In the past, before modern medical technology existed, doctors relied on a variety of signs and symptoms to determine if a woman was pregnant. Some methods were more reliable than others, but most involved looking for physical changes in a woman’s body that often accompany pregnancy. Doctors also asked women questions about their menstrual cycles and other symptoms to aid in making a diagnosis. Determining pregnancy was not always straightforward, but doctors in earlier eras did their best with the knowledge and tools available at the time.
Missed Menstrual Period
One of the first and most obvious signs of potential pregnancy that doctors looked for was a missed menstrual period. For women with regular cycles, an absence of menstruation was a strong indicator that she may be pregnant. Doctors would ask women the date of their last period and watch for its return. A missed or very late period often meant the woman had conceived.
Of course, women can occasionally have anovulatory cycles where no egg is released, meaning their period is delayed for reasons unrelated to pregnancy. Illnesses, stress, malnutrition, and other factors can also lead to irregular menses. So while a missed period was a significant clue, it was not absolute proof on its own. But doctors could combine this information with other symptoms.
Morning Sickness
Along with a missed period, morning sickness was another key symptom doctors used to assess for pregnancy. Morning sickness typically begins around week 4-6 of pregnancy and consists of nausea or vomiting that occurs mainly in the morning upon waking but can happen any time of day. It is thought to be related to the rise in hormones like human chorionic gonadotropin (hCG). Around 50-80% of pregnant women experience morning sickness.
Doctors would ask patients about feelings of nausea and vomiting, particularly if they seemed worse in the morning. The timing and description of symptoms would help determine if morning sickness was the likely cause. While viruses and other illnesses can also lead to vomiting, the link to the woman’s menstrual cycle gave doctors reason to suspect pregnancy.
Breast Changes
Doctors also looked for changes in the breasts as an early sign of pregnancy. From around 1-2 weeks after conception, hormonal shifts can lead to breast changes like:
- Swollen, tender breasts
- Tingling or sore nipples
- Veins appearing more prominent on breasts
- Nipples darkening and becoming larger
These happen as the breasts prepare for eventual breastfeeding. A woman may also notice a shiny appearance to the skin over her breasts. Doctors would examine the breasts for signs of enlargement, tenderness, or nipple changes. They would also ask about any breast-related symptoms the woman herself spotted. These signs gave clues that she may have conceived.
Quickening
Quickening refers to when a pregnant woman first feels fetal movements inside her uterus. This typically occurs anywhere from week 14-26 but often around week 16-20. The first sensations are often described as fluttering or tapping sensations. Doctors would ask patients later in pregnancy if they had felt any movement inside their womb, which was a strong sign of pregnancy. However, quickening did not allow pregnancy to be detected early on. But it did provide confirmation later in the course of pregnancy.
Uterine Changes
During gynecological exams, doctors could check for physical changes to the uterus that signal pregnancy. The main change being that the cervix becomes softer and the uterus begins enlarging. The enlarging uterus can sometimes be felt as a mass on abdominal exam, rising out of the pelvic cavity. With experience palpating pregnant uteruses, doctors could discern the enlarged, softened pregnant uterus from its typical non-pregnant state.
Hegar’s Sign
Related to uterine changes, doctors would check for Hegar’s sign as well. This refers to softening and increased compressibility of the lower uterine segment during early pregnancy. Around week 6, the cervix and lower uterine segment start softening to prepare for delivery. Doctors could gently pinch the cervix between two fingers and feel this softening and thinning. Presence of Hegar’s sign was a probable sign of early pregnancy.
Goodell’s Sign
Another gynecological sign doctors assessed was Goodell’s sign. This indicates a softening of the cervix that makes it much more delicate and prone to bleeding when touched. During exams, they noticed this increased friability and bleeding with light palpation of the cervix. Goodell’s sign starts around week 6, so along with Hegar’s sign, allowed pregnancy detection fairly early on.
Chadwick’s Sign
Later in pregnancy, doctors looked for Chadwick’s sign during gynecological exams. This refers to a dark bluish-purple color change of the mucous membranes of the vagina and cervix. It happens due to increased blood flow to the area. The darkening typically starts around week 6-8 and peaks around week 16. Doctors visually inspected for this sign during their exams.
Ballottement
Ballottement is a technique doctors used later in pregnancy to feel the fetus inside the uterus. It involves gently pushing the cervix and feeling a weight bounce back against the fingers when the fetus floats away, then taps back. This bouncing sensation confirmed the presence of a fetus of sufficient size and maturity tosink and bob freely in the amniotic fluid. Ballottement was typically felt after 16-20 weeks.
Urine Testing
Primitive urine tests existed to detect pregnancy dating back thousands of years. In the early 20th century, doctors could test urine for sugars like lactose that are elevated in pregnant women. This allowed pregnancy detection as early as 1-2 weeks after conception. From the 1920s onward, testing urine for the hormone human chorionic gonadotropin (hCG) became the norm. hCG rises rapidly after implantation, so allowed reliable pregnancy detection from as soon as 1 week after a missed period.
Abdominal Palpation
As pregnancy progressed, doctors were able to palpate the enlarging uterus during abdominal exam. The pregnant uterus can be felt at the level of the pelvic brim by week 12-14. By 20 weeks, it reaches half way between the pelvis and umbilicus. Feeling the height, shape, and hardness of the uterus allowed doctors to confirm and assess gestational age. They could also palpate fetal parts in later pregnancy.
Auscultation
Using a fetal stethoscope placed on the mother’s abdomen, doctors could listen for fetal heart tones to confirm pregnancy. The fetal heart starts beating around week 5-6 but is hard to hear until week 18-20. Doctors would listen for a fast, galloping rhythm around 120-160 beats per minute. Hearing this helped determine if pregnancy was viable and gestational age.
Clinical Pelvimetry
Pelvimetry involves measuring the mother’s pelvic diameters to assess if the pelvis is large enough to allow vaginal delivery of a baby. Doctors insert calipers in the vagina and measure between bony landmarks. Certain pelvic shapes are more concerning for cephalopelvic disproportion. Clinical pelvimetry allowed doctors to estimate fetal size, viability, and risk of obstructed labor late in pregnancy.
X-Ray Pelvimetry
Later on, x-ray pelvimetry allowed more visualization of the maternal pelvic anatomy. Imaging improved detection of bone deformities and atypical pelvic shapes. This helped doctors better determine if labor might be obstructed or if cesarean delivery may become necessary. Some concerns could be spotted earlier with x-ray pelvimetry.
Ultrasound
Ultrasound technology brought about a major advancement in being able to confirm and date pregnancy. Ultrasound uses soundwaves to create images of internal structures. It can detect a pregnancy sac as early as 4-5 weeks. The fetal heartbeat can be detected by about week 6-9. Ultrasound allows measurement of the fetus to estimate gestational age and due date throughout pregnancy. 3D ultrasound later improved imaging even further.
symphysis-fundal (SF) height measurement
The symphysis-fundal (SF) measurement is done by placing one end of the obstetrician’s tape measure at the top of the mother’s pubic bone and stretching the tape along the belly toward the top of the uterus. Between 20 and 38 weeks of pregnancy, the SF height (measured in centimeters) should roughly match the number of weeks of pregnancy. This measurement helps confirm the size and growth of the uterus and fetus.
Summary of Historical Methods
| Time Period | Methods Used to Detect Pregnancy |
|---|---|
| Ancient era | Missed menses Morning sickness Breast changes Quickening |
| Early 20th century | Pelvic exam for uterine/cervical changes Urine sugar tests Abdominal palpation |
| Mid 20th century | Urine for hCG Clinical pelvimetry Fetal heart auscultation |
| Late 20th century | Ultrasound technology X-ray pelvimetry symphyseal-fundal height |
Conclusion
Doctors in earlier eras did not have access to the laboratory tests and imaging technology we rely on today to diagnose pregnancy. However, through knowledge of female anatomy and physiology along with skills in abdominal palpation, gynecological exam, and patient history taking, pregnancy could often be determined fairly accurately. While rudimentary, these methods picked up on the myriad of changes that occur in a woman’s body to support gestation and fetal development. It required keen observation and deductive clinical reasoning. Modern ultrasound and hCG testing provides early and definitive confirmation, but the early signs and symptoms still hold true today and can indicate likely pregnancy when technology is unavailable. Though challenging, determining pregnancy in earlier eras was possible thanks to insightful medical pioneers.