A client is 5 hours postpartum and has completely saturated a perineal pad within 15 minutes. What is the priority nursing action?

• A. Massage the client's fundus
• B. Call the provider immediately
• C. Administer more oxytocin without assessment
• D. Empty the bladder

Answer: (A)

The priority is to treat potential postpartum hemorrhage from uterine atony by stimulating the uterus to contract. A completely soaked pad within 15 minutes five hours after birth signals heavy bleeding likely caused by a boggy, noncontracting uterus. Massaging the fundus firmly helps the uterus contract, which compresses bleeding vessels and reduces blood loss. While you massaged, you would also check that the uterus is midline and assess for bladder distention, but the immediate move to firm the uterus comes first. After achieving a firm fundus, reassess bleeding and vital signs, and follow protocol for any further treatment (such as uterotonics) if bleeding continues.