MANAGEMENT OF FOURTH STAGE OF LABOR

VIOLET MANJANJA

OBJECTIVE
EXPLAIN THE MANAGEMENT OF A WOMAN DURING THE FOURTH STAGE OF LABOR

MANAGEMENT OF THE 4TH STAGE OF LABOR

2 HOURS POST DELIVERY The woman must remain in the delivery room until the midwife is satisfied that the condition is satisfactory to exclude any conditions which could be life threatening during this period Ensure all precautions are taken to prevent infection

MANAGEMENT OF THE 4TH STAGE OF LABOR

Treat mother and baby as though they were HIV positive Observe the following: -Note the time of the delivery of the placenta -Check the uterus that it is well contracted and not bleeding -Examine the placenta and membranes

MANAGEMENT OF THE 4TH STAGE OF LABOR

-Assess blood loss; measured, assessed and recorded -Examine the perineum for lacerations, tear or if episiotomy is sutured General care: -swab and clean the woman and place a sterile pad over the perineum -remove all blood stained, wet and soiled linen on the delivery bed and replace with clean and dry linen

MANAGEMENT OF THE 4TH STAGE OF LABOR

General care: -cover the woman with dry and clean blanket -keep the woman warm and comfortable -assess blood loss and record Vital signs: -check blood pressure, pulse and respirations every 15 minutes and temperature every 30 minute

MANAGEMENT OF THE 4TH STAGE OF LABOR

The bladder -offer a bedpan to the woman and encourage her to pass urine -if she has difficulties to pass urine, a midwife should help the mother with conservative means e.g. leaving a tap of water dripping, pouring warm water on the vulva -only in rare circumstances will the woman need to be catheterized as a full bladder may interfere with uterine contractions causing PPH

MANAGEMENT OF THE 4TH STAGE OF LABOR

The uterus: recheck -the fundus is checked every 15 minutes to ensure that it is well contracted; midline, midway between upper border of symphysis pubis and lower part of the umbilicus -if the uterus is not well contracted it may mean there are blood clots -the midwife must rub up a contraction to expel the clots and ensure that it is well contracted

MANAGEMENT OF THE 4TH STAGE OF LABOR

Vaginal bleeding: -it is checked every 15 minutes to exclude excessive blood loss; PPH Full examination of the baby -ongoing care of the baby is carried out and the babys condition is carefully monitored General hygiene: -the mother should be given a wash or be allowed to shower if her condition is satisfactory in-order for her to feel refreshed

MANAGEMENT OF THE 4TH STAGE OF LABOR

If food is available encourage her to eat Provide for early infant skin to skin contact to promote bonding Assist with early breast and exclusive feeding within the first 30 minutes NOTE: where a spouse is allowed to be present at birth, allow time for family bonding

MANAGEMENT OF THE 4TH STAGE OF LABOR

Recordings: -ensure to record all relevant information of the delivery and the first post delivery management Transfer to the postnatal ward -transfer the woman for on going care when the condition is satisfactory -ensure to give a comprehensive handover

END