MEDizzy - A postpartum client, who had a forceps-assisted vaginal

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Care of Childbearing Families

A postpartum client, who had a forceps-assisted vaginal birth 4 hours ago, calls a nurse to her room to report continuing perineal pain rated at 7 out of 10 on a numeric scale and rectal pressure, even though an oral analgesic was given and ice applied to the perineum. Considering this information, what should be the nurse’s next intervention?

ExplanationUse of forceps for delivery places the client at risk for development of perineal hematomas. A symptom of a perineal hematoma is perineal pain, which is intense and disproportionate to initial objective find- ings. Also, if the hematoma is located in the posterior vaginal wall, the client may experience rectal pressure. If a hematoma is suspected, the nurse should closely examine the perineum and the vaginal introitus for ecchymosis and a bulging mass. Reexamination of the perineum should be completed before calling the HCP to report the pain level. A stool softener would be appropriate to avoid constipation but would not help the immediate problem. Ambulation also would not help the immedi- ate pain concern.