Following delivery, the nurse's assessment reveals a soft, boggy uterus located above the level of the umbilicus. The appropriate intervention is:

To check for postpartum hemorrhage.

This is because postpartum hemorrhage is a serious and potentially life-threatening complication that can occur within 24 hours of birth or later. It is defined as a blood loss of more than 500 mL in a vaginal delivery or more than 1000 mL in a cesarean delivery. The most common cause of postpartum hemorrhage is uterine atony, which is the failure of the uterus to contract after delivery. Other causes include lacerations, retained placental fragments, coagulation disorders, and uterine rupture. Monitoring the vital signs, especially blood pressure, and pulse, can help detect signs of hypovolemia due to blood loss. Other signs include pale skin, cold and clammy extremities, delayed capillary refill, decreased urine output, and altered mental status.

Choice B is not correct because determining if the mother's milk is coming in is not the primary rationale for monitoring a new mother every 15 minutes for the first hour after delivery. Milk production usually begins around 48 to 72 hours after delivery and is influenced by hormonal changes, breastfeeding frequency, and maternal health. Although breastfeeding support is important for postpartum care, it is not a priority over checking for postpartum hemorrhage.

Choice C is not correct because monitoring the mother's blood pressure to note any elevations is not the primary rationale for monitoring a new mother every 15 minutes for the first hour after delivery. Elevated blood pressure can indicate gestational hypertension or preeclampsia, which are serious conditions that can affect postpartum women. However, these conditions are more likely to cause symptoms such as headache, blurred vision, epigastric pain, and proteinuria⁴.

Moreover, blood pressure may not be a sensitive indicator of blood loss and may remain normal until a significant amount of blood is lost¹.

Choice D is not correct because answering questions the new parents may have is not the primary rationale for monitoring a new mother every 15 minutes for the first hour after delivery. Although providing education and support to the new parents is an essential part of postpartum care, it is not a priority over checking for postpartum hemorrhage. The new parents may have questions about infant care, feeding, contraception, recovery, and other topics that can be addressed during the postpartum period.

Check for blood under the client's buttock. This is because lochia rubra is the normal vaginal discharge that occurs after childbirth, consisting of blood, mucus, and tissue from the placenta and the uterus lining. It is usually heavy for the first three to four days and can pool under the client's buttocks if they are lying down. Checking for blood under the buttock can help assess the amount of bleeding and prevent complications such as infection or hemorrhage.

The other choices are not correct for the following reasons:

A. Increasing the rate of the IV fluids is not necessary because the client's fundus is firm and midline, indicating that the uterus is contracting well and preventing excessive bleeding.

B. Assisting the client to ambulate is not advisable because it can increase the lochia flow and cause fainting or dizziness due to blood loss.

C. Performing fundal massage is not indicated because the fundus is already firm and midline, meaning that the uterus is adequately contracted. Massaging a firm fundus can cause pain and discomfort to the client.