The Third and Fourth Stages of Labor

Your job is not quite finished. The placenta still needs to be expelled. The third stage usually lasts from 5 to 30 minutes. The nurse or caregiver keeps a hand on your abdomen to determine when the placenta separates from the wall of your uterus. Then he or she asks you to push it out. You may feel some cramps, but the discomfort is usually very slight.

The Fourth Stage

Immediately after birth, while you hold and admire your new baby, your doctor or midwife focuses on your well-being. The condition of your uterus and vagina is of major concern. It is important that your uterus remain contracted after birth, which keeps it from bleeding as much as when it is relaxed.

Most women lose about one cup of blood at the time of birth. While this may seem like a lot, remember that among the many other changes of pregnancy, your blood supply greatly increased. That excess blood is no longer needed; you lose some of it at the time of birth and continue to lose some over a period of several weeks (this discharge is called lochia). Your caregiver watches the amount of blood lost immediately after birth and, if necessary, takes measures to reduce the blood loss. These may include massaging your uterus vigorously, asking you to lightly stimulate your nipples, or giving you an injection of a medication such as Methergine (methyl-ergonovine) or Pitocin (oxytocin) that causes your uterus to contract.

Your doctor also checks your vagina to see if you need any stitches. If an episiotomy (an incision to make childbirth easier and to avoid tearing of tissues) was performed, you definitely need stitches. Some tearing of the vagina or perineum may also have occurred when the baby was born. Although the idea of tearing sounds rather unpleasant, be assured the tears (or cuts) are usually not serious and heal rapidly. If necessary, your doctor begins stitching within a few minutes after birth. You will receive a local anesthetic for pain relief if you have not already had one.

Childbirth is a natural process. Although labor may sound frightening and painful, it can be managed without complications and with wonderful results.