BUBBLE HE Assessment
Between 70% and 80% of women experience “baby blues” after delivery. Many of the women that experience baby blues also experience more severe postpartum depression. One in seven women experiences depression in the year following childbirth. The BUBBLE HE assessment helps nurses identify these issues in patients.
What is the BUBBLE HE Assessment?
BUBBLE HE is a mnemonic that nurses use to identify postpartum issues — including depression — in mothers after childbirth. Mothers can use this tool to recognize symptoms and speak to their doctor about them.
BUBBLE HE stands for:
- Breast: Some women experience cracked nipples after delivery, which can get infected. It is critical for new mothers to continually examine their breasts and express breast milk even if the child is not feeding.
- Uterus: Nurses regularly check the new mother’s cervix for firmness after birth. A softened cervix may be infected.
- Bladder: Mothers are encouraged to drink a lot of water and frequently urinate after childbirth. Clear yellow urine and an undistended bladder are good signs and indicate that the mother is healthy.
- Bowel: Bowel movements must be regular and painless.
- Lochia: The mother’s body produces vaginal discharge containing blood, mucous, and uterine tissue after childbirth. It must follow a natural pattern. For up to five days after birth, the lochia is typically dark red. It can have blood clots, but they shouldn’t be larger than a plum. Between days four and ten after childbirth, the lochia should become more watery. The lochia turns light-pink or brownish. From day ten to day 28, the color usually changes to whitish-yellow. Signs of clotting and unpleasant smell are indicators of infection.
- Episiotomy: Mothers that had an episiotomy may experience swelling for a few days after childbirth. If the swelling is excessive, or there’s bruising or discharge from the incision, the mother should see a doctor immediately.
- Homans’ sign: Stinging in the calf is the Homan’s sign. It is an indicator of thrombosis (blood clotting in veins or arteries). If the mother is experiencing discomfort behind her knees, she should seek medical attention.
- Emotional status: Women are most vulnerable to postpartum depression for six weeks after delivery. It can be concerning if the mother isn’t bonding with the newborn or displays erratic behavior. Nurses check the mother’s emotional status, and the mother should also monitor her emotional status and seek help if needed. It takes courage to look after yourself, and you should never hold back from asking for it.
When a woman gives birth, she goes through both physical and mental changes. Therefore, nurses need to understand how she is coping. Many of the symptoms indicated in BUBBLE HE are physical, but the physical pain often takes an emotional toll on the parents.
Using BUBBLE HE provides an excellent plan to look after the mother after childbirth.
How to Perform the BUBBLE HE Assessment
Other Maternal Nursing Mnemonics
BUBBLE HE is only one of the many mnemonics that nurses in the labor and delivery unit need to remember. Other mnemonics that these professionals use include VEAL CHOP, HELLP, and LARA CROFT. I also have an EKG interpretation cheat sheet you might find useful.
Lindsay Smith
Lindsay is an Adult-Gerontology Primary Care Nurse Practitioner with Nephrology Associates in Nashville, Tennessee. She is passionate about working with patients with End-Stage Renal Disease (ESRD) to maximize their function and wellness.