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