In normal maternity cases, a visit is made once a day for eight days. After that time, if the mother is up and about and the baby is in good condition, the nurse visits at least once a week for supervision until the fifth week, when the case is transferred automatically to the Child Welfare Nurses under the City. If, however, there is any complication with either the mother or baby, the nurse continues daily visits or twice daily as indicated by the condition, until both mother and baby are normal. Instruction to the mother in the care of the baby is one of the important phases of the maternity nurse’s program.
The points observed and recorded on the bedside cards are: condition of breasts, urination, condition of bowels, character of lochia, position of uterus, T.P.R. or any abnormality. If there is any rise in temperature or other abnormality noted, the physician is called by telephone and the situation reported.
Any one can call the nurse—children, husband, neighbor, doctor, social worker,—and a nurse is sent out on every call. A doctor must be in charge of every case, and if one has not been engaged when the nurse gets there, she sees to it that one is procured. The only exception is in cases delivered by midwives, in which instances the nurse gives any necessary care and supervision, having it clearly understood that if any abnormality occurs, she will first notify the midwife and then the midwife or the nurse will immediately call a doctor.
The doctor ordinarily brings his own equipment for delivery. The contents of the nurse’s bag is the same for delivery as for post-partum care, except for the addition of the nurse’s gown, extra towels and silver nitrate. Perineal pads, cotton, boric solution, etc., are supplied at cost, or free of charge if the patient is unable to pay. Bed linen, nightgowns, layettes, etc., are provided for patients who cannot procure them.
The cost per visit to maternity patients averages one dollar and the cost for services at the time of confinement averages five dollars. Miss Tucker says of the maternity work:
“A complete maternity service which includes prenatal work, service at time of confinement, post-partum care and subsequent supervision of mother and baby is essential if adequate results are to be accomplished. Anything less than this complete service does not give full protection to the life of the mother and the baby. The Philadelphia Visiting Nurse Society has found that the inclusion of service at time of confinement has given a tremendous stimulation to both their prenatal and postnatal service. In the branches where a delivery service has been added, the prenatal service has increased fourfold. Both doctors and patients are enthusiastic and see far more reason for instruction and supervision from a nurse who is going to see the case through than from one who drops out at the crucial moment. It certainly has strengthened our whole maternity service, both as to results accomplished and in our relationship to the doctor and to the community.”
FORMS AND ROUTINES FOR MATERNITY WORK, VISITING NURSE SOCIETY PHILADELPHIA
EQUIPMENT FOR BAGS
Bottles containing: 1. Alcohol. 2. Licreolisis. 3. Green soap. 4. Mouth wash. Jar with boric acid crystals. Jar with cord powder. Jar containing vaseline. 1. Hypodermic syringe. 2. Tongue depressors. 3. Two thermometers: rectal and mouth. 4. Toothpicks. 5. Adhesive plaster. 6. Fountain syringe or funnel and tube in linen bag. 7. Gauze and bandages in linen bag, cord dressing and cord tape. 8. Cotton and p.p. pads in linen bag. 9. Paper napkins on which to lay articles. 10. Granite pan. 11. Two towels. 12. One apron. 13. Hand-brush. Instrument case containing: Scissors, forceps, 2 artery clamps, glass catheter, rubber catheter, colon tube, connecting tube, glass nozzle, medicine dropper. Folder containing: Records. Fee slips. Literature.