Which nursing intervention is the priority during the fourth stage of labor?

• A. Promote bonding.
• B. Assess for hemorrhage.
• C. Provide comfort measures.
• D. Monitor uterine contractions.

Answer: (B)

Detecting postpartum hemorrhage early is the top priority in the fourth stage of labor. In the immediate postpartum period, the leading danger is uterine atony and bleeding from placental sites, so the nurse focuses on assessing the uterus and the bleeding pattern. This means checking the fundus for firmness and midline position, assessing the amount and rate of lochia, and monitoring maternal vital signs for signs of shock. If the uterus is boggy, continuous fundal massage and prompt administration of any prescribed uterotonic agents are essential to stop the bleeding. Ongoing assessment helps catch hemorrhage before it becomes life-threatening.

Bonding with the newborn and providing comfort are important for the mother–infant relationship and overall recovery, but they do not address the immediate, potentially life-threatening risk in this stage. Watching for uterine contractions is part of postpartum care, but the critical concern is ensuring the uterus contracts adequately and preventing hemorrhage.