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Signs and Symptoms of Pregnancy / Calculating the Correct DateHolistic Midwifery I?pages 360 – 367Part 1What does the term “presumptive sign of pregnancy” mean?These signs are changes that the woman sees in her own body, that are clues of pregnancy but don’t guarantee pregnancy. What does the term “probable sign of pregnancy” mean? These are things that are usually associated with pregnancy but there could be other causes possible to these signs that are outside of pregnancy. What does the term “positive sign of pregnancy” mean? These are sure signs that there in fact a fetus in the women’s womb. These usually cannot be detected until at least the fourth month of gestation. What are the presumptive signs of pregnancy? Mother’s sense of pregnancy, amenorrhea, breast changes, color changes in mucus membranes of the yoni, increased pigmentation, nausea and vomiting, pigmentation changes in the skin, urinary frequency, fatigue. What are the probable signs of pregnancy? Abdominal enlargement, changes in the shape size and consistency of the uterus, changes in the cervix, intermittent uterine contractions, ballottement of fetus, outlining the fetus, positive hormonal test for pregnancyWhat are the positive signs of pregnancy? Hearing and counting the fetal heart rate, feeling fetal movements on palpation, ultrasound or x-ray confirmation of pregnancyWhy might a woman not want to disclose whether she has had a previous pregnancy or not?The woman may not want her current partner to know that she has been pregnant before outside of their relationship. She may also be blocking trauma such as becoming pregnant from sexual abuse or not referring to a previous pregnancy due to adoption. List four exams that can be done to help determine a previous pregnancy. For each list what you are looking for and the differences between a woman that is pregnant for the first time and one that has had a previous pregnancy. 1: A Breast Exam of a first-time pregnancy will show a firm nipple that does not project excessively. A breast exam of a woman who has been pregnant before will show a softer nipple due to breast feeding or pigmentation of the area surrounding the nipple in some women. 2: Stretch marks in a first-time pregnancy will be a pinkish color and in a woman with a previous pregnancy they will be silvery white. 3: In a new mother, her uterine wall will be firm and be an oval, egg like shape. A previous pregnancy will show as the uterine wall being less rigid, rounder rather than an oval and the baby will be easier to feel. 4: Internal exam of a first pregnancy will show good muscle tone in the vulva and the cervical opening is the size of a pinhead. In a recurring pregnancy the vulva will be roomier, and the cervical opening looks more like a slit than being round. Part 2Why are due dates only estimates and not “exact science”?Menstrual cycles can vary in average length and start date. Conception date can sometime be unknown to the woman and may be more of a guess of the date of intercourse. Contraception can also play a role in the date as well. What is a gestation wheel? Explain how it works. With a gestation wheel, the Naegele’s method is used by placing the inner wheel pointer of the last start date of her period and then the pointer for the 40-week estimation will fall on the due date. When finding the due date based on the time of conception, you do the same thing with the inner wheel pointer but rather than the date of the last period, you place it on the date of fertilization which then still marks the pointer on the 40th week due date. Some people use what is known as “lunar reckoning.” What is this and how does it work? Lunar reckoning is a way that woman calculated their periods in relation to the different phases of the moon. A lunar cycle is just over 29 days so when the moon is gone and the period has not come, this is how they knew they were pregnant. What is Naegele’s rule? How does it work? Explain how you would calculate a due date using this? Naegele’s rule was made by a professor in England to calculate the due date. It is based on the menstrual cycle date and not the date of conception. Essentially, you subtract 3 months from the first day of the woman’s last period and add 7 days to find the due date. Though it applies to the first day of the last period for the math, some interchange that date with the date of predicted conception. What is a modified Naegele’s rule? Why would you use this? The modified Naegele’s rule factors in the variating cycle length of each woman. You subtract the number of her cycle to 28 to get a number that you then add to the estimated due date. What is Wood’s method? Explain how it works. The Wood’s method takes into account the various factors that occur in each woman’s menstrual cycle and also includes factors of previous pregnancies. To calculate you add 1 year to the first day of their last period, then for first time pregnancies you subtract 2 months and then subtract 14 days. For mother’s with previous pregnancies you subtract 2 months and then subtract 18 days. Then according to the variations in her cycle you add or subtract that to the due date similar to the modified Naegele’s rule. Give reasons why you might prefer Naegele’s rule (including modified) over Wood’s method. If you would not prefer it, why not? The Naegele’s rule seems a bit simpler than the Wood’s method to calculate. Although the Wood’s method is aimed for more accuracy, I feel like there might be more room for error. I would prefer the modified Naegele’s rule even over the original Naegele’s rule because it accounts for the fluctuation in all women’s menstrual cycles rather than sticking with the exact number of 28 days. Some midwives prefer to use a method known as “simple addition of days.” What is this and how does it work? Give an example. The ‘simple addition of days’ is the method adds 266 days to the date of conception. 266 days comes from 38 weeks x 7 days. An example would be a woman conceived on April 7 and so 266 days from then would be December 29. This method does allow for different lengths of cycles but does not incorporate the number of pregnancies as a changing factor. What was Middendorf’s study? Give an example of how this could be used in reality.This study took a sample of pregnancies, 31 first time pregnancies and 83 pregnancies that were not the first. From this study they found that for first time pregnancies, the length of pregnancy would be 289 days from the first day of their last menstrual cycle and for a reoccurring birth, gestation would be 283 days from the first day of the last period. This assumed ovulation to be on day 14 of a 28-day cycle but was adjusted for shorter or longer cycles by adding and subtracting days. How does race and genetic differences play a role in estimating due date? In comparing black woman to white woman, it was found that black woman has 8.5 days less in their gestation compared to white woman. This could have many factors including diet and environment. But another study eliminated those factors and found the underlying difference was height of the mother that influenced the difference in length of pregnancy. What role do ultrasounds play in estimating due date?Many OBs use the ultrasound as the main way to determine the stage of pregnancy based on the size of the baby in the womb. How can the menstrual cycle of a woman make EDD calculation complicated? If the woman is both not sure of date of conception as well as have irregular periods, none of these methods would work due to the lack of information for calculation. If she has irregular cycles, you can still work with her to figure out the date of occurrence and length for the past 6 months of cycles and from that average, an estimation can be made though still not entirely accurate. The most recent cycle will be the most telling of the time of ovulation for her pregnancy. After reading how the due date plays a role in Western society, write a short 250-word essay on how the due date plays a role in the developing world. You may use outside resources if you choose, but make sure you include a citation if you do. When you are able to determine a due date in the Western world, it typically can create an anxiety around that date for mom and family, thinking intervention is needed in a post-due date pregnancy. With the interventions available and the role, they play in medicine, often it is best for women to have a due “month” for a lessening of anxiety around the date and less questions about the time the baby needs in the womb before there is intervention needed. In the developing world a due date can be important to determine risk in the later stages of pregnancy. Risk is already extremely higher in mother and baby in the developing world, so the more information you have, the more helpful it is to watch how the mom and baby both are and do the best you can to keep them low risk. Due to inadequate testing and equipment in the developing world, you may be able to determine underlying causes of possible issues after the birth due to the baby and mom for being premature or late. Many women die of childbirth in developing nations due to things that can be prevented by simple evaluation and watchfulness. In accordance to due date, there are different directions and tests that can be done in each phase of gestation leading up to the due date. So in order to use these tools and recommendations to the mother at each stage of her pregnancy, it is helpful to know which stage and trimester she is in, which will show from the calculation of her due date. ................
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