Getting Ready for OB Clinicals:

Postpartum Physical Assessment

Remember…..

when assessing a maternity patient, you

complete a regular head-to-toe
assessment (cardiac, resp, GI, etc) but
then make it maternity-focused. That
means you add the elements covered
under BUBBLE-HE…..
 BUBBLE-HE
• Breasts/nipples
• Uterus
• Bladder
• Bowels
• Lochia
• Episiotomy
-Homan’s Sign
-Emotional/bonding
 BUBBLE-HE
• B: Breasts and Nipples
– Bottle-feeding or nursing?
• If bottle-feeding, have patient wear a
supportive bra 24/7 to prevent milk from
coming in (engorgement)
– Assess breasts
• Soft, engorged, filling, tender/non-tender,
any tissue breakdown, blood blisters
 BUBBLE-HE
• U: Uterus

– 1) Tone: firm or boggy (squishy/spongy)?

– 2) Location:
• i) Is the fundus midline or does it deviate to
the right or left (due to a full bladder)?
• ii) Where is the fundus in relation to the
umbilicus?
-ff @u (fundus firm @ the umbilicus)
-ff u/2 (fundus firm 2cm below umbilicus)
-ff 1/u (fundus firm 1cm above umbilicus)
 Uterine Involution
(Returning to Pre-pregnancy State)
Fundal Massage
Fundal Assessment
Remember….
• When assessing the fundus:
– Ensure pt.’s bladder is empty
– Ensure the bed is lowered
– Ensure the head of the bed is flat
– Ensure the patient is lying supine on
the bed with her knees bent
– The lower uterus must be stabilized
with one hand before the fundus can
be assessed correctly with the other
– Always look at the amount of lochia
expressed with fundal massage
– Wear gloves
 BUBBLE-HE
• B: Bladder
– Able to void spontaneously within 6-8 hours
of vaginal birth? Epidurals commonly cause
urinary retention
– Assess for frequency, burning or urgency
(UTI?)
– Bladder distention
• A full bladder displaces the uterus,
prevents involution (contraction of the
uterus) and puts the patient at great risk
for hemorrhage
• May require catheterization
 BUBBLE-HE

• B: Bowels
– Active bowel sounds in all four quadrants
– Bowel movement
– Flatus (in C-Section patients)
– Assess C-section incision site:
• REEDA
– Redness
– Edema or swelling
– Ecchymosis or bruising
– Drainage
– Approximation of wound edges
 BUBBLE-HE

• L: Lochia
– Color (lochia rubra, serosa, alba)
• Rubra is dark red, sanginous
• Serosa is pink, sero-sanginous
• Alba is a creamy, yellowish discharge
– Amount (scant, light, moderate, heavy)
– Odor: infection?
– C/section patients usually have less lochia.
This is normal
– C-section fundal assessments are gentle.
Otherwise very painful for the patient!
Assessing Lochia Amount
 BUBBLE-HE
• E: Episiotomy
– Assess entire perineum (area from
the opening of vagina to the rectum)
– Perineum may be intact, lacerated or
required an episiotomy
– Assess the episiotomy using:
• REEDA
– Redness
– Edema or swelling
– Ecchymosis or bruising
– Drainage
– Approximation (of laceration/episiotomy)
Assessing the Perineum
Proper Technique for
Assessing the Perineum
• Wear gloves
• Have patient lie on her side; have her
turn away from you
• Have her lift her top leg
• This will provide an unobstructed view of
the entire perineum (vagina to rectum)
• Be sure to assess for hemorrhoids also
• Commonly develop as a result of
pushing in L&D
BUBBLE-HE

• H: Homan’s Sign
– Dorsiflex the foot
– Assess for sharp, knife-like pain in the calf
area
– If present, also assess pedal pulses,
diameter, edema, warmth, redness and
inflammation
– Advise patient not to get out of bed; report
to attending physician. Anticipate orders
(ultrasound/MRI/CT/venography)
BUBBLE-HE
• E: Emotional
– Determine emotional status
• Normal “baby blues”

– Bonding
• Interacting appropriately with baby?
• Providing infant care?

– Evidence of postpartum blues or depression?

• Report to MD and anticipate a referral to social
work/psych
 Assessment Videos

• Visit the Canvas course (OB

section) to locate the link to
Youtube videos demonstrating
newborn and maternity patient
head-to-toe physical
assessments