Eight hours after a vaginal delivery, the nurse observes the fundus is 2 fingerbreadths above the umbilicus, displaced to the left, with a large amount of lochia rubra on the perineal pad. Which action should the nurse take first?

• A. Begin IV fluids
• B. Assist the client to the toilet
• C. Notify the provider
• D. Apply ice pack to perineum

Answer: (B)

A full bladder is the most likely reason the uterus is high and displaced eight hours after birth. When the bladder is distended, it pushes the uterus up and to the side, interfering with uterine contraction and increasing the risk of ongoing bleeding. The first priority is to empty the bladder to allow the uterus to contract and return to a midline position. So, you would assist the client to the toilet to void. After voiding, reassess the fundus—ideally it should be firm and midline at or below the level of the umbilicus. If the fundus remains boggy or displaced, then proceed with fundal massage and other interventions as needed. Ice packs and IV fluids may help later, but they don’t address the immediate cause of the abnormal fundal position.