Gestation and parturition (to give them their formal names) are usually quite automatic; but little things may go wrong.

Frank Leighton Wood, MD.

WHILE the expectant mother may contract any of the ordinary diseases which women are subject to, it is extremely seldom that these diseases will interrupt pregnancy if she has proper care. Even major operations, such as the removal of the appendix at any time during pregnancy, may be performed without harm to mother or child. There are, however, certain complications peculiar to pregnancy, which sometimes occur and which require the careful attention of the physician, if the welfare of both mother and child is to be protected. While few expectant mothers have any complications of consequence, all of them should place themselves under the care of their physician early in pregnancy that he may supervise their general care and prevent complications, rather than treat them after they have taken place. In addition to the common infections, the most important complications of pregnancy are nausea or vomiting, abortion (commonly called miscarriage), uremia or kidney insufficiency, and hemorrhage.

As far as infections are concerned, the best way to prevent them is to avoid public gatherings or other places where they may be contracted, when they are known to be prevalent.

If nausea occurs during pregnancy, it is apt to begin in about the sixth week. In many instances its cause is not known and, in all cases, the basic reason for its occurrence is not understood. It is well known, however, that overeating, constipation, overwork, fatigue, nervous excitement and loss of normal rest may predispose to its occurrence. The attacks usually come on soon after arising, so that they are commonly referred to as "morning sickness." In some instances they occur at other hours of the day and, in the more severe cases, the nausea is continuous and there is frequent vomiting.

Since the reproductive, the digestive and the nervous systems are involved in these attacks, the most logical method of preventing them is to see that these systems are relieved of all forms of irritation and kept in a condition as nearly normal as possible. Excesses in eating, particularly of rich and indigestible foods, should be avoided during pregnancy, and the bowels should be kept in as nearly a normal condition as possible. While physical union may be indulged in throughout at least the first half of pregnancy, provided it does not produce discomfort or prove to be disagreeable, at the first sign of nausea or vomiting it should be discontinued and not resumed until the nausea has entirely disappeared. Many women are caused to suffer much "morning sickness" because of such indiscretions the previous evening. Nervous strains and worries should be avoided or removed, if possible, and all things which irritate or cause undue excitement should be avoided. There should be as little loss of normal sleep as possible. In fact, more sleep than usual is desirable.

If, in spite of careful living, nausea or vomiting should occur, the patient should continue the above precautions and consult her physician. In severe cases, the first essential is complete rest in bed, but, in mild cases, a light breakfast, such as tea and toast, should be taken half an hour before rising. Sometimes this will settle the stomach satisfactorily. In other in stances, if a pinch of salt is placed on the tongue at the very first sign of nausea, the attack will he relieved. If such simple measures fail, the physician will resort to sedative medicines or glandular extracts. Due to great modern advances in the treatment of this condition, most cases can be cured or greatly relieved in a week or two of treatment. A few years ago, it was occasionally necessary to destroy the products of conception by therapeutic abortion in order to save the mother's life.

Another complication of pregnancy which is dangerous to the mother and fatal to the child is spontaneous abortion or premature birth. It is responsible for the loss of many babies, either during the first few weeks or months of pregnancy, or before they are sufficiently developed to survive after birth.

In order to clarify a much-misunderstood term, I shall divide "abortion" into three classes; those which are spontaneous or not due to outside interference-commonly called miscarriages; those which are criminal in nature and are brought about by means of drugs or instruments in the hand of the patient herself, a physician, or some other person; and those which are therapeutic in purpose, and are brought about by means of surgery in order to save the life of the mother.

Phantom view of the female body; the womb normally is way down in the pelvis and does not interfere with other organs.

Phantom view of the female body; the womb normally is way down in the pelvis and does not interfere with other organs.

Babies born after about the middle of pregnancy are called "premature" births. If born after the seventh month of pregnancy, they may live if cared for in an incubator. Those born during the seventh month or before do not have a good chance of surviving. There is no basis for the common belief that a seventh-month baby has a better chance of surviving than one born in the eighth month.

The most common causes of abortion or premature birth are irritable uterus (womb), childbirth injuries, syphilis and smoking. There are a few other causes but abortions are seldom due to them. Irritable uterus is a natural or acquired condition in which the organ is susceptible to irritation of various kinds. Hard work, lifting, reaching (as in hanging pictures, draperies or wall paper), physical union, or other forms of nervous excitement may bring about enough excitation to cause an irritable uterus to begin rhythmic contractions. Injuries of the neck of the womb, due to previous childbirths, may be the cause of such irritability. These injuries, of themselves, may cause miscarriage through weakening of the outlet of the womb. Since smoking by women has become so common, it is the experience of all observing obstetricians that the percentage of women who miscarry or have premature or still births is very much higher in those who smoke than in those who do not smoke. This is because nicotine causes a contraction of the blood vessels of the placenta and thus interferes with the supply of oxygen and nutrition to the child. 'This interference may become manifest at any time during pregnancy. Syphilis is a common cause of miscarriage and premature as well as still births.