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'.
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.
So we want to do what's called
'kangaroo care' where the fetus is actually
in skin to skin position with someone.
Now, it could be the wonderful
patient that just delivered,
but it also could be a support person.
So let's say this has been necessary
in birth, and the client is in recovery.
The other support person can
provide the skin to skin contact.
But it's important that we do it because
it helps the baby to maintain temperature.
We also want to start breastfeeding
if that's what the client has chosen.
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.
We want to monitor vital signs
to make sure everyone is stable.
We want to check the fundus, so we
want to make sure that ball stays in place
so we can minimize postpartum bleeding.
We want to monitor how much blood,
"lochia" is the term used to
describe the blood that comes out.
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.
We want to look at the perineum.
You saw that picture of crowning, you
saw how the vagina may need to stretch.
It may also tear.
We want to make sure
that there's not bleeding
from a laceration that hasn't
been repaired or anything like that.
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.
So all of these things may
occur during fourth stage.