Before We Start
One assessment tool, three different wound types
REEDA is used to assess healing across three distinct postpartum wound scenarios: an episiotomy (a surgical incision made to enlarge the vaginal opening during delivery), a perineal laceration (a tear that occurs naturally during delivery, graded by degree of tissue involvement), and a C-section incision. Regardless of which type of wound is present, the same five findings are systematically assessed at each check.
Four of the five REEDA findings — Redness, Edema, Ecchymosis, Discharge — are things you're watching FOR (their presence, especially if excessive or worsening, signals a problem). The fifth, Approximation, is something you're watching to CONFIRM (its presence is the desired, reassuring finding). Understanding this distinction is what makes REEDA immediately usable at the bedside rather than just a list to recite.
💡 Some Redness and Edema Are Expected — Know the Difference
A small amount of redness and swelling is a normal, expected part of the inflammatory healing response in the first 24–48 hours after any wound — episiotomy, laceration, or incision. What distinguishes a normal finding from a concerning one is degree and trajectory: mild redness/edema that is stable or improving over successive assessments is expected; redness/edema that is worsening, spreading, or accompanied by increasing pain, warmth, or fever suggests infection and needs to be reported.
Getting a Good Look
How to perform a perineal REEDA assessment
You can't assess what you can't see. For a perineal wound (episiotomy or laceration), put on gloves and help the patient into a side-lying (Sims') position with her upper leg flexed forward. Use a penlight for good lighting, and gently lift the upper buttock to expose the full perineum. For a C-section incision, the patient lies supine and the dressing is removed or lifted per protocol.
This is a very private exam. Explain what you're going to do before you do it, keep the patient covered except for the area being assessed, and work calmly and efficiently. A respectful approach makes patients far more willing to report pain or changes between checks.
💡 When to Assess
REEDA is part of the routine postpartum assessment (BUBBLE-HE). It is typically checked frequently in the immediate recovery period, then at least once per shift per facility protocol. Always compare each finding to the previous assessment so you can track trajectory.
Mnemonic
REEDA — the five components of wound assessment
R — Redness
Beyond expected mild inflammation
Some pink/red coloration around a healing wound is normal in the first day or two. Redness that is spreading, deepening, or increasing over time — rather than fading — is a warning sign for infection, especially when it extends beyond the immediate wound margin.
E — Edema
Excessive swelling around the wound
Mild swelling is expected in the initial post-delivery period. Edema that is significant, asymmetric, worsening, or associated with increasing tension/tightness at the wound site can indicate infection, hematoma formation, or impaired healing, and should be reported.
E — Ecchymosis
Bruising around the wound edges
Some bruising from the trauma of delivery or the surgical incision itself is expected and typically resolves over 1–2 weeks, following the normal color progression of a healing bruise. Extensive, rapidly expanding, or disproportionately severe bruising can indicate a hematoma or bleeding complication and warrants closer evaluation.
D — Discharge / Drainage
The character of any fluid from the wound
A small amount of clear or slightly blood-tinged (serosanguineous) drainage can be normal in early healing. Purulent (thick, yellow/green) or foul-smelling drainage is not normal at any point and is a strong indicator of wound infection requiring prompt provider notification.
💊 "Serosanguineous drainage, small amount, gradually decreasing = expected. Purulent or foul-smelling, at any amount, at any point = report it."
Don't confuse wound drainage with lochia. Lochia is the normal vaginal discharge from the uterus after birth, and it is assessed separately (the "L" in BUBBLE-HE). For REEDA, you're looking at fluid coming from the suture line or wound itself, not the normal lochia flow onto the pad.
A — Approximation
Wound edges together — the desired finding
Approximation means the edges of the wound (whether closed with sutures, staples, or healing by natural closure) are lying together, flush and aligned — this is the finding you want to see and document as present. Separation of the wound edges (dehiscence) — visible gapping between the edges — is a significant finding requiring immediate provider notification, as it indicates a breakdown in wound integrity that increases infection risk and may require intervention.
📊 The REEDA Score
Many units score each of the five REEDA items from 0 to 3 (0 = none/normal, 3 = severe), for a total score of 0 to 15. The higher the score, the poorer the healing. For Approximation, the scoring runs the opposite way from the finding itself: edges closed = 0, while any separation scores higher. A rising score across assessments is a clear, documentable way to show a worsening trend.
Red Flags
Two warning signs that go beyond the five letters
🚩 Hematoma
Pain out of proportion to the wound
A perineal (or vulvar/vaginal) hematoma is a collection of blood under the skin from a bleeding vessel. The classic clue is severe perineal pain or rectal pressure that is far worse than expected and not relieved by usual pain measures, often with a tense, bulging, purple-blue swelling. A large hematoma can hide significant blood loss, so also watch for rising heart rate and falling blood pressure. Notify the provider promptly.
🚩 Fever
100.4°F (38°C) or higher after the first 24 hours
A low-grade temperature in the first 24 hours after delivery can be related to dehydration or the exertion of labor. A temperature of 100.4°F (38°C) or higher after the first 24 hours suggests postpartum infection and should be reported, especially alongside worsening REEDA findings.
Comfort & Healing
Nursing measures that support normal healing
Ice packs to the perineum in the first 24 hours reduce swelling and pain. After that, warm sitz baths promote circulation and comfort. Teach the patient to use a peri bottle with warm water after every void or bowel movement, always cleansing and wiping front to back to avoid bringing bacteria toward the wound, and to change pads frequently. Topical anesthetic sprays and pain medication per order, plus stool softeners to prevent straining, round out routine care.
🏥 Clinical Scenario — Distinguishing Expected From Concerning
Two postpartum patients are assessed on day 2 following vaginal delivery with a second-degree laceration repair.
Patient 1
Mild redness at the repair site, slight swelling, small amount of light bruising, minimal serosanguineous drainage, edges well-approximated. Pain is well-controlled and improving. This is a normal, expected REEDA finding for day 2 postpartum — redness, edema, and ecchymosis are all mild and consistent with normal healing, drainage is minimal and appropriate in character, and approximation (the desired finding) is present. Continue routine monitoring.
Patient 2
Increasing redness extending beyond the wound margin, significant swelling, foul-smelling yellow drainage, and a visible small gap between the wound edges. Reports increasing pain and subjective fever. This combination — worsening redness/edema, purulent foul-smelling drainage, and separation (lack of approximation) — is a significant REEDA finding suggesting wound infection with possible dehiscence. Priority: notify the provider promptly, obtain vital signs including temperature (100.4°F / 38°C or higher after the first 24 hours supports infection), and prepare for likely wound culture and further evaluation.
📌 NCLEX Application
REEDA questions test the ability to distinguish normal from concerning findings:
Concerning discharge: "What characteristic of wound drainage should always be reported, regardless of amount?" → Purulent (thick, yellow/green) or foul-smelling drainage.
Desired finding: "What does 'approximation' mean in the REEDA assessment, and why is its presence reassuring?" → The wound edges are aligned and together — it indicates the wound is healing with intact integrity rather than separating (dehiscing).
Normal vs abnormal trajectory: "How does the nurse distinguish expected postpartum wound findings from signs of infection?" → By trajectory — mild, stable, or improving redness/edema/ecchymosis is expected; worsening, spreading, or increasing findings (especially with fever or purulent drainage) suggest infection.
Applies across wound types: "Is REEDA used only for episiotomies?" → No — it is used to assess episiotomies, perineal lacerations, and C-section incisions alike.
⚠️ The Trap — Dismissing Redness and Edema as "Always Normal After Delivery"
Because some redness, edema, and bruising genuinely are expected after any delivery-related wound, it's easy for a busy or less experienced nurse to reflexively categorize these findings as normal without tracking their trajectory across assessments. A wound that looked mildly red and swollen on day 1 but has become significantly more red, swollen, and painful by day 2 is showing a concerning trend — even though "redness and swelling" alone sounds like an expected, benign finding on either day.
The safeguard: Document REEDA findings specifically enough (degree, extent, comparison to prior assessment) to actually track trajectory across shifts — not just a checkbox of "present" or "absent." A finding that is worsening across assessments deserves escalation even if each individual assessment might look mild in isolation.
✓ Quick Self-Test
Answer before checking:
1. What does REEDA stand for?
2. Which REEDA finding is the one you want to be PRESENT, unlike the other four?
3. What type of wound drainage should always be reported, regardless of amount?
4. What three types of postpartum wounds can REEDA be used to assess?
5. How does the nurse distinguish expected, normal redness and edema from a concerning finding?
6. A patient reports severe perineal pressure far worse than expected, and you see a tense, purple, bulging area. What do you suspect?
7. On a 0 to 15 REEDA score, does a higher score mean better or worse healing?
Answers:
1. Redness · Edema · Ecchymosis · Discharge/Drainage · Approximation.
2. Approximation — the wound edges being together and aligned is the desired, reassuring finding; the other four are things being watched for as potential warning signs.
3. Purulent (thick, yellow/green) or foul-smelling drainage, at any amount.
4. Episiotomy, perineal laceration, and C-section incision.
5. By trajectory and degree — mild, stable, or improving findings are expected; findings that are worsening, spreading, or increasing over successive assessments (especially with fever or purulent drainage) suggest infection.
6. A hematoma. Notify the provider promptly and monitor for signs of hidden blood loss (rising heart rate, falling blood pressure).
7. Worse. Each item is scored 0 to 3, and the higher the total, the poorer the healing.
Next Lesson
Postpartum Assessment — BUBBLE-HE
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