Skin. There is usually profuse perspiration during the first few days, while the elimination of fluids is most active, but it gradually subsides and becomes normal by the end of a week. The perspiration sometimes has a strong odor and there is not infrequently an appreciable amount of desquamation.
Urine. Many patients find it difficult, even impossible, to void urine during the first several hours after delivery because of the removal of intra-abdominal pressure; the recumbent position and the swelling and bruised state of the tissues about the urethra. The bladder is likely to be less sensitive than usual and the patient will be able to retain an abnormally large amount of urine for several hours without discomfort, or desire to void.
The output of urine during the first few days is greater than normal, and there is also a considerable increase in the amount of nitrogen excreted, beginning two or three days after delivery. This is evidently derived from the broken down proteins in the uterine wall, and the excess gradually subsides as involution progresses, and disappears by the time the uterus descends into the pelvis.
When one considers the severe ordeal that the young mother has just passed through, her recovery and return to a normal state are surprisingly rapid, when she is given good care.
CHAPTER XV
NURSING CARE DURING THE NORMAL PUERPERIUM
In general, the nursing care during the puerperium is much the same as that which is given to a surgical patient, with special attention to the breasts and perineum and a sustained effort to prevent complications and restore the mother to a normal state of health in due time.
As the nurse doubtless realizes by this time, the principal complications to guard against during the puerperium are hemorrhage from the still raw area, where the placenta was attached to the inner surface of the uterus; infection of the birth canal; breast abscesses; displacement of the uterus and subinvolution, or failure of the uterus to return to its normal size and condition in the usual length of time.
In addition to guarding against these definite complications, the nurse must help to save her patient from the less tangible, but perhaps equally injurious effects of fatigue of mind and body. As many young mothers are in a more or less unstable, excitable condition after the baby’s birth, the beneficial effect of promoting a tranquil and contented state of mind can scarcely be overestimated.
The doctor may be ever so tactful and cheering and sustaining, but his contacts with the patient are short and infrequent as compared with the nurse’s constant companionship. She can, therefore, by her attitude, manner and conduct practically create or destroy the atmosphere that is necessary to her patient’s welfare.
In order to give the best and most helpful service the nurse must try from the very beginning to understand her patient as an individual and adapt herself to the patient’s temperament. Some women are rested and soothed by being talked with, read to, diverted and amused in one way or another, during most of the time, and will grow nervous and depressed if left to their own devices. Others, who have greater resources within themselves are happier and better off when left to themselves a good deal, and given an opportunity to think things over. Some women are much subdued as the consciousness of their motherhood grows upon them, and they feel a kind of awe and wonder about this baby that they begin to realize is their own. It is a big experience, this one of motherhood, full of promise and responsibilities, and the young mother herself very often wants to think it out. She will enjoy talking when she wants to talk, but may be irritated and exhausted by a nurse who tries to entertain her all of the time.