At the next assessment, Susan's uterus is midline. The fundus feels boggy at one fingerbreadth below the umbilicus. What should you do first?

• A. Massage Susan's uterus
• B. Administer pain medication
• C. Empty the bladder
• D. Apply ice to the abdomen

Answer: (A)

When the uterus is boggy postpartum, the first action is fundal massage to stimulate contractions and compress the blood vessels, helping the uterus firm up and reduce bleeding. In this case, the fundus is boggy and just below the umbilicus, which signals inadequate tone. Gently yet firmly massaging the uterus until it becomes firm and reaches the midline re-establishes normal uterine tone and helps prevent hemorrhage.

Pain meds don’t address the bleeding risk from atony, and ice on the abdomen doesn’t promote contraction. Emptying the bladder can assist if a full bladder is displacing the uterus, but the immediate, most effective first step is massage to stimulate contraction. After massage, reassess the fundus and continue with the appropriate protocol if the uterus remains boggy.