Pregnancy in a Collapse Situation
There was a time when the announcement of a pregnancy was met with concern as well as joy. In a collapse situation, some of these concerns will present themselves again. Despite this, we know a lot more about the importance of hygiene and clean conditions that we did before. This will help prevent some of the complications, such as infection, that caused risk to the mother in this situation.
Pregnancy is 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 in many ways to the community. To make a pregnancy a success, you, as medic, will need to have some knowledge regarding the condition and an idea of how to deliver the baby.
We are, of course, fortunate to have simple tests that can identify pregnancy; sometimes, even before your miss a period. What if these tests are no longer available? You will have to rely on the following tried and true symptoms to identify the condition:
Pregnancy Symptoms to Know
Nausea and Vomiting
Darkening of the Nipples/Areola
These symptoms in combination are indicative of pregnancy, although some will be noticed earlier than others. It should be noted that this investigation will likely be necessary only if those women experiencing their first pregnancy. Once you have been pregnant, you will probably just 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). Most of these 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 is 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: 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. A term pregnancy will measure 36-40 Centimeters from the pubic bone to the top of the now-humongous uterus! Twins, as you might imagine, will throw all of these measurements out the window.
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.
A common early pregnancy issue is hyperemesis. Be sure to ask your physician for prescriptions for Zofran and/or other anti-nausea medications to 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.
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. 10% of pregnancies end in miscarriage and an even higher percentage threaten to; this will be an issue that you will have to deal with.
Other than placing your patient on bedrest, 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. Penicillin-family drugs are acceptable for use in pregnancy.
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 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.
Weight gain is desirable during pregnancy; you should shoot for 25 pounds or so, total. Blood pressure should be taken to rule out pregnancy-induced hypertension. Elevated blood pressures behoove you to place your patient on bedrest. Laying 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). Of course, if modern medical care exists, you would want to get her to the nearest hospital.
As the woman approaches her due date, several things will happen. The fetus will begin to “drop”, assuming a position 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. If you examine your patient vaginally by gently inserting 2 fingers of a gloved hand, you’ll notice the cervix is firm like your nose when it is not ripe, and soft like your lips when the due date is approaching.
Contractions will start becoming more frequent. To identify a contraction, feel the skin on the soft area of your cheek, then touch your forehead. A contraction will feel like your forehead. False labor, or Braxton-Hicks contractions, will be irregular and will abate with bed rest, especially on the left side, and hydration. If contractions are coming faster and more furious even with bedrest and hydration, it might be time to have a baby! A gush of watery fluid from the vagina will often signify “breaking the water”, and is usually a sign of impending labor and delivery. The timing will be highly variable.
The delivery of a baby is best accomplished with the help of an experienced person or midwife. These professionals will be hard to find in a collapse situation. If there is no chance of accessing modern medical care, it will be up to you to perform the delivery. This topic will be covered in detail in an upcoming article, so keep an eye on our blog!