**3.3 Daily examination**

Every morning the mother should be seen and asked as to how she is feeling. The midwife should particularly note if the mother complains of feeling unduly tired. Any woman who is anaemic or who is developing an infection will not feel well. Temperature, pulse and Blood pressure should be measured. The temperature and pulse rate may be recorded at least twice a day for the few days and then once daily until the 10th days of the puerperium. If the temperature exceeds 37.3 degree Celsius or 99 degree Fahrenheit, the physician is to be notified. The pulse rate is normally 80 or below per minute. Any rise in the pulse rate above 90 beats per minute should be reported to the physician irrespective of whether it is accompanied by rise in temperature or not. Any rise in temperature may be indicative of excessive bleeding or of a developing puerperal infection. Tachycardia which is due to excessive bleeding will be accompanied by hypotension. When a nurse notices a rising pulse rate and fall in blood pressure she must check the state of the uterus and lochia in order to identify post partumhaemorrhage. The blood pressure is checked during the first 24 hours following a normal delivery and for a longer period of time, if there has been any history of bleeding, hypertension during pregnancy, or if the mother has had a Caesarean section or has required any other surgical intervention.

The breasts should be examined daily and noted whether the breasts are soft and are free from lumps, redness and soreness.

#### **3.4 Breasts problems: sore and damaged nipples**

Abnormal nipples: Inverted and flat nipples.

The complications of breast feeding are engorgement of breasts. In breasts feeding mothers breast engorgement occurs around the third and fourth post partum day. The breasts arehard, painful and sometimes flushed. The mother may develop pyrexia along with that. Engorgement results from an increased amount of blood and edema in the breasts and indicates that the baby is not ready to take the full quantity. Warm compresses to the breasts and removal of excess milk at the end of each feeding will relieve the condition. Even tight brassieres help.

#### **3.5 The Bowels**

The bowels tends to be sluggish during the puerperium for the following reasons.


It is good to give some mild laxative for the first 36 hrs after delivery such as liquid paraffin or milk of magnesia. When diet contains sufficient roughage and fluid, the bowel needs less artificial stimulation. If the bowels do not move 48 hrs after delivery, glycerine or dulcolex suppository is usually given.

#### **3.6 Diet**

The nursing mother needs a liberal nourishing diet to build up her strength and enable her to produce sufficient breast milk. Good whole food is essential containing sufficient proteins, minerals and vitamins. As so many women are anaemic at this time the nurse must ensure that food rich in iron are included in the diet. The haemoglobin is estimated on 8th or 9th day. Iron supplements are usually prescribed for one month. As the woman is losing calcium when she breastfeeds, she should take adequate dietary calcium. Fruit and vegetables should be served at every meal.
