1. Getting Ready for OB Clinicals: Postpartum Physical Assessment

2. 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…..

3. BUBBLE-HE Breasts/nipples Uterus Bladder Bowels Lochia Episiotomy
-Homan’s Sign
-Emotional/bonding

4. 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

5. 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?
(fundus the umbilicus)
-ff u/2 (fundus firm 2cm below umbilicus)
-ff 1/u (fundus firm 1cm above umbilicus)

6. Uterine Involution (Returning to Pre-pregnancy State)

7. Fundal Massage

8. Fundal Assessment

9. 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

10. 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

11. 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

12. 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!

13. Assessing Lochia Amount

14. 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)

15. Assessing the Perineum

16. 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

17. 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)

18. 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

19. 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