Component Task: Management of Client in 4th Stage of Labour

This is an intervention by the midwife to the puerperal mother during the first 6 hours after complete expulsion of the placenta and membranes. The puerperal mother is stabilized through close observation and adequate care to enhance the proper contraction of the uterus.

Aims

·         Offer the mother the opportunity to initiate bonding with the baby

·         Prevent excessive bleeding

·         Establish breastfeeding

·         Ensure adequate rest

·         Rule out abnormal physiological changes

Types

·         Immediate management

·         Subsequent management

Requirements

·         Blood Pressure apparatus

·         Thermometer

·         Pulse oximeter

·         Timer with second hand

·         Sanitary pad

·         Sterile gloves

Steps

·         Inspect client perineum for tears and suture if any

·         Ensure uterus is well contracted by massaging, expel clot to maintain firmness

·         Give uterotonic drug and call Obstetrician if bleeding persist

·         Clean the perineal area, thighs and apply clean perineal pad

·         Remove the drapes, soiled linen, clean and change client clothing

·         Inform client about successful completion of labour

·         Inform client she will be transferred to a clean and warm bed

·         Let client assume a desired position in bed

·         Observe client for chills and provide warmth

·         Check temperature, pulse, respiration, blood pressure and record (every 15 minutes for the first 1 hour, 30 minutes for the second hour and hourly for the remaining 4 hours)

·         Palpate and measure the symphysio-fundal height (every 15 minutes for the first 1 hour, 30 minutes for the second hour and hourly for the remaining 4 hours)

·         Educate and encourage client to massage uterus intermittently

·         Inspect the perineum for bleeding, swelling and manage as such

·         Encourage client to past urine intermittently or pass urethral catheter if necessary

·         Encourage client to change perineal pad often and maintain hand hygiene before and after

·         Offer a bowl of water, soap and encourage client to perform hand hygiene

·         Enquire client desired meal and serve as such

·         Help fix baby to breast

·         Encourage mobility after an hour rest if indicated

·         Assess the degree, location and intensity of pain and manage appropriate

·         Assess client interaction with her baby

·         Document all findings in Maternal and Child Health Record Book (Manual or Electronic)