A multiparous client is postpartum after rapid labor and birth. The fundus is boggy, lochia is heavy, and vital signs are unchanged. After voiding and uterine massage, the fundus remains difficult to locate and lochia remains heavy. What action should the nurse implement next?

• A. Notify the healthcare provider.
• B. Recheck the client’s vital signs.
• C. Insert an indwelling urinary catheter.
• D. Massage the fundus in 30 minutes.

Answer: (A)

Postpartum hemorrhage from uterine atony is the concern here. When the uterus is boggy and lochia is heavy after birth, the uterus isn’t contracting well enough to compress blood vessels, leading to ongoing bleeding. Even after voiding and attempting massage, if the fundus cannot be located and bleeding remains heavy, this signals a potentially developing or established hemorrhage that needs rapid escalation. The next step is to notify the healthcare provider immediately so orders can be given to initiate hemorrhage management—this may include additional uterotonic medications, securing IV access for fluids or blood products, and preparing for further interventions if the bleeding cannot be controlled. Rechecking vitals or delaying for another fundal massage would not address the ongoing bleed, and bladder catheterization or simply waiting 30 minutes would not be appropriate in this time-critical situation.