The Prospective Mother | Page 4

months to be able to do
this.
THE POSITIVE SIGNS.--The earliest absolutely trustworthy manifestation of pregnancy
is the motion of the fetus. The perception by the mother of these movements, which is
spoken of as "quickening," generally occurs toward the eighteenth week, if she has been
told to watch for them; otherwise they may pass unnoticed until the twentieth week or
later. At first the motion, felt in the lower part of the abdomen, is very gentle; it has been
variously likened to tapping, or to quivering, or to the fluttering of a bird's wings. As time
goes on the movements grow stronger and occur more frequently; they are, however,
perceived but rarely throughout the day and seldom interfere with sleep. Occasionally
women are annoyed by the sensation and complain that the child is hardly ever quiet.
Even these troublesome movements are never a cause for anxiety; but prolonged failure
to feel motion after it is once well established should be reported to the doctor.
In the first pregnancy the passage of gas through the intestines may be mistaken for
quickening long before the movements of the child are really perceptible; but those who
have once experienced quickening will not be deceived. Whenever women who have
borne children are in doubt the sensation is almost surely not quickening. Furthermore, in
any doubtful case, the motion should be observed by a physician before being accounted
a positive sign of pregnancy. This precaution will scarcely delay an absolutely positive
diagnosis, since the proper method of examination reveals these movements to the
physician almost as early as the patient feels them.
About the time these movements become perceptible another positive sign is available.
The physician whose ear has been trained to catch such sounds when he listens over the
lower part of the mother's abdomen will hear the fetal heart-beat. Other sounds may be
audible there, but the character and the rate of the heart-sounds are distinctive. Since the
child's heart beats almost twice as fast as the mother's, under ordinary conditions it is
impossible to confuse one with the other. The mother never feels the beating of the
child's heart, but occasionally she will mistake for it the throbbing of her own blood
vessels.
Ability to hear the fetal heart not only provides a means of confirming the existence of
pregnancy in doubtful cases, but also enables the physician to reassure his patient if she
fails temporarily to feel the child move. Sometimes the presence of twins is recognized in
this way. Toward the end of pregnancy the heart sounds are also of material assistance in
determining what position the child has permanently assumed.
There is a third positive sign of pregnancy to which the physician has recourse, but
generally it is inapplicable as early as those already mentioned. In the latter months of
pregnancy it is possible to outline the child through the mother's abdominal wall.
Although this procedure adds little or nothing to our resources for making an early
diagnosis, the information it ultimately affords proves one of the greatest aids in the

practice of obstetrics.
THE PROBABLE SIGNS.--Obviously, phenomena for which the child is
responsible--such as have just been described--supply the most trustworthy evidence of
pregnancy; and these phenomena alone are accepted as positive signs. But there are
earlier manifestations which intimate very strongly that conception has taken place.
Shortly after pregnancy has become established changes begin in the uterus, as
physicians call the womb, and soon reach the point where they may be recognized by a
simple examination which enables the physician to express an opinion little less than
positive. As one result of pregnancy, for example, the supply of blood is increased to all
the organs concerned with the reproductive process. Partly on account of this congestion
and partly on account of embryonic development, the uterus becomes altered in a number
of ways. Although these changes occur regularly in pregnancy, they may also occur when
the womb is enlarged from other causes; therefore, if a physician should make the
diagnosis of pregnancy whenever they were found, he would make it somewhat too
frequently. With a little patience, however, he excludes the chance of being misled; a
second examination, approximately four weeks after the first, will generally place the
existence of pregnancy beyond question, for under normal conditions the degree of
enlargement which takes place in a pregnant womb during a given interval is absolutely
characteristic.
THE PRESUMPTIVE SIGNS.--Although women are most often led to suspect that they
are pregnant by symptoms which are of such doubtful significance that they must be
regarded as merely presumptive evidence, the practical value of these symptoms is
attested by the fact that subsequent developments rarely fail to confirm the suspicion.
Perhaps they prove misleading once or twice in a hundred cases; the