PREGNANCY—LABOR—PARTURITION.
Perhaps there is no more eventful period in the history of woman than that in which she first becomes conscious that the existence of another being is dependent upon her own and that she carries about with her the first tiny rudiments of an immortal soul.
THE SIGNS OF PREGNANCY
are various. Many females are troubled with colic pains, creeping of the skin, shuddering, and fainting fits immediately on conception taking place. Where such symptoms occur immediately after connection, they are a certain indication of impregnation.
A REMARKABLE CHANGE
takes place in the face in most cases, varying in time from three days to three months. The eyes are dull and heavy, and present a glassy appearance; the nose pinched up; the skin becomes pale and livid, and the whole countenance appears as if five or ten years' advance in life had been taken at a single step.
Another important and remarkable sign, and one the most to be relied on, is an increase in the size of the neck. This often occurs at a very early period, and many females, by keeping a careful daily measurement of the neck, can always tell when they are pregnant.
A suppression of the menstrual flow is another strong presumptive sign. It is true a partial flow of the menses often occurs after pregnancy, from the lower part of the womb, but when the flow is suddenly stopped without any apparent cause, pregnancy is generally the predisposing cause.
SOON AFTER CONCEPTION
the stomach often becomes affected with what is called morning sickness. On first awaking, the female feels as well as usual, but on rising from her bed qualmishness begins and perhaps while in the act of dressing retching and vomiting takes place.
This symptom may occur almost immediately after conception, but it most frequently commences for the first time between two and three weeks after. Now and then it is experienced only during the last six weeks or two months of pregnancy, and subsides about the time the movements of the child begin to be felt.
CHANGES IN THE BREAST
are generally considered as strong signs of pregnancy. When two months of pregnancy have been completed, an uneasy sensation of throbbing and stretching fullness is experienced, accompanied by tingling about the middle of the breasts, centering in the nipples. A sensible alteration in their appearance soon follows, they grow larger and more firm. The nipple becomes more prominent, and the circle around its base altered in color and structure, constituting what is called the areola, and as pregnancy advances milk is secreted.
THE PERIOD OF GESTATION,
at which these changes may occur, varies much in different females. Sometimes, with the exception of the secretion of the milk, they are recognized very soon after conception; in other instances, particularly in females of a weakly and delicate constitution, they are hardly perceptible until pregnancy is far advanced or even drawing toward its termination.
The changes in the form and size of the breasts may be the result of causes unconnected with pregnancy. They may enlarge in consequence of marriage, from the individual becoming stout and fat or from accidental suppression of the monthly flow.
The changes which take place in the nipple, and around its base, are of the utmost value as an evidence of pregnancy.
ABOUT THE SIXTH OR SEVENTH WEEK
after conception has taken place, if the nipple be examined it will be found becoming turgid and prominent, and a circle forming around its base, of a color deeper in its shade than rose or flesh color, slightly tinged with a yellowish or brownish hue, and here and there upon its surface will be seen little prominent points from about ten to twenty in number. In the progress of the next six or seven weeks these changes are fully developed, the nipple becoming more prominent and turgid than ever, the circle around it of larger dimensions, the skin being soft, bedewed with a slight degree of moisture, frequently staining the linen in contact with it; the little prominences of larger size, and the color of the whole very much deepened.
Calculations of the
DURATION OF PREGNANCY,
founded upon what has been observed to occur after casual intercourse, or perhaps a single act, in individuals who can have no motive to tell us what is false, are likely to be correct. The conclusion drawn from these is, that labor usually, but not invariably, comes on about 280 days after conception, a mature child being sometimes born before the expiration of the forty weeks, and at other times not until that time has been exceeded by several days. A case is on record where the pregnancy lasted 287 days. In this case the labor did not take place until that period had elapsed from the departure of the husband for the East Indies, consequently the period might have been longer than 287 days.
CHILDBIRTH IS A NATURAL PROCESS,
and however complicated and painful habits or disease have made it, yet the work must be left to nature. Any efforts to assist or hurry matters will only end in harm. The only cases where interference is justifiable is where her powers are exhausted or some malformation exists or malpresentation occurs. When labor is about to commence, the womb descends into the bottom of the belly and the motions and weight of the child will be felt much lower down than usual. If in a natural position the head will fall to the mouth of the womb and press upon it. This drives forward the membranes which retain the water at the orifice, and at the proper moment they break and labor then commences.
Labor is caused by involuntary contractions of the uterus and abdominal muscles. By their force the liquor amnii flows out, the head of the fœtus is engaged in the pelvis, it goes through it, and soon passes out by the valve, the folds of which disappear. These different phenomena take place in succession and continue a certain time. They are accompanied with pains more or less severe, with swelling and softening of the soft parts of the pelvis and external genital parts, and with an abundant mucous secretion in the cavity of the vagina. All these circumstances, each in its own way, favor the passage of the fœtus.
It is proper here to remark that parturition is not necessarily either painful or dangerous. It is well known that women in an uncivilized state suffer very little pain or disablement in bringing forth children. Generally neither pregnancy nor labor interrupt the ordinary avocation of the mother, except for an hour or two at the birth itself. The suffering and debilitating influences that often attend childbirth now are caused by our unnatural modes of living and nonattention to the laws of health. Numerous well-authenticated instances are known where women who had previously suffered with severe labor in childbirth have, by attention to health and diet as here shown, been delivered of fine healthy children with comparative ease.
From the
BEGINNING OF PREGNANCY
more than ordinary care should be used in taking regular exercise in the open air, being careful to avoid fatigue and overexertion. During the whole period of pregnancy every kind of agitating exercise, such as running, jumping, jolting in a carriage, and plunging in cold water, should be carefully avoided, as well as the passions being kept under perfect control.
THE DIET
must chiefly consist of fruits and farinaceous food, as sago, tapioca, rice, etc. In proportion as a woman subsists upon aliment which is free from earthy and bony matter will she avoid pain and danger in delivery; hence, the more ripe fruit, acid fruit in particular, and the less of other kinds of food, but particularly of bread or pastry of any kind, is consumed, the less will be the danger and sufferings of childbirth. Nearly all kinds of fruit possess two hundred times less ossifying principle than bread or anything else made of wheaten flour.
Honey, molasses, sugar, butter, oil, vinegar, etc., when unadulterated, are entirely free from earthy matter. Common salt, pepper, coffee, cocoa, spices, and many drugs are much worse than wheaten flour in their hardening and bone-forming tendency, and should therefore be avoided. The drink should be tea or lemonade made with water, soft and clear, and, when practicable, distilled.
No mother who has adopted this mode of living but has blessed the knowledge of it, and it has saved many a young mother from needless terror.
In the third month of pregnancy, but not before, the belly begins to enlarge or swell, and gradually increases in size till the full term of pregnancy is completed. Between the sixteenth and twentieth week the womb rises up into the belly, and the motion of the child is felt, which is called
QUICKENING.
The first time a woman is with child this sensation of quickening is like that of a bird fluttering within her; at other times she feels a tickling or pushing sensation, or the child gives a kick or a jump, and this, too, with so much energy as to move the petticoats, a book, or any light article she may have in her lap.
It is important to remember these symptoms, and the order in which they occur: first, cessation of the menses; second, morning sickness; third, swelling and darting pains in the breast, and dark color around the nipples; fourth, gradual enlargement of the abdomen or belly; fifth, the movement of the child.
In ninety-nine cases out of a hundred, if these symptoms are present the woman is pregnant. Pregnant women are generally affected with heartburn, sickness of a morning, headache, and that troublesome disease, toothache, which accompanies pregnancy; all of which may usually be avoided by keeping the bowels gently open with seidlitz powders, caster oil, or pills of rhubarb, which should be taken occasionally, either alone or in combination with colocynth and soap. A clyster made of warm soapsuds will often be sufficient if repeated every few days; or senna and manna; and if there is any aversion to taking medicine, give some simple articles, such as roasted apples, figs, prunes, or anything that will quiet the stomach and prevent costiveness of the bowels.
THE TOOTHACHE
often complained of by pregnant women, and which may occur at any period, is seldom relieved by extraction, having its seat in the adjacent nerves of the face or jaws, and is neuralgic. The teeth ought not to be drawn during pregnancy, unless urgently required, but should be relieved by applying hot fomentations to the face, as a camomile poultice. Rubbing the jaw externally with spirits of camphor or laudanum, or applying mustard plasters or blisters behind the ears, will afford relief.
THE CRAMPS OF THE LEGS. ETC.,
in pregnancy, caused by the pressure of the enlarged womb on the nerves, are often troublesome, but not attended with any danger, and may be speedily relieved by a change of posture, and friction, or rubbing with opodeldoc, spirits of camphor, or hot whisky and salt. Palpitation of the heart occurs frequently, and usually about the period of quickening. In general, it is the result of a disordered stomach and may be relieved by attention to diet and moderate doses of magnesia and Epsom salts, of equal quantities.
THE PALPITATION OF THE HEART
may be produced by a morbid state of the nerves, and is then termed hysterical. Attention in all such cases should be paid to the diet, air, exercise, etc., with the view of improving the strength, the bowels being kept open by mild means. All exciting or agitating subjects should be carefully avoided, and the mind of the pregnant woman kept calm and tranquil; for the mind, in the early stages of pregnancy, exercises the most powerful influence over the child through life; and how many peculiar traits of character have been indelibly fixed upon their offspring from these exciting causes is evident in many families.
When the palpitation occurs from the state of the nerves, as before described, producing uncomfortable feelings, a teaspoonful of the tincture of castor or asafœtida, with an equal quantity of compound spirits of lavender, mixed in a little water, will seldom fail to afford relief, which may, if necessary, be repeated on its recurrence.
MORNING SICKNESS
is one of the most painful feelings attendant on the pregnant state, and it is one of those which medicine commonly fails to relieve. A cup of camomile or peppermint tea, taken when first awaking, and suffering the patient to be still for an hour, will frequently alleviate the distressing sickness; but should it recur during the day, and if these means fail, two or three teaspoonfuls of the following mixture should then be taken either occasionally or, when the vomiting and heartburn are more continual, immediately after each meal:
| Take of— | |
| Calcined magnesia, | One dram; |
| Distilled water, | Six ounces; |
| Aromatic tincture of rhatany, | Six drams; |
| Water of pure ammonia, | One dram. |
Mix. The anxiety and sometimes despondency of mind—in other words, lowness of spirits—to which pregnant women are more or less liable greatly depends on the state of their general health and the natural temper and character of the individual; but it can be greatly aggravated, and may often be excited by circumstances or officious persons. Let me, then, urge upon you the important necessity of keeping the mind as tranquil and cheerful as possible, particularly during the first four months of pregnancy. A judicious course of this kind will produce the most beneficial and well-balanced mind in the child; while, if the contrary, a desponding and nervous temperament, with many other peculiarities, will be the consequence.
SURE TEST FOR THE DETECTION OF PREGNANCY.
M. Nauche has found that the urine of pregnant women contains a particular substance, which, when the urine is allowed to stand separates and forms a pellicle on the surface. M. Enguiser, from an extensive series of observations, has confirmed the fact, and ascertained that kisteine, as this particular substance has been called, is constantly formed on the surface of the urine of women in a state of pregnancy. The urine must be allowed to stand for from two to six days, when minute opaque bodies are observed to rise from the bottom to the surface of the fluid, where they gradually unite and form a continuous layer over the surface. This layer is so consistent that it may be almost lifted off by raising it by one of its edges. This is the kisteine. It is whitish, opalescent, slightly granular, and can be compared to nothing better than the fatty substance which floats on the surface of soups after they have been allowed to cool. When examined by the microscope, it has the aspect of a gelatinous mass without determinate form; sometimes cubical shaped crystals are discovered on it, but this appearance is only observed when it has stood a long time, and is to be regarded as foreign to it. The kisteine remains on the surface for several days; the urine then becomes turbid, and small opaque masses become detached from the kisteine and fall to the bottom of the fluid and the pellicle soon becomes destroyed.
The essential character of the urine of pregnancy, then, is the presence of the kisteine; and the characters of the pellicle are so peculiar that it is impossible to mistake it for anything else. A pellicle sometimes forms on the surface of the urine of patients laboring under phthisis, abscess, or disease of the bladder, but may be easily distinguished by this circumstance, that it does not form in such a short time as the kisteine, and that in place of disappearing, as this last, in a few days, it increases in thickness and at last is converted into a mass of moldiness. There exists, likewise, a very marked difference between its mucous aspect and that of kisteine; a difference which is difficult to describe, but which is easily recognized.
Kisteine appears to exist in the urine from the first month of pregnancy till delivery. It has even been recognized in the urine of a few gravid animals.
“PARTURIENT BALM,”
For Rendering Childbirth Easy and Less Dangerous—A very Important Medicine.
Take blue cohosh root, four ounces; lady's-slipper root and spikenard root, of each one ounce; sassafras bark (of root) and clover, of each half an ounce. Bruise all, and simmer slowly for two hours in two quarts of boiling water. Strain, and add one pound of white sugar.
Dose: A wineglassful twice a day for two weeks or a month previous to expected confinement, for the purpose of rendering parturition, or childbirth, more easy.
Should be taken by every pregnant woman.
ABORTION.
Abortion, or miscarriage, means, in plain language, a woman losing her child previous to the seventh month of her pregnancy; that is, before its due time. When this occurs after that period it is called
PREMATURE LABOR.
Miscarriage involves pain and weakness in addition to the loss of offspring, and is often a severe trial to the maternal constitution. It may occur at any period of pregnancy, but particular stages are more liable to the accident than others. These are generally considered to be about the time of the first menstruation after conception; again at the twelfth week, and toward the seventh month; and the liability is increased at those times which correspond to the menstrual period. When abortion has once taken place it is more likely to occur again, and some have so strong a tendency to it that they never go beyond a certain stage, but then invariably miscarry.
THE CAUSE OF ABORTION
may exist in the constitution of the female herself, being the result of weakness and irritability, or of an overfull habit or a diseased condition of the womb; or the fœtus, or child, may die or be deficient in development, when it is cast off like a blighted fruit. Suckling after conception has taken place is not infrequently a cause of miscarriage. Active diseases occurring during pregnancy, such as fevers, severe inflammation, eruptive fevers, etc., are almost certain to occasion the expulsion of the uterine contents. Continued diarrhœa and the action of strong purgative medicines, particularly the aloetic, are dangerous. This is a very good reason for those who are pregnant avoiding all quack aperient medicines; they almost all contain aloes, and may be very injurious. All undue exertion or agitation of body or mind, sudden jerks or jumps, riding on horseback in the early stage, or in a shaking carriage in the latter stages of pregnancy, may any of them bring on miscarriage. To these may be added: exertion of the arms in doing anything on a level above the head; costive bowels and straining consequent therein; sexual indulgence, or, in plain language, too much connection with your husband; and luxurious habits. Those who have once suffered from abortion ought to be extremely careful during succeeding pregnancies, and all ought to bear in mind the possibility of the occurrence.
THE SYMPTOMS OF THREATENED ABORTION
vary with the constitution. In the strong and plethoric it is often preceded by shivering and febrile symptoms and by a feeling of weight in the lower bowels. In the weak there is languor, faintness, flaccidity of the breasts, general depression, and pains in the back and loins. Intermittent pains, and discharge of blood from the passage, tell that the process has begun. If miscarriage occurs within the first month or two after conception, the process may be accomplished with so little inconvenience as to escape notice and be mistaken for a menstrual period. More generally, however, the severity of the pain and an unusual clotted discharge of blood render the case evident. The pain, the discharge, and, at the same time, the danger of an abortion, are in proportion to the advancement of the pregnancy. When a miscarriage goes on, the pains increase in force and frequency, and continue, with discharge of blood, fluid or in clots, until the ovum, or first formation of the child, is expelled; after which both become moderated till they cease altogether and the red flow gives place to a colorless one. It is very important that those in attendance upon the patient should examine every clot that comes away. If large, tear it in pieces, that they may ascertain whether the contents of the womb are expelled or not, for there is no safety or rest, where miscarriage is progressing, till it has taken place and everything is cast off.
AS SOON AS A FEMALE
experiences threatenings of abortion she ought at once to retire to bed, upon a mattress, and keep perfectly quiet till every symptom has disappeared. Sometimes this simple measure, promptly adopted, is sufficient to avert the threatened evil. If there is much feeling of fullness, and the patient is of full habit generally, eight or a dozen leeches may be applied to the lower part of the bowels; if there is fever, saline medicines may be given, such as the common effervescing draft of carbonate of soda and tartaric acid or lemon juice; or, if the bowels are much confined, seidlitz powders, assisting the action by cold clysters, if necessary. When the pains are severe, particularly in the weak and irritable, twenty or thirty drops of laudanum should be given, and may be repeated in a few hours if the symptoms are not improved. In the case of profuse discharge, the patient should be kept very lightly covered, movement avoided, and every article of food or drink given cold, or iced if possible, provided the vital powers are not excessively reduced. Cloths dipped in cold or iced water should also be applied to the lower part of the body and frequently changed. Acid drinks, with cream of tartar, may be freely given. Ten or fifteen drops of elixir vitriol may be given in a wineglassful of water every two or three hours. Should slight faintness come on, it is better not to interfere with it, but use outward remedies—camphor, cold water, vinegar, etc.—as they maybe salutary. If it reaches to an extent to threaten life, stimulants, as brandy and water, and others, must be had recourse to. Profuse and continued discharge, though it may not threaten life, must occasion a weakness which will take a long time to overcome, and which may ultimately, if not properly attended to, promote the development of other diseases of the womb.
IF THE FLOODING IS PROFUSE
and uncontrolled by the means before mentioned, one grain and a half of sugar of lead may be given every two or three hours, and washed down with a drink of vinegar and water, to which, if there is much pain, add from five to ten drops of laudanum.
Pieces of linen or cotton cloth should be soaked in a strong solution of alum, or a decoction of oak bark; and then well oiled; with this cloth plug the passage or birthplace; or, some of this astringent wash may be thrown up with a syringe.
But, during the time and after miscarriage, the general strength must be supported by a strengthening diet, such as soups, meat, etc., avoiding stimulants as much as possible. Nevertheless, in some cases wine or malt liquors may be necessary in convalescence, or when recovering, and if so may be assisted by tonic or strengthening medicines, such as contain mineral acid. Bark or iron are generally given as the most appropriate remedies. The bowels will, in some cases, require strict attention, as indeed they do throughout, and for this purpose castor oil is a good medicine, or clysters of cold or tepid water are most useful. A teaspoonful of Epsom salts dissolved in half a pint of water, either cold or slightly warmed, to which add fifteen drops of elixir vitriol, forms a most excellent and mild purgative, which should be taken before breakfast. In all cases where the constitution of the woman has a tendency to miscarriage or abortion, a quiet state of mind should be observed, avoiding all violent exertions, particularly lifting heavy weights. These principles of treatment are to be kept in mind in the management of miscarriage:
The first, to prevent it, if possible, by rest, opiates, etc.
The second, to allay pain, moderate the discharge of blood, and to save and support the strength of the patient.
The third, when abortion must take place, to expedite the separation of the ovum and free the contents of the womb. This is generally done by simply occasionally drinking cold water, and in difficult cases, if necessary, by the administration of spurred rye. The dose is a strong infusion or tea given every twenty or thirty minutes until the desired effect is produced, as long as the stomach will bear it.
The health of pregnant females should at all times be an object of great care and interest; and they should be impressed with the conviction that while
BEARING THE FIRST CHILD
they may, by proper care and attention, lay the foundation for their future health and that of their offspring; while by neglect and imprudence in this matter, they may not only enfeeble their constitution, but entail upon their children an inheritance of infirmity and disease.
Miscarriage, or abortion, which includes all cases in which delivery takes place before the sixth month, seldom occurs without being preceded, or accompanied, or followed, by a morbid discharge of blood from the womb, which is commonly known by the name of flooding. Abortion, or miscarriage, takes place with the first pregnancy, and during the first two months; therefore, great care should be observed during this period, as any cause which either destroys the life of the child in the womb or brings on morbid or premature contractions in that organ may induce miscarriage. Coughing severely, or vomiting, a blow or fall, or a misstep leading to an effort to prevent falling, may, and does frequently, result in miscarriage; and this having once occurred, it is, without proper care, exceedingly liable to be the case again at the same period of a subsequent pregnancy. The same result may follow any vivid moral impression; for fright, or mental excitement by passion, or witnessing any accident, will be found often to end in miscarriage. In some healthy females, however, it occurs without any other cause than mere fullness of blood. A bleeding from the womb is often in such cases a first symptom of abortion, and should be attended to as early as possible before it goes to any considerable extent. The amount of flooding, in most cases, is in proportion to the early period of pregnancy at which it takes place, for in the latter months there is seldom much blood lost. But there are cases in which pregnant women will lose blood repeatedly from the womb and yet not miscarry, but these are very rare cases.
In most cases, the occurrence of a woman's flooding between the first and fourth months, unless very slight, or quickly relieved, is usually followed by a miscarriage; but as soon as the child and its membranes are both expelled by the contraction of the womb the flooding soon ceases. In many such cases it is often very difficult, and sometimes impossible, to deliver the afterbirth and membranes, which remain and finally pass off after putrefaction has taken place, resulting in long and offensive discharges from the womb, and which, unless treated by the most skillful management, frequently result in many internal mischiefs of a serious character, such as ulcers, cancers, etc.
In all cases, those who are constitutionally disposed to abortion, or have a tendency to miscarriage, should take great care to preserve a quiet state of mind and to avoid all violent exertion; and all active purgatives should be avoided, and exposure to great heat or cold, during the time of gestation or pregnancy.
When the miscarriage has really taken place, and the fœtus, or child, is expelled, together with the contents of the womb, the same precautions should in general be observed as in childbirth.
TO PREVENT MISCARRIAGE,
when it is threatened, or on the appearance of the first symptoms, the patient should lie down and be as quiet as possible; live on very light diet; bowels be kept freely open; and an injection of thirty drops of laudanum should be given in half a pint of slippery elm tea. Should flooding be present, cold lemonade should be drank freely, and cloths wet with cold or ice water applied to the thighs and lower part of the birthplace, which should be repeated until the flooding is relieved.
MEANS OF PREVENTING ABORTION.
To prevent abortion, women of weak or relaxed habit should use solid food, avoiding great quantities of tea, coffee, or other weak or watery liquors. They should go soon to bed and rise early, and take frequent exercise, but avoid fatigue. They should occasionally take half a pint of the decoction of lignum-vitæ, boiling an ounce of it in a quart of water for five minutes.
If of a full habit, they ought to use a spare diet and chiefly of the vegetable kind, avoiding strong liquors and everything that may tend to heat the body or increase the quantity of blood; and when the symptoms appear, should take a dram of powdered nitre in a cup of water gruel every five or six hours.
In both cases the patient should sleep on a hard mattress and be kept cool and quiet; the bowels should be kept regular by a pill of white walnut extract or bitterroot.