The Lochia.—By this term is meant the discharges from the womb and soft parts after labor. They are mixed with blood at first and contain dark clots, mucus, shreds of the after-birth and pieces of the membrane. They become paler in color from the end of the third to the sixth day. After this the color is yellow, greenish and contains pus and fatty cells, with a little blood. This discharge varies in different women. In those who menstruate freely and do not nurse they are usually copious; when decomposed, they smell badly and the odor is penetrating. The flow may cease entirely between the second and sixth week. It is increased by exertions at about the time the patient begins to move about.
Diet.—This should consist at first of liquid, unstimulating food, given in small quantities and frequently. If the baby does not nurse, the liquids should be restricted. Some women on the first day can take milk, milk toast, or if desired, dry or buttered toast with coffee, tea, weak cocoa, according to the patient's taste. Water may be given if desired. On the second and third days, simple soups or any of the following may be added to the dietary: Meat broths, beef tea, soft boiled or poached eggs, raw or stewed oysters (no vinegar or spices) and some simple dessert, such as boiled custard or junket. During the next few days, chicken (white meat), scraped beef or mutton in small quantities, baked potato, rice and cereals may be given and by the end of the week a gradual return to the ordinary diet may be made. Should there be any tendency to constipation, the bowels should be opened by a simple enema (as before stated) or glycerin enema, etc.; or by one or more doses, 2 drams, of the compound licorice powder repeated in three or four hours, if necessary; or a half ounce of castor oil, or a half glass of hunyadi water. Cooked fruits for the constipation may also be given.
Bleeding After Delivery, Post-Partum Hemorrhage.—Bleeding from the womb occurring six hours after delivery is called post partum and after that time, is known as puerperal child-birth bleeding or hemorrhage.
Causes.—A relaxed condition of the womb, the retention of clots or parts of the membranes, etc., in the womb, a full rectum or bladder, fibroid tumors, deep tears of the cervix.
Symptoms.—If the bleeding is profuse, the pulse is fast, the woman looks pale, anxious and feels cold, restless, gaping, usually it comes from a relaxed, softened and enlarged womb.
[OBSTETRICS OR MIDWIFERY 541]
Treatment.—In severe forms no time must be lost in securing contraction of the womb and the method employed for expelling the after-birth should be employed to expel clots. Grasp the womb over the abdomen, employ firm but gentle kneading, pressing downward. The pillows should be removed, the foot of the bed elevated twelve to eighteen inches, a preparation of ergot given by the mouth or hypodermically in the thigh. If these measures fail the hand and arm should be sterilized and inserted in the womb, all clots, etc., removed and pressure made over the abdomen on the womb while the hand is still there. This pressure and presence of the hand close the bleeding vessels in the womb. The hand should remain, while the kneading goes on externally, on the womb.
This kneading should be kept up until the womb contracts. The hand can then be removed from the vagina, while gentle kneading is slowly kept up over the womb. The womb should be closely watched for hours after. Bleeding very seldom occurs again, but it might. If the bleeding is more of an oozing, an injection of very hot water, 120 degrees F., through a long douche nozzle, directly into the womb cavity may be given. This is very effective for any kind of bleeding. Lemon juice or boiled vinegar can be added to the injection. Everything used must be perfectly clean or child-bed fever may be caused by these measures. After the womb has thoroughly contracted, it is sometimes of benefit to place a rubber bag filled with cold water over the pubic bone to prevent subsequent relaxations of the womb. Weakness can be met by hypodermics of whisky or brandy and strychnine, one-thirtieth of grain, injected hypodermically to stimulate the heart.
Pulse and Temperature.—The temperature may rise one to one and one-half degrees without the case being abnormal. The pulse falls after labor, ranging between sixty and seventy. A rise of temperature, a rapid pulse, a flushed face, a chill, pain or tenderness of the abdomen, and abnormal increase or decrease of the discharge, bleeding, or offensive odor of the discharge should cause suspicion of child-bed (puerperal) fever. This is a grave condition and results from infection which has taken place during labor or afterward. The septic matter may be carried in on the fingers or instruments by the physician or attendants, etc. The most usual sources are unclean hands, instruments and clothing which come in contact with the woman's genitals. The attack is usually ushered in during the second to the fourth day by a chill, or chilly sensations, etc., rise of temperature, rapid pulse, accompanied by headache and a feeling of weariness. The discharge may be increased at first, but later diminished and may cease; or it may be abundant, frothy and of a very fetid odor. Secretion of milk may fail, the bowels are usually constipated, pain in the abdomen develops.
Treatment.—If the interior of the womb is smooth, a single antiseptic womb injection should be given; if it contains foreign material or is rough, it should be scraped and then a douche given. This must be done carefully and with absolute cleanness. Turpentine stupes should be placed hot on the abdomen for the pain, or where cold feels more grateful the ice bag or cloths wrung out of cold or ice water should be applied over the abdomen, and covered with several thicknesses of flannel and changed as soon as they become heated. Medicines to relieve the pain may be given. Hot and cold sponging may be given to reduce the temperature, a little alcohol can be added to the water or the cold or hot pack may be used.