free flow afer delivery

[theamberdawns]

I am a new L&D nurse and have some questions!

How do you know how much bleeding is normal the hour after delivery? I am always concerned when I perform fundal checks and the woman is having free flow with a firm fundus and empty bladder...and how much do lacerations bleed/ooze after repair?

[bagladyrn, RN]

I usually find that when the fundus feels firm, but you continue to see "free flow" there are usually clots up inside the uterus keeping it from fully clamping down even though it feels hard. You may notice that the uterus is higher up than usual or the fundus may feel "lumpy" instead of a smooth "ball". Try some fundal massage to see if clots are expelled, or if the flow comtinues heavy, ask the provider to see if they can manually remove clots.

[NurseNora, BSN, RN]

If you patient saturates a peri pad in 15 min, she's bleeding too much. Whenever you are unsure of how much your patient is bleeding, weigh the pads. One gram equals 1ml of blood. We're not as good at estimating blood loss as we like to think that we are, but weighing will give you a much more accurate estimate