A nurse is caring for a client who is 10 hr postpartum following a vaginal delivery. Which of the following findings should the nurse expect?

In the immediate postpartum period, the uterus involutes at a predictable rate. At the time of delivery, the fundus is at or just below the umbilicus. By approximately 6 to 12 hours postpartum, the fundus rises to the level of the umbilicus (approximately 0 cm above or at the umbilicus) as the bladder fills and the uterus temporarily rises. Therefore, at 10 hours postpartum, a firm fundus located at the level of the umbilicus is the expected normal finding. Firmness is critical — a soft fundus indicates uterine atony and a risk for postpartum hemorrhage. A fundus displaced to the right of the umbilicus and soft suggests a distended bladder pushing the uterus aside, which is an abnormal finding. A fundus to the left of the umbilicus could similarly indicate a full bladder or abnormal positioning. A fundus 2 cm below the umbilicus would suggest involution has progressed further than expected for only 10 hours postpartum — the fundus typically descends approximately 1 cm per day beginning on postpartum day one. The normal expected finding at 10 hours is therefore a firm fundus at the level of the umbilicus.