The first duty of the physician, following the third stage of labor, is to see that the womb is well contracted and control of this organ should be continued for at least one hour after delivery.  This generally prevents excessive loss of blood.  If necessary to promote womb contraction one teaspoonful of ergot can be given.  After the womb has been kept in a state of contraction, the room should be rid of all evidences of labor and the woman made comfortable.  The buttocks and thighs which have been soiled during the labor should be bathed with warm water and soap and the external genitals sprayed with an antiseptic solution, then dried with sterile gauze or cotton, the dressing applied to the vulva and the temporary bed removed, her night dress pulled down and the patient thus lying in a clean, comfortable bedding.  The woman may then have a cup of weak tea, hot milk or broth and be left to rest; but during the first sleep the womb should be carefully watched lest it relax and serious, if not fatal, bleeding occur.  In a normal confinement the dressings need not be changed, as a rule, oftener than six times in twenty-four hours, for the first few days.  As soon as convenient after the first toilet is finished the physician sterilizes his hands and with the patient on her left side introduces one finger into the rectum and the thumb into the vagina to discover the condition of the perineum.  Washing out of the vagina is not necessary as a rule.

[Obstetrics or midwifery 537]

The binder is considered indispensable, and should be made of unbleached muslin and wide enough to extend from the pubic (bone) to the breast-bone, and long enough to go around the patient’s body and slightly lap.  The binder should be pinned or sewed tightest in the middle, but it should not be so tight as to press upon the womb and crowd it backward or to either side.  It acts as a splint to the muscles and assists in resting them to their natural condition.

Rest.—­Complete rest of the body and mind is essential to the well being of the lying-in woman.  She is better off without any company, and should see no one except her family for the first week or two.  Outside visitors should be prohibited.  The lying-in room should be kept free from noise and confusion, and the patient should be protected from annoyances of every kind.  She should remain lying on her back for a few days and immediately following delivery she should not have a pillow for her head.  Sleep is very necessary and desirable, and mild medicines should be given to produce it, if necessary.  It is best not to sit up in the bed until the womb shall have had time to become smaller, and has resumed its natural position behind the pubis.  Among the upper classes, when it takes the womb longer to regain its normal size, three weeks is a good rule to go by before sitting up in the room, and she should remain in her room until the end of the fourth week.  Among healthy women of the laboring class, whose muscular system has not been injured by “culture” and social excesses, the womb and appendages regain their normal proportions more rapidly; but even they should remain in bed two weeks.