Fourth stage of labour
The first four hours immediately following placental delivery are critical, and have been designated by some experts as the fourth stage of labour. This is because after the delivery of the placenta, the woman can have torrential vaginal bleeding due to failure of uterine contractions to close off the torn blood vessels where the placenta detached from the uterine wall. Therefore, you should be vigilant to detect revealed or concealed postpartum haemorrhage and manage it accordingly. (You will learn about this in detail in Study Session 11 of this Module).
The placenta, membranes and umbilical cord should be examined for completeness and for abnormalities (Study Session 6 covers this). Maternal blood pressure and pulse should be recorded immediately after delivery and every 15 minutes for the first four hours. Normally, after the delivery of the placenta, the uterus will become firm due to sustained contraction, so the woman might feel strong contractions after the birth. Reassure her that these contractions are healthy, and help to stop the bleeding.