Stage IV of Labor (Nursing)

00:01 All right, fourth stage, so the baby is out, the placenta is out and now it is time, we call this sometimes the 'golden hours'.

00:10 This is the first two hours after delivery and this is a really wonderful time for bonding with the baby, but it's also a time we have to encourage positive transition.

00:20 So we want to do what's called 'kangaroo care' where the fetus is actually in skin to skin position with someone.

00:27 Now, it could be the wonderful patient that just delivered, but it also could be a support person.

00:32 So let's say this has been necessary in birth, and the client is in recovery.

00:39 The other support person can provide the skin to skin contact.

00:42 But it's important that we do it because it helps the baby to maintain temperature.

00:47 We also want to start breastfeeding if that's what the client has chosen.

00:50 We want to do that right at the beginning, because the baby's actually going to get sleepy in about half an hour, so we want to make sure that we do that right after delivery.

00:58 We want to monitor vital signs to make sure everyone is stable.

01:02 We want to check the fundus, so we want to make sure that ball stays in place so we can minimize postpartum bleeding.

01:08 We want to monitor how much blood, "lochia" is the term used to describe the blood that comes out.

01:14 Is it too much? is there none, and maybe it's hiding somewhere? So we want to monitor the lochia to make sure that that's okay.

01:22 We want to look at the perineum.

01:23 You saw that picture of crowning, you saw how the vagina may need to stretch.

01:28 It may also tear.

01:29 We want to make sure that there's not bleeding from a laceration that hasn't been repaired or anything like that.

01:36 And then sometimes during this period, if there is a recovery or a postpartum unit, we're going to transfer the client and the baby and their support family over into postpartum.

01:47 So all of these things may occur during fourth stage.