There are certain signs which a female is taught to regard as essential evidences of pregnancy and it is supposed by most, if not by all women, that their presence is absolutely necessary to the existence of this state. In reference to one or two of these signs, this is far from the fact; for they are not unfrequently absent, although pregnancy exist, and the remainder may be present, although pregnancy be absent. Many a female, I am confident, has, from this very circumstance, experienced much difficulty in attaining certainty as to her state, and suffered months of anxiety and doubt. This has arisen from a want of those clear notions, and that precise information, which a question so important demands.

The object of this chapter is to remove this difficulty, by presenting a short account of those symptoms of conception which the female may herself observe, and to point out to what extent they may be relied on. It will be necessary to notice only four of the signs or symptoms of pregnancy, and they may be considered in the order in which they usually arise; that is, ceasing to be unwell; morning sickness; shooting pains through, enlargement of, and other changes of the breast; and, lastly, quickening.

Ceasing to be unwell.

The first symptom of pregnancy is the omission of that monthly return, which, in female phraseology, would be described as “ceasing to be unwell;” and it may be adopted as a general rule, that, in a healthy woman, whose menstruation has been established, and continued regular, and who is not nursing, “Conception is followed by a suppression of the menstrual discharge at the next return of its period.” Thus, a female may have been pregnant a week or two already; but she is not aware of it till that period of the month arrives when she is accustomed to menstruate, and then, when she expects to be unwell, she finds that she is not so.

Now this symptom, as a general rule, admits of four exceptions:—

First. A young female shall never have menstruated, and yet conceive.

Secondly. A mother shall conceive while she is nursing, and not menstruating.

Thirdly. A female shall conceive, and yet be unwell during the first three, four, or more months of pregnancy.

Fourthly, and lastly. Occasional conception takes place late in life, after menstruation has apparently ceased for ever.

First Exception.—Many cases are on record proving this point. I have met with only two cases; one quite a girl, not having arrived at her seventeenth year, and yet was in her sixth month of pregnancy when she applied for a letter for the Finsbury Midwifery Institution; the other was in her nineteenth year. Menstruation was, subsequent to confinement, established in the first; with the result of the latter, I am not acquainted.^[9]

Although pregnancy under such circumstances is not of frequent occurrence, still it does now and then take place. A knowledge of the fact may therefore prove useful.

Second Exception.—It is scarcely necessary to advert to the well known fact that a woman may conceive while she is nursing, without any previous return of the monthly discharge, except to expose the popular error, “that a female will not become pregnant during lactation.” This is very far from being the case. Poor women are much in the habit of nursing their infants eighteen months, two years, and even two years and a half, in order to protect themselves, as they imagine, from becoming pregnant; and many a poor creature have I seen with exhausted frame and disordered general health, arising from protracted nursing, pursued alone from this mistaken notion.

I have large opportunities of investigating this, as well as the several points touched upon in this chapter. On an average, between forty and fifty poor women call upon me every month, with midwifery letters for attendance in their confinement: and the result of my inquiries upon the present question has led me to believe, that more than one third of these women have conceived at least once while nursing, and very many of them oftener.^[10]

Mrs. M——, ætat. 30, married six years. Became pregnant three months after her marriage. Having suckled this child for more than two years, became pregnant a second time. This last died in three weeks, and immediately after she proved pregnant for a third time. The third child she brought this morning (being out of health), and assured me that she had not seen anything since she first conceived, that is, three months after her marriage, and six years from the present time.

Mrs. W——, ætat. 25, married five years. Has not been unwell since she first fell in the family way; is now pregnant with a third child, having hitherto fallen pregnant while nursing.

Many other cases illustrative of this fact I might assert, but these suffice to prove the exception.^[11]

Third Exception.—That a female should become pregnant, and yet be unwell during the first three, four, or more months of pregnancy, may appear an extraordinary statement; but it is a fact, that the menstrual discharge sometimes continues in its usual regularity for two, three, or more months after conception, and without any dangerous consequences.

It has been asserted, as an objection, that this discharge is not truly menstruation; but the discussion of that question does not concern us here. We have only to consider, whether there does not frequently, during pregnancy, take place a discharge, so closely resembling menstruation in its periods, quantity, duration, and appearance, that neither the female herself nor her medical adviser shall be able to detect any difference between them; and of this I have no doubt.

It may occur once only after conception, either in diminished quantity or more profuse than usual. It may thus give rise to miscalculation as to the expected time of confinement.

It may continue in its usual regularity for two or three months. The following instance of a patient I attended illustrates the fact of its going on to the period of quickening:—

Mrs. R——, ætat. 27, married eight years. Was first unwell when eighteen years of age, and continued to be so regularly until she became pregnant, two years from the time of her marriage. She suckled her first child for eleven months; soon after she became unwell, and continued so until she quickened with her second child; a circumstance which she had not the slightest suspicion of, for there was no perceptible difference either in the quantity or appearance of the monthly discharge. During the remaining months of gestation she did not see anything; she afterwards suckled her little one for ten months; and then was obliged to wean the child, having an attack of the cholera. She continued from this time regular for two years; but meeting with a fall, much to her surprise, two or three days after, miscarried of a four months’ child. She is now pregnant again, having been regular every month till she quickened, and expects to be confined, Feb. 1836.

In this case then, the female was unwell in two pregnancies till the period of quickening; and in the other for four months, when miscarriage took place from accident.

And lastly, it may occur through the whole period of pregnancy.

Mrs. F—— is now pregnant for the third time. In her first pregnancy the monthly returns appeared for three periods, regular as to time, and in quantity and appearance as heretofore. During the second child-bearing, at every month till confinement. During the third—her present pregnancy—for three months only. This patient is always unwell while nursing.

Mrs. J——, now in her eighth pregnancy. Was unwell every month throughout the first six pregnancies; but the quantity always slightly diminished. In the seventh, the same circumstances occurred; but premature labour was this time induced, between the sixth and seventh months, by a fall. During the present pregnancy she has not seen anything. Is always unwell while suckling.

Mrs. P—— is in her fourth pregnancy. In the first three was unwell, at her regular periods, to the time of confinement. The discharge the same in quantity, but rather lighter appearance. Has been unwell in her pregnancy every month up to the present time.^[12]

The following case proves how important it is that this fact should be generally known; for up to a very late period, some medical men have even denied the possibility of this occurrence.

The case I refer to was that of a young lady, privately married, the gradual enlargement of whose abdomen was decided by her medical attendant to arise from dropsy; for, although she had most of the symptoms of pregnancy, and the medical man was aware she had been married eight months, still, as she continued to menstruate, he declared it impossible that she could be pregnant. Tapping was proposed; and, except that her general health suffered much at this time, the operation would have been performed. The delay saved the patient such unfortunate and mistaken treatment—it might have proved fatal in its results—and she shortly gave birth to a living and healthy male child.

Fourth exception.—That women late in life have conceived after menstruation had apparently ceased for ever, the following cases prove:—

In September, 1834, I was called to the assistance of a female in labour in her forty-ninth year. She had not been pregnant for twelve years, and supposed she had ceased to menstruate two years previous to that time. She did well, and never afterward saw anything.

Mrs. B——, ætat. 39. Has been married eighteen years, commenced to be unwell very early in life. Has had three children; the last pregnancy seven years since. Is now again pregnant, her menses having left her sixteen weeks prior to conception; before which, she had been very irregular, and supposed she had ceased to be unwell for ever.

Other cases of a similar nature are on record. There can be no doubt they are authentic; but at the same time it must be acknowledged that a female is not unlikely to be deceived, by the irregularity which attends the returns of this discharge, late in life. It so happens, too, that just before the change of life takes place, there appears in the constitution of some females a great disposition to pregnancy; so that many who have ceased to bear children for years, or have been hitherto barren through the whole of their married existence, at this time, to the surprise of their friends and themselves, become pregnant.^[13]

A knowledge of these facts must be useful, as they will tend to allay apprehension at what might be supposed disease, both by the mother and by the hitherto childless woman.

A female must not forget, however, that she may mistake her condition, and that such mistakes are not at all unlikely to arise from the circumstance that the symptoms which naturally accompany the cessation of menstruation, much resemble those of pregnancy. She passes over the menstrual period;—she is struck with this. Other symptoms are soon manifested; the size increases—the breasts even become swollen and painful—the stomach disordered, and the appetite capricious;—flatulence collects in the intestines; and while on this account the size still increases, the air moving about the bowels gives an inward sensation which is mistaken by the female for the plunging of the child. Time alone, or the investigation of the medical attendant, detects the mistake; and the symptoms are then to be easily removed by the exhibition of carminative and purgative medicines, the use of active exercise, and bandaging the distended abdomen.

It must be remembered, also, that suppression of the monthly return may arise from a variety of causes, altogether independent of conception. Every female is aware, that exposure to cold, just before the expected period, is a frequent cause. Different forms of disease, hardship, or mental emotions, may produce the same result. It does not follow, therefore, because a woman ceases to menstruate, she must be pregnant; which naturally presents this inquiry: what dependence, then, is to be placed upon the omission of menstruation as a symptom or sign of pregnancy?

When a female ceases to be unwell, and experiences other symptoms of pregnancy, she must consider her situation as yet uncertain, because these signs are common to disease as well as pregnancy. But if toward the third month, while the suppression continues, she recovers her health, and if her appetite and colour return, she needs no better proof of pregnancy; for under other circumstances her health would remain impaired, and even become worse.^[14]

Morning Sickness.

Soon after conception, the stomach often becomes affected with what is called “morning sickness.” On first awaking, the female feels as well as usual, but on rising from her bed qualmishness begins, and perhaps while in the act of dressing, retching takes place.

This symptom may occur almost immediately after conception; but it most frequently commences for the first time between two or three weeks after. Now and then it is experienced only the last six weeks or two months of pregnancy, when it is attended, generally, with much distress and discomfort. And lastly, it is not unfrequently absent altogether.

It continues, more or less, during the first half of pregnancy, and subsides about the time when the movements of the child begin to be felt.

Irritability of the stomach, however, may arise from a variety of causes totally independent of pregnancy, and connected with disease or disordered function. Of what avail, then, it will be asked, is this symptom as a sign of pregnancy? It is so far available:—

The nausea and vomiting of pregnancy are not accompanied by any other symptom of ill health; but, on the contrary, the patient feels as well as ever in other respects, and perchance takes her meals with as much relish as formerly; but while doing so, or immediately after, she feels suddenly sick, and has hardly time to retire, when she rejects the whole contents of her stomach, and very shortly after is quite well again. Not so with sickness arising from disease, or disordered condition of the stomach.

Shooting pains through—enlargement of—and other changes of the breast.

When two months of pregnancy have been completed, an uneasy sensation of throbbing and stretching fulness is experienced, accompanied with tingling about the middle of the breasts, centring in the nipple. A sensible alteration in their appearance soon follows: they grow larger and more firm. The nipple becomes more prominent, and the circle around its base altered in color and structure, constituting what is called “the areola.” And, as pregnancy advances, milk is secreted.

The period of gestation at which these changes may occur, as well as the degree in which they become manifested, varies very much. Sometimes, with the exception of the secretion of the milk, they are recognised very soon after conception;—in other instances, particularly in females of a weakly and delicate constitution, they are hardly perceptible until pregnancy is far advanced, or even drawing towards its termination.

Enlargement of the Breast.—The changes in the form and size of the breast may be the result of causes unconnected with pregnancy. They may enlarge in consequence of marriage, from the individual becoming stout and fat, or from accidental suppression of the monthly return. There are, however, these differences: enlargement from pregnancy may in general be distinguished from that produced merely from fat, by the greater firmness of the breast, and its knotty uneven feeling—it is heavier; and the tension and enlargement from suppressed menstruation, by its subsiding in two or three days, whereas that caused by pregnancy continues to increase. Nevertheless, the dependence which may be placed upon the enlargement of the breast only, as an evidence of pregnancy, is not very great, and considered alone, but a doubtful sign.

The Nipple.—Not so the changes which take place in the nipple, and around its base. These alterations, if present, are of the utmost value, as an evidence of pregnancy. The changes referred to are these:—

About the sixth or seventh week after conception has taken place, if the nipple be examined, it will be found becoming turgid and prominent, and a circle forming around its base, of a colour deeper in its shade than rose or flesh-colour, slightly tinged with a yellowish or brownish hue, and here and there upon its surface will be seen little prominent points, from about ten to twenty in number. In the progress of the next six or seven weeks, these changes are fully developed; the nipple becoming more prominent and turgid than ever: the circle around it of larger dimensions, of an extent of about an inch or an inch and a half; the skin being soft, bedewed with a slight degree of moisture, frequently staining the linen in contact with it; the little prominences of larger size, from the sixteenth to the twelfth of an inch perhaps; and the colour of the whole very much deepened, but always modified by the complexion of the individual, being darker in persons with dark hair, dark eyes, and sallow skins, than in those of fair hair, light-coloured eyes, and delicate complexions.

Such are the essential characteristics of the true areola, the result of pregnancy, and, I believe, of that condition only.

This, then, is a most valuable sign; but, unfortunately, it is frequently absent; and how often it is present, although I have examined many hundred cases for it, I cannot determine, as unfortunately no note was made upon this point. It should also be observed, that both in dark and fair women, the change of colour, without the other appearances, may be present, and yet pregnancy exist; and I have also seen frequently the dark circle alone, where pregnancy did not exist; but I never saw an instance where these prominences were truly developed, without the presence of pregnancy.

This fact has been more particularly noticed of late years by an eminent physician-accoucheur, and the attention of the author has, in consequence, been much directed to it; and, as a striking illustration of its truth, he may mention, that, called upon very recently to visit one of the Institution patients, the third day after her delivery, and having occasion to examine the breast, I pointed out to the gentleman in attendance the presence of these little prominences around the base of the nipple; upon which the patient, to my great surprise, immediately observed, “Ah, sir, I always know when I am pregnant by them, for they appear about ten days or a fortnight after its occurrence, and subsequent to delivery diminish gradually, as my milk leaves me.”

It has occurred to me during the past year to be consulted in five cases of doubtful pregnancy. In two of them, circumstances forbade the probability of its occurrence; but in both the true areola was distinctly and fully developed. It decided my opinion; and the result proved its correctness: both became mothers. Two others had made themselves patients of the Lying-in-Institution, having obtained letters for attendance from governors of the charity, and upon which was marked, by their own calculation, the month of their expected confinement. But I was led to believe, from observing two or three symptoms, that pregnancy did not exist.

Their cases were examined, and at last the breast; in both the true areola was wanting: the review of symptoms decided all doubts. Had, however, the true areola been present in either, it would at once have reversed, instead of confirming my first suspicions.

The fifth was pregnant, but the true areola was wanting; and I was obliged to refer to those signs which can alone be recognised by a medical man.

The absence, then, of this sign, except in combination with other circumstances, proves nothing, but, if present, I believe it conclusive.

The Presence of Milk.—With regard to the presence of milk in the breasts, as this is a symptom which may arise, and does very generally, in the latter months of gestation alone, when the existence of pregnancy has been long determined, it is only mentioned here to refute the popular error, that “the presence of milk in the breasts is an infallible proof of pregnancy.” It is no such thing; and many well-recorded instances could be brought forward to prove the possibility of its formation under circumstances totally independent of pregnancy.

Belloc speaks of a servant girl, who being obliged to have sleeping with her an infant who was being weaned, and which by its crying disturbed her rest, bethought her of giving it her breast to appease its clamour; and the result was, that in a short time she had milk enough to satisfy the child.^[15]

The following case is related by Mr. George Semple: Mrs. B——, wife of John Breward, Simpson Green, near Idle, aged forty-nine, the mother of nine children, the youngest of whom is twelve years old, lost a daughter-in-law about a year ago, who died in about a fortnight after giving birth to her first child. On her death, Mrs. B. took charge of the infant, a little puny sickly baby. The child was so fretful and uneasy, that Mrs. B. after many sleepless nights, was induced to permit the child to take her nipple into its mouth. In the course of from thirty to thirty-six hours she felt very unwell; her breasts became extremely painful, considerably increased in size, and soon after, to her utter astonishment, milk was secreted, and poured forth in the same abundance as on former occasions, after the birth of her own children. The child, now a year old, is a fine, thriving, healthy girl, and only a few days ago I saw her eagerly engaged in obtaining an apparently abundant supply of healthy nourishment, from the same fountain which, nearly twenty years ago, poured forth its resources for the support of her father.”^[16]

There is only one other symptom which I think it useful to notice, that is quickening; by which is meant, the first sensation experienced by the mother of the life of the child within her womb.

The first time this motion of the child occurs, the sensation is like that of the fluttering of a bird within her, and so sudden that she frequently faints, or falls into an hysterical paroxysm. A day or two passes by when it recurs. It afterwards increases both in frequency and degree, until the movements of the child are fully recognised.

It is proper that a female should be informed that the period when quickening takes place is very uncertain; for an impression is popularly prevalent that it always occurs exactly at the end of four calendar months and a half. This is not the case; it varies in different women, and in the same women during different pregnancies, as the following one or two instances will prove:—

Mrs. F——. Quickened with her first child at four months: quickened with the second at fourteen weeks: and is now in her third pregnancy, and reckons from the fourteenth week again.

Mrs. B——. Has had seven children, and with all felt the motion of the child for the first time at the third month.

Mrs. Mc M——. Has been several times pregnant; seldom feels movements of the child at all until the sixth month, and not strongly till the eighth.

The annexed table of the periods of quickening of seventy cases taken in the order in which they have been entered in the author’s note-book, will forcibly stamp the truth of these opinions:

In a few of these cases, for the sake of convenience I have used round numbers, when two or three days before or after was the exact time; and for the sake of correctness, have omitted several cases, in which there was the slightest doubt in the patient’s mind of the exact time.

It appears from this table, that this symptom takes place more frequently between the twelfth and sixteenth week, than before or after these periods; and that subsequent to the 4½ and the expiration of the sixth month, it may occur in the proportion of more than one case out of every five.—Before the third month, quickening seldom arises.

This symptom may not be felt by the mother at all, and yet pregnancy exist. This is rare, but the fact is confirmed by many writers; and I have met during the last seven years with two instances, and in both the mothers gave birth to living and healthy children.

Now comes the question, how far this symptom is of value, as a sign of the pregnant state?

If it has been experienced in former pregnancies, it is invaluable, for I believe it is not to be mistaken. If it is a first pregnancy and doubtful, it removes all obscurity, provided the sensation grows stronger and stronger, until the movements of the child are distinctly felt.

Four only of the symptoms of pregnancy have been noticed, because the remainder are not recognisable, except by the accoucheur, although to him of the greatest value when pregnancy is complicated and doubtful from the presence of disease.

The nature of these symptoms has been described as plainly, and yet as briefly, as possible, because of the importance of their being clearly understood by married women.

I have also endeavored to point out their real value as evidence of pregnancy—how they are sometimes absent in patients who are pregnant, and some of them present in those who are not so—because of the doubt and obscurity which arise from these variations.

And lastly, in bringing these observations to a conclusion, I venture to say, that if the married female will only take the trouble to make herself familiar with this little detail, she will not regret the time as lost or misspent, because it will generally guide her aright, and I trust save her many moments of anxiety and discomfort.