Which measure would be least effective in preventing postpartum hemorrhage?

• A. Administer Methergine 0.2 mg every 6 hours for 4 doses as ordered
• B. Encourage the woman to void every 2 hours
• C. Massage the fundus every hour for the first 24 hours following birth
• D. Teach the woman the importance of rest and nutrition to enhance healing

Answer: (C)

Preventing postpartum hemorrhage hinges on promoting firm uterine contraction after delivery. A uterotonic medication like methylergonovine directly enhances uterine tone to compress blood vessels and reduce bleeding. Encouraging the bladder to empty prevents distension that can interfere with the uterus’s ability to contract, helping to maintain tone. Rest and good nutrition support overall recovery but do not directly prevent a heavy bleed; they are part of general postpartum care rather than targeted prevention of hemorrhage.

Fundal massage is used when the uterus is boggy to stimulate contractions and control ongoing bleeding. Doing it hourly as a preventive measure doesn’t address the underlying risk of atony and may be unnecessary or less effective for preventing hemorrhage, compared with medications and measures that directly promote contraction or prevent distension. Therefore, this approach is least effective in preventing postpartum hemorrhage.