Conclusion
The fourth stage of labour is a period of time
which demands to be investigated by rigorous
and methodologically sound research approaches.
There is a lack of high quality evidence to support
best practice around third stage management
(Wickham, 1999; Kashanian et al, 2010; Begley et
al, 2011). However, if the woman is asymptomatic
the relevance of the amount of blood lost should be
questioned, especially if at low risk of PPH.
In the UK today few women die in childbirth;
however, PPH still remains a cause of maternal
death (Centre for Maternal and Child Enquiries,
2011). Active management is not of benefit to all
women according to Edwards and Wickham (2011).
Rigor around evidence is questionable therefore
it is proposed that practitioners need to reflect
and critically analyse their approach to third stage
management, incorporating a fourth stage of
labour when caring for low risk women. There is
currently no extensive research that associates
the third stage and blood loss in the fourth
stage of labour that has been performed in the
home environment. I feel that this would provide
midwives with a wealth of knowledge when caring
for low risk, healthy women