Midwifery (RM)
Management of Client in 4th Stage of Labour
The fourth stage is the early postpartum observation period after placental delivery. Care focuses on detecting haemorrhage and deterioration, supporting uterine contraction, monitoring the newborn, promoting warmth and bonding, and beginning postnatal education.
Purpose
- Detect and manage early postpartum complications
- Support maternal recovery, bonding, and breastfeeding
- Establish safe transition to postnatal care
Indications
- All women after placental delivery
- Higher-risk observation after haemorrhage, operative birth, tear, hypertension, or anaesthesia
Equipment
- Vital-sign and uterine-assessment equipment
- Clean pads and weighing or blood-loss materials
- Newborn warmth and feeding equipment
- Urinary-output supplies
- Postnatal record and emergency equipment
Preparation
- Review the birth and third-stage record and check emergency equipment.
- Ensure mother and baby are warm and safely positioned.
Procedure steps
- Receive handover and confirm maternal and newborn identity, birth events, placenta, blood loss, medications, and risk factors.
- Assess airway, breathing, circulation, consciousness, pain, uterine tone, fundal height, vaginal loss, perineum, bladder, and vital signs at policy intervals.
- Monitor the newborn’s temperature, breathing, colour, feeding, and cord while supporting skin-to-skin when stable.
- Maintain warmth, privacy, hydration, comfort, and appropriate analgesia.
- Assist breastfeeding and observe attachment when the mother and baby are ready.
- Inspect and manage tears, check bladder function, and provide hygiene support.
- Recognize postpartum haemorrhage, shock, hypertension, infection, urinary retention, or newborn compromise and escalate.
- Reassess before transfer and communicate a complete handover to postnatal staff.
- Explain findings, warning signs, feeding, hygiene, and how to call for help.
- Document observations, interventions, education, transfer readiness, and handover.
Precautions
- Do not transfer until maternal and newborn stability and required observations are confirmed.
- Treat increasing bleeding, altered consciousness, severe pain, abnormal vital signs, or newborn distress urgently.
- Use standard precautions and safe handling of blood or body fluids.
- Monitor high-risk women more frequently according to policy.
Aftercare
- Provide structured postnatal handover and continue observation.
- Support feeding, rest, analgesia, hygiene, and emotional wellbeing.
Nursing considerations
- Use a systematic mother-and-baby assessment.
- Communicate trends and risks clearly during handover.
Patient education
- Teach the woman to report heavy bleeding, severe headache, breathlessness, fever, severe pain, or feeling faint.
- Explain feeding, hygiene, bladder care, and how to request help.
Documentation
- Record vital signs, uterine tone, fundus, lochia, perineum, bladder, pain, newborn observations, feeding, education, and handover.
- Document any escalation and response.
References and further reading
Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.
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