4th Stage/Recovery Stage

 The first 1-2 hours after the delivery of placenta

 Monitor V/S Q15 for 1st Hr, 2nd Hr Q30 mins. Check Placement of fundus at level of umbilicus
 If the fundus above the umbilicus, deviation of fundus

1.Empty bladder to prevent uterine atony

2.Check lochia

a.Maternal Observations – body system stabilizes

b.Placement of fundus
c. Lochia
d.Perineum

R-edness
E-dema
E-Ecchemosis
D-ischarges
A-pproximation of blood loss. Count pad and saturation

(Fully soaked pad: 30-40 cc weigh pad)

e. bonding interaction between the mother and the child – rooming in types

1. straight rooming in baby: 24 hours with mom

2.partial rooming in: baby in morning, at night nursery

Complications of Labor
Dystocia- difficulty in labor related to:
Mechanical factor – uterine inertia –sluginess of contraction
1. Hypertonic or primary uterine inertia- intense excessive contraction resulting to ineffective
pushing
MD administer sedative valium/diazepam –muscle relaxant
2. Hypotonic –secondary uterine inertia – slow irregular contraction resulting to ineffective
pushing
Give oxytocin

Prolong labor – normal length of labor in primi 14-20 hours , multi- 14 -20 hours

Maternal effect -exhaustion

Fetal effect - fetal distress, caput succedaneum , or cepal hematoma
Nursing care: monitor contraction and FHR

Precipate labor – labor of < 3hrs , extensive lacerations , profuse bleeding , hypovolemic shock if with
bleeding

Earliest sign : tachycardia and restlessness

Late sign: hypotension
Outstanding nursing diagnosis: fluid volume deficit
Post of mother: modified Trendelenburg
IV: fast drip due to volume deficit

Signs of Shock:
Hypotension
Tachypnea
Tachycardia
Cold clammy skin

Inversion of the uterus: situation uterus is inside out

Intervention: MD will push uterus back inside /hysterectomy

Factors leading to uterus inversion

1. short cord
2. hurrying of placental delivery
3. ineffective fundal pressure

Uterine rupture:
Causes:
1.Previous classical CS
2.Large baby
3.Improper use of oxytocin(IV Drip)

S/sx:
a. sudden pain
b. profuse bleeding
c. hypovolemic shock
Amniotic fluid embolism or placental embolism: amniotic fluid or fragments of placenta enters natural
circulation resulting to embolism
s/sx:
a. dsynea
b. chest pain
c. frothy sputum
end stage: DIC (dissimentated intravascular coagopathy – bleeding to all parts of the body – eyes noses
etc

Trial Labor: measurement of head and pelvis falls on borderline .Mom given 6hrs of labor . Multi- 8-14.
Primi - 14-20

Preterm labor : labor after 20-37 weeks (abortion <20weeks)

S/sx:
1. premature contractions q10
2. effacement of 60-80%
3. dilation 2-3 cm
home management:
1. complete bed rest
2. avoid sex
 3. empty bladder
4. drink 3-4 glasses of water –full bladder inhibits contractions
5. consult doctor if symptoms persist
Hospital management:
1. if cervix is closed 2-3 cm , dilation saved by administer tocolytic agents –halts preterm
contractions
Monitor FHR: >180 bpm
Maternal BP : <90/60
If cervix is open : d=steroid dexamethasone (bethamethazone) to facilitate surfactant
maturation preventing RDS
Preterm- cut cord asap to prevent jaundice

What do False Labour (Braxton Hicks) Contractions Feel Like?

Many women in their last trimester rush to the hospital when they feel tightening and hardening of the
uterus assuming labour pains have started, only to return home after being informed condescendingly
by smug medics that this was just false labour. So what do false labour pains feel like?

o These contractions generally painless, though uncomfortable

o The contractions are not regular, nor do they increase in frequency or severity as time
goes by
o The pain recedes if you change your position or if you walk around.
o The pain is in the lower abdomen, not in the lower back
o Foetal movements increases as the contractions come.

What Do True Labour Contraction Feel Like?

True labour is preceded by pre-labour, a series of physical changes that last almost a full month. The
changes are the beginning of cervical dilation and effacement, the descending of the foetus in to the
pelvis, a sensation of much more pressure on the pelvis and rectum, increase in number of Braxton
Hicks contractions and many more – all of which are integral in preparing the body for labour.

o Labour contractions are much stronger, more painful and more frequent.

o Labour pains get more intense with more activity, they also do not get better if you
change your position.
o Labour pains begin in the lower back, they then spread to the lower abdomen and
sometimes radiates to the legs.
o The pains sometimes mimic a stomach upset and are accompanied by diarrhoea.
o There is no set rule for patterns of labour which are the same for all women, but in
general – contractions become more frequent, painful and more regular. Each
contraction may not be more painful than the last one, but over time there is a definite
increase in the pain level.
o Membranes break and the water breaks, either as a trickle or a gush.