What overall assessment should be made regarding the uterus after the delivery of the baby?

The correct assessment of the uterus immediately following the delivery of the baby is that it should be hard and contracted. This firmness indicates that the uterus is effectively contracting, which is essential for several reasons. First, appropriate uterine contractions help to reduce the size of the uterus and facilitate the process of involution—returning to its pre-pregnancy state. This also plays a crucial role in controlling postpartum bleeding by helping to compress the blood vessels that were attached to the placenta.

A soft and relaxed uterus could indicate uterine atony, a condition where the uterus fails to contract adequately, leading to the risk of postpartum hemorrhage. It is vital for healthcare providers to assess uterine tone immediately after delivery to ensure that it is firm and adequately contracted to prevent complications.

Although checking for inversion of the uterus is important as well, it is a more specific assessment done in cases of abnormal findings or excessive bleeding and would not be the general expectation for every delivery assessment. A larger than normal uterus is also not an expected finding immediately post-delivery. Instead, the focus should be on ensuring that the uterus is properly contracted.