After epidural anesthesia during labor, forceps delivery after pushing, and a hematoma verified at 6 hours postpartum, the nurse, after notifying the health care provider, would immediately plan to:

• A. Reassure the client
• B. Apply perineal pressure
• C. Prepare the client for surgery
• D. Monitor fundal height

Answer: (C)

Postpartum hematomas that are large or expanding require urgent surgical management to evacuate the collected blood and achieve hemostasis. In this scenario, after forceps delivery and with an epidural in place, a hematoma by six hours postpartum signals ongoing bleeding that cannot be reliably controlled with local measures alone. Once the health care provider is alerted, the immediate plan is to prepare the client for surgery so the hematoma can be evacuated and the bleeding source addressed directly. This definitive intervention prevents continued blood loss and potential shock. Reassuring the client, applying perineal pressure, or monitoring fundal height would not stop the hemorrhage from the hematoma or address the actual source of bleeding.