Itching of the Vulva. Pruritus Vulvæ. Itching of the external genitals during pregnancy is not uncommon. This may be due to the fact that the vulva is generally congested and swollen during pregnancy or it may be caused by an increased leucorrheal discharge. The itching is sometimes very severe, and if the patient scratches with her nails and produces bleeding, she may cause an infection of the parts. The patient should be cautioned against scratching; she should try simple measures to relieve the itching. A small towel or gauze compress wrung out of boiling water and applied to the vulva several times a day, followed by a free application of stearate of zinc powder is often efficient. If it is not, the following salve may be tried: carbolic acid, 10 grains; menthol, 5 grains; resorcin, 15 grains; zinc oxide, 1 dram; and white vaseline, one ounce. In very severe cases the vulva should be painted with a solution of silver nitrate, 25 grains to 1 ounce of distilled water.
Varicose Veins. In most women during pregnancy the veins in the legs become somewhat enlarged. This is due to the pressure of the womb, which interferes with the circulation. If the veins become very prominent, swollen and tortuous, they are called varicose. This condition should be prevented, because it often and to some degree always persists permanently even after the pregnancy is over. The best precautionary measure is for the woman to wear a well-fitting abdominal belt or maternity corset, which supports the womb and does not permit it to sink too low into the pelvis. If varicose veins have been permitted to develop, the woman should wear well-fitting rubber stockings, or at least have the legs bandaged with woven elastic bandages. The bandage must be applied by a competent person, uniformly and not too tightly. Constipation has also a bad effect in making varicose veins worse; the bowels should therefore also be looked after. In some severe cases all measures are of little value unless the patient at the same time stays in bed or on a couch for a few days, with the legs elevated.
Swelling of the feet should be at once attended to. It may be a trifling matter due only to pressure of the womb; then again it may be due to some kidney trouble. The physician will determine the true cause and prescribe the appropriate treatment.
Liver Spots. Chloasma. In some cases irregular brownish patches or splotches develop on the skin around the breasts, on the sides, or on the face. These patches are known popularly as liver spots or in medical language as chloasma. Nothing can be done for them, but they generally disappear after the pregnancy is over. A few patches here and there may remain permanently.
Chapter Twelve
WHEN TO ENGAGE A PHYSICIAN
Necessity for the Pregnant Woman Immediately Placing Herself Under Care of Physician and Remaining Under His Care During Entire Period.
The disorders and disturbances described above are, with the exception of pernicious vomiting, of a minor nature. They are annoying, may cause considerable discomfort and suffering, but they do not endanger the life of the woman or of the child. Occasionally, however, fortunately not very often, the kidneys become affected, and for this condition treatment by a physician is absolutely necessary. In fact, the correct and safe thing for a woman to do is to consult a physician as soon as she knows she is pregnant, and have him take care of her during the entire pregnancy. Some women engage a physician during the eighth or ninth month and this is decidedly wrong, because it may then be too late to correct certain troubles which if taken at the outset could have been easily cured; while many troubles in the hands of a competent physician can be prevented altogether. I must therefore reiterate: every woman should engage a physician from the beginning of her pregnancy, or at least during the third or fourth and certainly not later than the fifth month. He will examine the urine every month and make sure that the kidneys are in order, he will make sure that the child is in a normal position, and will prevent a host of other ills.
Position of the Child in the Womb.
This is not a special treatise on the management of pregnancy, and therefore minute details are out of place. Besides, to the details the physician will attend. But some hints regarding diet and general hygiene will prove useful.
If everything is satisfactory, if there is no severe vomiting, kidney trouble, etc., the usual mixed diet may continue. The only changes I would make are the following: Drink plenty of hot water during entire course of pregnancy: a glass or two in the morning, two or three glasses in the afternoon, the same at night. From six to twelve glasses may be consumed. Also plenty of milk, buttermilk and fermented milk. Plenty of fruit and vegetables. Meat only once a day. For the tendency to constipation, whole wheat bread, rye bread, bread baked of bran or bran with cream.
As to exercise, either extreme must be avoided. Some women think that as soon as they become pregnant, they must not move a muscle; they are to be put in a glass case, and kept there to the day of delivery. Other women, on the other hand, of the ultramodern type, indulge in strenuous exercise and go out on long fatiguing walks up to the last day. Either extreme is injurious. The right way is moderate exercise, and short, non-fatiguing walks.
Bathing may be kept up to the day of delivery. But warm baths, particularly during the last two or three months, are preferable to cold baths.
Chapter Thirteen
THE SIZE OF THE FETUS
Approximately Correct Measurements and Weight of Fetus at End of Each Month of Pregnancy.
Men and women are always interested to know how large the fetus is and how far it is developed during the various months of pregnancy. Absolutely exact measurements cannot be given, but the following approximate measurements are correct:
1. Embryo Between One and Two Weeks Old.
2. Embryo About Four Weeks Old.
3. Embryo About Six Weeks Old.
At the end of the first month (lunar) it is about the size of a hazelnut. Weighs about 15 grains.
At the end of the second month it is the size of a small hen's egg. The internal organs are partially formed, it begins to assume a human shape, but the sex cannot yet be differentiated. Up to the fifth or sixth week it does not differ much in appearance from the embryos of other animals.
At the end of the third month it is the size of a large goose egg; it is about two to three and a half inches long. Weighs about one ounce.
At the end of the fourth month the fetus is between six and seven inches long and weighs about five ounces.
At the end of the fifth month the fetus is between seven and eleven inches long, and weighs eight to ten ounces.
At the end of the sixth month it is eleven to thirteen inches long and weighs one and one-half to two pounds. If born, is capable of living a few minutes, and it is reported that some six months' children have been incubated.
At the end of the seventh month the fetus is from thirteen to fifteen or sixteen inches long and weighs about three pounds. Is capable of independent life, but must be brought up with great care, usually in an incubator.
At the end of the eighth month the length is from fifteen to seventeen inches, and weight from three to five pounds.
At the end of the ninth month the length of the fetus is from sixteen to seventeen and one-half inches, and weight from five to seven pounds.
At the end of the tenth lunar month (at birth) the length of the child is from seventeen to nineteen inches and the weight from six to twelve pounds; the average is seven and a quarter, but there are full term children weighing less than six pounds and more than twelve; but these are exceptions.
Chapter Fourteen
THE AFTERBIRTH (PLACENTA) AND CORD
How