What Women Should Know/Chapter 13
Need of Rest.—Rest is what the patient needs above everything else. There is no reason in trying to tempt her appetite, and insisting upon her eating when she is not hungry, on the plea that she needs to get back her strength. That is precisely what she will do with rest and quiet, and when the need for food comes the appetite will come with it.
Advantages of Abundant and Undisturbed Sleep.—Let the patient eat as often as she will, but never awaken her out of a quiet, natural sleep under the impression that she needs food. A parturient woman often passes a weary, wakeful night, and it is not until toward morning that she sinks into a calm, restful slumber, from which it is a mercy—more than that, an absolute necessity if she is to regain her strength—not to awaken her. Let her sleep, then, even if she sleeps on until noon, and be glad of it. If the babe must be attended to, take it carefully away and leave the mother undisturbed.
Do not Force Food upon the Sick Woman.—I have known an otherwise excellent attendant, influenced by the belief that a nursing woman must eat as early in the morning as possible, insist upon waking up her charge at the usual breakfast-hour. Nature was crying for rest, not for food. So a few mouthfuls would be reluctantly taken, and the woman would try to go to sleep again. But outraged nature was not thus to be trifled with. Little or no sleep would come that day, there was so much to prevent it: people going in and out of the room; the usual household noises outside. By night a state of nervous wakefulness would be reached, often accompanied by slight touches of fever; and it would be far into the night before even a troubled sleep would close the eyelids.
The next day the same experience would be repeated. All protests from the sick woman were met with the invariable remark: "I was always taught that sick people should eat the first thing in the morning if they wanted to get well."
It was no wonder that this woman's convalescences were always very much delayed, and her strength a long time in coming back.
If sick people want to eat the first thing in the morning, by no means keep them waiting for their food. Their wants should always be first attended to, for in the lives of a good many women it is the only period when they or their needs are considered of the first importance either by themselves or any one else; and even now they are paying a heavy penalty for the privilege of extra consideration. But if they desire to sleep, bear in mind that sleep is doing for them all that food can do, and more than food will do if unwillingly taken.
Diet of a Lying-in Woman.—No matter how good a woman's appetite may be, her diet should be light and simple during the first three or four days of her confinement, until the flow of milk is fully established; for if anything of a stimulating character is eaten, it may help in bringing on a fever at the crisis, which is on the third day.
Diet for Three Days after Confinement.—In cases of extreme debility the diet had better consist of dry toasted bread and stewed and raw fruits, with weak tea, cold water or thin cold gruel for a drink. No milk or meat should be allowed. This diet may not be absolutely required by every one, though those who unnecessarily confine themselves to it will err on the safe side. Crackers, and everything likely to be binding in their effect upon the bowels, should be avoided.
How to Keep the Bowels Open without Medicine.—The bowels must be kept open at all hazards, but fruit should be made to do the work instead of drugs. Drugs should be avoided, if possible. The patient should neither be persuaded nor compelled to take castor oil for the purpose of opening the bowels, unless she is willing to run the risk of piles and kindred diseases. I am convinced that the piles, from which so many young mothers suffer, originate in the custom of taking castor oil during confinement for the purpose of opening the bowels.
Necessity for a Bed-Pan.—A bed-pan is an essential of a lying-in chamber. Either the slipper or the round form may be used. The patient need not of necessity have her bowels moved during the first twenty-four hours; but it is absolutely necessary that her bladder should be emptied in less time than that. If she finds difficulty in passing her water while lying down, I believe it is better to raise her up in bed upon the pan, her feet, well covered, hanging over the side of the bed, than run the risks which a distended bladder impose upon her. Even when she seems to have passed her water, if the quantity is small, and she still feels pain and soreness in the region of the bladder, she had better be raised in like manner, when it will very probably be found that only a small portion of the actual amount of urine had previously escaped. When the patient is very weak, a catheter will be found necessary when this difficulty occurs.
Evacuation of the Bowels on the Second Day.—By a judicious use of fruit the bowels can be made to open naturally on the second day. If there is a desire for evacuation which cannot be accomplished lying down, the patient should be raised in the manner already described. I think the results from this raising will be less disastrous than to allow inaction of the bowels, and be compelled to resort to drugs in consequence.
Lochial Discharges.—After the placenta and clots have passed away, there is still a discharge from the uterus at first brightly tinged with blood. Later it gradually assumes a lighter tint, until finally the dried cloths will present a light greenish hue. So long as the color of the lochial discharge is right, no apprehension need be felt concerning what may seem too great plentifulness. It should be profuse, and there is more danger of too little than too much.
How to Decide what is Over-exertion.—A woman can easily decide by the color of these discharges when she has overexerted herself. When this is the case, the cloths will be marked with fresh blood. When she first begins to get about, these discharges will naturally darken somewhat. But if there should be a liberal discharge bearing the tint of fresh blood, accompanied by pain and soreness within, the woman should at once keep herself quieter, and postpone further exertion for a day or two.
Duration of the Lochial Discharges.—The lochial discharges may cease at the end of fifteen days, or they may be continued for a month or even longer.
Untimely Checking of the Lochie.—If the lochial discharges are checked from any cause before the period of their proper cessation, it will be well to place a warm flax-seed poultice sprinkled with powdered camphor over the lower part of the abdomen. The poultice should be renewed as soon as it loses its heat.
Soreness in the Lower Part of the Abdomen.—The attendant should be careful to make frequent inquiries if there is any pain or soreness across the lower portion of the abdomen. If there is, it must not be neglected, as it may develop into inflammation of the peritoneum, or covering of the bowels. Let flannel saturated with burning fluid be immediately applied and suffered to remain until it produces a sensation of burning. Let this be repeated at intervals until all pain and soreness to the touch are gone. If burning fluid cannot readily be obtained, turpentine will do nearly or quite as well. I have recently read that some physician had found turpentine invaluable in cases of peritonitis.
Cleanliness.—Cleanliness is an essential to the recovery of the sick woman. The frequent use of a warm sponge over both body and limbs, administered in such a manner that she shall suffer no exposure to chill, will be beneficial.
Flow of Milk.—About the third day the flow of milk sets in, and now is the greatest danger from fever. The patient should not be left alone a moment at this period without having the means at hand of summoning assistance at once.
Milk Fever, and how to Check it.—The milk fever will be preceded by a chill or chilly sensations. There should be extra bed-clothes in the room ready for immediate use. There should also be, either in the room or where it can be obtained without a moment's delay, a flat-iron warm, but not hot enough to burn. The moment the patient feels the first symptoms of a chill the flat-iron should be wrapped in flannel and placed to her feet. At the same time more covering must be thrown over her. This will check the chill at once, and probably prevent the fever. All through her confinement a woman is liable to these chills, and they should always be treated in the same manner, or they may put back her convalescence seriously, if they do not result in her death. If, in spite of all precautions, fever should follow, let the patient be given a half teaspoonful of sweet spirits of nitre or a spoonful of spirits of mindererus in a little water every hour until the fever subsides. If the dose does not seem to allay the fever, increase the quantity and diminish the time of giving. Allow no visitors until the fever is subdued.
Superabundance of Milk.—There is often more milk than the babe can dispose of. It is very necessary that it should be drawn, as its accumulation is troublesome, not to say dangerous. The milk can be drawn by the mouth, or by the use of a breast-pump. If a breast-pump is not at hand, porter bottles can be filled with hot water, and after the bottles are thoroughly heated, the water is poured out and the mouths of the bottles applied immediately over the nipples. The air within the bottles is rarified and expanded by the heat, and as this condenses and contracts, the milk is drawn out.
Weed in the Breast.—Sometimes, in spite of all precautions, slight cold is taken in the breasts, and they harden and cake, and are extremely painful. This is far more liable to occur when the breasts are allowed to get too full. Cloths dipped in hot lard or oil and laid over the breasts will soften them and give relief. To avoid weed in the breasts, they should be kept well protected with an extra covering of flannel even in the warmest weather.
Gathered Breast.—There are two forms of gathered breast. One is a gathering in the gland of the breast, and is most serious in its nature. The other is a gathering in the outside tissues of the breast, and does not in any way affect the milk glands. This latter is of comparatively trifling importance. In the case of the first form of gathered breast the child must not on any account nurse from that side, though it may nurse from the healthy breast. In the latter form the child may safely nurse from both breasts.
Causes of Gathered Breast.—A gathered breast is more likely to occur after a first confinement and in the first month. It is frequently caused by carelessness in not keeping the breasts sufficiently protected from the air. Or it may result from the mother sitting up in bed to nurse her babe. This is an exceedingly bad practice, and ought never to be allowed. Sometimes, if the nipple is sore, the mother will keep her babe too much at the other bosom. The breast gets distended with milk, becomes inflamed, and finally gathers. Again, if the mother allows her babe to draw at a breast when there is no milk, the result may be equally bad. The habit of wearing stays will also produce this and other affections of the breast.
Symptoms of a Gathered Breast.—Gathering in the breast always begins with a shivering fit, followed by darting pains in the bosom. The breast is full, hot and painful. The milk lessens or entirely disappears; and if the infant attempts to nurse, it gives the mother exceeding pain. Fever and sickness follow. A doctor should be sent for without delay on the first symptoms of chill, as he may be able to prevent the gathering.
Sore Nipple.—A nursing woman is frequently troubled with sore nipples. A soft cloth, wet with glycerine, applied over the nipple whenever the infant is not at the breast, will very likely afford relief, or, mix finely powdered gum arabic with a small quantity. of powdered alum, and apply it to the nipple with a camel's hair brush. This application need not be wiped off when the infant nurses. If the nipple is very sore, a rubber nipple must be worn over it in nursing.
Diet after the Third Day.—After the third or fourth day, if there have been no unfavorable symptoms, the patient may begin to add to her bill of fare. Chocolate is better than tea or coffee for a drink. It has no injurious effect upon the nerves, is more nutritious, and promotes a flow of milk. It should be made fresh every time that it is needed, as there is nothing so disagreeable to a delicate stomach as chocolate that has been warmed over and displays particles of grease floating on the surface. It is best to make the chocolate with water, and after it has boiled sufficiently pour in the desired quantity of milk, allowing it to warm, but not to boil.
Broths and soups made of chicken, and of the lean of beef and mutton, either with or without rice or vegetables, will be not only palatable, but highly nutritious and strengthening and easily digested. Most kinds of vegetables may now be indulged in freely, and ripe fruit without stint. Brown bread is better than white, if the woman finds it sufficiently nourishing, as it is an excellent regulator of the bowels.
Regulating the Flow of Milk.—It is frequently the practice for attendants to urge an unusual quantity of food and drink—especially the latter—upon the sick woman, for the purpose of promoting a flow of milk. The consequence too often is that there is more milk than the babe can dispose of, and the breasts become distended and painful, and are liable to gather. The flow of milk should be regulated by the diet, as far as possible. The diet should at the first consist of fluids in a very limited degree, so that the incoming of the milk may be gradual and within the control of the babe. As the babe's needs increase, and as, with the advance of time, the dangers from too great a flow of milk decrease, the amount of fluid food may be gradually augmented until the required amount of milk is obtained. Chocolate, milk, not too strong black tea, gruel and broths, are the best drinks for a nursing woman. I suppose it is useless to make any protest against the use of coffee and green tea. Nevertheless, I cannot but think them injurious.
Quiet in the Sick-Room.—Keep the sick-room quiet. Allow no visitors at first, and none from first to last except such as have sufficient judgment not to stay too long, nor to excite or weary the patient by too much talking.
Appearance of the Sick-Room.—Do not allow the slightest evidence of sickness to be visible in the room. Keep all medicine bottles out of sight. Be careful to arrange the furniture exactly the same as usual. Allow no soiled or unused clothing to lie about, and cumber chairs, tables or lounges. If it is necessary to make up an extra bed on floor or lounge. for the accommodation of the nurse, remove every trace of it when morning comes. Let no unused food or dirty dishes remain in the room: let all the paraphernalia of each meal be removed as soon as the meal is concluded.
There is nothing so depressing to a sick woman's mind as to be constantly reminded of her invalid state. If, from the general appearance of the room, she can cheat herself into the belief that everything is as ordinary, that she is only lying down temporarily and can get up when she pleases, the cheerfulness which such a fancy will engender will go far toward helping her recovery.
Making the Sick Woman's Bed.—Keep the bed neatly and carefully made. There is much discomfort in a bed that has been laid in two or three days, the sheets crumpled and out of place, the quilts dragged to one side, and the pillows flattened and hard. If the woman is not able to sit up to have her bed made, let her be moved to one side of the bed while the other is being shaken up and arranged, the clean sheets folded lengthwise and put on, and the covers smoothed and straightened. When she is moved back to her place again, the other side can be arranged in like manner, the soiled sheets removed and the clean ones unfolded and drawn out.
Change of Clothing.—Change the woman's clothing frequently. There is such a sense of comfort, especially to an invalid, in clean, fresh undergarments. I have already recommended the use of short nightdresses. I think any one who has ever used them will never again adopt long ones for a sick-bed.
Light and Air.—Be sparing of light at first, but allow plenty of fresh air. Even in the winter the room should be aired at least once a day, proper precautions being taken that the sick woman is not exposed to cold or draught.
Fumigation.—A medical student in passing his examination was once asked what was the use of fumigation in the sick room. He replied that it produced such a disagreeable smell that people were obliged to open the windows, and so proper ventilation was secured. If fumigators are considered in that light, they are excellent things to use. But if it is supposed they do away with the need of ventilation, it is a great mistake. They may disguise a bad smell, but the impure air which causes it still remains, and can only be got rid of by proper ventilation. Burning rags, etc., in a sick-chamber, are therefore worse than useless.
Use of the Eyes During Convalescence.—Do not allow the patient to use her eyes. Positively forbid books and papers, for the first week at least, and even longer if it seems necessary. I know how tedious it is for an active woman to lie day after day deprived of reading or work; still, it is best and must be submitted to. After a time it may not hurt her to read for a short interval. But on the first feeling of weariness of the eyes or of the nerves, the book ought to be promptly laid aside. The same rule should be applied to work of any sort—work, of course, suited to a sick-room, such as light sewing or knitting.
How Long ought a Woman to Remain in Bed after Delivery?—The question is often asked, "How long ought a woman to remain in bed after delivery?" The usual answer is, "Until the tenth day." Still, I have seen women up and doing their ordinary work at the end of a week. The only proper answer can be: "It depends upon the woman." If she is healthy and strong naturally, and her delivery has been an easy one, to keep her in bed for ten days is both foolish and cruel. She ought to be able to sit up in four or five days, and by the tenth to be well advanced in her convalescence. If, on the contrary, her health is ordinarily poor, and her delivery has been severe, she may not be able to leave her bed under two weeks, nor even then without running serious risks.
The Woman the Best Judge of her own Strength.—The woman knows best herself what she can do. If she does not feel that she is able to sit up, no one ought to persuade her to try. If she does feel able, she ought to be permitted to make the experiment, on giving the promise that she will desist if she feels discomfort or too great fatigue. A woman is perhaps inclined to be too ambitious in this particular. But she should remember that, if she gets up a day too soon, she may have to remain a week longer in bed.
Injurious Effects of too Long Confinement in Bed.—On the other hand, a day longer in bed than is necessary is a positive injury, and a delay to ultimate recovery.
First Sitting Up.—The first attempt at sitting up should be very brief indeed. If that is followed by no serious results, the period can be lengthened on the following day, and so on, until finally the woman will return to her bed during the day for short periods of rest only, and will find herself far more comfortable in her easy-chair. The first feeling of weariness should be a signal for an immediate return to bed.
Going to Work too Soon.—Even after the woman is able to move with comparative ease about her chamber, and has assumed her ordinary dress, she should be in no haste about going back to her usual routine of work. The general impression—at least the general rule of action—is that as soon as a woman can creep down stairs and move slowly and hesitatingly about the house, she is ready to assume her daily burdens—that "she will get well the quicker for going to work." Every one lays down the share of burdens he or she has been bearing, and there is nothing left for her to do but to pick them up, long enough before she is physically fit. This is especially the case among working-people.
Dangers of Going to Work too Soon.—I believe more wives die from too early a return to work than in the hour of delivery. Even if this danger is escaped, there is discomfort, which is greater than spectators have any idea of (women learn so soon the lesson of suffering patiently and uncomplainingly); and most serious consequences are sure to follow in the future—a future so remote that few people ever think of connecting cause and effect.
Prevalence of Prolapsus Uteri.—If any one will take the trouble to inquire, he or she will be perfectly astounded at the amount of suffering from displacement or falling of the womb among women in the middle and humble walks of life-women of all ages, but especially among those of ages varying from forty upward. I do not think I am putting the case. too strongly when I say the difficulty is almost universal. These cases seldom come to the knowledge of a physician; it would be of little avail if they did, for they are past medical aid, and can only be helped—not cured—by mechanical means. The pattern for bandage or brace will be passed from neighbor to neighbor, without any one outside the freemasonry of sex and suffering having a suspicion of its frequent need.
Frequent Cause of Prolapsus Uteri.—The most usual, though of course not the only, cause of prolapsus uteri, or falling of the womb, is the haste with which young mothers resume household duties after their confinements. A woman may go about her work, and suffer comparatively trifling inconvenience, but the muscles fail to recover their proper tension; and when the period of child-bearing is past, if not sooner, then they give way altogether, and the woman is destined to suffer to the end of her life.
Change of Diet after Confinement.—There must be a change in the woman's diet after she has recovered from her confinement. During pregnancy her food should be fruit and vegetables, that her baby may be born with a frame soft and yielding—with gristle instead of bone. But now the child requires something to strengthen and harden its bones, which it can only obtain through its mother's milk. Vegetables and fruit should still be considered important articles of food; but in addition there should be meat—beef and mutton—bread, and other articles in which lime and other phosphates form an important element. Bread made from unbolted flour is the best if it proves sufficiently nutritious. If this change is not made, the baby will be weak and puny, perhaps rickety; the woman's own strength will fail her, and she may be the victim of morbid cravings.
Craving for Chalk.—I once knew a nursing woman who was seized with an inordinate desire for chalk, a substance which she never before could bear to put in her mouth. She began by eating little bits surreptitiously, until she had used up all there was in the house. The desire still grew upon her, and she was wise enough to believe that such a craving could not come without some reason, though the exact one she did not then understand. Her husband, when he came to know of it, objected and remonstrated; still, in compliance with her earnest entreaties, he bought her large quantities of chalk, which she ate in pieces as large as a hickory-nut, eating a number of such pieces during the day. This strange fancy continued for two or three weeks, and then suddenly ceased, and her repugnance to chalk became as great as ever.
A few years afterwards she learned the reason of this strange caprice. During her pregnancy, her fancies had led her ignorantly to adopt a correct diet, from which bread, meat and every kind of food containing bone-making material were excluded. Confined in early summer, just as fruit and vegetables were coming in season, she still made them, after her convalescence, her principal articles of food. But nature was not to be cheated thus; and her system being deprived of lime in its proper disguise of food in which phosphates largely enter, made a call for it direct. Hence the unconquerable desire for chalk. When this need was supplied, then the desire ceased. She never wanted chalk afterward. The very thought of it set her teeth on edge.