What is the first action a nurse should take for a client experiencing excessive vaginal bleeding postpartum?

The first action a nurse should take for a client experiencing excessive vaginal bleeding postpartum is to massage the client's fundus. This intervention is critical because it helps to stimulate uterine contraction, which is necessary to minimize bleeding. After childbirth, the uterus should contract to constrict the blood vessels that were supplying it, thereby reducing the risk of hemorrhage.

Massaging the fundus, especially if it is found to be boggy or not firm, encourages the uterus to contract effectively. Timely intervention in this way can significantly impact the client's condition, helping to control blood loss and stabilize their health.

While elevating the client's legs can be beneficial in certain contexts, it does not directly address the cause of postpartum bleeding. Inserting an indwelling urinary catheter is generally not the first step in managing postpartum hemorrhage and is primarily used for urinary retention or monitoring urine output. Initiating an infusion of oxytocin may be necessary if uterine atony persists after fundal massage, but it is typically not the immediate first action to take before trying to stimulate the uterus manually. Thus, massage of the fundus is the most direct and effective initial response to help manage excessive postpartum bleeding.