3. MANAGEMENT OF THE 4TH STAGE
OF LABOR
• 2 HOURS POST DELIVERY
The woman must remain in the delivery room
until the midwife is satisfied that the
condition is satisfactory to exclude any
conditions which could be life threatening
during this period
Ensure all precautions are taken to prevent
infection
4. MANAGEMENT OF THE 4TH STAGE
OF LABOR
• Treat mother and baby as though they
were HIV positive
• Observe the following:
-Note the time of the delivery of the
placenta
-Check the uterus that it is well contracted
and not bleeding
-Examine the placenta and membranes
5. MANAGEMENT OF THE 4TH STAGE
OF LABOR
-Assess blood loss; measured, assessed and
recorded
-Examine the perineum for lacerations, tear or if
episiotomy is sutured
• General care:
-swab and clean the woman and place a sterile
pad over the perineum
-remove all blood stained, wet and soiled linen on
the delivery bed and replace with clean and dry
linen
6. MANAGEMENT OF THE 4TH STAGE
OF LABOR
• General care:
-cover the woman with dry and clean blanket
-keep the woman warm and comfortable
-assess blood loss and record
• Vital signs:
-check blood pressure, pulse and respirations
every 15 minutes and temperature every 30
minute
7. MANAGEMENT OF THE 4TH STAGE
OF LABOR
• The bladder
-offer a bedpan to the woman and encourage her
to pass urine
-if she has difficulties to pass urine, a midwife
should help the mother with conservative means
e.g. leaving a tap of water dripping, pouring
warm water on the vulva
-only in rare circumstances will the woman need to
be catheterized as a full bladder may interfere
with uterine contractions causing PPH
8. MANAGEMENT OF THE 4TH STAGE
OF LABOR
• The uterus: recheck
-the fundus is checked every 15 minutes to ensure
that it is well contracted; midline, midway
between upper border of symphysis pubis and
lower part of the umbilicus
-if the uterus is not well contracted it may mean
there are blood clots
-the midwife must rub up a contraction to expel
the clots and ensure that it is well contracted
9. MANAGEMENT OF THE 4TH STAGE
OF LABOR
• Vaginal bleeding:
-it is checked every 15 minutes to exclude
excessive blood loss; PPH
• Full examination of the baby
-ongoing care of the baby is carried out and the
baby’s condition is carefully monitored
• General hygiene:
-the mother should be given a wash or be allowed
to shower if her condition is satisfactory in-order
for her to feel refreshed
10. MANAGEMENT OF THE 4TH STAGE
OF LABOR
• If food is available encourage her to eat
• Provide for early infant skin to skin contact
to promote bonding
• Assist with early breast and exclusive
feeding within the first 30 minutes
NOTE: where a spouse is allowed to be
present at birth, allow time for family
bonding
11. MANAGEMENT OF THE 4TH STAGE
OF LABOR
• Recordings:
-ensure to record all relevant information of
the delivery and the first post delivery
management
• Transfer to the postnatal ward
-transfer the woman for on going care when
the condition is satisfactory
-ensure to give a comprehensive handover
