LETTER XXVIII.. Management After Delivery.

MANAGEMENT AFTER DELIVERY.

Importance of Attention to this Period—Evils of too much Company—Bathing—The Bandages, Compresses, etc.—Sleep—Sitting up soon after the Birth—Walking about—The Food and Drink.

Supposing that the mother has been safely delivered, the child separated, and the after-birth cast off, what advice have we to give in regard to her recovery?

I have before remarked that the birth of the secundines is the most dangerous part of labor, although not the most painful. I have now to remark, that the real danger in midwifery does not commence until after the whole birth is completed. Childbed fever, inflammation and abscess of the breasts, these are the sad mishaps which we have to fear in these circumstances, and for which I feel an anxious solicitude in your behalf.

You may think me strange when I inform you, that I have had more trouble in the practice of midwifery from the one circumstance of the woman having too much mental excitement within a few days after delivery, than from all other things combined. I am sure I am not mistaken when I assert that I have known more accidents and mishaps to occur from this one cause of seeing company too soon after the birth, than from all other causes put together. So important do I consider it for you to keep, as it were, quiet in this respect, I should think my labor in writing these letters a hundred-fold rewarded, if I could be successful in warning you of the danger of over-excitement at the time when you are getting up from confinement. As the most important advice, then, which I can give in regard to all the subjects connected with midwifery, DO NOT ALLOW YOURSELF TO SEE COMPANY FOR MANY DAYS AFTER THE BIRTH.

“Most of the diseases which affect a woman in childbed,” says the great Velpeau, “may be attributed to the thousands of visits of friends, neighbors, or acquaintances, or the ceremony with which she is too often oppressed; she wishes to keep up the conversation; her mind becomes excited, the fruit of which is headache and agitation; the slightest indiscreet word worries her; the slightest emotions of joy agitate her in the extreme; the least opposition instantly makes her uneasy, and I can affirm, that among the numerous cases of peritonitis met with at the Hospital de Perfectionnement, there are very few whose origin is unconnected with some moral commotion.”

Is it not possible to change the fashion in regard to this matter? This remains wholly with yourselves; for we of the masculine gender have nothing to do with it. Are you not all sisters? Why, then, be offended with each other if you do not go to see the sick woman for a whole month after her child is born. Could you not write her now and then a friendly note, or send her some little delicacy to eat, which would be evidence enough that you had not forgotten her? I am aware there are among your sex a certain set of gossiping idlers, who do not know how to kill time in any better way than to be gadding abroad when they are least needed. If one is really sick and needs aid, they are the last persons in the world to leave their homes; they are good for nothing among the sick. To such women I care to say but little, for I consider the task of reforming them a very hopeless one, as all experience proves. Especially where a new method of treatment, as, for example, the water-cure, is practiced, do these twattlers gad about, making mischief wherever they go.

Bathing.—It is no new thing for a woman to be bathed, and that in cold water, soon after delivery. It was practiced among the Romans, and, as we have seen in another part of these letters, is still the custom among several of the savage nations.

I need not remind you, however, that this practice has, for a long time at least, found no place among the more enlightened portions of our race; that instead of cold water being regarded as a most estimable remedy in childbirth, it has been considered as a very dangerous agent, which, in truth, it is when improperly administered. Many of you can but too easily call to mind the old notions which were instilled into your minds on this subject; notions which you now know to be not only erroneous, but sadly mischievous when carried out in practice.

More than ten years ago, and while I was yet a student in medicine, and had never heard of the water-cure as practiced by the great Priessnitz, I was in the habit of revolving these matters in my mind. It occurred to me often, that if the Roman women, and the Indian women of different nations, could reap so great a benefit as appeared to be derived from ablutions performed soon after childbirth, that our own females too, weakly although they are many of them, could gain similar advantages from pursuing a like course. It was thus that I was led, as far back as 1843, to strike out a course of treatment for myself in these cases, having no medical authority or precedent to go by. The result of this treatment is now, fortunately, getting to be pretty well understood, and the merits of the new method appreciated in almost all parts of our country. In Europe they are altogether behind us in the improvement to which I allude.

I need not here go into any lengthy details concerning the methods of bathing that are proper to be adopted in the parturient state. The numerous cases which I have given will serve as a sufficient guide, I trust, to all of you who are concerned. I may remark, however, in general terms, that there is no need of doing any violence in the way of a bath; and those who have not access to the personal advice and superintendence of a physician who understands the practice, may always act safely by washing the patient in her bed. Thus, if a blanket or some other extra article is placed beneath her, she may easily be washed over the whole surface, piecemeal, a practice which, though it is neither so thorough nor useful in most cases, as it would be to go at once into the tub, is yet a good one, and productive of great comfort.

The Binder, Compresses, etc.—As to the use of the wet bandage, the compresses, etc., a few words will here be in place. If a dry bandage is ever needed as a support, the wet one is much to be preferred to it. As a general thing, however, we put no bandage upon the woman soon after the birth, as will be seen by reference to the cases given in this work; we wish to change and rewet the application frequently, and for this reason the simple compresses are the most convenient. But when the patient is to sit up or walk about, the wet girdle, if properly arranged with tapes to secure it, and made pretty tight at the lower part of the abdomen, affords a good deal of support. The wet bandage does not slip upward and get out of place near so readily as the dry one.

It will naturally occur to you, whether the going without the old-fashioned belly-bandage will not be likely to prove injurious to the woman’s form. The sum and substance of this whole matter is just this: whatever tends to weaken the constitution in general, and the abdominal muscles in particular, must have a tendency to produce laxity of the fibers, thus rendering the part more pendulous. On the other hand, whatever tends to strengthen the system and to give tone to its fibers, must have a contrary effect. Now, the dry belly-band, even when it is so arranged as to keep its place—which it generally is not—is too apt to become heating, and, of course, a source of debility under such circumstances. For this reason it is plain that a cold wet girdle is altogether better than a dry one. Nor should this even be left on too long a time without changing and rewetting it. This should be done, as a general thing, every three or four hours at farthest, and in warm weather oftener.

The Repose.—Some have feared to allow the woman to go to sleep for some hours after delivery, fearing that she might be taken in hemorrhage as a consequence. It is possible that a patient under such circumstances may wake suddenly with a flooding upon her, particularly if she be too warmly covered up in bed. But by all of the best authorities it is regarded that the sooner the woman sleeps after she has passed through the agony of labor the better. Sleep is, indeed, no less “nature’s sweet restorer” under such circumstances than at other times; and it would be most cruel to deny a patient this privilege, when it would be so grateful and refreshing to her.

Sitting up soon after the Birth.—I have proved satisfactorily to myself, that there is great error abroad in this country generally in regard to the parturient woman rising soon after the labor is past. It appears to be the belief of physicians generally in this country, that it is highly dangerous for a woman to sit up before some days after accouchement. The common saying concerning the ninth day you have all of you heard.

Velpeau, of Paris, who is higher authority by far than any old-school man in this country, says: “After this first sleep—that is to say, after the lapse of two or three hours—the patient should sit up in bed, and take a little broth; this position seems to rest her, and allows the lochia which had accumulated in the vagina to flow readily off.” That is the point: it serves to REST her; that is, when a woman is tired of lying down, both common sense and instinct declare that she should change her position; in other words, sit up. This very same thing I have taught strenuously for these seven or eight years, as many of you know; and just now, while I am writing, I find that Velpeau long ago recommended the same thing.

Walking About.—Precisely the same principle holds good in regard to walking and all other modes of exercise as in sitting up. A little and often should be the rule. The cases which I shall give you will form a sufficient guide on this point.

I have known a great many more persons to be injured by inactivity, remaining too much in bed and in overheated rooms, than by walking about too much and too soon.

The Food and Drink.—I have but a word here to say on this subject. The patient should begin directly after birth with the same kinds of food and drink which she intends to use during the period of nursing. If she is to eat fruit, which I consider good for her, she should take it from the first. Prudence should, of course, be exercised in regard to quantity as well as quality of food under these circumstances.

One of the greatest and most common errors in regard to the diet soon after labor, is that of partaking of articles which are of too fine and concentrated a nature. The bowels tend naturally to sluggishness for some days after confinement; hence the diet should be of an opening nature, such as brown bread, cracked-wheat mush, good fruit in its season, and good vegetables. It is a poor practice to keep the patient for nine days on tea, superfine bread, toast and butter, and the like articles. It is no wonder that women dieted in this way become constipated, nervous, low-spirited, and feverish.