POST PARTUM ASSESSMENT  Often when mothers feel their “milk has come in”
(engorgement)-occurs between birth to 5 to 10 days
Introduction: The postpartum nursing assessment is an
important aspect of care in order to identify early signs of
complications in the woman who has just given birth. Following
pregnancy, the woman is at risk for infection, hemorrhage, and
the development of a Deep Vein Thrombosis (DVT). The nurse
can remember the key points of a postpartum assessment by
learning the acronym BUBBLE-HE, which stands for breasts,
uterus, bladder, bowels, episiotomy, lower extremities, and
emotions.
Purposes:
1.To identify post partum clients who are at risk after their
child’s delivery.
2.To promote and maintain the health of the woman during
post partum period.
The abbreviation BUBBLE-HE is used to recall the
components of the post partum assessment. The post partum
phase lasts from the moment of birth to around 6 weeks after
delivery.
B- BREASTS
U- UTERUS
B- BOWEL
B- BLADDER
L-LOCHIA
E- EPISIORAPHY
H-HOMAN’S SIGN
E- EMOTIONAL STATUS
1.Lactation
 Driven by hormones from the hypothalamus to the
pituitary gland in order to secrete the lactation
hormones
 This is identified by four phases of lactogenesis
(human milk production)
FOUR PHASES:
LACTOGENESIS 1 – milk synthesis
 Begins around 16 weeks gestation as the glandular
luminal cells in the breast begin to secreting
colostrum (thin, watery prelactation secretion)
LACTOGENESIS II
 Triggered at birth by the delivery of the placenta,
when the progesterone (prolactin is no longer
inhibited) and other circulating pregnancy hormones
suddenly decrease and oxytocin sharply increases as
a result of the infant sucking.
postpartum; termed as “transitional milk”
LACTOGENESIS III
 occur from day 10 until weaning postpartum
 When the “mature milk” supply is driven by the
circulating lactation hormones oxytocin and
progesterone
LACTOGENESIS IV
 Occurs after complete weaning and the breasts
involute to their prelactation state
• Breast milk forms in response to the decrease in
estrogen, and progesterone levels that follows
delivery of the placenta
• This stimulates prolactin production and milk
production and an increase in prolactin and oxytocin
• Signs and symptoms: breasts become fuller, larger
and firmer as blood and lymph enter the area to
contribute fluid to the formation of milk
 Breasts distention, engorgement with feeling of heat
or tenderness
 Engorgement phase: the breast tissue appear
reddened- 3rd or 4th day after birth- primary
engorgement
 Fades when infant begins effective latching and
begins transferring colostrum followed by milk from
the breasts
Position of the Client: Sitting or Supine Position
Method of Assessment: Inspection and Palpation
A. INSPECTION
 Involves using the senses of vision, smell, and
hearing to observe and detect any normal or
abnormal findings
 Used from the moment the client is seen by the nurse
and continues throughout the examination
• Guidelines for Inspection:
1.Make sure the room is at comfortable temperature
2.Use good lighting: preferably sunlight
3.Look and observe before touching. Touch can alter
appearance and distract you from a complete, focused
observation
4. Completely exposed the body parts you are inspecting while
draping the rest of the client as appropriate
Supine Position:
 Ask client to lie down with the legs together on the
examination table
  Place a small pillow under the head to promote
comfort
5. Note the following characteristics: symmetry, presence of
discharges from the nipple and pain upon palpation
B.PALPATION
 Consists of using parts of the hand to touch and feel
for the following characteristics:
 Note the following characteristics:
• Consistency: soft/hard
• Temperature: warm/cold
• Tenderness upon palpation
Reminders:
1.examiner’s fingernails should be short and the hands should
be at comfortable temperature
2. Standard precautions should be followed if applicable
3. Proceed from light palpation, which is safest and the most
comfortable for the client, to moderate palpation and finally to
deep palpation
4.Use light palpation-there should be very little or no
depression: less than 1 cm.
U- UTERUS
 Time involution is complete (6 weeks)- wt: 50g
 The uterus of a breastfeeding mother may contract
more quickly because oxytocin stimulates uterine
contractions
Position of the Client: Dorsal recumbent position
 Client lies down on the examination table or bed with
the knees bent, the legs separated and the feet flat on
the table or bed.
Method of Assessment: Inspection and Palpation
 Inspection: Involves using the senses of vision, smell
to observe and detect any normal or abnormal
findings
 Note the following characteristics: symmetry, uterine
contour
 Consistency of the postpartal uterus- well contracted
fundus feels so firm
• If soft and boggy in the first hour after delivery-
uterine atony-post partum bleeding
Nursing Mgt: assess the bladder, massage the uterus, apply
cold compress over the abdomen, check the vital signs,
administer Oxygen, notify the physician.
B- BOWEL
 Digestion and absorption begin to be active again
soon after delivery unless the woman has had a
cesarean delivery
 Hemorrhoids (distended rectal vein) that has been
pushed of the rectum during pregnancy may be
present
 Bowel sounds are active but passage of stool may be
slow because of the still-present effect of relaxin ( a
hormone which softens and lengthens the cervix and
pubic –symphysis for preparation of the infant’s birth
Management:
> Advice the woman to eat high fiber diet and increase fluid
intake
B- BLADDER
 During pregnancy- 2,000-3,000ml of excess fluid
accumulates in the body so extensive diaphoresis
(excessive sweating) and diuresis (excess urine
production) begin almost immediately after birth to
rid the body of this fluid.
 Daily urine output-from a normal level of 1,500 to as
much as 3,000ml/day during the 2nd to 5th day after
birth
 This marked increase in urine production causes the
bladder to fill rapidly.
 Advice:
• reassure the mother that this is normal
• Instruct the mother to continue to drink a healthy
amount of fluids daily especially if she is
breastfeeding
L-LOCHIA
> Lochia is vaginal discharge after childbirth. It consists of
blood, mucus, uterine tissue and other materials from the
uterus. 
Lochia rubra
is the term for the first stage of lochia
* 3-4 days vaginal bleeding
* Dark or bright red blood. Lasts for three to four days. Flows
like a heavy period. Small clots are normal. Mild, period-like
cramping
Lochia serosa
is the term for the second stage of lochia.  4-6 days vaginal
bleeding
• Pinkish brown discharge that's less bloody looking.
Thinner and more watery than lochia rubra.
• Lasts for four to 12 days
Lochia alba
the last stage of lochia
• Yellowish white discharge.
• Little to no blood.
 • Light flow or spotting.  Client lies on his/her right or left side with the lower
arm placed behind the body and the upper arm flexed
• Lasts from about 12 days to six weeks. at the shoulder and elbow
• No clots.  The lower leg is slightly flexed at the knee while the
upper leg is flexed at a sharper angle and pulled
forward

 The REEDA scale is a tool that assesses the

inflammatory process and tissue healing in the
perineal trauma, through the evaluation of five items
of healing: redness (hyperaemia), edema,
ecchymosis, discharge and approximation of the
wound edges (coaptation).

R- EDNESS

E- EDEMA

E- CCHYMOSIS

D- DISCHARGE

A- APPROXIMATION OF THE
WOUND
EDGES/STITCHES

 In an episiotomy, the perineum is incised with scissors

or a scalpel as the infant’s head is crowning.

 Two types of episiotomy have been described: midline

(median) and mediolateral (see the image
below). Generally, midline episiotomies are more
commonly performed in the United States, whereas
mediolateral episiotomies are more common in
other parts of the world.

H-HOMAN’S SIGN

-is often used in the diagnosis of deep venous

thrombosis of the leg. 
E- EPISIORRHAPHY
 A positive Homans's sign (calf pain at dorsiflexion of
> surgical repair of injury to the vulva by suturing. the foot) is thought to be associated with the presence
• episiotomy- a surgical cut made at the opening of the of thrombosis.
vagina during childbirth, to aid a difficult delivery and
prevent rupture of tissues.

Position of the client: Sims’ Position

E- EMOTIONAL STATUS

Phases of the Puerperium

a.Taking-in phase

 2 to 3 days postpartum

 Woman is dependent and largely passive

b.Taking-hold phase

> 3 days to 2 weeks

> Woman initiates actions and makes her own decisions

c.Letting-go phase

> Varied time frame

> Woman redefines her new role

 Bed
 Pillow
 Top linen
 Stethoscope
 70% alcohol
 Source of light/drop light
 Pair of gloves
 BP apparatus
 Thermometer