BUBILEHE: The Trauma Of Delivery

Giving birth can be an amazing experience for a woman; however, there are a multitude of complications that may occur related to the trauma of delivery. After a woman gives birth, there are an array of assessments a nurse must perform that to prevent these complications. The acronym “BUBBLEHE” is an assessment tool that nurses utilize as a guide to ensure the post-partum mother is assessed properly. This paper will discuss each component of BUBBLEHE more in depth.

The acronym BUBBLEHE stands for B-Breasts, U-Uterus, B-Bladder, B-Bowels, L-Lochia, H-Homan’s sign, E-Episiotomy and perineum. The BUBBLEHE’s focus is a head-to-toe type assessment tool. While performing the assessment, many nurses utilize the time to also provide patient education.

Whether or not the new mother chooses to breastfeed or formula feed, the breasts should be assessed, and should be soft and non-tender the first day or two after delivery (McKinney, James, Murray, Nelson, & Ashwill, 2018). The nurse will assess the breasts for size, shape, firmness, redness, and symmetry (Jayashree, Ajith, nurse educator at Gwalior Follow, 2015). The nipples will be assessed, if the nipples are flat or inverted, the breastfeeding mother may have difficulty. If the mother is breastfeeding, the nipples may present with cracking, blisters, or fissures. These may indicate the mother needs assistance with positioning of the neonate, or with the neonate’s latch. Upon palpation, the breasts may feel firm, and “lumpy”, and the mother may complain of tenderness. These are indicators the breasts are beginning to produce milk. Teaching is imperative, especially for the breastfeeding mother. She should be educated on signs and symptoms of infection, breast care, breastfeeding techniques, and support groups for after discharge. (McKinney, et al

The nurse should check The fundus for location and whether or not it is firm or “boggy”. To assess the location of the fundus, the nurse will place her nondominant hand above the woman’s symphysis pubis, this supports and anchors the lower uterine segment, the lower uterine segment should always be supported to prevent involution of the uterus. The nurse will then use the flat part of her fingers to paplpate, starting at the umbilicus. The fundus should be located in the medial abdominal region, deviation to the left or right generally indicates a full bladder. The nurse should instruct the woman to empty her bladder, then reassess uterine location. The location of the fundus is measured in fingerbreadths above or below the umbilicus. The nurse will place her fingers flat on the fundus horizontally and measure how many fingers above or below the umbilicus the fundus is located. For instance, if the fundus is palpated one fingerbreadth below the umbilicus, the nurse will document “U/1”. If the nurse palpates the fundus, and it does not feel firm, but feels “boggy”, the nurse will massage the fundus until it becomes firm. If the fundus continues to be “boggy” after becoming firm with fundal massage, the nurse will contune to massage the fundus, and apply pressure in an attempt to expel any clots that may be present. The nurse will then notify the physician and administer oxytocin to facilitate a firm fundus. If