Postpartum

BUBBLE-HE is useful only when it helps the nurse notice deterioration. It is not a substitute for looking at the patient first. Begin with appearance, vital signs, pain, respiratory effort, level of consciousness, and the amount of vaginal bleeding. A patient who is pale, dizzy, tachycardic, hypotensive, or increasingly weak may be developing significant blood loss even before the fundal assessment is complete. Call for help, quantify the blood loss, reassess vital signs, and follow the postpartum-haemorrhage protocol while correcting the likely cause. The World Health Organization (WHO, 2022) recommends that every postpartum woman have regular assessment of vaginal bleeding, uterine tonus, fundal height, temperature and pulse during the first 24 hours, starting from the first hour after birth. Blood pressure should be measured shortly after birth; if it is normal, a second measurement should be taken within 6 hours. A void should be documented within 6 hours. This is an international minimum, not a Canadian schedule: the exact frequency and escalation pathway vary by setting, so follow the local postpartum protocol (many Canadian units use an obstetric early-warning tool)...