A dose of Arnica should usually be given, and perfect quiet maintained in order that she may procure a little sleep. After an hour or two, when she may have thus rested, the nurse may safely proceed to place her in bed, by gently moving her up to her place, rolling the soiled clothes up into a lump and removing them. Thus the patient will be at the same time rendered neat and comfortable; her clean clothes being brought down from her waist as the others are removed, and her lower limbs made dry and warm. The nurse will, of course, understand her duty of keeping the patient clean and comfortable, by constant attention to the lochia, and in other respects.
The natural phenomena of the lying-in state may now be briefly stated. The relief experienced immediately after parturition is, in a great majority of cases, truly remarkable, according to her own expression, the patient feels “as though she were in heaven. Afterwards, it is no uncommon occurrence, however, for the patient to be seized with a shivering, or chattering of the teeth. With the addition of a little covering this soon passes off; she begins to feel a glow of heat, her skin becomes moist, and there is no more trouble. After a little sleep, which, as already suggested, she should seek to obtain as soon as possible, she seems to recover from the shock of delivery, and once more appears in a natural, healthy condition.
In this place I cannot too strongly deprecate the habit in which some accoucheurs indulge, of entering into a little pleasant chat with the patient before he quits the room. This often excites hemorrhage, either internal or external, and in other respects exerts a pernicious influence. How little does the newly-confined woman feel like indulging in conversation? The effort which in her exhausted condition she must necessarily make, is exceedingly injurious; since her system absolutely needs rest after her severe and protracted exertions.
Let her room be kept darkly shaded and as quiet as possible, till the milk becomes well established; then, other things being equal, her room may be gradually lighted up, and she may begin to see a little more of the world, her own family first, and afterwards her friends and neighbors. In the first few days after parturition the lying-in woman generally has more perspiration than usual; and this is one of the means by which her system returns to its normal state. The urine remains usually in the normal condition; still at our first visit after labor, we should not fail to inquire if the patient has passed water. If no inclination to urinate has been felt, a dose of Arsenicum should be administered at once, or Causticum, or Hyoscyamus, according to the particular indications. The bladder being in a paralyzed state, and needing help in order to relieve itself. Unless spontaneously moved, the patient’s bowels should not be in any way disturbed for eight or nine days; the rectum being so much bruised by the passage of the child’s head, as to need rest in order to recover its tone. The custom, frequently much more general than now in Allopathic practice, of giving a purgative in the first day or two after confinement, very greatly predisposes to puerperal peritonitis; and in many instances it has been observed directly to produce this dangerous condition.
The uterus, by alternations of contraction and repose, gradually returns, after parturition, from its enormous distention to its natural size. Its complete restoration, in size and position, generally occupies about six weeks. Sometimes, on the contrary, it suddenly grows larger, from some abnormal condition, and may be felt rolling from side to side, as the patient turns in bed. This condition need excite no alarm, since the uterus will soon subside to its normal size, except in some few instances, in which it still remains large, with a sensation of bounding as if it contained a foetus; in such cases a dose of Crocus will soon set all things to rights. As the uterus regains its normal size, the new mucous, membrane becomes completed, and the spot from which the placenta was peeled off is also supplied with a new mucous membrane by a process of granulation.
As the uterus returns to its normal state the vagina also grows shorter and shorter; its transverse rugae return, and in the course of six weeks it is in all respects as before pregnancy, except that the subvaginal portions of the neck may be more or less permanently shortened on account of the extreme stretching upwards during gestation.
The uterus and vagina return to their usual condition, by virtue of the elasticity of their tissues, and where this is sufficient, the process is unattended with pain. But if necessary, organic contractility is also brought to aid, and this is always attended with more or less pains, constituting what are called the after- pains.
During all this time a discharge from the vagina is taking place; first of pure blood, for a day or two, which grows paler and paler, till finally it appears as a sero-purulent liquid, often of a pinkish color, then it becomes lighter, watery, and at last entirely disappears.
THE AFTER-PAINS.
Of the after-pains, it is proper to state more particularly, that they are really the organic contractions of the uterine fibres, where the elasticity of the general uterine tissue is insufficient to expel the liquids with which the walls of the uterus are engorged, or the clots which are contained within its cavity. When they make their appearance at all, which is some times not the case, these pains usually come on soon after delivery, and continue, with greater or less severity, from two to eight days. Fluids, or coagula, in greater or less quantity, are discharged with each pain. It is very important to diagnose between the after-pains and those which indicate the accession of puerperal inflammation; but this is an easy thing to do, since the former contract the uterus, while the latter do not.
Arnica should be administered immediately after delivery, unless contraindicated; and this remedy is particularly called for by the bruised condition of the genital organs, as it often aids in restoring the parts to their usual state, thus preventing severe after-pains, by removing the causes which otherwise would have produced them.
Belladonna When the pains come on suddenly, and after a time disappear with corresponding suddenness; or if the pains be severely forcing, as if all would be forced out through the external organs.
Bryonia If the after-pains are excited by the least motion, as in taking a deep inspiration, &c.
Chamomilla The pains are very distressing; she feels that she can hardly bear them. She wishes to get away from herself. She is irritated and ill-natured. Dark lochial discharge.
Coffea She is very sleepless, wide awake, and the pains are very distressing. She feels them very acutely.
Cuprum acet.
Terrible cramping pains; pains which often produce cramps in the extremities.
Ferrum In feeble women with fiery red face.
Hyoscyamus Much jerking and twitching in various parts of the body; she is delirious; spasmodic.
Ignatia Much sighing and sadness with the pains.
Kali-c The pains are stitching and shooting, or they are in the back, shooting down into the glutaei muscles, or buttocks.
Nux-v Aching pains. Every pain cause an inclination to go to stool.
Pulsatilla In mild, tearful temperaments; the pains grow worse towards evening; no thirst; not a good taste in the mouth.
Rhus The pains are always worse at night, with restlessness; they last, sometimes, the whole night.
Sabina The pains run from the sacrum to the pubis.
Secale c.
In feeble, thin, scrawny females; or the pain is much prolonged, as if pressing and forcing the uterus.
Sepia A constant sense of weight in the anus; much upward shooting in the vagina.
Sulphur Flashes of heat, weak, faint spells; feet either cold or burning hot, particularly in the soles.
Sulphuric acid Great sense of general weakness; or a sense of trembling all over without absolute trembling.
THE LOCHIA
The lochia constitute the discharge from the genital organs, which commences soon after the expulsion of the placenta, and continues until the complete restoration of the uterus to its normal condition. This discharges results from the disgorgement of the uterus, in its return to its usual size, and it is principally derived from that portion of the uterine surface to which the placenta had been adherent. During the first twenty- four hours, the lochial discharge is quite sanguineous, and sufficient in quantity to soil ten or twelve napkins. After the first few hours, this discharge gradually becomes less and less, as it passes through its four or five successive stages: first, sanguineous; second, serous; third, milky; fourth, puriform. And, when it has nearly subsided, it is not an uncommon occurrence for it to freshen up and assume a pinkish hue, and then resuming the appearance of a delicate, limpid pus, rapidly disappear.
In about six days after parturition, the sanguineous discharge should disappear entirely; and in two or three weeks more, the patient should be completely well. In severe cases the lochia will cease sometimes earlier, sometimes later, either as a natural consequence of the attendant, conditions, or as an exception merely to the general rule. And, in all such variations, the accompanying sensations and conditions of the patient will indicate the treatment.
