Question One: Concerning the Uterine Life of the Fetus, and Its Development and Birth — Physiological Notions

I. The natural and physiological development of the fetus¹² is that which occurs in the maternal uterus, when the fertilized ovule descends into the uterus and there comes to rest. Moreover, in whatever place of the uterus it comes to rest, there it remains.

¹ We have taken the physiological notions especially from Antonelli, Medicina Pastoralis; we have before us the second edition (1906), which we follow in noting cited words. These can also usefully be consulted: Dr. Capellmann, Medicina Pastoralis; Eschbach, Disputationes Physiologico-Theologicae; Dr. Surbled, La Morale dans ses rapports avec la Medecine; Salsmans, Geneeskundige Plichtenleer; Dr. Vigouroux, Traite de medecine pratique; Vivat, Nederlandsche Encyclopedie; and other works of anatomical or medical science.

² It is so called from the moment at which it has human form, namely from the end of the third month, or the beginning of the fourth month, or, as others speak, after the face begins to be manifested, that is, after 6 weeks; before that it was called embryo (dier- or menschenkiem, lichaamsvrucht), when it acquires a certain development and characteristic form, so that the form of the body and members appears, after 15 days or a little more; at the beginning it is a fertilized ovule. We suppose it known how conception and generation occur. Our little work On Chastity and Lust, p. 13, can be compared.

It is covered by three membranes (eihulsels, eivliezen):

1. The first is called the decidua, from cadere, to fall, because in birth it falls from the mother (la caduque, netvlies or huntervlies).³ This is formed from the mucosa (slijmvlies) of the uterus, which is multiplied and grows around the ovule in such a way that gradually it covers it completely, and between the ovule and the wall of the uterus gives origin to a spongy body of red color which is called the uterine placenta of the mother (moederkoek) and serves for the nutrition of the fetus after the internal nourishment of the egg has been consumed.⁴

³ It is so called from Doctor Hunter.

⁴ The placenta at the time of birth has a thickness of about 3 cm., breadth 15-18 cm., and weight 500 grams.

2. The second is called the chorion, etymologically "envelope" (adervlies or vaatvlies). This is thicker, and on its whole external surface produces many villosities, which remain in one place only, namely toward the wall of the uterus above the placenta of the mother, where they are developed, divided into several branches, which partly penetrate into the placenta of the mother so that the fetus may be nourished, and partly into the blood-filled sinuses of the uterus so that they may bring blood to the fetus. Thus, by its extreme part, the chorion adheres to the wall of the uterus and keeps the whole fetus in the uterus; and since this part corresponds to the placenta of the mother, it is therefore called the placenta of the fetus, because it takes its origin from the ovule itself.

3. The third is the amnios (lamsvlies), which immediately surrounds the whole fetus and is very thin, and can be regarded as, so to speak, a continuation of the skin of the fetus. It contains a whitish liquid (liquide amniotique; lamsvocht, vrucht- or kinderwater), in which the child, immersed, wonderfully floats, and which serves to protect the fetus, and probably, according to some, also contributes to nourishment.

The fetus, however, communicates with the placenta through the umbilical cord (cordon ombilical; navelstreng), which proceeds from the navel all the way to the placenta, about 50-55 cm. long,⁵ 12-15 mm. in diameter. It consists of: a) two umbilical arteries, which are a continuation of the arteries of the hypogastrium (onderbuik) of the fetus, and carry blood from the fetus to the placenta; and b) the umbilical vein, which transfers blood from the placenta to the fetus. Hence the blood of the fetus is in no way mixed with the blood of the mother, but the circulation is altogether closed and independent of the mother's circulation.

⁵ Sometimes longer, and then it surrounds some part of the fetus, namely the neck, arm, leg, and trunk itself, while it is wound several times upon itself.

The first membrane is of maternal origin; the other two, like the cord, are of fetal origin.⁶

⁶ Concerning the preceding, see Antonelli, cited work, t. I, n. 238-239.

II. "The whole time during which the fetus remains in the uterus is called pregnancy (gestation, grossesse; zwangerschap), and ordinarily runs through a space of nine months or about 280 days, that is, ten lunar months.⁷ During pregnancy, the uterus generally preserves an oval form, because the infant is inverted, namely, it has the head lower and the rest of the body higher, the legs bent against the belly, the knees, which are somewhat disposed crosswise, against the legs, and the arms, after the manner of a cross, before the breast. This state of the fetus is ordinary and normal; sometimes, however, the fetus has the head higher and the rest of the body lower, or is situated transversely, so that it presents its side to the opening of the uterus. In these anomalies of position, birth requires the help of a surgeon. During pregnancy, the opening of the uterus is closed by a certain mucous covering."⁸ Meanwhile, around the fifth month, the breasts of the mother increase in volume and prepare the production of milk.

⁷ We are accustomed to make the computation in the vulgar manner in solar months, except under n. V, where the whole progress of fetal development is described more scientifically.

⁸ Antonelli, cited work, t. I, n. 240.

As to the signs of pregnancy,⁹ it must be said that in the first times there are not absolutely certain indications from which it can be affirmed that pregnancy is present, because the changes which occur at this time can have other causes.

⁹ Antonelli, cited work, t. I, n. 242-243. It is not useless to know these. For girls sometimes greatly fear that they are pregnant, sometimes to such a degree that they procure abortion for themselves, or prepare an end of life for themselves by suicide. Hence the confessor can render them tranquil.

Some signs are merely presumptive, such as a sense of languor, a certain general weakness, depression of spirit, pains of the head and teeth, and vomiting, especially in the morning.

Others are probable and quasi-certain, such as the suppression of the menstrual flow in a woman who previously had regular menses (regles: maandstonden);¹⁰ changes in the genitals and, in part, the size of the belly and uterus, which moreover can grow from other causes; greater secretion of the female genital canal and swelling of the breasts, which also can secrete milk. Yet this secretion of milk, although it is a very probable sign of pregnancy, nevertheless does not indicate absolutely that fertilization has occurred. For it is certain that sometimes women, after birth, preserve milk in the breasts for several months, years, and even the whole of life; sometimes women who have never conceived, and who were suffering from various diseases of the uterus, ovaries, tubes, and peritoneum, have been subject to this secretion of milk, which can be renewed as often as the aforesaid inflammations again have place.

¹⁰ Let it be noted, however, that the menses can cease also because of other causes, and that even during the time of pregnancy they can appear once or twice, because ordinarily, when a flow of blood is observed several times in pregnant women, it is not referred to the menses, but to uterine hemorrhages of an altogether diverse nature.

The certain signs are: 1. internal exploration to be made by a physician or midwife, from which the presence of a fetus in the uterus can be known; nevertheless deception can be possible because of certain diseases which can produce similar effects; 2. active motions of the fetus, which, when they are known with certainty, indicate certain pregnancy, at least from the sixth month; 3. pulsations of the heart of the fetus to be heard especially by means of the stethoscope, which is a certain instrument of auscultation, already in the fifth month.

III. Birth¹¹ (accouchement; bevalling) consists essentially in the expulsion of the fetus by contractions of the muscles of the uterus. These contractions rupture the membranes enveloping the fetus; from this it happens that the amniotic liquid begins to flow. Vehement pains accompany birth. The placenta and membranes of the fetus, after birth, are called the afterbirth, because after the birth they fall in the second place from the bosom of the mother (la delivre, l'arriere-faix; de nageboorte, het vuil).

¹¹ Antonelli, cited work, t. I, n. 241.

After birth, great fatigue holds the woman; a flow of blood follows for several days, 10-15, because of the placenta separated from the uterus; but the uterus, birth having been completed, immediately contracts. After six weeks or two months, it acquires almost its primitive volume.¹² The time which immediately follows birth is called the puerperium (couches; kraam, kraam- or kinderbed); at this time, the woman needs particular care.

¹² The ordinary dimensions of the uterus in the normal state differ from virgins to multiparas, namely from about 60 mm. to 68 mm. in length, and from 38 to 43 mm. in breadth.

When the infant has been born, the breasts become places of particular activity, by which they immediately secrete milk. This physiological labor brings about in the whole body of the woman a certain reaction, which is accompanied by a special fever, called from the milk. Namely, on the second or third day after birth, the breasts become hard, are affected by pain, and fever appears, which ordinarily ceases after 24 hours, or sometimes sooner. After this, the secretion of good milk is definitively established. The first milk is rather liquid, insufficient for nourishing, and is called colostrum (biest). Yet it is useful to the infant, for whom it serves, as a light purgation, to eject the meconium which, during the time of intrauterine life, the stomach and intestines contained. Colostrum, however, gradually undergoes some changes and becomes true milk, so that after two or three days the elaboration and secretion of milk becomes perfect.¹³

¹³ Antonelli, cited work, t. I, n. 241 and 479.

During the time of lactation, ordinarily, the menses are suspended; when lactation ceases, the milk gradually diminishes and the menses reappear. But if the menses begin to flow before the end of lactation, the secretion of milk is generally diminished.

IV. Abortion¹⁴ is the premature expulsion from the uterus of the mother of a fetus that is immature (onrijpe vrucht), namely, not viable (niet leefbare vrucht), from a natural or artificial cause (avortement, fausse couche; miskraam, misval, misgeboorte, vruchtafdrijving). Hence obstetrical abortion consists in provoking birth before the fetus is viable, and therefore when it can in no way live outside the uterus (kunstmatige vruchtafdrijving).

¹⁴ Antonelli, cited work, t. I, n. 416. Cf. below, Question 5 and II, Question 4.

On the contrary, premature or accelerated birth (accouchement premature; vroeggeboorte or vroegbevalling) is the expulsion of a fetus already viable but not fully mature. Artificial premature birth (kunstmatige vroeggeboorte) consists in provoking birth before pregnancy is complete, around the seventh or eighth month, or even sometimes in the sixth month, especially if special care is present by means of artificial incubation (couveuse d'enfant; broeikasje).

V. Phases of development. The egg which is expelled through abortion is ordinarily expelled enveloped in membranes, and has varying size according to the time of development¹⁵ (ontwikkelingsgeschiedenis).

¹⁵ Antonelli, cited work, t. II, n. 21. The numbers which are handed down for dimensions or weight have been taken from various authors compared with one another, and indicate a certain mean between various possible extreme cases.

In the first month: at the end of the second week, after 12-13 days, the embryo has a size of 2 mm. and the egg 6 mm.¹⁶ In the third week, the head is indicated in a round form; the members are indistinct, but the rudiments of extremities are visible; the heart probably already beats; no distinction appears from the embryo of animals, birds, reptiles. The embryo has a scaphoid form (forme de nacelle; bootvormig), length 4 mm. At the end of the month, the length is 7.5 mm. up to 11-13 mm., and the ovule has the size of a hazelnut.

¹⁶ We recall to memory that the ovule is 0.2 mm. and the zoosperm 0.05 mm.

In the second month, the head is very large, almost half the embryo; the extremities are perfectly articulated, and the face begins to be manifested. The length is found to be 13-16 mm. up to 2-3 cm. In the sixth week the placenta is formed.

In the third month, it is now nourished by the blood of the mother, whence it begins to be developed more rapidly. At the end of the month, the form of the body is perfect: the fingers and toes are well seen; the genitals, perhaps even the external ones, begin to be changed according to sex; the fetus is 7-9 cm. in length and 15-20 grams; the egg has the size of a common duck's egg.

In the fourth month, the sex is easily seen; the fetus is 10-13 cm. long, of 120-150 grams weight.

In the fifth month, hair appears on the head, and also nails on the members; if at this time it is brought forth alive, pulsations of the heart are perceived from its beating against the breast. Sometimes it breathes for a short time, but quickly dies. The length is 13-27 cm., the weight 250-300 grams.

In the sixth month, it has the eyelids open, the skin is covered with pigment, fat is formed under the skin. It makes some inspirations, moves the extremities, but almost immediately dies. The length is 28-34 cm.; weight 700-1000 grams.

In the seventh month, the form of the body appears more rounded, the appearance more beautiful. It acquires a stable position so that it no longer floats in the amniotic fluid. If alive, it cries with a thin voice; generally it dies; sometimes, however, with special cares applied, it is preserved. The length is 35-38 cm.; weight 1000-1500 grams.

In the eighth month, the length is 40-43 cm.; weight 1500-2000 grams. Those born at this time can live, although many die in the first hours or days after birth.

In the ninth month, the length is 46-48 cm.; weight 2500-3000 grams. There is a greater quantity of fat under the skin. Those born at this time ordinarily live, although their mortality is not very small.

In the tenth month, the length is 48-50 cm., indeed up to 53 cm.; weight 3000-3800 or even 4000 grams. The cartilages of the nose and ears are, at the beginning of the month, very soft; the nails increase; and finally the fetus exhibits the characters which are noted in perfect pregnancy. Complete maturity is present.

VI. Pregnancy can also be unnatural, namely extrauterine or ectopic (buitenbaarmoederlijke zwangerschap), by which the fetus is developed outside the uterus, for example in the tubes (eileiders), in the ovary (eierstok), or in the cavity of the abdomen, where it is applied to some intestine of the mother and thus begins to grow.¹⁷ In the first months it is very difficult to discern an extrauterine fetus from a tumor or from a uterine fetus. Generally before the fourth month it perishes from anemia or oppressed by the maternal viscera, or the pregnancy has an end before the time because of rupture of the membranes enveloping the fetus;¹⁸ sometimes the fetus pursues perfect development but cannot be born. In either case the life of the mother is constituted in great danger, though not always.¹⁹

¹⁷ Antonelli, cited work, t. I, n. 244-246.

¹⁸ From this there arises hemorrhage which can bring death to the mother through anemia.

¹⁹ Death is incurred in the proportion of 68%.

Both pregnancies, uterine and extrauterine, can exist at the same time. But the causes which induce extrauterine pregnancy are many: on one side, zoosperms can pass from the tubes into the ovary or into the abdomen, the latter of which is sufficiently understood from the fact that the tubes are not always perfectly adapted to the ovary; and on the other side, the ovule can be impeded from descending into the uterus; an ovule having descended into the uterus can enter the opposite tube; a fertilized ovule can pass from the uterus or from the tube, because of some rupture, into the cavity of the abdomen.

Let it be noted that such pregnancy supposes a uterus; if this does not exist or has been removed, no pregnancy is possible: the uterus is the necessary way for the passage of the sperm.

VII. False pregnancies²⁰ are appearances of pregnancy. Sometimes:

²⁰ Antonelli, cited work, t. I, n. 249.

1. a fertilized ovule after some time dies, and the placenta and other parts of the fetus grow in such a way that fleshy moles (vleeschklomp) are generated;

2. because of occlusion of the neck of the uterus, the menstrual blood, since it cannot flow, remains in the uterus, which is enlarged more and more, so that for some months it can feign pregnancy;

3. in the uterus certain vapors are accumulated by which the uterus is inflated, simulating pregnancy; the absence of pregnancy is very well known from the sound obtained by percussion of the belly.

Likewise imaginary pregnancies²¹ are not rarely noted in women. This occurs more often among women who vehemently desire or fear to become mothers, for example those who are close to menopause; unmarried women who are very nervous and hysterical; those who have lost their first children or, having been deprived of a first husband, think that they ought to be fertile with another man. The thought of maternity so disturbs them that they quickly come into the firmest persuasion that they must be pregnant, even though they experience the menses regularly,²² and with every effort they seek to persuade the physician concerning this supposed pregnancy; indeed, they observe the breasts to be enlarged, vomiting to appear, that they suffer nausea, and that they experience the desires of pregnant women.

²¹ Antonelli, cited work, t. I, n. 250.

²² Even by imagination the menses can be absent; then the time must be awaited, in order to remove every doubt, at which the pulsations of the heart of the fetus can be heard, that is, to the fifth month.

VIII. Anomalies which are sometimes noted in the body of man, and often generate horror, are called monsters, especially when in the fetus the species of the human body is totally or notably deformed.²³ For the human body does not always present all the regular anatomical and physiological organs which constitute a truly normal man, and often bears before itself several irregularities of greater or lesser moment, monstrosities, deviations from the normal type, which necessarily induce not slight physiological changes.

²³ Antonelli, cited work, t. I, n. 263 and 307. Anomalies can affect one or several organs, and be slight or grave. Cf. below II, Question 5.

They are distinguished into simple, and double or twinned, according as one fetus is born, or two twin fetuses adhering to one another, whether equally or unequally developed.

The causes are several: some preceding fertility, for example a morbid anatomical or physiological state of the parents, weakenings, alcoholism, heredity; likewise the physical state or conditions of the ovule or zoosperm or of both. Others are consequent, such as the action of the nervous system which, being moved by moral causes, can bring changes in the circulation of the fetus and in the contractions of the uterus; external mechanical pressures; diseases of the fetus and of the membranes; the development of several fetuses; the umbilical cord, which can surround and constrict several parts of the body; particular deviations and changes of development in the fetus.

IX. Surgical operations and incisions which more frequently occur during the time of pregnancy or birth are of several kinds:

1. some apt for extracting the fetus without injury to the fetus and the mother are all those, had by hands or instruments, which can effect birth, whether by producing uterine contractions through compression, as they say, namely by suitably rubbing the hands over the abdomen, or by extracting the fetus through instruments fitted for this, forceps, retroceps (verlostang), or through mechanical means apt for increasing the power of the instruments. These operations are not only licit but also prescribed, because they are done only for this purpose: that the work of nature may be aided in accomplishing birth;

2. others injure the organs of the mother, not of the fetus;

3. others kill the fetus itself and are gathered under the name of embryotomy, from [Greek: tome], section or cutting away;

4. others, namely the procuring of abortion and artificial birth, act upon the mother and the fetus at the same time.

Concerning the liceity of all these we must now speak.