resting after birth

Fourth Stage

Now that you are aware of the events of the third stage, you may not even notice the fourth stage of labour. Seeing, smelling and touching your baby and offering the breast will stimulate the flow of oxytocin. This hormone is responsible for your contractions and bonding with your baby.  The contractions (or afterpains) help your placenta to separate from your uterine wall.

These afterpains also help to keep your uterus contracted and in doing so, help to control your bleeding after birth. You may feel a bit shaky thanks to the adrenaline rush and the adjustments your body starts to make immediately, or you may simply be on a high.

All the exhaustion you felt during your birth temporarily disappears, and you couldn’t sleep if you tried. Many women are hungry and ready to eat; others want to share the fantastic news via phone, Facebook or Instagram. However, the birth of your placenta marks the beginning of the very important but little known fourth stage of labour.

During these vital first hours after the baby is born, both of you are at the highest risk of complications related to the birth. It is also the time where the necessary process of bonding and the initiation of feeding starts. This stage is so crucial that you are fully supported by a health care provider (e.g. a midwife) until you are stable. We will then transfer you to postnatal care, or send you home on an early discharge plan.

Postpartum Haemorrhage

A postpartum haemorrhage (PPH) is a loss of blood of 500mls or more in the first 24 hours after the birth of your baby. It remains one of the biggest dangers to birthing women around the world. While modern medicine is beneficial and efficient at managing PPH, not all women have access to these drugs or trained birth attendants.

While skilled birth attendants are aware of the possibilities and the observation necessary to manage it, they are also mindful of your need for quiet time. This quiet time is vital to support your body in its efforts to adjust after birth. These efforts include your uterus contracting down due to the oxytocin that skin to skin and early breastfeeding provides.

Interruption and excitement can result in extra adrenaline, a hormone which blocks the action of oxytocin. Your midwife will regularly check your blood pressure and heart rate, feel your tummy to make sure your uterus is well-contracted. They will also check how much blood you are losing down below. If your uterus does not feel firm, she may need to rub your uterus. While you are very sore and it is quite painful it is necessary and the lesser of two evils. If your uterus does not respond to this massage, other measures such as drugs may be required to stop your bleeding.

Skin-to-skin contact in the fourth stage

Touch is incredibly important for babies, and skin-to-skin contact is an essential first step for your baby’s adaptation to the outside world. This transition support is the reason we encourage skin to skin with your baby as soon as possible after she is born. This skin-to-skin contact helps you and your baby to bond. It also regulates her temperature, blood sugar levels and her breathing.

In addition to all these necessary physical functions, most babies love to be touched. It’s a critical part of their emotional growth and development. This time is also vital for your new family. We know your parents, siblings and friends all want to meet your new addition. However, please keep in mind that the birthing process is not over until after the fourth stage of labour is complete, and you are both stable. Bringing others into the birth space too soon can compromise the health of both you and your baby.

Bonding with your baby

First, they grow in you, and then they grow on you!

Child experts describe bonding as the intense feelings of attachment you develop for your baby. For some parents, this can happen as soon as they are born. The love and affection you feel may be all-consuming. Nature has instilled the instinct to care for and protect for your baby to have all his needs met.

However, it doesn’t always kick in early. For some, the bond is instant; for others, it can take days or even weeks. Sometimes this is due to factors around your pregnancy. Sometimes they can be factors from your birth experience. Bonding is a very individual experience, so don’t worry or feel guilty if you aren’t feeling what others perhaps expect you to be feeling.

For more information on the fourth stage of labour, please click here.

Dr Janelle McAlpine (PhD) Clinical Midwife
Photo by ChameloensEye used under license from