b. How delivered (spontaneously or manually removed by the physician).
c. 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.
d. If the placenta is delivered complete and intact or in fragments.
Section V. FOURTH STAGE OF LABOR (RECOVERY STAGE)
2-14. FOURTH STAGE OF LABOR
The fourth stage of labor, as previously mentioned, is the period from the delivery
of the placenta until the uterus remains firm on its own. In this stabilization phase, the
uterus makes its initial readjustment to the nonpregnant state. The primary goal is to
prevent hemorrhage from the uterine atony and the cervical or vaginal lacerations.
Atony is the lack of normal muscle tone. Uterine atony is failure of the uterus
2-15. 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
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 you place 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
Suction and oxygen in case patient becomes eclamptic.
Pitocin is available in the event of hemorrhage.
IV remains patent for possible use if complications develop.
e. Check the fundus.