Chapter VI
). At this time, as during pregnancy, she must avoid all food which may produce any form of indigestion, but for the baby’s sake, now, as well as her own. While it is not generally believed, to-day, that there are many, if any articles of diet which in themselves affect the mother’s milk unfavorably, it is generally conceded that a derangement of her digestion may, and usually does, have a deleterious effect upon her milk, and therefore upon the baby.
The old, and widespread, belief that certain substances from such highly flavored vegetables as onions, cabbage, turnips and garlic are excreted through the milk, to the baby’s detriment, is not given general credence to-day. On the other hand, it is known, however, that certain protective substances in certain foods are excreted through the milk, to the baby’s distinct advantage, and it is therefore, important that the mother’s diet should regularly contain those articles of food which contain them. These foods are milk; egg yolk; glandular organs, such as sweet-breads, kidneys and liver; the green salads, such as lettuce, romaine, endive and cress and the citrus fruits, or oranges, grapefruit and lemons.
These are called “protective foods” because they protect the body against the so-called deficiency diseases known as scurvy, beri-beri, xerophthalmia, which with rickets and pellagra are discussed in the chapter on Nutrition. It is possible for a baby who nurses at the breast of a woman whose diet is poor in protective foods, to be so insufficiently nourished, in some particular, as to be on the border line of one of these diseases, or even to develop the disease itself. This is one reason for the statement that the nursing mother must “eat for two.”
Certain drugs are excreted through the milk and may affect the baby in the same way as though they were administered directly, for example: salicylic acid, potassium iodid, lead, mercury, iron, arsenic, atropine, chloral, alcohol and opium.[9]
In addition to her food the nursing mother should have an abundance of water to drink, and to facilitate this it is a good plan to keep a pitcher or thermos bottle of water on the bedside table, and replenish it regularly, every four hours.
In general, the young mother should have light, nourishing, easily digestible food, with little, if any meat; an abundance of cereals, creamed dishes, creamed soups, eggs, salads and the fresh fruits and vegetables which ordinarily agree with her; at least a quart of milk, daily, in addition to that which is used in preparing her meals, and an abundance of water to drink.
=The Bowels.= The puerperal patient is almost always constipated, and needs assistance in regaining regularity in the movements of her bowels.
The routine use of cathartics and enemata varies, but it is very common to give an enema on the second morning after delivery or castor oil or Rochelle salts, followed by an enema if necessary. After this, a mild cathartic or a low enema is given often enough to produce a daily movement when this is not accomplished by means of the diet.
Some doctors, however, prefer that the bowels shall not move for four or five days after delivery, believing that this delay reduces the danger of infection from the intestinal contents, which are swarming with organisms, particularly the colon bacillus.
In cases of third degree tears, catharsis is practically always delayed for four to six days in order that the torn edges of the rectal sphincter may become well united before being strained by a bowel movement. In these cases an enema of six or eight ounces of warm olive oil is often given and the patient encouraged to retain it over night, in order to soften the contents of the rectum and lessen the strain and irritation of evacuation.
=The Bladder.= The question of helping the patient to void after delivery is one of extreme importance, because she will almost certainly have difficulty in emptying her bladder, and yet catheterization is not to be resorted to unless absolutely necessary. As a rule the patient should be encouraged to try to void from four to eight hours after delivery. If she is unable to do so at first there are several aids which the nurse should employ before admitting the patient’s inability to empty her bladder. Inducing her to drink copious amounts of hot fluids is the first step. Very often she will then void if placed upon a bedpan containing water hot enough to give off steam, and more warm, sterile water is poured directly upon the urethral outlet; or hot and cold sterile water may be dashed, alternately, upon the meatus.
The sound of running water is often helpful as well as the application of hot stupes over the supra-pubic region. When everything else fails, success frequently follows the application of a partly filled hot-water bottle over the bladder, held in place by a tight binder, particularly if the patient rests upon a pan of steaming water at the same time.
The danger of infecting the bladder, by carrying lochia into it upon the catheter, is so great that some doctors choose what they regard as the lesser of two evils, and allow the patient to be assisted to the sitting position, if she has not a serious tear. Not infrequently the patient’s inability to void is due to the fact that she is unaccustomed to using a bedpan, and would have difficulty in using one under any conditions, but is able to void while sitting up. As the danger of infection is greater two or three days after delivery than at first, because of the beginning decomposition of the lochia, it is very evidently important to help the patient to establish the habit of voiding from the beginning, for if she is catheterized once there is great likelihood that she will need to have it continued for some days.
If the first attempts are unsuccessful, therefore, but the patient thinks that she may be able to void later, if the efforts are repeated, catheterization is sometimes delayed for as long as sixteen to eighteen hours after delivery in the hope that it may be avoided altogether.
When the most persistent and painstaking efforts fail, and catheterization is necessary, the nurse must remember the extreme gravity of her responsibility and preserve asepsis throughout the procedure. Although there is extreme danger of infection, it can be prevented as a rule, and its occurrence is therefore regarded as almost inexcusable.
In preparing for catheterization, the nurse should drape the patient as for a vaginal examination, making sure that she is warmly covered, and place her on a sterile douche- or bedpan. If it is done at night she should place the light in a position at once safe and advantageous. She should have at hand on a tray: sterile forceps; cotton pledgets; two glass catheters (in case one should be broken or become contaminated); a disinfecting solution such as bichlorid, 1–4,000 or lysol 1 per cent.; a sterile receptacle in which to receive the urine; sterile towels and a dressing basin or paper bag for the used pledgets.
The preparation of the nurse’s hands, at this point, varies in different hospitals, but always the greatest care is taken to bring nothing unsterile in contact with the vulva and meatus.
According to one method, the nurse scrubs her hands for three minutes and prepares the patient as for a vaginal examination, removes the douche pan and places a sterile towel over the vulva. She then scrubs and soaks her hands as described in