Fig. 137.—Walking on all fours. (From a photograph taken at the Long Island College Hospital.)
Walking on all fours is violent exercise and has to be taken up very gradually. Some patients are able to attempt it on the first day out of bed, if they have been taking the other exercises, but as a rule it is not started until the second or third day. The patient’s clothes should be free from all constrictions; the knees should be held stiff and straight with the feet widely separated, to allow a rush of air into the vagina, and the entire palmar surface of the hands should rest flat on the floor. (Fig. [137].) The patient should start by taking only a few steps each morning and evening, gradually lengthening the walk to five minutes twice daily and continuing it for about two months.
It is believed that as the patient walks in this position the uterus and rectum rub against each other producing something the same result as would be obtained by massage. The effect of the exercise is to promote involution and diminish the tendency toward constipation and retroversion, apparently preventing malposition entirely in a large percentage of cases. Though not widely used, its beneficial effects are unquestioned by those doctors who employ it.
In taking a general survey of the young mother and her needs, we realize that in a broad sense she is not ill, in so far as no pathological condition exists. But she is in a transitional state and may become acutely or chronically ill if not carefully watched and nursed. In general her mental, physical and nervous forces must be conserved and increased, and this requires thoughtful and devoted attention from the nurse. She must be scrupulously clean in her care of the nipples and perineum, and in order to be able promptly to inform the doctor of any departure from the normal in the patient’s condition, the nurse’s watchfulness should embrace regular observations upon the following:
1. The patient’s general condition; the amount and character of her sleep; her appetite; her nervous and mental condition. 2. The temperature, pulse and respiration. 3. The height and consistency of the fundus. 4. The quantity, color and odor of the lochia. 5. The persistence and severity of the after-pains. 6. The condition of the perineum. 7. The condition of the nipples and breasts. 8. The functions of the bladder and bowels.
If all goes well and there are no complications, the patient will usually be able to assume full charge of her baby by the sixth or eighth week, and practically return to her customary mode of living, with the difference that she now has the care of a baby which she did not have before. The care of that baby requires certain, definite care of herself, as a nursing mother, which will be described in detail in the next chapter.
To sum up the general principles of nursing the young mother during the puerperium, we find that just as during pregnancy and labor, the nurse must first be familiar with the normal changes that occur in order that she may recognize the abnormal. Then, as before, the nurse’s care of the individual patient must rest unfailingly upon a foundation of cleanliness in order to prevent infection; watchfulness, which implies ability to recognize normal changes and unfavorable symptoms; adjustment to the methods of the attending physician and to all of the circumstances surrounding the patient, and the wisest and tenderest consideration for her patient as an individual.
CHAPTER XVI
THE NURSING MOTHER
Not infrequently the nurse remains with her patient after the end of the puerperium, and therefore she may have the care of the mother and baby for several weeks, or even months. The most valuable single service which she can perform in this capacity is to help in making it possible for the mother to nurse her baby at the breast. For both the nurse and the mother must realize that the breast-fed baby is much more likely to live through the difficult first year, and is markedly less susceptible to disease and infection than is the bottle-fed baby.