Stage 4: Recovery/Postpartum Stage

Timeframe

First 1–2 hours after placenta delivery.

What You See

• Uterus should be firm, midline, at/near umbilicus.

• Lochia rubra (moderate bleeding, no large clots).

• Maternal shaking/chills common.

• Risk for hemorrhage is highest here.

Nursing Care

• Fundal massage, monitor uterine tone.

• Monitor VS, bleeding, bladder.

• Encourage bonding and breastfeeding.

• Administer meds as ordered (oxytocin, pain meds).

What is the greatest risk?

Hemorrhage risk

Newborn Assessment

• Posture: Flexed preferred.

• Vital signs, temperature (axillary).

• Bonding and breastfeeding (skin-to-skin).

• Eye prophylaxis: erythromycin.

• Vitamin K injection (clotting factors).

• Hepatitis B vaccine.

Maternal Assessment

• Vital signs.

• Fundal position: Firm, midline, at or near umbilicus.

• Lochia: Amount, color, clots.

• Bladder: encourage urination or straight cath if needed.

• Perineum: assess for tears, lacerations, swelling.

• Monitor for anesthesia recovery (activity, movement, BP, LOC, sensation).

• C-section site: redness, edema, ecchymosis, drainage, approximation.