A postpartum patient has a soft, boggy fundus. Which intervention is most appropriate to begin addressing the issue?

• A. Massaging the uterus until it is firm
• B. Pushing gently on the uterus
• C. Assisting the woman to urinate
• D. Rechecking the uterus in 1 hour

Answer: (A)

When the fundus is soft and boggy after birth, the uterus isn’t contracting well (uterine atony), and the first, most effective step is fundal massage to stimulate contraction and compress the bleeding vessels at the placental site. Use a cupped hand to gently but firmly massage the fundus in a circular motion, continuing until you feel firmness and a rounded fundus. Support the lower uterus with your other hand while you massage, and reassess after several minutes. If the fundus remains soft despite massage, escalate with additional measures per protocol (for example, uterotonic medications and further assessment), but starting with massage addresses the immediate cause of the atony. Pushing on the uterus is not appropriate and delaying evaluation for an hour misses a critical intervention window. Encouraging urination can help if a full bladder is displacing the uterus, but it does not replace the need to restore uterine tone right away.