If the postpartum fundus is soft and boggy, what is the most appropriate initial nursing intervention?

• A. Massage the fundus until it is firm
• B. Elevate the mother's legs
• C. Push on the uterus to express clots
• D. Encourage the mother to void

Answer: (A)

Dropping after delivery fundal tone into a soft, boggy state signals uterine atony, meaning the uterus isn’t contracting well enough to compress the blood vessels at the placental site. The most appropriate initial intervention is fundal massage. Gently place one hand at the fundus and rub in a circular motion with the other hand, continuing until the uterus firms up. This direct stimulation prompts the myometrium to contract, which helps control bleeding by compressing the vessels that were exposed when the placenta separated. After achieving firmness, reassess the fundus and continue to monitor bleeding and IV fluids or medications as ordered. While elevating the legs and encouraging voiding are supportive, they don’t address the primary issue of uterine tone, and pushing on the uterus to express clots can cause injury or inversion, so they’re not the initial step.