The next hour is called the fourth stage of labor. If all goes well, during this time you should be getting to know your new baby. But your doctor or midwife will also want to repair any tears or your episiotomy, if you've had one, and monitor you and your baby closely to make sure you're both recovering well.

Repairing Tears and Episiotomies

During this time, your doctor or midwife will inspect your vulva, vagina, and perineum (the muscles and tissue between the vagina and anus) for tearing. If you've had an episiotomy or have a tear that requires stitching, it will be repaired now. Usually, you'll be given a shot of a local anesthetic before the stitches. You may be completely numb or you may feel some discomfort or pain depending on how extensive the tear or episiotomy and how sensitive the area.

Stitching usually takes anywhere from five to fifteen minutes. In teaching hospitals, the job of suturing a tear or episiotomy is often given to a student for practice, but this will make the stitching last longer. The first hour of your baby's life is precious time for you. If you would rather use it for getting to know him or her instead of sitting through a lengthy suturing job, you are within your rights and perfectly within reason to ask your doctor or midwife to do it instead. Or you can ask to hold your baby while you're stitched, which will make a nice distraction.

No Stitches Required

Tears are often minor enough that they don't need stitching at all. Your doctor or midwife may tell you that you have a “skid mark,” which is a minor abrasion that won't need stitches, though it may sting for a while, especially when you use the bathroom.

Bleeding

Your bleeding will be carefully monitored during this first hour. In order to help your uterus contract, a care provider will massage your uterus through your belly and may watch to see how much blood comes out when your uterus contracts. This may be uncomfortable or painful if your nurse is very rough with the massage. Ask for a gentler touch if you are in pain. You can keep it “rubbed up” yourself, and keeping the baby on your chest, skin to skin, even if she isn't nursing yet, will help keep your uterus firmly contracted. This decreases your bleeding and the need for the nurses to intervene.

The gushes of blood that come out during these early contractions can feel alarming, but you're usually not losing nearly as much blood as it feels like. Remember, while you were pregnant, your blood volume increased by about a factor of one half. Your body no longer needs that extra blood volume, so you can lose what might seem like a lot of blood before it becomes worrisome, and your care provider will watch your bleeding carefully, especially during the first few hours. Don't hesitate to tell your care providers anyway if you feel at all concerned.

The blood and tissue left over from pregnancy is called lochia. For the first few hours after giving birth, you can expect what seems like a lot of bright red lochia, and it may contain pieces of tissue and blood clots, which are sometimes quite large. A nurse or other caregiver may place a pad directly at your perineum to catch lochia, and you'll sit or lay on absorbent pads to soak up any extra that may spill over. For the first day after birth, sudden movement, standing up, sitting, or breastfeeding may allow lochia that's pooled in your vagina to come out all at once, so it's not unusual to feel a gush when you sit, stand, or walk. Your uterus will continue to discharge lochia for weeks after delivery. It will gradually change from red to pink, then brown, yellow, and finally white.

After your doctor or midwife checks for tearing, does any necessary repair work, checks the size and position of your uterus, and monitors your bleeding, a nurse or midwife will clean your perineal area and the insides of your legs with warm water. Someone may place an ice pack on your perineum, and you can change into a comfy gown or pajamas if your birthing clothes got messy. Ask for help while changing in case you get dizzy.