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.