Postpartum

Postpartum assessment uses the BUBBLE-HE framework to systematically evaluate the physiological and psychological transition following delivery. Breasts are assessed for engorgement, nipple integrity, colostrum or milk production, and breastfeeding latch. Uterus is assessed for involution (the fundus should be firm, midline, and descend approximately one fingerbreadth per day from the umbilicus to below the symphysis pubis over 10-14 days; a boggy uterus indicates uterine atony and risk of postpartum hemorrhage). Bladder function is assessed (urinary retention is common after epidural anesthesia and can displace the uterus and impair involution). Bowel function is monitored (constipation risk from iron supplements, opioid analgesics, dehydration, and perineal pain). Lochia follows a predictable pattern: rubra (red, days 1-3), serosa (pink-brown, days 4-10), alba (white-yellow, days 11-28); foul-smelling lochia or return to rubra after serosa suggests endometritis. Episiotomy and laceration repair are assessed using REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation). Homan sign and lower extremity assessment screen for DVT. Emotional status screens for postpartum mood disorders using the Edinburgh Postnatal Depression Scale. The nurse performs BUBBLE-HE assessments at standardized intervals, performs fundal massage for uterine atony,...