The possibility of estimating the date of confinement is still further complicated by the fact that there is evidently considerable variation in the length of entirely normal pregnancies. Many healthy children are born before ten lunar months have elapsed, while more deliveries occur after than on the expected date. The first pregnancy is usually shorter than subsequent ones, and women who are well nourished and well cared for have longer pregnancies, as a rule, than those less favored.
Fig. 32.—Contour of abdomen at ninth month of pregnancy, or before the waistline drops.
Fig. 33.—Contour of abdomen at tenth month of pregnancy, or after the waistline has dropped.
Although the symptoms of pregnancy have been observed throughout the ages by women who have borne children, and accoucheurs of one sort and another who have attended them, a positive diagnosis at an early stage of this condition is sometimes still baffling to the most experienced obstetricians.
So many symptoms of pregnancy are known to women the world over, that an expectant mother frequently recognizes her pregnant state at a very early date. This is particularly true of women who have previously borne children. But as these same symptoms closely resemble those of other conditions, they are not infrequently ascribed to impaired health, with the result that the pregnancy is not discovered until it is well advanced, and then sometimes only by accident. And one even hears of an occasional case in which a woman is entirely unaware of her condition until she goes into labor.
The converse is also true, for women sometimes erroneously believe themselves pregnant because of the appearance of well recognized symptoms, which are due to other causes. This condition is known as pseudocyesis, or spurious pregnancy, and is usually found in women approaching the menopause or in young women who intensely desire offspring. It is a pathetic occurrence, and the patient is usually so tenacious of her belief in her approaching motherhood that the obstetrician dispels it only with great difficulty.
For all of these and other reasons it is customary to divide the signs and symptoms of pregnancy into three groups, under self-explanatory headings, namely: presumptive symptoms, and probable and positive signs. Although it is never within the province of a nurse to make a diagnosis, it is important that she be familiar with symptoms. In obstetrics this seems to be particularly true, and especially so if the nurse be engaged in prenatal work or in any branch of public health nursing that brings her in touch with possible or expectant motherhood. The wider her grasp of obstetrical knowledge, the more helpful and reassuring can be her relation to her patient. To this end, therefore, we will take up the most reliable symptoms and signs of pregnancy.
The presumptive signs, which consist largely of subjective symptoms observed by the patient herself, are as follows: