Fortunately the majority of young mothers are happy and normal in their outlook and may be kept so by the exercise of an average amount of tact and amiability on the part of the nurse. The actual physical care of the patient during the puerperium is a fairly simple matter for the well trained nurse. She will find, however, that in hospitals, private practice and public-health work alike there will be wide differences in the treatment given by different doctors, during this period, just as there were during pregnancy and labor, and she will have to carry out the prescribed directions enthusiastically and loyally no matter how they vary from those of the doctors who helped in her training. The details of the care will be indicated by the individual doctor, but the general, underlying principles—cleanliness, watchfulness, adaptability and sympathetic understanding will apply to the nursing of all patients. The most notable differences of opinion relate to the care of the breasts, the perineum and the use of abdominal binders, the accepted routine for the general nursing of average, normal cases being fairly uniform the country over. NURSING CARE As has been stated, the general nursing care of the puerperal patient is much the same as that given to any surgical patient, with such adaptations as are indicated by the condition and needs of the young mother. =Position in Bed.= The question of the patient’s position in bed is probably the first one that presents itself to the nurse after that first hour when the patient must be kept flat on her back and the fundus closely watched. She should continue to lie quietly on her back for a few hours, with only a small pillow under her head, as moving about may cause hemorrhage. Some doctors permit the patient to turn from side to side at will after a few hours of quiet, while others do not allow this for two or three days particularly if the patient has perineal stitches, unless her knees are tightly bound together. Their reason for this precaution is fear that the stitches may be torn out if the thighs are separated and also that air may gain access to the uterine vessels, through the relaxed and gaping birth canal, and produce air embolism. It is a routine in some hospitals to keep the head of the patient’s bed elevated during the first week, to promote drainage, but as a rule it is in the usual position. [Illustration: FIG. 116.—Height of fundus on each of the first ten days after delivery. ] Quite commonly the patient is encouraged to lie first on one side and then on the other, after she begins to move about in bed unassisted, and then face downward at intervals, in order to change the position of the uterus and thus tend to prevent backward displacement.