There is a knack about stripping and it requires practice, but those doctors who advocate it feel that it empties the breast, when this is necessary, with less disturbance than that caused by pumping, and as the milk is projected directly from the nipple into the sterile glass, without any of it running over the nipple or breast as may happen in pumping, it has the additional advantage of always being sterile.
Extreme gentleness must be used; the openings of the milk ducts must not be touched by the fingers, and the thumb and finger must not press deeply enough to reach the glandular tissue itself. If done properly stripping neither stimulates nor bruises the breast tissue nor does it cause the patient even temporary discomfort.
Abdominal Binders and Bed Exercises. There is considerable difference of opinion about the advantage of using abdominal binders upon the puerperal patient while she is in bed, and the nurse will accordingly care for the patients of some doctors who use them and for those of others who do not.
The application of a moderately snug binder for the first day or two is a fairly common practice, for multiparæ, particularly, are often made very uncomfortable by the sudden release of tension on their flabby abdominal walls; a discomfort which a binder will relieve. And during the first few days after the patient gets up and walks about, she is sometimes given great comfort by a binder that is put on as she lies on her back, and is adjusted snugly about her hips and the lower part of her abdomen.
But the continued use of a binder after the first day or two, while the patient is still in bed, is not as general as it formerly was. Many women ask for binders in the belief that they help to “get the figure back” to its original outline, and some doctors feel that the use of the binder is helpful in restoring the tone to the abdominal muscles, which amounts to about the same thing. Both the straight swathe and the Scultetus binder are used for this purpose and they are put on in the usual manner; snugly and with even pressure, but not tight enough to bind.
Those doctors who disapprove of the binder believe that it interferes with involution and, by making pressure, tends to push the uterus back and cause a retro-position, in addition to retarding instead of promoting a return of normal tone to the abdominal muscles.
Accordingly, they instruct their patients to take exercises, instead of wearing binders, and they have these exercises started while the patient is still in bed. Their adoption, and the rate at which they are increased, are entirely dependent upon the individual patient’s condition, for they must never be continued to the point of fatigue. There are, therefore, no definite rules laid down, concerning these exercises, beyond a description of the positions and movements themselves, and their sequence.
Those which are taught to the patients at the Long Island College Hospital are so simple, and evidently productive of such happy results that they offer excellent examples of this form of treatment. They are, of course, taken only by the doctor’s order, but the nurse’s intelligent supervision increases their effectiveness.
Fig. 129.
Figs. [129] to [135], inclusive, are bed exercises taken during the puerperium.
For description see text. (From photographs taken at The Long
Island College Hospital.)