3rd and 4th Stage of Labor

Topics: Childbirth, Uterus, Pregnancy Pages: 6 (1487 words) Published: August 7, 2013
THIRD STAGE OF LABOR: PLACENTAL STAGE

Stage 3 refers to the delivery of the placenta. At stage 3, the baby has already been born however, contractions will continue until the placenta is delivered. The placenta separates from the wall and natural removal occurs by uterine contractions. The birth of the placenta takes place 5 – 30 minutes after the birth of the baby.

The placental stage is crucial because of the possibility of maternal hemorrhage. Signs of the placental separation are as follows: a. The uterus becomes globular in shape and firmer.
b. The fundus rises in the abdomen.
c. Lengthening of the cord.
d. Sudden gush of blood.

There are two different placental mechanisms which are the following: * Duncan - For Duncan’s mechanism the margin of the placenta separates, and the dull, red, and rough maternal surface emerges from the vagina first. * Schultz. For Schulze’s mechanism the center portion of the placenta separates first, and its shiny fetal surface emerges from the vagina.

The mother’s vital signs and uterine fundus location should then be checked. The fundus, at this point, is located 2 fingerbreadths below the umbilicus. The placenta will be checked for the presence of cotyledons (lobes of placenta), to make sure none of the placenta is missing, including making sure that the placenta membranes are intact. The mother may begin to shiver do to a decrease in body core temperature, provide blankets to warm up. Medical staff should promote baby-mother attachment.

Nursing Care During the Third Stage of Labor

a. Continue observation. Following delivery of the placenta, observe the fundus. Ensure that the fundus remains contracted. Retention of the tissues in the uterus can lead to uterine atony and cause hemorrhage. Massaging the fundus gently will ensure that it remains contracted.

b. Allow the mother to bond with the infant. Show the infant to the mother and allow her to hold the infant.

c. Record the following information.
(1) Time the placenta is delivered.
(2) How delivered (spontaneously or manually removed by the physician). (3) Type, amount, time and route of administration of oxytocin. Oxytocin is never administered prior to delivery of the placenta because the strong uterine contractions could harm the fetus. (4) If the placenta is delivered complete and intact or in fragments.

FOURTH STAGE OF LABOR: RECOVERY STAGE

The fourth stage of labor is the period from the delivery of the placenta until the uterus remains firm on its own. It begins with the delivery of the placenta and usually ends 2-4 hours after the delivery of placenta. In this stabilization phase, the uterus makes its initial readjustment to the non-pregnant state. The primary goal is to prevent hemorrhage from uterine atony or cervical/vaginal lacerations.

Nursing Care During the Fourth Stage of Labor

a. Transfer the patient from the delivery table. Remove the drapes and soiled linen. Remove both legs from the stirrups at the same time and then lower both legs down at the same time to prevent cramping. Assist the patient to move from the table to the bed.

b. Provide care of the perineum. An ice pack may be applied to the perineum to reduce swelling from episiotomy especially if a fourth degree tear has occurred and to reduce swelling from manual manipulation of the perineum during labor from all the exams. Apply a clean perineal pad between the legs.

c. Transfer the patient to the recovery room. This will be done after the nurse places a clean gown on the patient, obtained a complete set of vital signs, evaluated the fundal height and firmness, and evaluated the lochia.

d. Ensure emergency equipment is available in the recovery room for possible complications.

e. Check the fundus.
(1) Ensure the fundus remains firm.
(2) Massage the fundus until it is firm if the uterus should relax. (3) Massage the fundus every 15 minutes during the first hour, every 30...
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