Urination.—One of the commonest difficulties after labor concerns micturition.
Owing to the swollen and bruised condition of the urethra and the nerves supplying the neck of the bladder, the usual stimuli do not act and the woman, conscious of a painful distention, is unable to pass water. The helplessness is increased by her position in bed.
The nurse must make every effort to have the bladder emptied naturally. The process is aided by letting the water run from the faucet into the toilet basin, by using hot applications to bladder or vulva, by allowing warm, sterile water to run down over the vulva and perineum, by an enema, by putting smelling salts to the nose, by using slight pressure over the bladder, or by having the patient sit up on the bedpan.
If these measures fail and moral suasion is fruitless, the bladder must be catheterized at the end of twelve hours. The two dangers of catheterization are injury to mucous membrane, and infection. Many cases of cystitis have resulted from an unclean catheter or the improper use of a sterile instrument.
To catheterize a patient, she is first given aseptic care during which particular attention is paid to the meatus. This should be cleansed with an applicator dipped in a solution of boric acid. Next, the nurse prepares her hands by scrubbing ten minutes in hot running water with sterile nail brush and green soap. The catheter either of soft rubber or glass, is boiled for fifteen minutes and passed, not by touch, but by sight, and the flow is received in a clean basin and the amount recorded. As soon as the urine ceases to flow freely, the tip of the index finger is placed tightly over the end of the catheter and the instrument is gently withdrawn. The finger is placed over the end of the catheter not only to avoid the dripping of urine as it is removed, but especially to prevent the disagreeable sensations produced by the inrush of air.
Usually one catheterization is sufficient, and every time the bladder fills, the nurse must take the time and trouble to make the patient urinate spontaneously, if possible, for some women form a catheter habit, from which it is difficult to break them. After natural urination and after catheterization, the aseptic care should be repeated.
The Genitals.—The vulvar pads should be changed as often as they are soiled. Four a day is an average number, and six or eight in the first three days is not unusual. Every time the pad is changed, the nurse should give aseptic care, and extra attention whenever the bowels and bladder are emptied.
The dried secretions should be washed off with sterile sponges, wiping always toward the rectum and throwing away the sponge. Smegma collects in the folds of the labia and about the clitoris. This should be carefully sponged away. If it becomes dry and hard, oil or albolene will soften it and facilitate its removal. Plenty of soap and warm water should be used, then with a pitcher or douche point, the whole area is irrigated with a solution of lysol 1 per cent. Especial care is given to the stitches if any are present. No traction must be made on the ends of the sutures, and if unusual soreness is complained of, the doctor should inspect them at his next visit.
The nurse should be careful not to get lochia on her hands as the discharge contains germs which she may carry to herself, to the baby, or to the patient’s breasts or eyes.
Painful swelling of the vulva, or edema of the rectal protrusion may be relieved by hot boric dressings or by ice bags to the anus.