Obstetrics for Nurses

by Charles B. Reed

The vaginal douche is rarely employed at present except under specific indications.

If the involution is slow, it is safer to use ergot by mouth, rather than the hot vaginal douche, as sometimes recommended. The douche is a frequent source of infection, as well as a useless procedure. Nevertheless, a dainty woman gets much comfort mentally, as well as physically, if she is kept clean and free from odors; hence if the lochial discharge becomes offensive on the fifth day or sixth day, as sometimes happens, a single hot vaginal douche may be permitted. A 1:5000 solution of potassium permanganate, or a teaspoonful of formaldehyde to a quart of water, or a chinosol solution 1:1000 may be used.

Rest.—Since the patient will be in bed from eight days to two weeks in normal cases, she must be made as happy and comfortable as possible, and nothing contributes so much to her satisfaction as a cheerful, competent nurse. Her mind is at ease about herself and her child, and the companionship of the nurse can be made one of the pleasantest recollections of her illness.

Any patient who is at all reasonable can be managed by a tactful nurse without the consciousness of being opposed or directed. Gossip, hospital stories, criticism of other cases, other nurses, or of doctors should be avoided. The patient is deeply interested in her own case, and the private troubles of the nurse do not concern her nor enlist her attention for more than a few polite but unpleasant moments.

The nerves of the patient are highly sensitized, and therefore she should sleep as much as possible at night, and take an additional nap in the afternoon. Only the members of the family should be allowed to see the patient the first week, and they but for a short time. It takes the strength of the patient unnecessarily to see guests even though they be close friends. Importunate visitors may be pacified frequently by a view of the baby. The patient must be spared all household responsibilities, and if necessary, the nurse must take charge. Tact must be used to avoid being dictatorial, either to family or servants. If anything unusual arises, the nurse must show no surprise, annoyance, or bewilderment. Everything is attended to quietly, firmly, and without friction.

Getting Up.—It is a tradition that the woman is lazy who does not get out of bed by the ninth day.

There are three factors to be considered, the progressive involution of the uterus, the strength of the patient, and the presence of stitches. Involution may be complete on the fifth day, but the prostration from the labor may make the woman indifferent to arising. She may be strong enough to rise on the third day, but the uterus is large and heavy, and the erect position will put an unnecessary strain on the supports which may retard involution and cause displacement or disease later. Also, it is not desirable for a woman to sit up until her perineum is well on the road to restoration.

In general, the woman should not get up until the uterus has gone down into the pelvis and is nonpalpable. If this is the case on the fifth day and she feels strong, she may get up. If she is not strong, time will be saved by staying in bed until her vigor returns, whether it is ten days or twenty.

Getting up may be followed by a return of the bloody discharge. This may come from subinvolution, from a relaxed and flabby uterus, from a cervical tear, or from change in posture.

If there has been a retroversion before pregnancy, lying prone with an occasional knee chest position for a few moments will aid. Massage and passive exercises while in bed will aid the patient to recover and to maintain her strength. Even after she is up and about, she should lie down frequently during the day and always when nursing the babe, until she feels quite normal again.