Obstetrics for Nurses

by Charles B. Reed

Gas pains can be relieved by hot spiced drinks, asafœtida and the high rectal tube.

Subinvolution is treated by the administration of fluid extract of ergot, in twenty to twenty-five drop doses, three or four times daily. This will bring about the discharge of the irritating fragment or clot, and the nurse can aid the process by gently massaging the uterus several times daily or by giving a hot vaginal douche. Codeine may be used for after-pains if absolutely necessary.

Diet in Normal Cases.—There is no restriction on the kind of food the patient may take, so long as she can digest it cleanly and without gas. Acids or alkalies, cold or hot, rich or otherwise, fruits, meats or vegetables, all go to the formation of good milk if properly digested. The old idea that acids should not be eaten is fallacious. There is more acid in the stomach normally, than could be added in a meal made up entirely of citrus fruits. At the same time, the heavy foods should be avoided on account of the serious demand on the liver and kidneys in the absence of exercise.

On the other hand, if the breasts are engorged, the fluids must be reduced to a minimum, and a relatively dry diet enforced.

The patient loses about one-ninth of her previous body weight in the course of labor and the puerperium.

The breasts are made ready for lactation twelve hours after delivery by cleansing with sterile green soap and warm water and bathing in 50 per cent alcohol. Next, the nipple is attended to, and the infant is put to the breast.

The nipple is prepared by cleansing it with an applicator soaked in fresh boric acid solution, and after nursing, the same process is repeated. This is routine, whether the mother is in bed or walking about. In the latter case, the mother must be taught to care for her own breasts.

The child is put to the breast every three hours and given six feedings a day. This leaves a six hour interval at night, which is very necessary for the mother’s rest and for the child. If the babe is feeble, seven or eight feedings in the twenty-four hours may be required for the first two weeks.

At first the breast only secretes a thick, yellowish secretion called colostrum, of which the child gets from a drachm to an ounce. It is a mild laxative.

The irritation of the nipple by the child’s mouth is begun as early as possible in order to stimulate the breasts to secrete milk and the uterus to contract, and thus aid involution and the preservation of the maternal figure.