The return to normal life must be very gradual and this also must be regulated by the patient’s general condition and her recuperative powers. A pinkish or red discharge or backache should be taken as warnings against standing or walking or working. The possible consequences of ignoring these warnings and being up and about too soon, may be displacement, even prolapse of the uterus; hemorrhage, from dislodgment of clots in the uterine vessels; metritis or endometritis.
It is not a good plan, as a rule, for the patient to go up and down stairs until the baby is about four weeks old, nor wholly to resume her normal activities within six or eight weeks after delivery.
In addition to this sustained, general care, it is a customary preventive measure for the doctor to make a thorough pelvic examination from four to six weeks after delivery. A slight abnormality, if detected at this time may usually be corrected with little difficulty, but if allowed to persist may result in chronic invalidism or necessitate an operation. If the uterus is not properly involuted, for example, or the perineum is found to be flabby, more rest in bed is indicated; while a uterine displacement, which seems to be present in about a third of all cases, usually may be corrected by the adjustment of a pessary.
The time of sitting up, of getting up and of walking about varies so with the individual, therefore, that it is not possible to describe a definite routine, for some patients recover slowly and would be injured by getting up and about at a period which would be entirely safe and normal for the majority. It must be determined in each case by the condition of the uterus, the appearance and amount of the lochia and the patient’s general condition.
Quite evidently, then, much ill health and many gynecological operations may be prevented by caution, prudence and good care during the first few days and weeks after the baby’s birth, while the patient returns to a normal mode of living.
The Daily Bath. During the first week or two the patient’s skin must aid in excreting fluids from the edematous tissues throughout the body and broken down products from the involuting uterus. Therefore she should have a bath of warm water and soap every day, to remove material already on the surface and stimulate the skin to further activity, and an alcohol rub at night, if possible. It is important for the nurse to remember, while bathing her patient, that she is perspiring freely and therefore may be easily chilled if not well protected.
It is often a good plan to have the patient, without stitches, begin to bathe herself in bed, after the third or fourth day, for the sake of the exercise, and also the encouragement that it offers. When all is going well, tub-bathing is usually resumed by the third or fourth week.
Diet. Opinions as to diet vary slightly with different doctors and in different hospitals, but in general, a patient in good condition is given liquid food during the first twelve to twenty-four hours after delivery; then a soft diet for a day or two, a nourishing, light diet being resumed by the third or fourth day, or after the bowels have moved freely.
The patient will usually have little appetite, at first, and will have to be tempted by small amounts of invitingly served food. The factors which the nurse must bear in mind when arranging the patient’s dietary are the general nutrition of the mother; the desirability of minimizing her loss of weight during the puerperium; increasing her strength and, particularly, of promoting the function of her breasts, in order to produce milk of a quality and quantity adequate to nourish the baby.
The best producer of such milk is a diet consisting largely of milk, eggs, leafy vegetables and fresh fruits, taken with an appetite that is made keen by constant fresh air. The nurse will do well to convince her patient of this, in addition to bearing it in mind herself, and to place little reliance on so-called milk producing foods.