GRAVIDANZA.—This is the state of a woman who carries within herself one or more fertilized ova that develop, through the stages of embryo and fetus, to that degree of organic perfection which allows them to live separately from the mother. Under normal conditions, when pregnancy reaches its physiological term and is resolved by the expulsion of the mature fetus in childbirth (v.), it has a fixed duration (gestation) for each animal species; in women, specifically, it is completed in a period ranging from 260 to 270 days, that is, approximately 9 months; less (180–260 days) if the birth is premature; below 180 days one speaks of miscarriage (v.), and this period establishes the legal limit below which the fetus is considered incapable of living separated from the maternal organism.
Pregnancy is, as is clear, found only in animals whose offspring develop within the mother’s organism and are born alive (viviparous), even if, as in the case of human beings, they are initially incapable of moving freely in the external environment and procuring food for themselves—needs met by breastfeeding and the rearing of the newborn, acts which in the human species assume the highest degree of psychological and moral content, the initial stages of that education of offspring from which parents may exempt themselves only for corresponding grave reasons (CIC, can. 1013).
The state of pregnancy produces in the mother a series of modifications which, although they appear particularly evident in her reproductive system, always affect, more or less intensely, at times even to the point of creating a genuine state of illness, her entire psychophysical being, from the most diverse organic systems to her neuropsychological and moral equilibrium.
Gestation, as is well known, takes place in the uterus, a hollow muscular organ situated in the lowest region of the pelvis; approximately the size of a small pear in the virgin state, having received within itself the fertilized ovum, by then approximately at the end of its first week of life and as large as a hemp seed, it must follow the progressive development of the new being and of the ovular appendages that accompany it (membranes, amniotic fluid, placenta), ultimately reaching, when pregnancy is at term, a volume sufficient to occupy almost the entire abdominal cavity, pushing the intestinal loops backward and upward, and the anterior wall of the abdomen forward, thereby revealing, in the more advanced periods of pregnancy, the woman’s particular condition.
From this arises a first series of mechanical modifications, which make themselves felt in the organs and functions of digestion, respiration, and circulation, creating discomforts and disturbances that, although often reaching an almost intolerable limit in the final stages of pregnancy, must be considered physiological and not such as to constitute illness in the strict sense.
But the woman is burdened by pregnancy not only mechanically, but also by the particular conditions of her organic metabolism, whose equilibrium is displaced by the more difficult conditions under which her major organic functions operate, as was just said; this applies especially to the major excretory organs for metabolic waste substances (intestines, kidneys, liver), which are further burdened by the vital exchanges of the fetus, completing their cycle in the mother through the circulation of the placenta.
To all this must be added a new equilibrium of the endocrine constellation (v. ENDOCRINA, GLANDOL) proper to the pregnant woman; this would be due to the secretion of the chorion and decidua, producing hyperfunction of the thyroid, pituitary, and adrenal cortex; a displacement of the neurovegetative equilibrium follows, with predominance of the vagus in the first months and of the sympathetic in the final months of pregnancy; the disorders of pregnancy (nausea, vomiting), present in almost all women during the first months of the new condition, are particularly attributable to this.
But such conditions of abnormality, physiological, so to speak, may be exceeded, with the appearance of pathological conditions, sometimes very serious, associated with pregnancy; these, together with gynecological defects and obstetrical abnormalities, may endanger the mother’s life, creating abortion (v.) and giving rise to their moral discussion.
The medical pathological conditions associated with pregnancy consist in the aggravation of diseases from which the woman was already suffering, manifestly or occultly, or in the development of episodes, pregnancy intoxications (v.), of varying severity, which ordinarily disappear during or at the end of pregnancy, but may sometimes mark the beginning of a pathological condition that will remain permanent. Of the first group, tuberculosis and heart disease are of particular practical importance: they undoubtedly create a state of impairment in the woman embarking upon pregnancy and in the past constituted one of the most absolute indications for therapeutic abortion.
tuberculosis (v.), the progressive advances in surgical therapy (pneumothorax, thoracoplasty, etc.) and especially in medical therapy (antibiotics: streptomycin, PAS, etc.) have undoubtedly transformed the prognosis of the disease and, in particular, the medical necessity of interrupting pregnancy by abortion. If the woman is properly assisted and treated during gestation, childbirth, and the puerperium, repeated births of children may occur without appreciable harm to the mother’s health.
With regard to heart disease, it must be borne in mind that these are chronic conditions which, in themselves, progress more or less slowly toward the fatal outcome of cardiovascular decompensation, related to the wear and tear that the course of daily activity imposes upon the heart through the continual demand for performance. It may be maintained that, among the causes of such wear and tear which maternal life, despite increased mechanical conveniences, imposes particularly upon the nervous and circulatory systems, pregnancy weighs only secondarily and to a very limited extent; hence a woman suffering from heart disease, possibly relieved of breastfeeding, does not, as was formerly thought, receive a decisive blow in connection with motherhood, whereas it has been demonstrated that interruption of pregnancy presents a greater risk for the woman than its continuation. The well-known cardiologist from Budapest, I. Zarday, in a communication whose summary is reproduced verbatim here (A. V. Lombardi [V. BIBLICA.], pp. 217–22), states: «Before 1900 the mortality of pregnant women with heart disease was, on average, 48.4%; whereas during the first four decades of this century that figure fell to 6.2%.» In the material examined by Lombardi and in the case series of others, mortality due to decompensation—in the course of or at the end of pregnancy—is 0% (!). He believes that the risk constituted by the coexistence of gestation and heart disease may, through suitable treatment, be reduced to such an extent that interruption of pregnancy is never necessary.
The normal course of pregnancy and, finally, of childbirth (v.) may be pathologically modified by congenital or acquired anomalies of the maternal reproductive system (gynecological causes), or by abnormalities in the course of gestation, by implantation of the ovum elsewhere than in the uterine cavity, by the occurrence of hemorrhages, by malpositions and abnormal presentations of the fetus at the time of childbirth (obstetrical causes). Such eventualities may constitute a very serious threat to the life of the woman, of the embryo, of the more or less mature fetus during its development, and at the moment when it leaves the maternal organism that had housed II. Between medicine, which places the mother’s life first and attempts to save it even by sacrificing that of the child, and morality, which, evaluating both on the same plane with regard to their natural right to life, absolutely forbids every positive act that would prove fatal to the unborn child, the most painful conflicts abortion (v.) and acts
embryotomic procedures (v. EMBRIOTOMIA). Thus, for example, with regard to the case of the ectopic implantation of the fertilized ovum with extrauterine development of the p. (in the most frequent case, development in the tube, or tubal p.), whereas amoral medicine, considering solely the grave, even mortal, danger to the mother and her greater social value, recommends and performs the preventive removal of the pregnant tube, resulting in abortion—which in this case is unfortunately permitted by many civil laws as therapeutic and noncriminal abortion—medicine that respects the limits of ethics, on the contrary, prohibits its performance, considering it direct killing, and deems the operation licit only if serious hemorrhagic complications are already under way and the danger of death for the woman is imminent; in this case, the action is directed primarily toward repairing this damage, whereas the death of the fetus, if it has not already occurred, follows indirectly and is not intended in itself (indirect abortion [P. G. Payen, V. BIBLICA.]).
Apart from the moral cases mentioned above, p. gives rise to particular duties for the woman who bears it; for she is directly entrusted with the protection of the new life that has been kindled and of the new organism that is being formed. First 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 its birth; and toward society, of which the child is already a part before coming into the world, the woman assumes moral and legal duties, for which human law also requires her to give a strict account.
Although it must be admitted that she is passing through a condition which, in the overwhelming majority of cases, belongs to the physiological order and is undoubtedly a means of attaining and progressively perfecting full femininity, she is nevertheless bound by certain particular precautions that may enable her to preserve or attain the state of health necessary for an excellent p.; she must therefore avoid, insofar as it depends on her, excessive exertion (violent sports), deterioration, pleasurable intoxications (smoking is highly harmful, as is also shown by the high percentage of spontaneous abortions among tobacco workers), and illnesses—all causes which, through harm to her own organism, could affect, even very seriously, the life, development, and future health of the new being entrusted to her by God and society. A woman in a state of p. has the duty to know well the duties of her condition together with the possible risks connected with it, thereby more easily managing to avoid them; in this she must not rely on the advice and judgments of unqualified persons, often ignorant and full of prejudices from the hygienic and moral standpoint, but have her conduct and way of life regulated by honest, intelligent guides of sound knowledge, such as a Catholic physician.
Psychic serenity, too, and the constant application of the mind to reflection on the greatness of motherhood and on the joy of one’s own child, desired to be physically and morally perfect; the arousal, through suitable sensations, of images of beauty, goodness, and perfection in one’s own mind—all this, in accordance with popular belief, exerts a beneficial influence on the development and, in part, on the qualities of the child. This conviction is based on the psychophysical nature of the human organism, on what physiology and psychology teach concerning the relations between passions (v.) and their organic effects, and on the experimental findings of psychosomatic medicine (v. MEDICINA).
Giuseppe de Ninno