During the fourth stage of labor, a pulse increase from 70 to 100 bpm is observed. What is the priority action?

• A. Documenting the vital signs in the client's medical record
• B. Notifying the nurse-midwife immediately
• C. Checking the client's uterine fundus
• D. Continuing to check the client's vital signs every 15 minutes

Answer: (C)

A rising pulse after delivery is a red flag for possible postpartum hemorrhage, often from uterine atony. The most immediate step is to assess the uterus by locating and palpating the fundus to determine its firmness and position. If the fundus is soft and boggy, massage the uterus to stimulate contraction, check for bladder distension, and ensure uterotonic measures are in place as ordered. This directly addresses the likely cause of bleeding and guides further treatment. While documenting vitals or notifying the nurse‑midwife and continuing monitoring are important, they come after confirming the uterus’s status and initiating fundal support.