What is the nursing care plan for the fourth stage of labor?

September 24, 2025 •

3 min read

The fourth stage of labor, the immediate postpartum recovery period, is a critical time when complications are most likely to arise. Understanding what is the nursing care plan for the fourth stage of labor is essential for nurses to provide vigilant care, prevent complications, and promote a healthy transition for the new family.

Quick Summary

A nursing care plan for the fourth stage of labor focuses on frequent maternal assessment, including monitoring vital signs, uterine tone, and lochia, while also prioritizing newborn bonding, pain management, and complication prevention.

Key Points

Frequent Assessments: The nursing plan mandates close monitoring of vital signs, uterine fundus, and lochia every 15-30 minutes during the critical first two hours of recovery.
Hemorrhage Prevention: Vigilant monitoring of uterine tone and bleeding is the primary focus to prevent and detect postpartum hemorrhage, a major risk during this stage.
Fundal Massage: Nurses use fundal massage to help the uterus contract and prevent uterine atony, a key cause of excessive bleeding.
Newborn Bonding: The care plan promotes early skin-to-skin contact and breastfeeding to aid in parent-newborn bonding and promote newborn stability.
Bladder Management: Preventing bladder distention is crucial, as a full bladder can displace the uterus and increase the risk of bleeding.
Pain and Comfort: Providing pain management and emotional support are key components, addressing both physical discomfort and the emotional needs of the new mother.

The Critical Recovery: Understanding the Fourth Stage

The fourth stage of labor, the period immediately following placenta delivery, typically lasts one to four hours. This time is crucial for monitoring both mother and newborn for stability after birth. Nursing care during this stage focuses on preventing and managing complications, particularly postpartum hemorrhage. A comprehensive nursing care plan includes physical assessment, pain management, emotional support, and promoting early family bonding.

Core Components of the Maternal Assessment

Regular and thorough assessment is fundamental to nursing care in the fourth stage.

Monitoring Vital Signs

Vital signs (blood pressure, pulse, respiration) are checked frequently, often every 15 minutes for the first hour and every 30 minutes for the second hour, or per facility protocol. Comparing these to baseline helps identify deviations. Temperature is also monitored.

Fundal and Lochia Assessment

Nurses perform fundal massage to ensure the uterus is firm and contracted, which helps control bleeding. A soft or 'boggy' uterus indicates uterine atony, a risk factor for hemorrhage. The fundus should be midline at or below the umbilicus; displacement can suggest a full bladder. Lochia (vaginal discharge) is assessed for amount, color (initially bright red), consistency, and clots. Large clots are a concern. Quantitative blood loss (QBL) measurements are used for accurate monitoring.

Perineal and Bladder Care

The perineum is checked for swelling, bruising, and hematoma formation. Lacerations or episiotomies are assessed for healing. Postpartum urinary retention is common. A full bladder can impede uterine contraction and increase hemorrhage risk, necessitating assistance with voiding or catheterization.

Essential Care for the Newborn

Newborn care in the fourth stage emphasizes stability and bonding.

Skin-to-Skin Contact: Encouraging immediate skin-to-skin contact between mother and baby promotes bonding, temperature regulation, and breastfeeding initiation.
Breastfeeding Initiation: The fourth stage is ideal for starting breastfeeding, with nurses assisting with positioning and latch. Oxytocin released during breastfeeding aids uterine contraction.
Apgar Scoring: The 5-minute Apgar score is considered as part of the newborn's transition assessment.

Comparison of Key Monitoring Assessments


Assessment Area	Rationale	Normal Findings	Abnormal Findings	Intervention
Vital Signs	To detect early signs of instability, hemorrhage, or shock.	Stable, returning to pre-labor baseline.	Hypotension, tachycardia, tachypnea.	Frequent monitoring, notify provider.
Uterine Fundus	To ensure uterine contraction and prevent hemorrhage.	Firm, midline, at/below umbilicus.	Boggy, soft, displaced from midline.	Fundal massage, assist with voiding.
Lochia	To monitor for excessive bleeding.	Rubra, moderate amount, no large clots.	Excessive bleeding, large clots, foul odor.	Assess QBL, fundal massage, notify provider.
Perineum	To detect swelling, hematoma, or infection.	Minimal edema, no large hematoma.	Severe pain, swelling, expanding hematoma.	Apply ice packs, notify provider.
Bladder	To prevent uterine displacement and atony.	Able to void, non-distended.	Palpable distention, inability to void.	Assist with toileting, catheterize as needed.

Pain Management and Comfort Measures

Nurses provide comfort through pain management for issues like contractions or perineal trauma. Ice packs can help with perineal swelling. Emotional support and a calm environment are vital for the new mother. Education on self-care and rest is also provided.

Conclusion

The nursing care plan for the fourth stage of labor is a comprehensive approach focused on the safety and well-being of both mother and newborn. By diligently monitoring for complications, supporting maternal recovery, and promoting bonding, nurses play a critical role in the immediate postpartum period. This vigilant care is essential for a healthy start for the new family.

For more detailed information on postpartum care and complications, consult authoritative sources such as OpenStax Maternal-Newborn Nursing.

Frequently Asked Questions

The primary goal is to prevent postpartum hemorrhage and monitor for other complications, ensuring the maternal and newborn dyad remains stable during this critical recovery period.

The fundus is checked frequently to assess its tone and position. A firm, contracted fundus helps clamp down on blood vessels to prevent bleeding. A soft or 'boggy' uterus is a sign of uterine atony, a leading cause of postpartum hemorrhage.

Nurses assess lochia for its color (initially bright red), amount, and consistency. They also check for large clots or a foul odor, which could signal complications like infection or excessive bleeding.

A full bladder can prevent the uterus from contracting properly by displacing it upwards. This interference with uterine involution increases the risk of postpartum hemorrhage.

Newborn care includes promoting early skin-to-skin contact with the mother to regulate temperature and encourage bonding. Nurses also assist with the initiation of breastfeeding and perform initial assessments.

Nurses provide comfort through pain management, applying ice packs to the perineum, ensuring a restful environment, and offering emotional support and reassurance to the new parents.

Nurses educate the new parents on self-care, warning signs to watch for, newborn care basics, and the importance of breastfeeding and bonding during this initial period.