Stage III of labor begins with the birth of the baby and is completed with placental separation and expulsion. Lasting anywhere from 1–30 min, with an average length of 3–4 min in the nullipara, and 4–5 min in the multipara, this stage is the shortest. Careful management and monitoring are necessary, however, to prevent short- and long-term negative outcomes.
CLIENT ASSESSMENT DATA BASE
Activity/Rest
Behaviors may range from excitement to fatigue.
Circulation
BP increases as cardiac output increases; then returns to normal levels shortly thereafter.
Hypotension may occur in response to analgesics and anesthetics.
Pulse rate slows in response to change in cardiac output.
Food/Fluid
Normal blood loss is <500 ml.
Pain/Discomfort
May complain of leg/body tremors/chills, leg cramps
Safety
Manual inspection of uterus and birth canal determines presence of tears or lacerations.
Extension of the episiotomy or birth canal lacerations may be present.
Sexuality
Dark vaginal bleeding beginning as a trickle occurs as the placenta separates from the endometrium, usually within 1–5 min after delivery of the infant.
Umbilical cord lengthens at vaginal introitus.
Uterus changes from discoid to globular shape and rises in abdomen.
NURSING PRIORITIES
1. Promote uterine contractility.
2. Maintain circulating fluid volume.
3. Promote maternal and newborn safety.
4. Support parental-infant interaction.
CLIENT ASSESSMENT DATA BASE
Activity/Rest
Behaviors may range from excitement to fatigue.
Circulation
BP increases as cardiac output increases; then returns to normal levels shortly thereafter.
Hypotension may occur in response to analgesics and anesthetics.
Pulse rate slows in response to change in cardiac output.
Food/Fluid
Normal blood loss is <500 ml.
Pain/Discomfort
May complain of leg/body tremors/chills, leg cramps
Safety
Manual inspection of uterus and birth canal determines presence of tears or lacerations.
Extension of the episiotomy or birth canal lacerations may be present.
Sexuality
Dark vaginal bleeding beginning as a trickle occurs as the placenta separates from the endometrium, usually within 1–5 min after delivery of the infant.
Umbilical cord lengthens at vaginal introitus.
Uterus changes from discoid to globular shape and rises in abdomen.
NURSING PRIORITIES
1. Promote uterine contractility.
2. Maintain circulating fluid volume.
3. Promote maternal and newborn safety.
4. Support parental-infant interaction.
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