Within the past thirty years a revolution has been experienced in the dietetic treatment of puerperal women, and they are no longer, as formerly, kept for ten days or a fortnight upon a diet of toast water, "slops," etc., with the idea that semistarvation would keep down puerperal fever and "milk fever." This change is largely due to methods of antiseptic midwifery, but the reaction started even earlier, and in 1876 Fordyce Barker, who was one of the first to forsake the old routine, wrote of the puerperal state: "I have never seen the slightest evil result from good, ample, judicious alimentation," and "I have had patients eat a good piece of tenderloin steak the day after labour with a relish, and with happy results".

A pregnant woman may eat her ordinary diet up to the commencement of labour.

If the labour is greatly protracted, the first stage lasting, as it exceptionally does, for more than a few hours, it will not do to let her strength become further exhausted from lack of food, and she must be urged to take stimulating hot broths, gruels, or similar easily digested food. Under the circumstances she is naturally nervous and may decline all food, so she should be given only that which is quickly swallowed without effort. In ordinary cases, however, no food is necessary or desirable during labour.

Immediately after delivery the woman, exhausted by muscular effort and agonising pain, and possibly also under the influence still of an anaesthetic, needs rest rather than food, and as she is more thirsty than hungry, she may drink freely of water or Vichy.

On the other hand, many puerperal complications, including mania, are favoured by exhaustion and inanition, and good feeding must not be delayed too long. The nursing woman, moreover, needs a more liberal diet than other patients. Her milk contains a large percentage of proteid and fat, and she also loses proteid substance to a greater or less extent through the lochia. A low diet means poor breast milk, for it diminishes both its fats and proteids.

Spiegelberg says: "It is a bad practice to allow healthy lying-in women to fast long; they need to be well fed, and if the appetite is good they may be encouraged to eat." If they are well nourished they both sleep and feel better. "Four or five hours after confinement the patient may be given a cup of hot bouillon or chicken or mutton broth. She usually does not care for meat before the second or third day, but she may have it then. Meanwhile she is allowed broths of any kind, thickened with egg or rice, milk, tea, light farinaceous gruels or puddings, soft-cooked eggs, toast, milk toast, custards." Schroder gives meat and vegetables within a day or two after the conclusion of labour. Lusk recommended a light fluid or semisolid diet for the first three days. Then, after the bowels have moved once or twice and the appetite returns, steak, chops, a piece of fowl or a bird, eggs, and cooked fruits are given.

Playfair adopted the following system: If the woman is confined in the early morning hours, at 9 A. m. she is given a cup of tea and a piece of toast; at 1 p. m. a light -lunch of some form of predigested meat preparation; at 5 p. m. tea or beef tea, and at 7 p. m. a small bit of chicken with bread and butter or milk toast. Tea again at 9 p. m. He discountenanced a continued use of gruels, "slops," and stimulants. During the next day or two if the patient is hungry, he allowed sweetbread, chicken, fish, eggs, and milk.

On the whole, the patient's own appetite is a better guide for feeding than are any rules as to the exact time which has elapsed since parturition. She should not be urged to take food, unless greatly exhausted, and the stomach must not be overloaded; but if hungry after the establishment of the milk secretion and after free action of the bowels, she may be allowed a reasonable quantity and variety, though while still in bed she needs less than if up and about. The occurrence of fever is a contraindication for giving much proteid food except milk, but extreme exhaustion without febrile reaction demands it.