👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Physiological Adaptation🔖 Free to read, print, and share
Also known as: postpartum check · after-birth assessment · BUBBLEHE · post-delivery nursing assessment
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Use this quick-reference guide to spot, treat, and prevent Postpartum Assessment (BUBBLE-HE) on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Bubble
Breasts, Uterus, Bladder
Bowel, Lochia, Episiotomy
+ Homans, Emotions (HE)
📌 Normal
Fundus firm, midline, ↓ 1 cm/day
Lochia: rubra → serosa → alba
✅ Do
Boggy uterus → massage fundus
Empty bladder (displaces uterus)
🚩 Report
Saturate pad < 1h → hemorrhage
Foul lochia, fever → infection
📚 Postpartum Assessment (BUBBLE-HE) — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
BUBBLE-HE is the systematic postpartum head-to-toe assessment performed to detect complications such as hemorrhage, infection, and thromboembolism. The letters stand for Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/perineum, Homans/lower extremities, and Emotional status. Hemorrhage is the leading early postpartum threat.
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Key points
Understand these first
The fundus should be firm, midline, and at the umbilicus right after birth, descending about one fingerbreadth (1 cm) per day.
A boggy or displaced (off-midline) fundus suggests uterine atony or a full bladder, the most common causes of early hemorrhage.
Lochia progresses rubra (red, days 1 to 3) to serosa (pink-brown, days 4 to 10) to alba (white-yellow, up to 6 weeks); it should never have a foul odor.
Saturating one perineal pad within an hour or passing large clots indicates excessive blood loss.
Engorgement, redness, or a localized hot tender area on the breast may indicate mastitis.
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Nursing priorities
What to do, in order
Palpate the fundus for tone and position; massage it if boggy and reassess after the bladder is emptied.
Assess lochia amount, color, and odor and weigh pads if bleeding is heavy (1 g = 1 mL).
Inspect the perineum/episiotomy using REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation).
Encourage early ambulation and assess legs for warmth, redness, and swelling to detect DVT.
Screen emotional status and bonding, distinguishing normal baby blues from postpartum depression.
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Red flags — report now
Escalate immediately
A boggy fundus that does not firm with massage plus heavy bleeding is a postpartum hemorrhage emergency.
Foul-smelling lochia with fever and uterine tenderness signals endometritis and must be reported.
Calf pain, unilateral swelling, or chest pain with dyspnea suggests DVT or pulmonary embolism.
Lochia that returns to bright red after lightening can indicate retained placental fragments or overexertion.
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Labs & values
Numbers to know
Hemoglobin: 12 to 16 g/dL; a drop of 1 to 1.5 g/dL roughly equals 500 mL blood loss
Hematocrit: 37 to 47 percent
WBC: postpartum elevation up to 25,000 to 30,000 can be normal, complicating infection detection
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Patient teaching
What patients must know
Change perineal pads frequently and wipe front to back; report a pad soaked within an hour.
Report foul-smelling discharge, fever, or worsening pain as signs of infection.
Feeling sad or weepy for a few days is common, but persistent hopelessness or thoughts of harming yourself or the baby must be reported.
❓ Postpartum Assessment (BUBBLE-HE): NCLEX FAQs
What are the priority nursing interventions for Postpartum Assessment (BUBBLE-HE)?
Palpate the fundus for tone and position; massage it if boggy and reassess after the bladder is emptied. Assess lochia amount, color, and odor and weigh pads if bleeding is heavy (1 g = 1 mL). Inspect the perineum/episiotomy using REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation). Encourage early ambulation and assess legs for warmth, redness, and swelling to detect DVT.
What are the warning signs of Postpartum Assessment (BUBBLE-HE) a nurse must report?
A boggy fundus that does not firm with massage plus heavy bleeding is a postpartum hemorrhage emergency. Foul-smelling lochia with fever and uterine tenderness signals endometritis and must be reported. Calf pain, unilateral swelling, or chest pain with dyspnea suggests DVT or pulmonary embolism. Lochia that returns to bright red after lightening can indicate retained placental fragments or overexertion.
What do I need to know about Postpartum Assessment (BUBBLE-HE) for the NCLEX?
The fundus should be firm, midline, and at the umbilicus right after birth, descending about one fingerbreadth (1 cm) per day. A boggy or displaced (off-midline) fundus suggests uterine atony or a full bladder, the most common causes of early hemorrhage. Lochia progresses rubra (red, days 1 to 3) to serosa (pink-brown, days 4 to 10) to alba (white-yellow, up to 6 weeks); it should never have a foul odor. Saturating one perineal pad within an hour or passing large clots indicates excessive blood loss.
What patient teaching is important for Postpartum Assessment (BUBBLE-HE)?
Change perineal pads frequently and wipe front to back; report a pad soaked within an hour. Report foul-smelling discharge, fever, or worsening pain as signs of infection. Feeling sad or weepy for a few days is common, but persistent hopelessness or thoughts of harming yourself or the baby must be reported.
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Quick Tip
The fundus should be firm, midline, and at the umbilicus right after birth, descending about one fingerbreadth (1 cm) per day.