A nurse is assessing a client in the fourth stage of labor and notes that the fundus is firm, but that bleeding is excessive. Which of the following would be the initial nursing action?

A. Record the findings: Documentation is important, but it does not address the immediate cause of excessive bleeding. Active assessment and intervention are required before charting when postpartum hemorrhage is suspected. B. Notify the HCP: Provider notification is appropriate if initial nursing interventions fail, but priority is to address the most common reversible cause first. Early nursing actions can often correct the problem and reduce severity. C. Massage the fundus: Excessive bleeding with a firm fundus suggests retained clots within the uterus preventing adequate contraction. Fundal massage helps expel clots, promotes uterine contraction, and directly reduces postpartum bleeding. D. Place the client in Trendelenburg’s position: Trendelenburg positioning does not correct uterine bleeding and may worsen maternal discomfort or respiratory status. Positioning alone does not address the underlying uterine or placental cause of hemorrhage.