In the first six hours, evaluate the mother for the danger signs described below:

• Inadequate uterine contraction: A poorly contracted uterus is a danger sign; consider referral if (after six hours) the uterus is bigger than the normal size at 20 weeks of gestation, and it cannot be felt easily because it is soft in consistency.
• Fresh vaginal bleeding: Some bloody discharge (called lochia) is normal in the immediate postnatal period, but there shouldn't be active bleeding visible with fresh bright-red blood.
• Vital signs unstable or indicating shock: Blood pressure and pulse rate should be normal before you leave the mother. If her blood pressure is dropping and her pulse rate is rising, the woman may be going into shock due to internal bleeding. If the uterus remains enlarged after the birth, and the vital signs indicate shock, it may be due to blood accumulating in the uterus.