A multiparous client who delivered an 8-lb 7-oz infant 4 hours ago has a completely saturated perineal pad within 15 minutes. What action should the nurse implement next?

• A. Perform fundal massage.
• B. Assess blood pressure.
• C. Notify the healthcare provider.
• D. Encourage the client to void.

Answer: (A)

A saturated pad within minutes after delivery points to postpartum hemorrhage from uterine atony, where the uterus isn’t contracting well enough to close off the placental vessels. The immediate action is fundal massage because massaging the fundus stimulates the myometrium to contract, which helps firm the uterus and compress the bleeding vessels. As you massage, you’re checking and improving tone, guiding the uterus to a firm, midline position, which often slows or stops the hemorrhage.

After achieving a firm uterus, continue to monitor bleeding and vital signs, and reassess the uterus frequently. If bleeding persists despite a firm uterus, escalate per protocol by notifying the provider and initiating additional hemorrhage-control measures. It’s also important to ensure the bladder isn’t distended, since a full bladder can impede contraction, but it doesn’t replace the need for fundal massage in this urgent situation.