Post-Partum Care

Abstract

his life, his father. I have, of course, not commented on his feelings about his mother or the patterns predicated thereon, but they are quite as interesting and instructive.Treatment of this boy entails a long-time process of reconditioning. He must, with assistance, gain insight into the varied and subtle ways by which this initial pattern reaction to his parents and sib-lings is reactivated with such disastrous results in later and other situations entailing adults and children who are not his parents and not his favored siblings even though they may have a few elements or attributes in common. In the terms of Pavlov, he must learn to differentiate the people who stand before him as stimuli. Beacon StreetPOST\p=m-\PARTUM care* POSTNATAL care is not new in the true sense of the word, and yet in years past, the application of this care has been indifferent and, in general, without sufficiently close supervision to be of any value, either to the patient or to the physician.One of us (C. W. S.), after close supervision of his own private cases for a period of years, has been impressed by the fact that it would be just as practicable to administer this same care to house cases. Prenatal care is now highly developed and specialized. Why should not postnatal care, which is just as important although not so well recognized, be carried out in the same painstaking manner? It is our opinion that insufficient time is devoted to that part of the post-partum period when most of the serious, persistent and chronic conditions of the postparturient woman present themselves.In most postnatal clinics, patients are discharged six weeks after delivery, unless unusual complications are present. This, we believe, is a serious error because, as previously mentioned, many of the conditions that adversely affect the patient's future life occur after this period. Moreover, a follow-up of this period furnishes excellent clinical material for the instruction of medical students, interns, residents and junior staff members. Green-hill1 advocates the follow-up of the postnatal patient for one year and predicts that, if as much care is given after delivery as prenatally, untold misery will be avoided such as cancer of the genital organs, a high incidence of which is found even in well-run clinics. Accordingly, we decided on a program of examining patients routinely six, twelve, twenty-four and forty-eight weeks post partum, and at as many other times as each case seemed to require. This procedure has been carried out for only a year, and this is therefore merely a preliminary report.One of the problems was to impress on the patients the value of our follow-up of one year. Enlisting the aid of the Social Service Department, we decided on preparing three form letters: the first letter, which was given to the patient while she was in the hospital, explained our plans and made the first appointment (six weeks after delivery); the second letter, which was sent if the patient did not keep her appointment, gave another date; the third letter, which...