- Head raising, body straight and stiffened.
- Arm raising, well extended.
- Leg stretching, with knees stretched and toe extended.
- Massage, administered by the nurse.
A splendid tonic circulatory bath may be administered at the close of the second week (in normal puerperium), known as the "cold mitten friction," which is administered as follows: The patient is wrapped in a warm blanket, hot water bottle at feet, and each part of the body—first one arm then the other; the chest, the legs, one at a time—is briskly rubbed with a coarse mit dipped in ice water. As one part is dried it is warmly covered, while the next part is taken, and so on until the entire body has been treated. The body is now all aglow, the blood tingling through the veins, and the patient refreshed by this wide-a-wake bath. Properly given, the cold-mitten friction bath is one of the most enjoyable treatments known and under ordinary conditions, if intelligently administered, may be given as early as the eighth day.
AFTER PAINS
After the birth of the first baby the uterus usually is in a state of constant contraction, hence there are no "after pains;" but after the birth of the second or third child, the uterine muscle has lost some of the tone of earlier days—there is a tendency toward relaxation—so that when the uterine muscle does make renewed efforts at contraction, these "after pains" are produced. They usually disappear by the third day. Nothing should be done for them, indeed they should be welcomed, for their presence means good involution (contraction) of the uterus.
THE TEMPERATURE
Careful notations of the temperature should be made during the first week. A temperature chart should be accurately kept and if the temperature should rise above 100° the physician should be notified at once. The third day temperature is watched with expectancy, for if an accidental infection occurred at the time of labor, it is usually announced by a chill and sudden rise of temperature on the third day. This may be as good a place as any to mention the commonly met night sweating. This is due to a marked accentuation of the function of the skin. It is not at all unusual for a sleeping mother in the early puerperium to wake up in a sweat with night gown very nearly drenched. The gown should be changed underneath the bedding, while alcohol is rubbed over the moistened skin surface.
These sweats will disappear as soon as the mother begins to regain her strength. A vinegar rub administered on going to bed may often prevent these sweats.
THE TOILET OF THE VULVA
Immediately after the birth of the baby and the expulsion of the afterbirth, the thighs and vulva are cleansed as follows: Into a basin of warm, boiled water are dropped four small antiseptic tablets of bichlorid of mercury; this gives a proper antiseptic wash. Into this solution are placed four pieces of sterile cotton Two of these are used, one at a time, without being returned to the solution to wash each inside of the thigh, the remaining two to cleanse the vulva. Without drying the vulva, two sterile pads are applied and pinned to the binder. These pads are changed every hour during the first day or two because of the profuse lochial flow.
After each urination and bowel movement, a lysol solution (prepared by putting one teaspoonful of lysol in a quart of sterile water) is poured from a clean pitcher over the vulva into the bed pan, and fresh pads applied. This toilet continues until the close of the second week or longer, if there is a lochial flow.