PREGNANCY. – It is the state of a woman who carries within her one or more fertilized ova that develop, through the stages of embryo and fetus, until they reach that organic perfection which enables them to live separately from the maternal organism. Under normal conditions, when pregnancy reaches its physiological term and is resolved by the expulsion of the mature fetus in the act of childbirth (v.), it has a fixed duration (gestation) for individual animal species; in particular, in women it is completed in a period ranging between 260 and 270 days, i.e., approximately 9 months; less (180–260 days) if the birth is premature; below 180 days, it is considered an abortion (v.), and this fixed period determines the legal threshold under which the fetus is deemed incapable of living apart from the maternal organism.
Pregnancy, as is clear, is experienced only by animals whose offspring develop within the mother’s body and emerge alive (viviparous), even if, as in the case of humans, they are unable to move freely in the external environment or procure food for themselves in the early stages. These needs are met by breastfeeding and the rearing of the newborn, acts that in the human species assume the highest degree of psychological and moral content, the first unfoldings of that education of offspring from which parents may be excused only for grave corresponding reasons (CIC, can. 1013).
The state of pregnancy produces in the mother a series of modifications that, while manifestly evident in her reproductive system, also affect, more or less intensely—sometimes to the point of creating a state of illness—her entire psycho-physical being, from the most diverse organic systems to her neuro-psychological and moral equilibrium.
Gestation, as is well known, takes place in the uterus, a hollow muscular organ located in the lowest region of the pelvis. In the virginal state, it is about the size of a small pear; once it has received the fertilized ovum—by the end of the first week of life, when it is about the size of a hemp seed—it must accommodate the progressive development of the new being and its associated structures (membranes, amniotic fluid, placenta), reaching, at the end of pregnancy, a volume that nearly fills the abdominal cavity, pushing the intestinal loops backward and upward and the anterior wall of the abdomen forward, thus revealing, in the later stages of pregnancy, the woman’s particular condition.
This gives rise to a first series of mechanical modifications that affect the organs and functions of digestion, respiration, and circulation, creating discomfort and disturbances that, though often reaching an almost intolerable limit in the final stages of pregnancy, are to be considered physiological in nature and do not constitute disease in the strict sense.
Yet, beyond these mechanical effects, the woman is burdened by pregnancy due to the particular conditions of her organic metabolism, which is thrown out of balance by the heightened demands placed on her major organic functions, as mentioned above. This is especially true for the major excretory organs of metabolic waste (intestines, kidneys, liver) and is compounded by the vital exchanges of the fetus, which complete their cycle in the mother through the placental circulation.
To this must be added a new equilibrium in the endocrine constellation (v. ENDOCRINE, GLANDOLE, GLANDS) characteristic of the pregnant woman. This is attributed to the secretion of the chorion and decidua, producing hyperfunction of the thyroid, pituitary, and adrenal cortex. The result is a shift in neurovegetative balance, with vagal predominance in the first months and sympathetic predominance in the later months of pregnancy. To this, in particular, are attributed the disturbances of pregnancy (nausea, vomiting), present in almost all women in the early months of this new state.
However, such conditions of what might be called physiological abnormality can be exceeded, giving rise to morbid states—sometimes quite serious—linked to pregnancy. These include gynecological defects and obstetric abnormalities that may endanger the mother’s life, creating the so-called indications for therapeutic abortion (v.) and their moral discussion.
The morbid states of a medical nature linked to pregnancy are represented either by the worsening of diseases from which the woman was already suffering, manifestly or secretly, or by the development of episodes of pregnancy intoxication (v.) of varying severity, which usually disappear during or at the end of pregnancy, though sometimes they may mark the beginning of a permanent morbid condition. Of the first group, tuberculosis and heart disease are of particular practical interest, as they undoubtedly create a state of debilitation in a woman embarking on pregnancy and in the past constituted one of the most absolute indications for therapeutic abortion.
With regard to tuberculosis (v.), the progressive advances in surgical therapy (pneumothorax, thoracoplasty, etc.) and particularly medical therapy (antibiotics: streptomycin, PAS, etc.) have undoubtedly transformed the prognosis of the disease and, in particular, the medical necessity of interrupting pregnancy. If the woman is well cared for and treated during gestation, childbirth, and the puerperium, it is possible to witness the birth of even multiple children without appreciable harm to the mother’s health.
With regard to heart disease, it must be borne in mind that these are chronic conditions that, in their course, proceed—more or less slowly—toward the inevitable outcome of cardiovascular decompensation, linked to the wear and tear imposed on the heart by the demands of daily life and the continuous need for performance. It can be argued that, in the array of causes contributing to this deterioration—which maternal life, despite increased mechanical conveniences, imposes in particular on the nervous and circulatory systems—pregnancy plays a secondary and greatly reduced role. Thus, a woman with heart disease, possibly relieved of breastfeeding, does not, as was once thought, suffer a decisive blow in relation to motherhood. On the contrary, it has been shown that interrupting pregnancy poses a greater risk to the woman than continuing II. The well-known cardiologist from Budapest, I. Zarday, in a communication whose summary is quoted verbatim (A. V. Lombardi [V. BIBLICA.], pp. 217–22), states: “Before 1900, the mortality rate among pregnant women with heart disease averaged 48.4%, whereas in the first four decades of this century, this figure has been reduced to 6.2%.” In the material observed by Lombardi and in the statistics of others, the mortality due to decompensation—during or at the end of pregnancy—is 0% (!). He believes that the risk posed by the coincidence of pregnancy with heart disease can, through appropriate treatment, be so reduced as to render interruption of pregnancy never necessary.
The normal course of pregnancy and, ultimately, of childbirth (v.) can be morbidly altered by congenital or acquired anomalies of the maternal reproductive system (gynecological causes) or by abnormalities in the progression of gestation, such as the implantation of the ovum outside the uterus, the occurrence of hemorrhages, malpositions, and abnormal presentations of the fetus at the time of birth (obstetric causes). Such eventualities can pose a serious threat to the life of the woman, the embryo, or the fetus at various stages of development and at the moment of leaving the maternal organism. Between medicine, which prioritizes the mother’s life and seeks to save her even at the cost of the child’s, and morality, which, valuing the natural right to life of both equally, absolutely forbids any positive act that would be lethal to the unborn, the most painful conflicts arise in the prescription and evaluation of abortion (v.) and related acts.
embryotomic (v. EMBRYOTOMY). Thus, for example, with regard to the case of ectopic implantation of the fertilized ovum with extrauterine development of pregnancy (in the most frequent case, development in the Fallopian tube or tubal pregnancy), while medicine, evaluating solely the grave and even mortal danger to the mother and the preponderant social value of the latter, advises and applies the preventive removal of the pregnant tube, resulting in abortion—which in such a case is unfortunately permitted by many civil laws as therapeutic and not criminal abortion—the medicine that respects the limits of ethics, on the contrary, forbids its execution, considering it a direct killing and deems the operation licit only when severe hemorrhagic complications are already underway and the danger of death for the woman is imminent; in such a case, the action is directed primarily at repairing these damages, while the death of the fetus, if not already occurred, follows indirectly and not as an end in itself (indirect abortion [P. G. Payen, V. BIBLICA.]).
Apart from the aforementioned moral cases, pregnancy gives rise to particular duties for the woman who carries it; to her, in fact, is entrusted directly the protection of the new life that has begun and of the new organism that is forming. First of all toward God, who has associated her directly with the work of creating new lives, then toward the unborn child, powerless to defend its own life and of which she is largely the arbiter, toward the spouse who collaborated in the birth, toward society of which the child is already a part even before coming into the world, the woman assumes moral and legal duties, for which even human law demands strict account.
She, although it is admitted that she is undergoing a condition that in the vast majority of cases belongs to the physiological order, a means of achieving and progressively perfecting full femininity, is nonetheless bound by certain particular precautions that can help her preserve or attain that state of health necessary for an optimal pregnancy; she must therefore avoid, as far as depends on her, excessive strain (violent sports), physical deterioration, voluntary intoxications (smoking is particularly harmful, as is demonstrated by the high percentage of spontaneous abortions among tobacco workers), diseases—all causes that, by harming her own organism, could gravely affect the life, development, and future health of the new being entrusted to her by God and society. The pregnant woman has the duty to be well aware of the duties of her state along with the possible risks connected to it, thus being better able to avoid them; in this regard, she should not rely on the advice and judgments of non-technical persons, often ignorant and full of prejudices from both the hygienic and moral points of view, but should regulate her conduct and lifestyle according to honest, intelligent, and scientifically reliable guides, such as the Catholic physician.
Even psychological serenity, the constant application of the mind to reflecting on the greatness of motherhood, on the joy of a child who is desired physically and morally perfect; the fostering, through appropriate sensations, of images of beauty, goodness, and perfection in one’s mind; all this, in accord with popular belief, exerts a beneficial influence on the development and in part on the quality of the child. This conviction is based on the psycho-physical nature of the human organism, on what physiology and psychology teach about the relationships between the passions (v.) and their organic reflexes, and on the experimental findings of psychosomatic medicine (v. MEDICINE).