Postpartum Recovery & Hemorrhage

Postpartum assessment follows a consistent pattern, often remembered with the mnemonic BUBBLE-HE (breasts, uterus, bladder, bowel, lochia, episiotomy/perineum, homans/legs, emotional status). The uterine fundus should be firm and midline, at approximately the level of the umbilicus right after delivery, descending roughly one fingerbreadth per day — a boggy (soft) fundus is the hallmark finding of uterine atony, the most common cause of postpartum hemorrhage, and the priority nursing action is fundal massage, since a relaxed uterus can't compress the blood vessels at the former placental site to control bleeding. Lochia (postpartum vaginal discharge) progresses in a predictable pattern — lochia rubra (red, days 1–3), lochia serosa (pink/brown, days 4–10), lochia alba (white/yellow, up to 4–6 weeks) — and a return to bright red bleeding after it has progressed past rubra, or lochia with a foul odor, are both findings that need to be reported.