Printer Friendly Close

Review
Page 4 of 4

Intrapartum Nursing Assessment: Fourth Stage of Labor

Once the birth has been completed, the mother

enters the fourth stage of labor, or the
immediate postpartum period. This period of
assessment focuses on maternal vital signs,
uterine involution, maternal response to
anesthesia, and potential problems with the
newborn.

Maternal vital signs and fundal

assessments (fundal checks) are
usually performed every 15 minutes x 4,
then every 30 minutes x 2, then every
hour until the mother is stable and/or
she is transferred to the postpartum unit.
However, institutional policies may vary
and should be followed accordingly.
Fundal assessments are performed by
palpating and locating the maternal
fundus in relation to the abdomen.
Immediately after delivery the fundus will
be midway between the umbilicus and Click on the picture to enlarge.
symphysis pubis. It should be firm and
midline. Vaginal bleeding should be of
moderate amounts.
Frequently, laboring women will choose a regional anesthesia, such as an epidural, for
pain control. This will provide a sensory and motor block from the xiphoid process to
the lower extremities. Nurses will need to assess the mothers recovery from the
anesthesia by checking her motor and sensory responses in her lower extremities.
Bladder assessment is also important at this time. Because of the effects of regional
anesthesia and of the stress of the delivery process, urinary bladder tone may be poor.
In turn, the mother may have a full bladder but may not realize it or be able to void.
Bladder distension can displace the uterus and prevent it from contracting properly,
which can lead to excessive vaginal bleeding.
The maternal perineum requires assessment for intactness, or if there is a laceration or