Which action should the nurse implement first after notifying the provider during postpartum hemorrhage?

• A. Place the client in a lateral position with legs elevated
• B. Massage the fundus
• C. Administer oxytocin with IV fluids
• D. Insert an indwelling urinary catheter.

Answer: (B)

Uterine atony is the most common cause of postpartum hemorrhage, so the immediate goal is to stimulate the uterus to contract and clamp down on bleeding. Fundal massage directly promotes contraction, helps express clots, and firms the uterus to reduce ongoing blood loss. This action addresses the underlying problem right away, which is why it’s the first step after notifying the provider. Other measures like placing the patient in a left-side position, emptying the bladder with a catheter, or starting uterotonic meds (oxytocin with IV fluids) are important and typically follow or occur in parallel with massage, but they don’t stop the bleeding as quickly as initiating fundal massage.