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Care of the Mother After Labor.One point may be profitably borne in mind : that she will obtain more benefit and less discomfort by taking food in small quantities at short intervals, than by indulging in larger quantities at longer intervals. After five or six days she will usually have, if everything go on well, both the desire and ability to take ordinary food ; at this time her only care need be to avoid stimulating and highly-spiced food. For two or three days after delivery there is usually a torpor of the bowels, and oftentimes of the bladder as well. The time-honored custom of giving a dose of castor o'il on the third day is still largely observed, and it will be doubtless insisted upon during the natural life of the present generation of nurses. With reference to this matter, it may only be said that if a movement of the bowels have occurred just prior to delivery, as should be the case, there is no necessity for an evacuation on the third or fourth day. Furthermore, castor oil as ordinarily given usually provokes straining at stool, and sometimes causes hemorrhoids or piles ; hence if it be necessary to administer a laxative at all, one of the saline purgatives - preferably Husband's magnesia - maybe better given instead. In many cases it is quite unnecessary, and therefore undesirable, to administer any medicine, since the bowels move spontaneously ; and a simple enema of warm water, with or without the usual addition of soap or salt, will secure the desired result without straining. The bladder, too, often requires attention ; sometimes there will be no voluntary evacuation of the urine for one or two days after delivery-a state of inactivity which may be attended with serious local or general effects. The condition of the bladder is one of the first points to which a physician directs his attention in his first visits after delivery; in the absence of a medical attendant the friends should observe whether the bladder is evacuated, and if this function be not performed, cloths wrung out in hot water may be applied over the lower part of the abdomen. This simple measure will usually suffice to stimulate the bladder to contraction ; if it do not, the catheter must be employed. These measures should be insti tuted early, so that the urine may be evacuated within twelve hours after the completion of labor, and at equal intervals thereafter. After-pains usually ensue upon delivery, and at times constitute a most annoying and even painful feature of the case. These afterpains are the natural accompaniments of those contractions of the womb which continue after the expulsion of its original contents, and which seem to be caused by the presence of blood clots in the womb and by the natural reduction of size which now begins. These may be often modified, or perhaps avoided, by the exercise of proper care to prevent the accumulation of blood clots in the womb. If the directions already given for securing prompt and efficient contractions of this organ be observed ; if the hand be kept upon the abdomen over the womb for an hour or more from the time of the expulsion of the child ; and if the delivery of the placenta be followed by gentle kneading of the womb ; if the bandage be daily loosened, and any blood which may have collected in the womb be expelled by stimulating the organ to contraction through the abdominal wall; if these measures have been duly observed, the after-pains will usually be but slight. These pains are provoked and aggravated by any irritation of the vagina or of the rectum ; hence due care should be observed to remove such causes of irritation so far as possible by avoiding unnecessary manipulation of these parts. The application of the child to the breast is usually followed during the first three or four days by somewhat painful uterine contractions - another indication of the immediate sympathy which prevails between the womb and the breasts. A certain amount of after-pain is then natural and cannot be avoided ; and up to a certain extent no interference is required beyond the application of hot cloths to the abdomen ; if, however, these pains be so severe and persistent as to interfere with sleep, they should not be neglected. Measures should be taken to expel the possible contents of the womb, and to quiet the irritation by the administration of an opiate ; the gentle injection of a quart of warm water into the vagina may also be employed. It may also be a consolation to a young mother to know that she will probably escape after-pains at her first confinement, since these occur with especial force and frequency in women who have previously borne children. The Lockia. - For a variable time after delivery, ordinarily eight to twelve days, there is a discharge from the vagina termed the lochia. This discharge results from the changes which are going on inside of the womb as a preparation for the return of this organ to its previous condition ; it is ordinarily composed, during the first day or two, of almost pure blood, but becomes in the succeeding days lighter in color and less in quantity. The amount and character of this discharge should be carefully noticed, since it furnishes valuable information as to the above-mentioned changes, and therefore as to the probable outcome of the case ; for in certain complications, such as puerperal or childbed fever, the lochial discharge is either suppressed or assumes an extremely offensive character. On the other hand, the persistence of a bright red color after the ninth or tenth day indicates that the womb is not undergoing the usual and proper reduction in size. In ordinary cases the lochia requires no interference other than simply cleanliness, which must be, however, strictly observed. The external part may be washed without unnecessary violence with warm carbolized water ; and if there be any unusual odor, the vagina also should be gently syringed out two or three times a day with a two-percent, solution of carbolic acid. To promote the escape of the discharge from the vagina, it may be advisable to change the woman's position, having her lie upon one side and the other ; and so soon as practicable, she may, for the same purpose, elevate her shoulders upon pillows. For the first few days after delivery the woman should, in a great majority of cases, maintain strictly the recumbent posture; on the third or fourth she may be permitted, if all goes well, to sit up in bed for a short time and to assume any other desired position. But it must be remembered that this is not equivalent to getting out of bed and performing any of her domestic duties; while special cases demand special regulations, it may be stated, as a generally applicable rule, that the woman should not assume the erect posture nor even leave her bed for two weeks after delivery. This may seem an unnecessarily long period for those who have been accustomed to the nine-day rule of nurses ; but it should be remembered that the object of repose after delivery is to promote that process whereby the enlarged uterus undergoes a reduction in size- resumes nearly the size, shape and position which characterized it before conception had occurred. This process, whereby the pregnant womb returns after delivery to the unimpregnated state, is termed the involution of the*uterus. This involution is a gradual process which requires from six weeks to two months for its completion ; if, for any reason, the process be arrested, the womb remains, of course, larger than it should be, and, as a result of this increased size and weight, it drags upon and stretches its supports - a condition known as " falling of the womb." It is of the utmost importance that every opportunity should be allowed the womb to undergo this natural reduction in size ; that no impediment of any sort should be opposed to this involution, since such impediment must necessarily endanger a subsequent falling of the womb. Now, it is a fact easily understood, that in the recumbent posture the decrease in the size of the womb occurs more rapidly and more surely than if the woman be allowed to perform the usual domestic duties, or even to stand and walk. Hence the advice that a woman remain in bed two weeks after delivery, that is, until the process of involution of the womb has been well initiated, and that for at least two further weeks she assume none of the responsibilities of housekeeping. Many times a more prolonged confinement to bed will be necessary; if, for example, as has been already stated, the lochial discharge retain its bright red color beyond the usual time, it is evident that the involution of the womb is not proceeding with the usual rapidity, and that it will not be wise for the woman to rise even at the expiration of two weeks. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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