Preterm birth

“ If there is no hemorrhage, or other cause of alarm, there is no more reason for giving assistance to deliver the placenta than if only one child had been present; we ought either to wait for the spontaneous operation of nature, or, at most, give very little assistance, precisely as we would in a case of single birth. ”

“ The stimulus of the sperm so pent up causes that ovary to mature a germ, although it may do so slowly, and after two or three months it is perfected, fertilized, and a second conception occurs within the uterus. If each embryo observe a regular period of growth and each be born at maturity, there must be an interval of two or three months between their births. But it is far more common for the parturition of the first, displaying signs of full maturity, to coincide with the birth of a second which is immature and which cannot sustain respiratory life. ”

“ Concerning the varied results of eclampsia, the opinion seems to be growing that if it develops during late pregnancy, labor 193is likely to set in and a premature child be born spontaneously; in some cases, however, for reasons already given, labor is induced, while in others the mother dies undelivered. The fetus may die, after which the convulsions practically always cease and the infant is often born later in a macerated state; or the patient may recover, go to term and give birth to a normal, healthy baby. ”

“ Furthermore, if there is to be notable improvement in the management of cases of childbirth, the appearance of untoward symptoms should not be awaited before consulting a physician; on the contrary, prospective mothers must be taught that they should be under competent medical supervision throughout pregnancy.
At present intelligent women demand some knowledge of the anatomical and physiological changes incident to the development of the embryo and the birth of the child. ”

“ THE PLACENTAL STAGE.—Although the third stage is chiefly concerned with the separation and the delivery of the after-birth, on which account it is known as the placental period, the description of other no less remarkable events belongs here. Even after the infant is born the umbilical cord extends from its navel to the placenta, just as it has done throughout pregnancy. Among larger mammals separation of the new-born from the mother is brought about in one of two ways; sometimes the activity of the young breaks the navel-string, though more frequently the mother bites it in two. ”

“ GROWTH AND PHYSIOLOGY OF THE FETUS Although the fetus at term is in many respects simply a diminutive, immature man, or woman, its anatomy and physiology present certain characteristics which have adapted it to a protected existence in a sac of fluid. Some of the fetal structures and functions become increasingly active after birth, while others subside and disappear. ”

“ They are tiny threadlike bodies, which may work their way towards the ovum long after they have left the body of the man and been placed in the body of the woman, and the uterus has a searching movement, and may by its pulsations draw the spermatazoa upwards. For these reasons a woman cannot be quite sure of the exact time of fertilisation, and hence cannot predict exactly the date of the child-birth. ”

“ It is equally unwise for inexperienced persons to press upon the womb in the hope of pushing out the placenta. To encourage the mother to strain just as she did in assisting the birth of the child would always be a safer plan. ”

“ Physicians and their scientific colleagues have regarded that event with less interest and have tended to focus either upon conception, upon live birth, or upon the interim point at which the fetus becomes "viable," that is, potentially able to live outside the mothers womb, albeit with artificial aid. ”

“ It is quite possible to become pregnant and yet it may be wholly impossible to give birth to a child. It is necessary to be constructed normally, or as near what is regarded as normal as is possible, in order safely to assume the responsibility of carrying a pregnancy to a successful completion. No one but a physician, who is skilled and familiar in the knowledge of what constitutes the proper size, and shape, and quality, and relations, one with another, of [69] your bones, and ligaments, and muscles, can tell whether you can safely be permitted to carry a pregnancy to term or not. ”

“ If you arrive to the time of her period when she is pregnant, whether she knows she is pregnant or during the time of nursing, that they are 24 months after the birth of the fetus, even if the fetus dies, you don’t need to separate from the time of the period and you don’t need to check.
סעיף ח היתה נחבית במחבא מפני פחד, והגיע שעת וסתה, אינה חוששת לו. הגה: וי"א דוקא אם עבר הוסת ולא בדקה ולא הרגישה, טהורה בלא בדיקה. ”

“ That the embryo probably lives in utero in virtue of its own life-principle, even through the entire period of gestation, (51, 56, and 58,) is rendered probable by many facts related by unimpeached authorities, which go to prove that when the whole intact Ovum has been expelled at an advanced period of gestation, or at the natural termination of that period, the fœtus has continued to live, and the circulation of the blood has not ceased for an instant during a space of time of from nine minutes to a quarter of an hour. ”

“ It also affords the fetus greater freedom of motion, and protects the womb and other parts from injuries which might otherwise be inflicted by the fetus after quickening. Within this fluid the fetus floats during its formative period, and when the time of birth comes the breaking of the sac which contains this fluid enables it to flow out, lubricating the parts, or channel, through which the newly formed being is to pass in its exit into the outer world. ”

“ CHAPTER VIII MISCARRIAGE Frequency—Causes and Prevention—Habitual Miscarriage—Warning
Symptoms—After-effects—Criminal Abortion—Therapeutic Abortion—
Premature Delivery.
We have learned that forty weeks are required for the full development of the human embryo, but this fact carries no assurance that pregnancy will last so long; in reality, it may end abruptly at any time. If growth is interrupted before the twenty-eighth week (the seventh lunar month) , the infant will be too immature to live. Even when born alive, it will usually perish within a few hours, or a few days at most. ”

“ At the same time, the viability standard takes account of the undeniable fact that as the fetus evolves into its postnatal form, and as it loses its dependence on the uterine environment, the State's interest in the fetus' potential human life, and in fostering a regard for human life in general, becomes compelling. ”

“ In point of frequency, premature delivery ranks far below either abortion or miscarriage.
Unlawful interference with pregnancy generally proceeds from a desire to avoid offspring, and lacks incentive after the infant becomes capable of living independently. Criminal operations, therefore, are not a conspicuous cause of premature delivery. Occasionally physicians resort to artificial means to end gestation during the later months in order that organic complications may be relieved; but most premature births occur spontaneously. ”

“ Moreover, it is found that premature birth, one of the commonest accidents of modern life, tends to be prevented by such rest. The children of mothers who rest enjoy on the average three weeks longer development in the womb than the children of the mothers who do not rest, and this prolonged ante-natal development cannot fail to be a benefit for the whole of the [9] child's subsequent life. ”

“ The disturbance of uterine existence between conception and birth is that which has engaged most attention, and the fact that such disturbances can take place requires that the expectant mother should be protected from anything that can so act on her own organism as to prevent the due operation of the law of heredity. ”

“ With the exception of tuberculosis, physicians recognize no condition that necessarily unfits a mother for nursing. As we have already seen, pregnancy is generally incompatible with lactation; in the event of conception the mother's milk almost always takes on qualities which render it unsatisfactory for the infant, and yet occasionally pregnancy advances several months before these changes in the milk occur. Meanwhile the infant suffers no inconvenience, and often in these cases the symptoms of threatened miscarriage give the first intimation of the mother's condition. ”

“ Universal experience, however, teaches us that the likelihood of rearing a premature child is, by a rapidly increasing proportion, the greater for every week that it remains within the uterus. This is precisely what we should expect, for the period of its existence there measures the perfection of its development ”

“ Compare Brief for Scholars of Jurisprudence as Amici Curiae 12–14, and n. 32 (emphasis deleted) (“ ‘a quick child’ ” meant simply a “live” child, and under the era’s outdated knowledge of embryology, a fetus was thought to become “quick” at around the sixth week of pregnancy) , with Brief for American Historical Association et al. as Amici Curiae 6, n. 2 (“quick” and “quickening” consistently meant “the woman’s perception of fetal movement”) . We need not wade into this debate. ”

“ In case pregnancy has occurred before the deformity is discovered, and it is then found that a full grown child cannot be born, premature delivery must be brought on; or, in other words, the Uterus must be made to expel the child before the full term, while it is yet small enough to pass through the Pelvis. This operation is of course only allowable when needed to preserve life, or to escape great suffering and danger. ”

“ Menstruation is more likely to return early after the birth of the first baby than after those born subsequently. Mothers sometimes wonder whether this early discharge is menstrual or lochial, and though they, themselves, cannot possibly distinguish between them, a physician can easily decide by examination, and in the interest of the 136mother’s future health it is important that this uncertainty be cleared up. ”

“ A new human being is the ultimate result of conception, but the chorion, amnion, placenta and umbilical cord must also be created to serve as aids in building and protecting the developing child during its uterine life. The part played by these accessory structures is so vital, in spite of being temporary, that it will be well for us to look into their origin and functions before considering the fetus itself which they serve. ”

“ It is scarcely probable that any woman lives through the ten months of pregnancy without seeing, hearing or thinking things that would disfigure a baby if maternal impressions could produce such results, and yet newborn babies are very rarely blemished. Although the ultimate causes of marks and deformities of the fetus are not definitely known, they are probably to be found in faulty development very early in the embryonic life, and, therefore, are not preventable. ”

“ The foetus in this condition may be otherwise well developed, and it would be not a misuse of words to say that it was healthy, since it is adjusted to and in harmony with its narrow environment, but it would not be normal. The intra-uterine life of the unborn child, it must be remembered, is carried out by the transmission of energy from the mother to the foetus by means of the close relation between the maternal and foetal circulation. It is only when the free existence demands activities not necessary in intra-uterine life that existence without a central nervous system becomes impossible. ”

“ The most obvious problem with any such argument is that viability is heavily dependent on factors that have nothing to do with the characteristics of a fetus. One is the state of neonatal care at a particular point in time. Due to the development of new equipment and improved practices, the viability line has changed over the years. In the 19th century, a fetus may not have been viable until the 32d or 33d week of pregnancy or even later. [51] When Roe was decided, viability was gauged at roughly 28 weeks. See 410 U. S., at 160. Today, respondents draw the line at 23 or 24 weeks. ”

“ Again, the amniotic fluid prevents injuries that might otherwise befall the child in case the mother wears her clothing too tight. Harmful as the practice of tight-lacing during pregnancy is, it does not, thanks to the presence of the amniotic fluid, result in the disfigurement of the child. For the same reason a blow struck upon the abdomen, as in a fall forward, is not so serious as might be thought, since the fluid, not the child, receives the force of the impact. Some physicians believe that the fetus swallows the amniotic fluid and thus secures nourishment. ”

“ Certain abnormalities of the developing fetus are inconsistent with life, and are, therefore, a frequent cause of abortion. Dr. Mall, of Johns Hopkins University, showed after years of investigation that at least one-third of the embryos obtained from abortions were malformed and would have developed into monstrosities had they lived to term. It is often a great comfort to the expectant mother who loses her baby early in pregnancy to realize that had she carried her baby to term it might have been a monster, and that, therefore, she has not lost a beautiful, normal child. ”

“ None the less, bleeding, however moderate, should always excite suspicion, as we know it usually denotes the breaking to some degree of the connection between mother and child. The extent of the separation usually determines the degree of the hemorrhage, which in turn indicates the seriousness of the accident. The fate of the fetus will depend upon the area of placenta, which has been incapacitated. Flooding, however, always imperils the fetus, and generally warrants the inference that so much of the placenta has been separated as to render further development impossible. ”