Getting Patients Out of Bed Early in the Puerperium

Early Rising in the Puerperium

“…fore it appears that the lochial discharge was increased for 2 to 3 days by early rising, but that subsequently the red loss was diminished. This agrees with the observations of Rotstein (1944) and Hall (1947).…”

“…Rising on the 2nd or 3rd day was advocated by Charles White of Manchester, in 1793, in in order to prevent uterine infection by stagnation of lochia (quoted Adami, 1922), but Gooch in 1820 recommended 31 days in the recumbent position to prevent prolapse (quoted Rotstein, 1944, andGuerriero, 1946). Early rising was encouraged by Fitzgibbon in Dublin from 1910, and he is convinced that it is of benefit to the patients (Fitzgibbon, 1946).…”

“…In this country in hospital practice the average time of rising up to 10 years ago was the 8th or 9th day, but during the London blitz rising from the 2nd day was practised in one centre in order that mothers should not feel helpless if damage occurred in the neighbourhood and also that they might walk to an underground shelter (Basden, personal communication). In America rising on the 1st or 2nd day was started shortly afterwards because of bed shortages (Guerriero, 1943(Guerriero, , 1946Rotstein, 1944), and it has been employed extensively since (Rosenblum, Melinkoff, and Fisk, 1945;King, 1946;Hall, 1947;Eastman, 1950). All writers seemed satisfied that the patients benefited from early rising and that no harmful effects followed.…”

The tortuous history of the implementation of early ambulation after delivery

“…2,12 Gooch, also from the UK, held the opposite opinion in 1820; this professor of obstetrics cautioned his student obstetricians not to allow their patients out of bed before the twenty-first day after delivery. 11 At the end of the nineteenth century women were advised to stay in bed for 28 days. 13 Around 1900, German gynaecologists started early mobilization.…”

“…Fewer cases of venous thrombosis (0.11%) were found compared to women who had to remain in bed for the usual length of time (0.41%) after delivery between 1927 and 1936. 11,27 For a long time after the Second World War gynaecologists and obstetricians faced a dilemma. As it was becoming more and more accepted that early ambulation prevented the risk of venous thrombosis, they were also afraid that premature ambulation might lead to increased risks of prolapses of the uterus, bladder and even rectum (Huisjes, Bennebroek-Gravenhorst, personal communication).…”