A postpartum patient has heavy vaginal bleeding with a soft, non-tender uterus that does not firm with massage. What is the next nursing action?

• A. Massage the uterus and reassess in 30 minutes.
• B. Notify the provider, prepare for uterotonic meds, obtain IV access, monitor vital signs, and continue massage.
• C. Apply cold packs to the abdomen and rest.
• D. Provide analgesia and discharge instructions.

Answer: (B)

This situation shows postpartum hemorrhage due to uterine atony—the uterus remains soft and does not firm with massage, so bleeding continues despite initial stimulation. The goal now is to restore uterine tone quickly and control the bleeding by starting pharmacologic contractions and supporting the patient.

The best action is to notify the provider and prepare for uterotonic medications, while obtaining IV access, monitoring vital signs, and continuing fundal massage. Uterotonic drugs (like oxytocin and other agents) help the uterus contract to compress vessels and reduce bleeding. Establishing IV access early ensures fluids or blood products can be given as needed, and continuous vital signs monitoring helps detect progression to shock so timely interventions can occur. Keeping up the massage while these measures take effect supports immediate uterine contraction.

Other steps like applying cold packs, rest, or simply giving analgesia and discharge instructions do not address the ongoing hemorrhage or stabilize the patient. Waiting 30 minutes after massage delays potentially life-saving treatment.