The Prospective Mother | Page 5

number of mistakes
is small, because the diagnosis is commonly made not from only one of these doubtful
signs but from a group of them. In order of importance the doubtful or presumptive signs
of pregnancy are these: (1) cessation of menstruation, (2) changes in the breasts, (3)
morning sickness, (4) disturbances in urination.
The Cessation of Menstruation.--The failure of menstruation to appear when it is
expected is nearly always the first symptom of pregnancy to attract attention, and, as a
rule, when this happens to healthy women during the child-bearing period--which usually
extends from the fifteenth to the forty-fifth year--it may be taken to indicate that
conception has occurred. But there are exceptions to this very good rule. Besides
pregnancy we are acquainted with several conditions that cause temporary suppression of
menstruation; and to understand its significance we must learn something of the
menstrual process itself.
Menstruation is a function of the womb and in all probability is brought about through
the influence of the ovaries. The bleeding, popularly regarded as the entire menstrual
process, is, in fact, indicative of only one of its stages; the others give rise to no
symptoms whatever. What the stages in the menstrual process are, what relation they bear
to each other, and what the significance of the whole process is, are problems that have
been solved with the aid of the microscope. In this way the mucous membrane lining the
womb has been studied both at the time of the periods and in the interval between them,

and we have learned that it is constantly undergoing changes intended to facilitate the
reception and the maintenance of an embryo. Anticipating these duties the mucous
membrane receives a more abundant supply of blood; it also increases in thickness and all
the structures which enter into its composition become more active. Unless conception
takes place these preparations, which represent the most important phase in the menstrual
process, are without value; and therefore failure to conceive means that the mucous
membrane will return to the same condition as existed before the preparations were
begun. The congestion is relieved by rupture of the smallest blood vessels, and there
follow other retrogressive steps which completely restore the various structures to their
former state. Then there is a pause, though it is not long, until preparatory changes are
again initiated, or, as we say, another Menstrual Cycle is begun. Each cycle lasts
twenty-eight days, and includes four stages, namely, a stage of preparation, of bleeding,
of restoration, and of rest.
Although pregnancy may become established at any time during the interval between the
periods of bleeding, it is more likely to be established just before a period is expected or
shortly after it has ceased. Furthermore, whenever conception does take place, the
preliminary preparations for the reception of the embryo are followed by much more
elaborate arrangements for its protection and nutrition. Under these circumstances the
hemorrhagic discharge does not appear.
Were there no other condition to bring about the cessation of menstruation, the diagnosis
of pregnancy would be greatly simplified. But any one can appreciate the fact that
diseases of the womb may interfere with the menstrual process. Menstruation is
influenced, also, by the ovaries. As a result of age, for example, the ovaries undergo
changes which invariably bring about the permanent cessation of menstruation, called the
menopause. This event occurs prematurely if both the ovaries are removed by operation.
In view of these facts it is not surprising that sometimes ovarian disorders abolish
menstruation. An impoverished state of the blood, or nervous shock and strain, or
constitutional debility may also interrupt the regular appearance of the menstrual
discharge.
The value of menstrual suppression as an evidence of pregnancy is not, however, to be
discounted to the extent that we might expect. This is true because the ailments which
lead to confusion are relatively infrequent, and also because they exhibit characteristic
symptoms which are foreign to pregnancy. Often these symptoms are obvious to the
patient herself; if not to her, they will be obvious to her physician. It is about the doubtful
cases, naturally, that a professional opinion is sought, and on that account physicians are
perhaps inclined to overestimate the difficulty women have in learning for themselves
whether or not they are pregnant. As a matter of fact, it is unusual for a prospective
mother to fail to reach a correct decision--a decision for which she relies chiefly upon the
suppression of her menstrual periods.
It is doubtful whether menstruation ever continues after conception has taken place.
Instances in which the menstrual function is believed to persist are not uncommon, and
yet in all probability the discharge regarded as menstrual has a different origin. In most
cases it should be interpreted as meaning that there is some danger