I] The Fourth Stage of Labour

This is from complete delivery of placenta and membranes to 2 hours post delivery. During this period the midwife performs various activities on the mother and the baby. The activities include:

• Note the time of delivery of placenta and membranes.
• Check the uterus to ensure that it is well contracted every 15 minutes.
• Examine the placenta and membranes.
• Assess blood loss - measure all the blood lost.
• Explain to the woman that she will be left on the delivery bed for two hours.
• Examine the perineum for any tears, lacerations and episiotomy.
• Clean up the woman- remove all wet and dirty linen.
• Replace with clean linen.
• Place a sterile pad over the perineum.
• Suture tears, lacerations, episiotomy if any.
• Let her lie flat in bed with legs crossed.
• Check vital signs every 15 minutes.
• Help the woman onto a pan to empty bladder, catheterize PRN.
• Recheck uterus and blood loss every 15 minutes.
• Provide her with a cup of tea or porridge.
• Maintain baby to the breast- explain the likely pains to occur with the nursing.
• Keep her informed on whatever is going on.
• Let significant other know the condition of the woman and her baby.
• At the end of two hours, assess her vital signs uterus, bladder and blood loss.
• Record all pertinent data.
• Assist her to get up and have a bath at the end of two hours.
• Examine the baby fully.
• Transfer her to postnatal ward providing a thorough handover note to postnatal midwives.