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Stage Four  


The fourth stage of labor is the recovery period beginning just after the birth of the placenta and lasting until the mother's condition is stable. Generally this stage lasts one to two hours. During this time, the mother's blood pressure, pulse rate, lochia (blood) flow, and uterine tone are assessed.

The nurse will periodically palpate the uterus by cupping her hand and pressing firmly into the abdomen to ensure that the fundus (the top part) of the uterus is firm. If not, she will massage the fundus to make it contract. A firm, contracted fundus prevents excessive blood loss. Lochia flow initially is moderate and gradually tapers off over the coming weeks; changing from bright red, to dark red, to brown, to yellow, and then clear.

Also during the recovery time, women often notice trembling in their legs, soreness in the perineum, and cramping pains due to the contracting fundus. This cramping is most notable when the baby is breastfeeding and seems to increase in intensity with each birth. Usually a mild pain medication (e.g. Motrin) is available to help with this discomfort. Although uncomfortable, these contractions help the involution process of returning the uterus to its normal size within six weeks.

Perineal soreness is due to swelling from a vaginal delivery and an episiotomy that was performed. Ice packs between the legs just after birth can help relieve this discomfort and reduce swelling. A sitz bath is a very valuable comfort tool for the postpartum period. A squirt bottle filled with warm water is excellent in cleaning the perineum after urination. Toilet paper should be used only to pat, not wipe, the area dry.

Most women are hungry and thirsty right after the birth. Make sure there is food and drink readily available for the mother. Most of all, this stage is a time for bonding with the new baby and beginning the breastfeeding. Not all babies nurse right away as they are learning right along with you. Seek help from the nurse or lactation consultant to ensure the proper latch on and positioning for breastfeeding. It is often wise to attend a breastfeeding class prior to the delivery, if one is available in your area.

Take some time to savor the moments just after birth. These moments are priceless. A new family is just beginning.

References:

1.    Simkin, et al. Pregnancy Childbirth & the Newborn (4th Edition): The Complete Guide. (2010)

2.    Lowdermilk & Perry. Maternity & Women’s Health (9th Edition). (2007)

3.    Kitzinger, S. The New Pregnancy & Childbirth: Choices & Challenges. (2011)

4.    Lothian, J. The Official Lamaze Guide: Giving Birth With Confidence, 2nd edition (2010)




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