The swelling ordinarily starts at the foot and gradually extends up to the thigh. The patient complains of pain in the calf of her leg and she may have an elevated temperature, rapid pulse and the general wretchedness associated with an infection.
The main feature of the treatment is rest in bed; the patient should be kept there for at least a week after her temperature becomes normal; her leg should be elevated, wrapped in cotton batting and the bedclothes held from it by means of a bed cradle or some sort of a light frame. The nurse should never rub the affected leg, and the patient should also be cautioned against this for fear of dislodging a particle of the thrombus and causing an embolism elsewhere, possibly in the lungs. For the same reason, the patient must be warned not to make sudden or violent movements for some time after she is allowed to be up and about, but to walk and move rather slowly. The swelling and discomfort may subside in a few weeks or they may persist for months.
Puerperal Mania. A word about extreme mental unbalance during the puerperium is worth while at this point because the nurse will frequently hear of this distressing condition, and will almost inevitably come in contact with it at some time. It was formerly believed that there were certain mental disorders which were peculiar to pregnancy and the puerperium, but this belief has given way before the present knowledge of psychiatry.
The puerperal patient is sometimes delirious and violent for longer or shorter periods of time, but apparently these conditions are due to toxemia or fever, or a mental unbalance has resulted from her reaction to the idea of motherhood, just as it would have resulted from an equal strain of some other character.
In other words, the young mother may suffer mental derangement from the same causes that would produce this state in any other person, but not from causes or conditions which are peculiar to the puerperium.
If the excitement or delirium are due to a toxemia, they are relieved by treating the cause, while from the nurse’s standpoint the care would be the same as for any delirious patient. The patient should not be left alone and she should be protected against doing herself any injury.
A mental disturbance which is due to the patient’s inability to adjust herself to the state of motherhood, and all that that implies to her, is a different matter, and is discussed in the chapter on mental hygiene.
“Sympathy with, interest in the poor so as to help them, can only be got by long and close intercourse in their own houses—not patronizing—not ‘talking down’ to them—not ‘prying about’—sympathy which will grow in insight and love with every visit.”—Florence Nightingale.
PART VI
THE MATERNITY PATIENT IN THE COMMUNITY
CHAPTER XIX. ORGANIZED PRENATAL WORK. Mortality in Childbearing. Aims of Prenatal Care. Difficulties: Educational, Economic, Social, Professional. Prenatal Work in Other Countries. Progress of Prenatal Work in this Country. The Women’s Municipal League of Boston. Maternity Centre Association of New York. Routine and Methods. Results. The Situation in the Country as a Whole. Prenatal Care in Rural Communities. Forms and Routines used by Maternity Centre Association, New York City.