CHAPTER XI. POINTS OF SPECIAL INTEREST DURING Puerperium.
Sleep. The nurse should insist on the family keeping out of the lying-in chamber. It is so strange, women who have been mothers themselves, who one would expect should know the importance and necessity of quiet sleep, and rest after labor, should be so thoughtless, they call and almost insist on seeing the patient. No one should be allowed in the room immediately after labor except the father of the child. Keep the mother quiet. The patient, after she is dressed and toilet over should be encouraged to go to sleep. The exertion of labor is usually followed by a feeling of comfort and repose. The patient is often inclined to talk. This should not be allowed, but the patient encouraged to go to sleep.
Chill After Labor. — The birth of the child is often followed by a nervous chill or rigor, which is usually of short duration and seldom lasts over ten minutes, it is of little importance and is caused by the shock of the sudden expulsion of the uterine contents and the great muscular effort the patient has been through. It is usually relieved by applying hot water bottles and joining warmly covered after which the patient usually, when encouraged, falls into a refreshing, restful sleep. It is never accompanied by a rise of temperature.
The Pulse. — The pulse exhibits a remarkable diminution in frequency, lower than her ordinary normal pulse. In perfect normal cases it ranges from 50 to 70 beats per minute. Usually more marked on this third day. It is not influenced by the establishment of lactation.
The Temperature. — The temperature is about the same as in health, although a rise of a half of a degree to a degree and a half is not unusual on the third day, caused by the disturbance attended upon the establishment of lactation.
The Abdomen. — The abdomen is tender under pressure, but this should diminish daily and after a few days disappear. It is caused by severe labor, or a great deal of manipulation during labor. Ice bags applied to the abdomen will prevent and correct this condition.
The Uterus. — The uterine contractions should be firm and persistent. At the close of labor the fundus is midway between the umbilicus and pubes, and by the ninth day it should be behind the pubes. Watch the bowels and bladder and see that they do not become full and cause misplacement.
The Appetite. — The appetite is diminished and thirst increased.
The Skin. — The skin is active and the patient sweats freely and is consequently susceptible to changes. The nurse must be careful of draughts.
The Bladder and Bowels. — The bowels are usually sluggish and the urine abundant. The first two or three days following confinement the retention of urine is common. Many women who are unable to urinate when reclining can do so when raised to a sitting position.
The Lochia. — The discharge from the birth canal after delivery is termed lochia. At first the normal flow is composed of pure blood with clots and shreds of membrane, but after the first day it contains a large percent of serum. About the fourth day the discharge is quite pale and it continues to lose its red color, and about the eight day it is a greyish-cream color, and of the creamy consistency. Microscopically after the third day the lochia contains red and white blood corpuscles, shreds of cast-oil membrane which contain hundreds of germs. The germs are harmless, not perulent. unless the patient is septic. It gradually diminishes in quantity from the close of labor. The duration is from three to six weeks. It varies in different women, usually according to the menstrual flow. Those who menstruate freely generally have a profuse discharge after birth, those women whose menstrual flow is scant, the lochia discharge will not be so abundant. After the patient is allowed to sit up fresh red blood often makes its appearance. It should never have a fetid odor. Watch the discharge for any unnatural odor and save a pad each morning for the doctor's inspection. Note the character and amount of the lochia, clots and membrane expelled, also the position of the uterus on the record sheet, note also, anything abnormal and save same for the doctor's inspection. Be very careful of all vaginal discharges. It is never to be gotten into abrasions of the skin or the eyes. If gotten into the eyes it will often produce blindness, and if gotten into abrasions of the skin it may carry with it septic germs. The nurse must be very careful of her hands. Be careful to cleanse them thoroughly after each manipulation around the genitals before touching or handling the breast as it is possible to earn infection to them in this manner. Nurses may carry infection on their fingers from the lochia of a perfectly normal puerperal and infect the mother's breast and the infant's eyes if care is not exercised to keep the hands clean. When the discharge is infectious and there is a suspicion of gonorrhea or syphilis rubber gloves should always be worn as a personal safety.
The Breast. — The breasts are distended and on the third day of the lying-in period the milk appears. The breasts then become full, hard and tense, and are very painful. The auxiliary glands enlarge and radiating pains are felt in the arms and breast. It often causes considerable disturbance and is sometimes ushered in with a chill and rise of temperature. Treatment has already been described.
Lacerations. — Lacerations of the perineum are very common, but they differ much in extent from a mere skin tear to one requiring sutures, internal as well as external. The treatment the same as other surgical cases, observing strict surgical cleanliness in regard to the dressing, keeping the wound clean by washing and irrigating with antiseptic washes, keeping the parts dry and covered with proper antiseptic powders, such as boric acid or arristol and sterilized gauze or dressings each side of the sutures, and being careful that all instruments used on the patient and the hands of the nurse are surgically clean. With care and treatment of this kind the wound usually heals nicely.
Chills. — A chill with a high temperature is evidence of serious illness, very often sepsis. A chill with no temperature has no important significance.
The Record of the Nurse. — The nurse should keep a daily record or history of the cases of both mother and child until the case is discharged. Keep it neatly and accurately filled up to the date and hour, always ready for the doctor's inspection. If the case is a perfectly normal one, he may not pay much attention to the record, just glance over it; but if any complications present themselves he will feel very grateful to find an accurate history of the case.
<Callout type="important" title="Importance of Quiet Rest">The patient should be kept quiet and encouraged to sleep after labor. This rest is crucial for recovery.</Callout>
<Callout type="warning" title="Prevent Infections">Be very careful with hand hygiene, especially when handling the lochia or breasts, as infections can spread easily.</Callout>
<Callout type="tip" title="Lochia Monitoring">Keep a record of the lochia's character and amount daily to monitor for any abnormalities that could indicate infection or other complications.</Callout>
Key Takeaways
- Encourage the mother to rest and sleep after labor.
- Monitor lochia for any unusual changes or odors.
- Keep the perineal area clean and dry to prevent infections.
- Record daily observations of both mother and child.
Practical Tips
- Ensure the new mother has a quiet, comfortable environment to rest in post-labor.
- Regularly check for signs of infection such as fever or foul-smelling lochia.
- Help the mother with breast care to prevent mastitis and ensure proper milk flow.
Warnings & Risks
- Be cautious of any unusual symptoms like high fever, which could indicate a serious condition.
- Avoid touching the lochia or breasts without clean hands to prevent infection.
- Keep an eye on the patient's temperature; a sudden rise can be a sign of sepsis.
Modern Application
While many of these techniques have evolved with modern medical practices, understanding postpartum care is crucial for survival in remote or resource-limited settings. Knowledge of basic hygiene and monitoring can prevent complications that could otherwise lead to severe illness or death.
Frequently Asked Questions
Q: What should I do if the new mother experiences a chill after labor?
A chill with no temperature is usually not significant, but if accompanied by a high temperature, it may indicate sepsis. Keep her warm and monitor for other symptoms.
Q: How can I prevent infections during postpartum care?
Maintain strict hygiene, especially when handling the lochia or breasts. Use antiseptic powders and gloves if necessary to avoid spreading germs.
Q: What should I look for in the lochia discharge after delivery?
The lochia should start as bright red blood with clots and gradually change to a pale, creamy color over several weeks. Any foul odor or unusual changes should be reported immediately.