion;feeling of fluttering, as if something moving about the navel.
-In the early months, much pain, discharge of bright-red blood.
-In weak, exhausted persons;; blood discharged at intervals, with bearing-down pain;spasmodic pains in womb; giddiness, drowsiness, fainting. Very useful for weakness after the discharge has ceased.
Varicose Veins.-During pregnancy the veins of the lower limbs often become varicose in consequence of the pressure of the enlarged womb impending the return of the blood from the limb to the heart. After delivery they generally regain their natural condition.
General Treatment.-When the condition is serious the patient must be kept lying down. If she is compelled to go about the limbs must be bathed in cold water or in spirit-and-water, and bandaged. It may be necessary to wear an elastic stocking.
Medicines.-See under VARICOSE VEINS.