Fundal massage is a technique used after delivery to help the uterus contract and prevent excessive bleeding. The fundus is the rounded, uppermost part of the uterus. This article clarifies the role of fundal massage, particularly after a C-section, and what to expect during postpartum care.
Purpose of Fundal Massage
After childbirth, the uterus undergoes a natural process called involution, contracting and gradually returning to its pre-pregnancy size. This process begins immediately after the placenta is delivered, with uterine contractions compressing blood vessels at the placental site to minimize bleeding. Fundal massage encourages these contractions. If the uterus does not contract adequately, it can remain soft or “boggy,” a condition known as uterine atony, which is a primary cause of postpartum hemorrhage. By stimulating contractions, fundal massage helps the uterus firm up, expel blood clots, and reduce significant blood loss.
Fundal Massage After Cesarean Delivery
Yes, fundal massage is typically performed after a C-section. Even though a C-section involves an abdominal incision, the uterus still needs to contract firmly to prevent postpartum bleeding, as the risk of hemorrhage remains present regardless of the delivery method. The medical team prioritizes uterine health and safety, making fundal massage a necessary part of postpartum care for mothers who have had a C-section.
The uterus has expanded significantly during pregnancy to accommodate the baby, placenta, and amniotic fluid. After a C-section, the uterus still needs to shrink back to its pre-pregnancy size, and this process relies on strong contractions. Healthcare providers perform fundal massage to ensure the uterus is firm and continues contracting effectively, reducing potential complications related to uterine atony.
The Procedure and Patient Experience
Fundal massage involves applying gentle but firm pressure to the top of the uterus through the abdomen. For C-section patients, one hand might stabilize the lower abdomen near the incision to reduce discomfort. Nurses typically perform these checks and massages frequently in the immediate postpartum period, often every 15 minutes for the first hour, then every 30 minutes for the second hour, and then spaced out further. The sensation can range from uncomfortable pressure to cramping or pain; many patients describe it as unpleasant and some find it very painful. Pain medication is usually available to help manage this discomfort, and patients should communicate their pain levels and needs to their care team for appropriate relief.
Important Considerations and When to Alert Your Care Team
While fundal massage is a routine procedure, it is important for patients to be aware of signs that might indicate a complication. Excessive or bright red bleeding that soaks more than one sanitary pad in an hour, or the passing of large blood clots (larger than a golf ball), can be signs of postpartum hemorrhage. Other signs include dizziness, lightheadedness, rapid heartbeat, or shortness of breath. Any sudden increase in bleeding, a change in blood color to bright red after it had lightened, or severe, unmanageable pain should be reported to nurses or doctors immediately. Patient communication is important for prompt intervention, ensuring any potential complications are addressed quickly.