Fig. 118.—Equipment, in rack, used at The Manhattan Maternity Hospital in bathing perineum. A, pitcher of lysol, 1%. B, basin of pledgets in lysol. C, sponge-sticks in alcohol.
When the urine is being measured, as it frequently is during the first week, the solution which is used for irrigating the vulva should be measured beforehand and the contents of the bedpan measured after the dressing, in order that the amount of urine passed, if any, may be ascertained.
Another method of bathing the perineum, that employed at Johns Hopkins Hospital, is simply to bathe the perineum with soap and warm water, without separating the labia, using a clean wash cloth and afterwards applying a sterile pad, the pads being changed every four hours, or oftener if necessary. The theory upon which this procedure is based is that the steady outward flow of the lochia constantly carries material, infective and otherwise, away from the generative tract, and that if nothing is introduced between the labia or into the vagina the patient will not be infected.
In caring for the perineum, the nurse must remember also the real danger of the patient infecting herself with her own fingers and should caution her against taking this risk. The patient should be told that if she feels uncomfortable, or thinks she is bleeding, she must lie quietly and summon a nurse, but on no account to try to find out for herself what is wrong. There is little doubt that cases of severe infection have been caused by the introduction of organisms into the vagina by means of the patient’s own fingers, after the most scrupulous precautions had been taken by doctors and nurses to avoid that very disaster.
In most instances the care of the perineum is the same whether or not there are stitches, and in any case the method employed will be specified by the doctor. The nurse’s responsibility is to appreciate the object of the care, whatever form it may take, and bring intelligence to bear in giving it.
When there are perineal stitches, it is a wise and harmless precaution to fasten a towel or bandage about the patient’s knees for a few days, to prevent her pulling apart the uniting edges of the tear as she moves about in bed.
Douches. In connection with perineal dressings, it may be well to caution the nurse against giving douches without explicit orders. Douches are seldom given early in the puerperium, for fear of carrying infective material up into the uterus, except occasionally in cases of hemorrhage, in which case they are given by the doctor.
Sometimes, however, a low vaginal douche is given daily for some time after the patient gets up, with the idea of increasing her comfort and promoting involution. About two quarts of some weak antiseptic solution at 110° F. is given with the nozzle introduced just within the vaginal outlet, and the container of the solution placed only slightly above the level of the patient’s hips, in order that the stream may be very gentle.
