Pregnancy

PREGNANCY. - It is the state of a woman who carries within herself one or more fertilized ova that develop, through the stages of embryo and fetus, up to that organic perfection which permits life separate from that of the mother. Under normal conditions, when the pregnancy reaches its physiological term and resolves with the expulsion of the mature fetus in the act of childbirth (v.), it has a duration (gestation) that is fixed for the individual animal species; in particular in the woman it is completed in a time that oscillates between 260 and 270 days, that is, about 9 months; less (180-260 days) if the birth is premature; below 180 days one speaks of abortion (v.) and this time fixes the legal limit under which the fetus is considered incapable of living detached from the maternal organism.

Pregnancy is, as is clear, only of those animals whose offspring develop within the mother's own organism, coming into the outside world alive (viviparous), even if, as for man, they are at first incapable of moving freely in the external environment and of procuring food for themselves, needs fulfilled by the nursing and rearing of the newborn, acts which in the human species assume to the highest degree a psychological and moral content, the first developments of that education of the offspring from which parents can be exempted only for corresponding grave reasons (CIC, can. 1013).

The state of pregnancy produces in the mother a series of modifications which, if they appear manifestly clear in her reproductive apparatus, always affect, more or less intensely, at times so much as to create an actual state of illness, her entire psycho-physical entity, 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 situated in the lowest region of the pelvis; it, about the size of a small pear in the state of virginity, having received within itself the fertilized egg, by about the end of the first week of life, as large as a hemp seed, must follow the progressive development of the new being and of the ovular appendages that accompany it (membranes, amniotic fluid, placenta), reaching, when the pregnancy is at term, such a volume as to invade almost entirely the abdominal cavity, pushing back and upward the intestinal loops, and forward the anterior wall of the abdomen which thus reveals, in the more advanced periods of pregnancy, the particular state of the woman.

From this arises a first series of modifications of a mechanical order, which make themselves felt on the organs and functions of digestion, respiration, and circulation, creating discomforts and disturbances which, although often reaching an almost intolerable limit in the last stages of pregnancy, are to be considered of the physiological order, such as not to constitute illness in the strict sense.

But, besides mechanically, the woman is burdened by pregnancy because of the particular conditions of her organic metabolism, displaced in its equilibrium by the more difficult conditions of activity of her great organic functions, as was said a little earlier, and this holds particularly for the great emunctories of metabolic waste substances (intestines, kidneys, liver) and weighed down by the vital exchanges of the fetus which close 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 woman in pregnancy; it would be due to the secretion of the chorion and of the decidua producing hyperfunction of the thyroid, of the hypophysis, of the adrenal cortex; there follows a displacement of the neurovegetative equilibrium, with predominance of the vagus in the first months and of the sympathetic in the last months of pregnancy; to this particularly are to be attributed the disturbances of pregnancy (nausea, vomiting), present in almost all women in the first months of the new state.

But such conditions of abnormality, so to speak physiological, can be surpassed, with the appearance of morbid states, even quite grave, linked to pregnancy; these, the gynecological defects and obstetric abnormalities that can endanger the life of the mother, 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 by the aggravation of diseases with which the woman was already ill, in a manifest or hidden manner, or by the development of episodes, toxemias of pregnancy (v.), of varying gravity, which usually disappear in the course and at the term of pregnancy, at times instead can be the beginning of a morbid state that will remain permanent. Of the first group, tuberculosis and heart diseases assume particularly practical interest, which undoubtedly create a state of impairment in the woman who embarks on pregnancy and in the past constituted one of the most absolute indications for therapeutic abortion.

With regard to tuberculosis (v.), the progressive conquests in the field of 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 abortive interruption of pregnancy. If the woman is well assisted and treated during gestation, childbirth and the puerperium, one can witness the birth, even repeated, of children without appreciable harm to the mother's health.

With regard to heart diseases, it must be borne in mind that these are forms with a chronic course, which on their own proceed, more or less slowly, toward the fatal outcome of cardiovascular decompensation, linked to the wear that the unfolding of daily activity imposes on the heart with the continuous demand for performance. It can be maintained that, in the value of the causes of such wear that maternal life, despite the increased mechanical conveniences, imposes in particular on the nervous and circulatory systems, pregnancy weighs in a secondary and greatly reduced manner; for which the woman ill with heart disease, possibly relieved of nursing, does not receive, as was once thought, a decisive blow in relation to maternity, while it is demonstrated that the interruption of pregnancy is for the woman a greater risk than its continuation. The well-known cardiologist of Budapest I. Zarday in a communication of his whose summary is quoted verbatim (A. V. Lombardi [v. bibl.], pp. 217-22), affirms: "Before 1900 the mortality of pregnant cardiac patients was, on average, 48.4%; whereas in the first 4 decades of this century this figure has been reduced to 6.2%." In the material observed by Lombardi and in the case series of others, the mortality due to decompensation - in the course of or at the term of pregnancy - is 0% (!). He holds that the risk constituted by the coincidence of gestation with heart disease can, by means of adequate treatment, be so reduced as never to make the interruption of pregnancy necessary.

The normal course of pregnancy and, finally, of childbirth (v.) can be morbidly modified by congenital or acquired anomalies of the maternal reproductive apparatus (gynecological causes) or by anomalies in the unfolding of gestation, by the implantation of the ovum elsewhere than in the uterine site, by the appearance of hemorrhages, by malpositions and anomalous presentations of the fetus at the moment of birth (obstetric causes). Such eventualities can constitute an attack, even a very grave one, on the life of the woman, of the embryo, of the more or less mature fetus in the course of development and in the act of leaving the maternal organism that hosted it. Between medicine, which places the life of the mother first and attempts to save it even at the sacrifice of that of the child, and morality which, evaluating on the same plane the natural right of both to life, absolutely forbids any positive act that proves lethal for the unborn child, the most painful conflicts arise in the prescription and evaluation of abortion (v.) and of the acts embryotomic (v. EMBRIOTOMIA). Thus, for example, with regard to the case of ectopic insertion of the fertilized ovum with extrauterine development of the pregnancy (in the most frequent case, development in the tube, or tubal pregnancy), while amoral medicine, evaluating solely the grave danger, even mortal, to the mother and her preponderant social value, advises and applies the preventive removal of the pregnant tube, whence the abortion, which in that case is unfortunately permitted by many civil laws as therapeutic and non-criminal abortion, medicine that respects the limits of ethics, on the contrary, forbids its performance, considering it direct killing, and holds the operation lawful only if the grave hemorrhagic complications are already under way and the danger of death for the woman is imminent; in that case the action is directed primarily at repairing these harms, while the death of the fetus, if it has not already occurred, follows indirectly, not willed in itself (indirect abortion [P. G. Payen, v. bibliography]).

Apart from the aforementioned moral cases, pregnancy gives rise to particular duties for the woman who bears it; to her, in fact, is directly entrusted the protection of the new life that has been kindled and of the new organism that is being formed. In the first place toward God, who has associated her directly with the work of creating new lives, then toward the unborn child, powerless to defend its life by itself and of which she is in large part the arbiter, toward the spouse who collaborated in its conception, toward the society of which the child is a part even before coming into the light, the woman assumes moral and legal duties, of which even the law of men demands strict account from her.

Although it is granted that she is passing through a state that in the vast majority of cases belongs to the physiological order, undoubtedly a means of attaining and progressively perfecting a full femininity, she is nevertheless bound by certain particular precautions that can enable her to 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), wasting away, pleasurable intoxications (smoking is very harmful, as is also shown by the high percentage of spontaneous abortions among tobacco workers), illnesses — all causes that, through harm to her own organism, could influence, even in a very grave manner, the life, the development, the future health of the new being entrusted to her by God and by society. A woman in a state of pregnancy has the duty to know well the duties of her state together with the possible risks connected with it, thus succeeding more easily in avoiding them; in this she must not avail herself of the advice and judgments of non-technical persons, often ignorant and full of prejudices on the hygienic and moral side, but must have her conduct and her regimen of life regulated by honest, intelligent guides of sure science, such as the Catholic physician can be.

Also psychic serenity, the constant application of the mind to reflection on the greatness of motherhood, on the joy of a creature of one's own that one desires physically and morally perfect; the arousing, through adequate sensations, of images of beauty, goodness, perfection in one's mind; all this, in accordance with popular belief, exercises a beneficial influence on the development and in part on the quality of the child. Such a conviction is based on the psycho-physical nature of the human organism, on what physiology and psychology teach concerning the relations between the passions (v.) and their organic reflexes, on the basis of the experimental findings of psychosomatic medicine (v. MEDICINA).

Giuseppe de Ninno