Chart — Maternal-Newborn

Postpartum Assessment Checklist

A systematic BUBBLE-LE format checklist for postpartum assessment — covering fundus, lochia, perineum, breasts, bladder, bowel, emotional status, and vital signs with expected findings, assessment technique, and warning signs requiring escalation.

Educational use only. Assessment protocols vary by facility, delivery method, and patient risk. Follow your institution's postpartum assessment guidelines and provider orders. This checklist reflects general AWHONN principles for nursing education. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.

Assessment Frequency

Time Period	Frequency	Priority
Recovery room (Stage 4)	Every 15 min × 4, then every 30 min × 2	Highest-risk period for PPH
Postpartum unit (hours 2–24)	Every 4–8 hours per facility protocol	Monitor involution; watch for complications
Prior to discharge	Complete BUBBLE-LE; discharge teaching	Confirm readiness; review warning signs

BUBBLE-LE Assessment Checklist

#	Area	Normal / Expected Findings	Warning Signs
B	Breasts	Colostrum days 1–4 (yellow, thick) Soft to tender as milk transitions Nipples intact; latch assessed Engorgement bilateral when milk in	Unilateral redness/warmth/fever (mastitis) Cracked/bleeding nipples with poor latch Breast abscess (fluctuant mass)
U	Uterus (Fundus)	Firm (contracted), midline At umbilicus immediately postpartum Descends 1 cm/day (day 3 = 3 cm below) Non-palpable abdominally by day 10	Boggy (soft) uterus = atony → massage Deviated to side (full bladder) Failure to descend (subinvolution)
B	Bladder	First void within 4–6 hours postpartum Adequate urine output (>30 mL/hr) No bladder distension palpable	Unable to void after 6 hrs → catheterize per order Bladder distension displacing uterus upward Burning on urination (UTI)
B	Bowel	Bowel sounds present First BM within 1–3 days Adequate oral intake; hydration	No BM after 3 days without stool softeners Severe pain with defecation (hemorrhoid complications)
L	Lochia	Rubra (days 1–3): bright red, small clots OK Serosa (days 4–10): pink/brown Alba (day 10–6 wks): white/yellow, minimal Amount ≤1 pad saturated/hour	Saturating >1 pad/hour → PPH alert Clots > golf ball size Return to rubra after serosa Foul odor (infection)
E	Episiotomy / Lacerations	REEDA score: mild redness and edema acceptable Wound edges approximated; sutures intact Minimal serous drainage; no foul odor	Wound dehiscence (edges separating) Increasing pain/pressure (hematoma) Purulent drainage (infection)
E	Emotional Status	Taking-in phase: passive, focused on own needs (days 1–2) Taking-hold phase: ready to learn infant care (days 2–4) Mild tearfulness (baby blues) days 2–3 — normal Positive maternal-infant attachment behaviors	Persistent sadness >2 weeks (PPD) Disinterest in infant; inability to bond Hallucinations or delusions (psychosis — emergency) Thoughts of self-harm or harming infant

Vital Signs — Postpartum Normal Values

Parameter	Normal Value	Concern / Action
Temperature	36.5–38°C (97.7–100.4°F)	Fever >38°C after first 24 hours — assess for infection
Pulse	50–90 bpm (physiologic bradycardia common)	Tachycardia >100: assess for hemorrhage, infection, PE
Blood pressure	<140/90 mmHg	BP ≥140/90: postpartum preeclampsia workup
Respiratory rate	12–20 breaths/min	Tachypnea with chest pain: assess for PE
Urine output	>30 mL/hr; adequate voiding within 4–6 hours	Oliguria: assess fluid status, hemorrhage, renal function

Immediate Nursing Interventions

Boggy uterus:

Massage fundus; encourage voiding; notify provider if unresponsive; oxytocin per order

Heavy lochia:

Assess fundal tone; weigh pads; call provider if >1 pad/hour or hemodynamic instability

Fundus deviated:

Have patient void; reassess fundal position after bladder emptied

Perineal hematoma:

Do not massage; notify provider immediately; prepare for possible surgical drainage

Related Resources

Postpartum Care BasicsFull guide with detailed explanations of all BUBBLE-LE components

Open →

Postpartum Warning SignsHemorrhage, infection, hypertension, depression, DVT/PE with escalation guidance

Open →

Standards & sources

Fact-checked Jun 20, 2026

This page is written to align with AWHONN Postpartum Assessment Standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →