Vaginal hematomas occur from injury to the uterine artery and are associated with forceps delivery. A substantial amount of blood can collect in the para vaginal space, so much so that it can lead to hypovolemic shock. The most common symptom is rectal pressure. Pelvic exam generally shows a large mass invading the vaginal vault. A bowel obstruction is highly unlikely since the woman is having normal bowel movements. Retained products of conception and infection at the episiotomy site would not usually cause a sense of rectal pressure. Signs of bleeding or infection, respectively, would be seen in the vagina. The nurse should assess vitals and contact the medical team if vaginal hematoma is suspected.