Taking Care of a Pregnancy in Hard Times
Our last article (http://www.doomandbloom.net/2012/11/how-and-why-to-prevent-pregnancy-if-the-shtf.html) detailed the risks and perils of pregnancy in a societal breakdown and discussed the Natural Family Planning method as an option in the early going. Sometimes, however, the best laid plans of mice and men go awry. In a long-term survival situation, you may find yourself responsible for the care of a pregnant woman. It will be important to know how to support that pregnancy and, eventually, deliver that baby. As always, leave this duty to experienced professional if modern medical care exists.
In a survival situation, you won’t have access to ultrasound technology to take a look at the fetus; whether it’s a boy or a girl will once again become a mystery. Even twins might be a surprise.
Without prenatal mega-vitamins, babies will be smaller at birth. This may also not be so bad, since Caesarean Section will no longer available. It’s less traumatic for the mother to deliver a 6 or 7 pound baby than a 10 pounder.
Despite all the possible complications that I mentioned in the previous section, pregnancy is still a natural process. It usually proceeds without major complications and ends in the delivery of a normal baby. Although your pregnant patient will not be as productive for the survival group as she would ordinarily be, she will probably still be able to contribute to help make your efforts a success. To make a pregnancy a success, the medic will need to have a little knowledge of the subject and an idea of how to deliver the fetus.
We are, of course, fortunate to have simple tests that can identify pregnancy almost before your miss a period. What if these tests are no longer available? You will have to rely on the following tried and true signs and symptoms to identify the condition:
- Absent menstruation
- Tender Breasts
- Nausea and Vomiting
- Darkening of the Nipples/Areola
- Frequent Urination
These symptoms, in combination, are indicative of pregnancy. The timing of each will be variable; some will be noticed earlier than others. It should be noted that this investigation will likely be necessary only in those women experiencing their first pregnancy. Once you have been pregnant, you will most likely know when it happens again.
Of course, as time goes on, the abdominal swelling associated with uterine and fetal growth will be undeniable. Stretch marks come later, as do hemorrhoids, backache, and varicose veins (all very common but not universal). These changes are part and parcel of the average healthy pregnancy. Most of the above will improve after the pregnancy is over, but may not disappear completely.
So, what’s the due date? This is the question everyone will want answered once a pregnancy is identified. A human pregnancy lasts 280 days or 40 weeks from the first day of the last menstrual period to the estimated date of delivery. This used to be called the “estimated date of confinement” because, yes, they confined women to their beds as they approached it.
This date is simple to calculate if you have regular monthly periods. To get the due date, subtract 3 months and add 7 days to the first day of the last period. Example: If the first day of last menstrual period (LMP) is 9/7, then the due date is 6/14.
If the woman does not know when her last cycle started, you can still estimate the age of the pregnancy by physical signs. When you gently press on the woman’s abdomen, you will notice a firm area (the uterus) and a soft area (the intestines). Identify the uppermost level of firmness, and you will able to estimate the approximate age of the pregnancy. If the “lump” is peaking just over the pubic bone, you’re at 12 weeks. Halfway between the pubic bone and the belly button is 16 weeks. At the belly button is 20 weeks. Each centimeter above the belly button adds a week, so have a measuring tape handy. A term pregnancy will measure 36-40 Centimeters from the pubic bone to the top of the uterus.
Twins, as you might imagine, will throw all of these measurements out the window. They will occur in 1 in 60 births, more often if there is a family history. Don’t worry about triplets: They occur in 1 in 7,000 births, unless you use fertility drugs.
Once you have identified the pregnancy, you should make every effort to assure that your patient is getting proper nutrition. Deficiencies can affect the development of the fetus, so obtaining essential vitamins and iron through the diet will give the best chance to avoid complications. If you have stockpiled prenatal vitamins, use them.
Common early pregnancy issues will include hyperemesis, as described in the last section. Be sure to ask your physician for prescriptions for Zofran and/or other anti-nausea medications to add to your stockpile. Hyperemesis will disappear in almost all women as they advance in the pregnancy. Dry bland foods, like crackers, are helpful in getting a woman through this stage. Ginger tea is a time-honored home remedy to decrease “morning sickness”.
Another early pregnancy issue is the threatened miscarriage. This will be characterized by bleeding or spotting from the vagina, along with pain that simulates menstrual cramps. As 10% of pregnancies end in miscarriage and a higher percentage threaten to, this will be an issue that you must know how to deal with.
Other than placing your patient on bed rest, there will not be much you’ll be able to do in this circumstance. Some of these pregnancies don’t continue because the fetus is abnormal, and no amount of rest will stop many of these pregnancies from ending very early. The good thing is that a single miscarriage generally does not mean that future pregnancies will be unsuccessful.
Keep a close eye out for evidence of infection, such as fever or a foul discharge from the vagina. Women with these symptoms would benefit from antibiotic therapy. See our articles on “Antibiotics and their Use in Collapse Medicine”.
Pregnant women should be evaluated periodically to see how the fetus is progressing. Besides verifying progressive growth in the size of the uterus, the fetal heartbeat should be audible via stethoscope at around 16-18 weeks, or much earlier if you have a functioning battery-powered fetal heart monitor (also called a Doppler ultrasound). These are available for sale online. Your exams should be more frequent as the pregnancy advances. Every 4 weeks until 22 weeks or so, then every 2 weeks until 35 weeks, then every week thereafter.
Weight gain is desirable during pregnancy; you should shoot for 25 pounds or so, total. Blood pressure should be taken regularly to rule out pregnancy-induced hypertension. Elevated blood pressures behoove you to place your patient on bed rest. Lying on the left side will keep her blood pressure at its lowest. Check for evidence of edema (swelling of the feet, legs and face) as well as excessive weight gain).
As the woman approaches her due date, several things will happen. The fetus will begin to “drop”, assuming a position deep in the pelvis. The patient’s abdomen may look different, or the top of the uterus (the “fundus”) may appear lower. As the neck of the uterus (the cervix) relaxes, the patient may notice a mucus-like discharge, sometimes with a bloody component. This is referred to as the “bloody show” and is usually a sign that things will be happening soon.
Next time, we’ll be talking about how to birth that baby!