The fourth stage of labor is the roughly two to three hours immediately after you deliver the placenta. While many people only hear about three stages of labor, some experts recognize this recovery window as its own distinct phase because so much is happening: your uterus is clamping down to stop bleeding, your care team is watching for complications, and you’re meeting your baby for the first time. It’s a critical transition period for both your body and your newborn.
What Happens in Your Body
As soon as the placenta separates from the uterine wall, your uterus begins contracting again. These contractions squeeze the blood vessels at the site where the placenta was attached, reducing blood flow and preventing excessive bleeding. You can actually feel these contractions as cramping, sometimes called “afterpains,” which range from mild to surprisingly intense.
This process, called involution, is your uterus starting its weeks-long journey back to its pre-pregnancy size. It gets a boost from oxytocin, the same hormone involved in labor contractions. Breastfeeding or nipple stimulation triggers oxytocin release, which is one reason skin-to-skin contact and early nursing are encouraged right after birth. In one study comparing early breastfeeding initiation to delayed feeding, the early group lost roughly 100 milliliters less blood on average. Your care team may also give you a synthetic form of oxytocin through an IV to help your uterus stay firm.
What You Might Feel
The minutes after delivery can bring some unexpected physical sensations. Many women experience intense, uncontrollable shivering almost immediately after birth. The exact cause isn’t fully understood, but it likely relates to fluid loss, heat loss, and the sudden hormonal shift that occurs once the baby and placenta are delivered. These postpartum chills are normal and typically pass within an hour. If the shivering is accompanied by deep, flu-like aching, that could signal a fever and possible infection, so it’s worth mentioning to whoever is caring for you.
You’ll also begin passing lochia, a vaginal discharge made up of blood, tissue, and mucus from the healing uterine lining. In the first hours and days, this discharge (called lochia rubra) is dark or bright red and flows like a heavy period. Soaking one thick maxi pad every two to three hours is typical. Small clots, smaller than a quarter, are normal too.
What Your Care Team Is Monitoring
The fourth stage is when the risk of postpartum hemorrhage is highest. Postpartum hemorrhage is defined as total blood loss greater than about one liter after delivery, or any blood loss that causes a significant drop in blood pressure or spike in heart rate. Your nurses will check your vital signs frequently, feel your abdomen to make sure the uterus stays firm, and keep track of how much you’re bleeding by counting or weighing blood-soaked pads.
Your bladder also gets close attention during this window. Labor can displace the bladder and stretch the urethra, and if you had an epidural or other anesthesia, the numbing effect can reduce your ability to sense when your bladder is full. A full bladder pushes against the uterus and can prevent it from contracting properly, which increases bleeding. Signs of a distended bladder include the uterus shifting to one side (usually the right), sitting higher than expected on the abdomen, and heavier-than-normal discharge. You’ll be encouraged to urinate as soon as possible after delivery, even if you don’t feel the urge.
If you had any tearing during delivery, or if an episiotomy was performed, this is also when repair happens. Your care team will do a thorough visual and physical exam of the vaginal and perineal area to assess whether stitches are needed and how deep the tear extends. Minor, first-degree tears that aren’t actively bleeding may not need sutures at all.
Warning Signs of Abnormal Bleeding
Some bleeding is completely expected, but certain patterns warrant immediate attention. Watch for soaking through a pad every hour (rather than every two to three hours), passing clots the size of a golf ball or larger, or discharge that has a greenish color or foul smell. Dizziness, feeling faint, worsening pelvic pain, or fever and chills that feel like the flu are also red flags.
Lochia rubra normally lasts three to four days, then gradually lightens in color and volume over the following weeks. If you’re still passing bright red, heavy discharge more than a week after delivery, it could mean the uterus isn’t shrinking the way it should.
Bonding and Early Breastfeeding
Beyond the medical monitoring, the fourth stage is when most parents have their first real chance to hold and connect with their baby. Skin-to-skin contact, where the baby is placed directly on your bare chest, helps regulate the newborn’s temperature and heart rate while stimulating your oxytocin production. This creates a feedback loop: holding and nursing your baby triggers the very hormone that helps your uterus contract and reduces your bleeding risk.
Most babies are alert and ready to attempt their first latch within the first hour or two after birth. This early feeding window matters for establishing breastfeeding, but it also has a direct physiological benefit for your recovery. Even if breastfeeding doesn’t go smoothly right away, the skin contact and nipple stimulation alone contribute to the hormonal signals that support uterine contraction.