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What is the Bubble-He Postpartum Assessment?

new mom holding her baby in a striped blanket

Did you know there’s a specific term used in postpartum care by nurses to determine how your mental and physical healing is progressing? Learn more about the Bubble-He postpartum assessment and why you should know it, too.

While traditionally a nursing term, knowing what the Bubble-He acronym stands for is essential for those healing from birth.

Not only will you feel more empowered about your postpartum recovery, but you’ll also – hopefully – have a better sense of what red flags to look out for and when it’s time to ask for support.

new mom holding her baby in a striped blanket

When is the Bubble-He assessment done?

Your postpartum nurse will perform this assessment to you at some point during your recovery while still in the hospital. You can continue to use this assessment at home to determine how you are healing both physically and emotionally.

What does the acronym Bubble-He stand for?

The Bubble-He assessment covers seven different touchpoints, so having an acronym is helpful to remember everything being assessed.

The acronym Bubble-He stands for:

B: breasts
U: uterus
B: bladder
B: bowels
L: lochia
E: episiotomy and perineum

H: hemorrhoids
E: emotions

A closer look at a Bubble-He postpartum assessment

Let’s break down each letter of Bubble-He and what it looks for in postpartum recovery. Remember, this assessment can help you – a recovering mother – feel more in tune with how you’re healing.

If you find yourself concerned about what you see during this assessment, please make sure to reach out to your care provider.

The below was initially published in Vaginal Birth Recovery Tips from a Postpartum Nurse.

B: breasts

Your nipples should point out, and you should see tiny drops of colostrum when you express your breast tissue before your milk comes in entirely. Ideally, you shouldn’t have extreme pain while breastfeeding, and no cracking or bleeding should develop.

If you are experiencing pain or have concerns over your baby’s latch, an IBCLC lactation consultant can help you assess what’s happening.

U: uterus

It can take up to six weeks for your uterus to slowly shrink back to size.

While not often discussed, afterpains – or pains after birth caused by the contraction of your uterus – are common, especially when breastfeeding.

Your care team will most likely offer pain medications, but some herbal options can ease cramping as well. Make sure to ask your provider.

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B: bladder

If everything is healing normally, you should have full function of your bladder once your nurse removes your foley catheter. In most cases, you’ll only have a catheter if you have an epidural.

It’s critical to empty your bladder frequently and stay hydrated. You may find that you pee out a lot more in the postpartum period – that’s because you’re flushing out all the retained fluids from pregnancy.

Also, if you have a sense of frequency, urgency, burning while voiding, or foul-smelling urine, these are signs of infection and must be reported to your nurse or provider immediately. 

If you are experiencing persistent incontinence, please reach out to a pelvic floor therapist to help address your postpartum pelvic floor issues. While typical, this leaking is not normal.

pregnant woman with bladder issues

B: bowels

The first postpartum bowel movement can be intimidating, especially if you experienced:

  • Hemmorhoids
  • Vaginal tearing
  • An episiotomy

To help ease yourself into your first bowel movement, make sure to eat plenty of fiber and stay hydrated. Also, make sure to take the stool softeners offered to you and have some available at home, too.

L: lochia

Lochia is the bleeding after birth as your uterine wound – where the placenta attached to your uterus – begins to heal.

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Woman with vaginal pain after birth

Most women have moderate period-like bleeding for up to six weeks, but this can depend on how they give birth. If you find that your bleeding tapers off and then picks back up, it could be a sign that you’re doing too much too quickly.

Bleeding should gradually become scanter; it is normal to see small clots and see more bleeding when you are up and about, physically active, or breastfeeding.

It is NOT normal to saturate a pad in less than an hour or pass huge clots. Please call your doctor or care team if you become concerned about the amount of blood you pass.

E: episiotomy and perineum

Even if your perineum is intact and you suffered no tears, swelling and inflammation are common in the early weeks. 

To best support your perineum, make sure to have the below items at home:

Pro tip: Your provider can also order a combination of topical medication containing witch hazel and hydrocortisone, which you can use as needed for extra relief.

woman holding half of an orange

H: hemorrhoids

While uncomfortable, hemorrhoids are common during the late part of pregnancy and early postpartum.

Make sure to communicate your discomfort with your care team as needed or if it becomes alarming. Use witch hazel pads, organic hemorrhoid balm, and a stool softener to help encourage healing at home.

E: emotions

The first thing we want to know is whether you’re in physical pain. If so, know that you have options, so it’s essential to be honest and upfront about how you’re feeling.

Secondly, how are you feeling? Know that it’s normal to be overwhelmed and experience a range of emotions during this time. 

If you are worried you’re experiencing the baby blues, know that they’re expected for the first two weeks. If these feelings progress longer than two weeks, talk to your provider about postpartum depression and anxiety. Browse our mental health resources.

You might like these other postpartum resources

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