Three hours after a vaginal delivery the patient reported vaginal pain and rectal pressure. Apple was told to do an external exam by the MD. After doing the external exam Apple noted the results were normal and no vaginal bleeding was noted. However, due to the patient's complaint of rectal pressure, Apple thought there maybe something more serious. She performed an internal exam and found a vaginal hematoma. After identifying the hematoma, she promptly called the MD and the patient was promptly taken to the OR for repair. The prompt diagnosis allowed for an uncomplicated repair and ultimately saved the patient's life and had an improved clinical outcome.