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Should midwives measure blood loss in the fourth stage of labour?

02 June 2014
12 min read
Volume 22 · Issue 6

Abstract

The first 1 to 2 hours following delivery of the placenta is defined as the fourth stage of labour and it could be argued that blood loss during this stage is often overlooked by practitioners. In this article, it is suggested that midwives should be considering how much blood a woman loses in the fourth stage of labour as this could enhance our future understanding of third stage management. This paper presents a critical analysis of the evidence surrounding the fourth stage of labour and suggests an altered perspective about expectant, physiological or conservative management. Further research is needed to improve our understanding around the significance of the type of management adopted in the third stage of labour and the impacts of this on blood loss in the fourth stage.

The fourth stage of labour is defined in some research as the first 1 to 2 hours following delivery of the placenta (Kashanian et al, 2010; Gungorduk et al, 2011). However, in undertaking a literature search, the fourth stage of labour often goes unmentioned. Modern midwifery textbooks define labour as having three stages and do not identify the fourth stage as a stage that exists at all (McCormick, 2009; Harris, 2012). A possible explanation for this could be that the fourth stage is deemed unimportant as it does not need to be managed in any way. However, McDonald (2009) states that the woman and infant should remain in the care of the midwife following the birth of the placenta for at least 1 hour. I believe this should be considered the fourth stage and is a period of time that demands to be considered as a separate phase of labour. I propose this should be incorporated into how we define the physiology of childbirth.

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