3rd and 4th Stage of Labor
THIRD STAGE OF LABOR: PLACENTAL STAGE
Stage 3 refers to the delivery of the placenta. At stage 3, the baby has already been born however, contractions will continue until the placenta is delivered. The placenta separates from the wall and natural removal occurs by uterine contractions. The birth of the placenta takes place 5 – 30 minutes after the birth of the baby.
The placental stage is crucial because of the possibility of maternal hemorrhage. Signs of the placental separation are as follows:
a. The uterus becomes globular in shape and firmer.
b. The fundus rises in the abdomen.
c. Lengthening of the cord.
d. Sudden gush of blood.
There are two different placental mechanisms which are the following: * Duncan - For Duncan’s mechanism the margin of the placenta separates, and the dull, red, and rough maternal surface emerges from the vagina first. * Schultz. For Schulze’s mechanism the center portion of the placenta separates first, and its shiny fetal surface emerges from the vagina.
The mother’s vital signs and uterine fundus location should then be checked. The fundus, at this point, is located 2 fingerbreadths below the umbilicus. The placenta will be checked for the presence of cotyledons (lobes of placenta), to make sure none of the placenta is missing, including making sure that the placenta membranes are intact. The mother may begin to shiver do to a decrease in body core temperature, provide blankets to warm up. Medical staff should promote baby-mother attachment.
Nursing Care During the Third Stage of Labor
a. Continue observation. Following delivery of the placenta, observe the fundus. Ensure that the fundus remains contracted. Retention of the tissues in the uterus can lead to uterine atony and cause hemorrhage. Massaging the fundus gently will ensure that it remains contracted.
b. Allow the mother to bond with the infant. Show the infant to the mother and allow her to hold the infant.
c. Record the following
Stage 3 refers to the delivery of the placenta. At stage 3, the baby has already been born however, contractions will continue until the placenta is delivered. The placenta separates from the wall and natural removal occurs by uterine contractions. The birth of the placenta takes place 5 – 30 minutes after the birth of the baby.
The placental stage is crucial because of the possibility of maternal hemorrhage. Signs of the placental separation are as follows:
a. The uterus becomes globular in shape and firmer.
b. The fundus rises in the abdomen.
c. Lengthening of the cord.
d. Sudden gush of blood.
There are two different placental mechanisms which are the following: * Duncan - For Duncan’s mechanism the margin of the placenta separates, and the dull, red, and rough maternal surface emerges from the vagina first. * Schultz. For Schulze’s mechanism the center portion of the placenta separates first, and its shiny fetal surface emerges from the vagina.
The mother’s vital signs and uterine fundus location should then be checked. The fundus, at this point, is located 2 fingerbreadths below the umbilicus. The placenta will be checked for the presence of cotyledons (lobes of placenta), to make sure none of the placenta is missing, including making sure that the placenta membranes are intact. The mother may begin to shiver do to a decrease in body core temperature, provide blankets to warm up. Medical staff should promote baby-mother attachment.
Nursing Care During the Third Stage of Labor
a. Continue observation. Following delivery of the placenta, observe the fundus. Ensure that the fundus remains contracted. Retention of the tissues in the uterus can lead to uterine atony and cause hemorrhage. Massaging the fundus gently will ensure that it remains contracted.
b. Allow the mother to bond with the infant. Show the infant to the mother and allow her to hold the infant.
c. Record the following