The Care of a Woman During the Third and Fourth Stages of Labor

The third stage of labor is the time

from the birth of the baby until the
placenta is delivered.
The Delivery of the Placenta
TWO PHASES:
● Placental separation
● Placental expulsion
Delivery of the Placenta
1. Placenta will deliver spontaneously following most births
( up to 30 minutes is considered normal)
2. Inspected
3. Normally,one sixth the weight of an infant
After the delivery of the placenta..

1. Massage the fundus to urge it to contract

2. Oxytocin may be prescribed
3. Injection of carboprost thromethamine ( Hemabate) or
methylergonovine maleate (Methergine)
4. Pitocin

* It is important to know prior the second stage whether a woman

has a contraindication to either of these drugs such as asthma or
hypertension.

- Be certain to obtain a baseline blood pressure measurement before

administration
Perineal Inspection
● The perineum is carefully inspected after birth
● About 3% of women do have a small tear extending backward from the
vagina
● Some tears are small enough that no suturing is needed but there are
instances that a tear is large enough to require suturing
● Perineal tears are rated grade 1 to grade 4.
Management
● Treatment of a perineal tear depends on the severity of the injury:
a. First degree tear - Sometimes a 1st degree tear needs stitches and other
times it can heal without stitches.
b. Second degree tear – Suturing is given to repair the injury which they
heal better when they are repaired with stitches.
c. Third and Fourth degree tear – Usually be repaired as soon as possible
after your baby is born and your healthcare provider may need to repair
the injury to the anal sphincter as well.

● The suturing will be done with dissolvable stitches and these will dissolve
on their own within six weeks.
Nursing Interventions to help ease the patient’s
discomfort:
● Instruct patient to use a peri-bottle to wash yourself clean after using the
bathroom and gently pat yourself dry with toilet paper instead of wiping.
● Instruct to drink plenty of water to avoid constipation.
● Give medication such as paracetamol and ibuprofen to alleviate patient’s
pain.
● Give antibiotics to reduce the risk of infection.
● Instruct if she notices any bleeding from the tear, any smell or any increase
in pain then she should come back to the hospital for an assessment.
The Immediate Postpartum Assessment and Nursing Care
This is the beginning of the postpartal period or the fourth stage
of labor.

Because the uterus may be so exhausted from labor that it cannot

maintain contraction. There is a high risk for hemorrhage during
this time (it is the most dangerous time of birth for the mother).
Assessment
1. Obtain vital signs, (pulse, respirations, and blood pressure)
every 15 minutes for the first hour and then according to
agency policy or the woman’s condition. Pulse and
respirations may be fairly rapid immediately after birth (80 to
90 beats/min. and 20 to 24 breaths/min), and blood
pressure may be slightly elevated due to exertion and
excitement of the moment or recent oxytocin administration.

2. Palpate a woman’s fundus for size, consistency, and position

and observe the amount and characteristics of lochia each
time you record vital signs.
Nursing Care
1. Wash the perineum with the agency-designated solution and apply
perineal pad.
2.Return the birthing bed to its original position. Offer a clean gown and
warmed blanket because a woman often experiences chills and a shaking
sensation 10 to 15 minutes after birth. This may be due to the low
temperature of a birthing room but may also be a result of the sudden
release of pressure on pelvic nerves or of excess epinephrine production
during labor. In any event, it is a normal phenomenon but can be frightening
to the mother if she associates the chill with fever or infection and worry she
will be ill at a time when she most wants to be well to care for her new child.
You can reassure her this is a transitory sensation, is very common and
passes quickly.
THANK YOU!