_Treatment after labour._ As soon as the placenta is expelled, the soiled
and wetted sheet should be removed and a warm napkin applied to the
external parts: the patient should remain thus for half an hour or more,
and enjoy a little rest, or even a short sleep: by this time the nurse
will have washed and dressed the child, and be ready to attend to the
mother. The external parts should be sponged with warm water, her linen
changed, and a broad bandage pinned firmly round the abdomen to give it
the necessary degree of support. Where there has been great abdominal
distension and more than one child, it is sometimes advisable to apply the
bandage immediately after the birth of the first, in order to assist the
uterus in expelling the second, and in contracting afterwards. The
bandage, therefore, should be gradually tightened as the abdomen
diminishes in size: without this precaution the removal of so much
pressure from the abdominal circulation will be sometimes attended with
alarming faintings. A similar effect may be produced by the patient
incautiously sitting up in bed to take any refreshment which may be
offered to her at this moment; she should be warned, more especially if
she be a primipara, not to raise herself from the horizontal posture for a
few hours after labour; at any rate, not until the bandage has been
properly applied: from inattention to this point, cases have occurred
where, on the patient's sitting up immediately after labour, she has
fallen back in a faint from which she never recovered; in other cases it
has been attended by profuse hæmorrhage, which has instantly proved fatal.
"The influence of position," says Dr. Meigs, "in determining the momentum
of blood in the vessels is well known to the Profession, but there are few
cases where it is of more consequence to pay a profound regard to this
influence than in the parturient woman. A uterus may be a good deal
relaxed or atonic, and yet not bleed, if the woman lie still with the head
low; whereas, upon sitting up suddenly, such is the rush of blood down the
column of the aorta, the hypogastric and the uterine and spermatic
arteries, that the resistance afforded by a feeble contraction is
instantly overthrown, and volumes of blood escape with an almost
unrestrained impetuosity: the vessels of the brain under such
circumstances become rapidly drained, and the patient falls back in a
state of syncope, which now and then proves immediately fatal."
(_Philadelphia Practice of Midwifery_, by Charles D. Meigs, M. D. p. 192.)
Even if all these directions have been strictly obeyed, if every thing has
gone well, and the uterus is firmly contracted, we are not sure of its
remaining so: after the lapse of many hours it may again relax, and
flooding come on, its power of contraction being impaired either by the
exhaustion of the previous labour, the warmth of the bed, &c. It will,
therefore, be desirable to adopt such measures, as will ensure the
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