Final answer:
The nurse should immediately notify the provider or nurse-midwife if a woman's uterus feels boggy thirty minutes post-delivery, and fundal massage doesn't lead to change. This action helps address potential postpartum hemorrhage due to retained placental fragments or other related issues.
Step-by-step explanation:
If a woman's uterus feels boggy thirty minutes after giving birth and massaging the fundus does not lead to any change, the next action the nurse should take is to notify the provider or nurse-midwife immediately. It is imperative to rule out postpartum hemorrhage, which can occur if fragments of the placenta remain in the uterus. The obstetrician should also ensure that the expelled placenta and fetal membranes are intact as retained placental fragments can contribute to this condition.
Additionally, it is crucial for uterine contractions to continue to promote involution, the process of the uterus returning to its pre-pregnancy size. These contractions help the mother's abdominal organs return to their pre-pregnancy locations. Breastfeeding can facilitate this process due to the release of naturally occurring oxytocin, which can help the uterus contract.
If the placenta is not birthed spontaneously within approximately 30 minutes, it is considered retained, and it may be necessary for the obstetrician to undertake manual removal or, if that is not successful, pursue surgical options.