Obstetrical Nursing / A Text-Book on the Nursing Care of the Expectant Mother, the Woman in Labor, the Young Mother and Her Baby

by Carolyn Conant Van Blarcom

Changes in the urinary apparatus include frequency of micturition mentioned among the symptoms of pregnancy.

The changes in the bony structures of the pregnant woman are characterized by partial decalcification. This is accounted for by the fact that the developing fetus requires a definite amount of calcium in the formation of its osseous structures, and unless the expectant mother absorbs an adequate quantity from her food, it must be extracted from the bones and similar structures, such as the teeth. Her bones and teeth accordingly grow softer, and we have the well-known adage, “for every child a tooth,” as well as the fact that fractures during pregnancy unite very slowly. There are also the softened cartilages which were referred to in connection with the anatomy of the pelvis. A part of the softening of the pelvic cartilages, however, is due to a temporarily increased blood supply. As will be explained in the chapter on nutrition, this partial decalcification of the mother is entirely unnecessary, and the newer knowledge of nutrition points the way to its prevention.

The skin changes consist chiefly in the appearance of striæ and the increased pigmentation to which reference has already been made. There is also an increased activity of the sebaceous and sweat glands and the hair follicles, the latter sometimes resulting in the hair becoming much more abundant during the period of gestation. Although the pigmented areas on the breasts and abdomen never quite return to their original hue, the chloasmata, sometimes called the “masque des femmes enceintes,” practically always disappear and leave no trace, a fact that is frequently a comfort to an expectant mother.

The carriage is somewhat affected during pregnancy because the increased size and weight of the abdominal tumor shifts the centre of gravity. In an effort to preserve an upright position the woman throws back her head and shoulders and finally assumes a gait that may be described as a waddle, particularly noticeable in short women.

Temperature changes are probably not caused by pregnancy per se, though some authorities believe that there is normally a slight elevation during the latter part of the day.

Mental and emotional changes are usually included among the alterations which occur during pregnancy, but the present status of psychiatry suggests that this may not be altogether true. It is a fact that many pregnant women show marked mental and emotional unbalance, but as yet there seems to be no evidence that these states are inherently due to pregnancy, though the same condition may recur in the same woman each time that she is pregnant.

We shall consider this important subject more at length in the chapter on mental hygiene, so it may be enough simply to say at this juncture that, in a sensitively strung or uncertainly poised woman, the state of being pregnant may be merely the last straw, so to speak, that upsets her equilibrium; and that some other experience, which would be an equal strain upon her slender ability to make adjustments, would result in exactly the same mental or emotional distortion, just as certain physical signs in pregnancy may be produced also in the non-pregnant state, and are not, therefore, necessarily inherent to the gravid state.

Changes in the ductless glands are in much the same category. Functional disturbances of these glands occurring at any time may give rise to great irritability, excitability or to other mental symptoms. A non-pregnant woman with even a very slight degree of hyperthyroidism, for example, may be noticeably unstable mentally or emotionally. Since there is evidently an inter-relation and inter-dependence of the functions of the ductless glands, and since ovulation, the function of one of these glands, is suspended during pregnancy, we can readily believe that other glands would undergo changes as a result. Alterations in the thyroid are particularly apparent as it becomes enlarged and more active in the majority of pregnant women, as does also the anterior lobe of the pituitary body. This increased activity may tend to compensate for the suspended function of the ovaries. But the alterations in the functions of the other glands, compensatory though they be in part, apparently produce much the same sort of nervous symptoms that they are capable of producing in a non-pregnant woman.

Taking the condition as a whole, pregnancy is usually characterized by an improved state of health. During the first few months there may be lassitude and loss of weight, but the latter part of the period is notable for an unusual degree of general well being and for an increase in flesh over the entire body, which may amount to as much as twenty-five or thirty pounds.

About fifteen pounds of the increased weight is lost at the time of labor and a still further reduction occurs during the succeeding weeks when the mother’s body returns approximately to its original condition. But it sometimes happens that the improved state of nutrition acquired during pregnancy becomes permanent.