A. PHYSICAL SIGNS OF COMING MOTHERHOOD.
B. ON BIRTH.
C. SUGGESTIONS FOR CALCULATING DATE OF ANTICIPATED BIRTH.
APPENDIX A
Physical Signs of Coming Motherhood
Sometimes a woman is doubtful whether or not she is about to become a mother, and may be too shy to ask those with whom she is associated. She should, if it is possible, seek the advice of a highly qualified midwife or medical practitioner, but this is not always possible, and it may be useful for her to know the following signs:—
The first and most widely recognized indication that conception has taken place is “missing a period” or the cessation of the menstrual flow, while, at the same time, there is no ill-health. A woman may even feel unusually bright and well.
There is generally an increase in the size of the breast, followed as the months progress by a very noticeable increase in the size and bright blue colour of the veins round the breast, and also a darkening in colour and a changing from pink to brownish tint of the area round the centre of the breast.
After the third month, there is visible a steadily increasing enlargement of the lower part of the body, but, as this also happens with some forms of illness, this alone and without the other signs is not proof that motherhood has commenced.
“Quickening” or the movements of the child, are a much better indication of motherhood, and these are generally to be perceived about the twentieth week, or roughly half-way through the whole period of prenatal life; but see further the remarks in Chapter XIII, p. 113.
The perception of the child’s heart beats is absolute proof of coming motherhood. These may be perceived after the fourth or fifth month quite readily by a nurse or other observer, though the mother herself can but seldom perceive them.
“Morning Sickness,” which is so often experienced, and in most books for the “expectant mother” is quoted as one of the first signs of pregnancy, should never occur at all—see Chapter XI—although unfortunately it is true that it does frequently occur in women who are bearing children under present conditions.
APPENDIX B
On Birth
The usual agonies of child birth vary greatly in extent according to the structure of the woman. But, as was shown in Chapter II, the tendency already is present, and probably will increase, for this to be an almost intolerable strain upon the woman. Tardily indeed have efforts to relieve her agonies in child birth been made; Queen Victoria took a grave and adventurous step when she bore one of her children under chloroform. Chloroform, however, only deadens consciousness at a comparatively late stage in child birth, and its use through the many long hours, even perhaps sometimes days of agony which precede the later stages is not often possible. It is, therefore, for some types of women a very insufficient narcotic.
Natural “painless Child Birth” is, of course, the ideal, and is claimed to be the result of the “fruit and rice diet,” see Tokology by Dr. Alice Stockham, but although this greatly reduces the pain for many, and undoubtedly makes the months of pregnancy easier, it cannot make birth anything but a torture if the proportion of the child’s head to the bony arch is above a given limit. The “Christian Science” claim for not only painless but bloodless birth has been reported to me, but never at first hand, and I have not yet had the first-hand statements of women who are said to have experienced it.
“Twilight Sleep,” a comparatively recent discovery, has been much advocated, much praised and much blamed. There may be types of women who find it advantageous, but the fact that it necessitates going to a nursing home, away from home, is very much against its use under ideal circumstances. For those who have no home, or a sordid and overcrowded one, a nursing home may be a place of refuge. “Twilight Sleep” (scopolamine-morphine) is, however, for the more sensitive type of woman, an extremely unreliable drug, which may frequently take no narcotic effect upon the patient, who suffers added agony as the result of relying upon it, and it may be very dangerous for the child.
There is also the method of birth through the soft part of the body, avoiding the birth of the child through the bony structure altogether. This operation is described as Cesarean section, and involves incision both through the abdominal walls and through the walls of the womb. For some women with very small bones Cesarean section is necessary if they are to produce living children. Even for women who, by paying the price of agony, can produce children by normal birth, this method may be found very advantageous. I see a possibility of its widely extended future use. In hundreds, perhaps thousands of years hence when the child’s head will be proportionately even larger in comparison with the mother’s bones than it is to-day, it may indeed be the only method which will stand between the higher human races and their total extinction.
There is a certain amount of rather gossipy opinion that women who are spared the full torture of child birth do not have equally passionate love for the child. This, however, is nonsense. Love depends far more on the mother’s desire for parenthood at the time of the child’s conception and her feelings towards it all through the months of waiting than on the hours of birth, although the appealing weakness and fascination of a baby may win a deeper love than the mother-to-be expected to feel for her child.
APPENDIX C
Suggestions for Calculating the Date of Anticipated Birth
The leading authority in the Manual of Human Embryology, edited by Franz Keibel and Franklin P. Mall in two volumes, London, 1910, says:—
“In ancient times it was generally believed that the duration of pregnancy in man, unlike that in lower animals, was of very uncertain length; and it was not until the seventeenth century that it was more accurately fixed, by Fidele of Palermo, at forty weeks, counting from the last menstrual period. In the next century Haller found that if pregnancy is reckoned from the time of a fruitful copulation it is usually thirty-nine weeks, and rarely forty weeks in duration. In general these results are fully confirmed by the thousands of careful data collected during the nineteenth century.”
“However, from thousands of records it is found that the mean duration of a pregnancy varies in first and second pregnancies, is more protracted in healthy women, in married women, in winter, and in the upper classes.”
“From these figures it is seen that most pregnancies take place during the first week after menstruation, and that the duration of pregnancy is longer if copulation takes place towards the end of the intermenstrual period. And this is explained if we assume that in the first week, especially the first few days after the cessation of menstruation, the ovum is in the upper end of the tube awaiting the sperm and that conception immediately follows copulation. When the fruitful copulation takes place in the latter two weeks of the month the opposite is usually the case; the sperm wanders to the ovary and there awaits the ovum; and, therefore, on an average, pregnancy is prolonged in this group of cases, when determined from the time of copulation.”
“In determining the age of human embryos it is probably more nearly correct to count from the end of the last period, for all evidence points to that time as the most probable at which pregnancy takes place.”
On the whole it is generally found that 280 days (i.e., 40 weeks) can be reckoned as the average period during which the child develops internally if the date is counted from the first day of the last menstrual period and 269 days if estimated from the date of actual union.
Leuckart tabulated results from a large number of births which took place within the first ten months of marriage, and found that there was a maximum number of births on the 275th day, then a decrease and a second maximum on the 293rd day. Nevertheless, in spite of careful reckoning, there are, as will be recognized, many sources of error, and medical men and nurses are often wisely cautious of giving any exact date for an anticipated birth; sometimes too cautious even to suggest the week within which the birth will take place. I have known a good many mothers, however, who were much more accurately certain about this point than their attendants, and have found that the birth took place exactly on the day they anticipated. As an illustration of this, I give the answer from one of my correspondents, both of whose children were born on the exact day she anticipated. I asked her how she estimated these periods, and she said:—
“I simply took old Dr. Chevasse’s rule which he gives in Advice to a Wife; you know how he puts the date of conception and opposite it the probable date of birth. I went by the first union after the last period. It so happened that my husband was seedy and there was no union for a fortnight after the end of the period. I took that first union as the date of conception and looking up the date in Chevasse and the corresponding date of birth opposite, I found it to be August 20th, and sure enough on August 20th he was born. With the second boy, the union took place the day after the last period, and I took that as the starting date and against it I found January 21st and on January 21st he arrived in spite of the doctors insisting in each case that it would be three weeks earlier. What I do is, I always make a mark in my diary against the date of first union after every period. Then when I had missed a period and so knew that there was probably conception, I could at once tell the probable date.”
The table Chevasse quoted from Galabin is as follows—
| From | Jan. 1st to Oct. 1st = 273 (274) | days, | add | 5 (4) | days |
| „ | Feb. 1st to Nov. 1st = 273 (274) | „ | „ | 5 (4) | „ |
| „ | Mar. 1st to Dec. 1st = 275 | „ | „ | 3 | „ |
| „ | Apl. 1st to Jan. 1st = 275 | „ | „ | 3 | „ |
| „ | May 1st to Feb. 1st = 276 | „ | „ | 2 | „ |
| „ | June 1st to Mar. 1st = 273 (274) | „ | „ | 5 (4) | „ |
| „ | July 1st to Apl. 1st = 274 (275) | „ | „ | 4 (3) | „ |
| „ | Aug. 1st to May 1st = 273 (274) | „ | „ | 5 (4) | „ |
| „ | Sep. 1st to June 1st = 273 (274) | „ | „ | 5 (4) | „ |
| „ | Oct. 1st to July 1st = 273 (274) | „ | „ | 5 (4) | „ |
| „ | Nov. 1st to Aug. 1st = 273 (274) | „ | „ | 5 (4) | „ |
| „ | Dec. 1st to Sep. 1st = 274 (275) | „ | „ | 4 (3) | „ |
Printed in Great Britain by
UNWIN BROTHERS, LIMITED, THE GRESHAM PRESS, WOKING AND LONDON
