CHAPTER XIV. THE PUERPERIUM. Physiology. Involution. After-pains. Lochia. Loss of Weight. Menstruation. Lactation. Abdominal Wall. Digestive Tract. Temperature. Pulse. Skin. Urine.
CHAPTER XV. ROUTINE NURSING CARE DURING THE PUERPERIUM. Complications to be Guarded against. General Treatment of the Patient. Nursing Care. Position in Bed. Sitting up. The Daily Bath. Diet. The Bowels. The Bladder. Catheterization. Temperature, Pulse, and Respiration. Care of the Perineum. Care of the Breasts. Lactation. Stripping. Abdominal Binders and Bed Exercises.
CHAPTER XVI. THE NURSING MOTHER. Normal Routine. The Establishment of Breast Feeding. The Mother’s Frame of Mind and State of Nutrition. Method of Nursing. The Nursing Schedule. Personal Hygiene of the Nursing Mother. Diet. Bowels. Rest and Exercise. Recreation. Weaning. Drying up the Breasts.
CHAPTER XVII. NUTRITION OF THE MOTHER AND HER BABY. Importance of Adequate Nutrition in First Weeks of Life. Necessary Elements of an Adequate Dietary. “Vitamines.” Danger of Deficiency Diseases. Danger of Conditions Approaching Recognizable Disease. The Deficiency Diseases. Scurvy. Infantile Scurvy. Corrective Diet. Beriberi. Xerophthalmia. Pellagra. Rickets. Corrective Diet. Application of Principles of Nutrition to the Diet of the Nursing Mother.
CHAPTER XVIII. COMPLICATIONS OF THE PUERPERIUM. Postpartum Hemorrhage. Causes, Treatment and Nursing Care. Puerperal Infection. History of Disease. Prevention. Symptoms, Treatment and Nursing Care. Phlegmasia alba dolens, or “Milk leg.” Puerperal Mania.
CHAPTER XIV
THE PHYSIOLOGY OF THE PUERPERIUM
The puerperium[[8]] is ordinarily regarded as comprising the five or six weeks immediately following delivery. During this period the mother’s body undergoes various changes which restore it very nearly to its pre-pregnant state, leaving the patient in a normal, healthy condition. The most important of these changes are involution of the uterus, loss of weight and improvement in tone of the abdominal and perineal muscles. The alterations which produce this restoration are normal physiological processes, but mismanagement or lack of care while they are taking place may result in serious complications; these may be immediate or remote, such as hemorrhage and infection or chronic invalidism.
Recognition of these dangers, and the possibility of preventing them, is responsible for the present custom of obstetricians to watch over their patients during the puerperium. This is in sharp contrast to the old practice of the doctor’s visiting the puerperal woman only when there was a complication so apparent that he was summoned.
The precautions and the care which the doctor takes of his patient after delivery involve intelligent and watchful nursing. In order to give this the nurse must understand something of the normal physiology of the puerperium, just as she did in pregnancy and labor. Otherwise she may not be able to distinguish evidences of normal changes from symptoms of complications.
Involution. Considerable attention is centred in the remarkable atrophic changes that take place in the uterus during the puerperium, for it is upon their being normal that the patient’s recovery and future well-being so largely depend. Immediately after delivery the uterus weighs about two pounds; is from seven to eight inches high; about five inches across and four inches thick. The top of the fundus may be felt above the umbilicus, and the inner surface, where the placenta was attached, is raw and bleeding. At the end of six or eight weeks the uterus has descended into the pelvic cavity and resumed approximately its original position and size, and its former weight of two ounces; a new lining has developed from the few glands which have not been cast off in the discharges.