Uterine massage (fundal massage) is a manual intervention performed on the lower abdomen immediately following childbirth. The technique involves applying firm, rhythmic pressure to the top portion of the uterus, called the fundus. This routine postpartum procedure stimulates the uterus to contract effectively after delivery.
Why Uterine Massage is Essential for Postpartum Health
The primary purpose of uterine massage is to encourage uterine involution, the process of the uterus shrinking back toward its non-pregnant size. After the placenta detaches, it leaves an open wound with exposed blood vessels that must be compressed to prevent excessive blood loss.
The uterine muscle fibers contract strongly, acting like ligatures to clamp down on the blood vessels. If the uterus fails to contract effectively, uterine atony occurs, leaving the vessels open and leading to significant bleeding. Uterine atony is the most common cause of early postpartum hemorrhage (PPH).
Massaging the uterus mechanically stimulates the myometrium, triggering necessary contractions. This stimulation helps the uterus maintain a firm tone, indicating that the blood vessels are being compressed. Routine fundal checks and massage are important components of postpartum care to reduce PPH risk.
Locating the Fundus: Preparation for Massage
Before attempting massage, the individual should be positioned lying flat on their back for accurate abdominal palpation. An empty bladder is helpful, as a full bladder can displace the uterus and interfere with contraction. The massage must only be performed after the placenta has been delivered.
The fundus is the rounded, uppermost part of the uterus, palpable near or slightly below the belly button immediately after birth. To locate it, use the flat part of your fingers to gently but firmly feel the central abdomen. When contracted, the fundus feels firm, similar to a hard grapefruit.
A crucial preparatory step involves stabilizing the lower segment of the uterus, which sits just above the pubic bone. Place one hand horizontally above the symphysis pubis, bracing the lower section of the uterus. This action anchors the uterus and prevents displacement during the massage.
The Step-by-Step Technique for Uterine Massage
With the lower segment stabilized, the second hand is placed flat on the abdominal wall directly over the fundus. The fingers of this upper hand should be cupped slightly to encompass the top of the uterus. The goal is to stimulate the muscle fibers to contract fully and expel accumulated blood or clots.
The technique involves applying firm but gentle pressure, using a kneading or circular motion on the fundus. The massage should be performed rhythmically and consistently, typically for less than a minute, until the muscle tone improves. The pressure must be sufficient to stimulate the muscle without causing undue pain or trauma.
The effectiveness of the massage is confirmed when the uterus feels significantly firmer and smaller, indicating a successful contraction. Massaging the uterus may cause a gush of lochia, the normal postpartum vaginal discharge, often containing blood clots. Expelling these clots allows the uterus to maintain its firm, contracted state.
Once the fundus feels firm, the hands can be removed, and the tone of the uterus should be reassessed periodically. In the immediate postpartum period, checks are typically performed every 15 minutes for the first hour, then less often as the uterus remains contracted. If the uterus softens or becomes “boggy” again, the massaging action must be repeated.
Recognizing Complications and When to Stop
The massage should be stopped immediately if the uterus becomes firm and contracted, as continued pressure can be counterproductive and increase discomfort. The primary sign that the massage is ineffective is the uterus remaining soft or “boggy” despite the kneading action. A soft uterus indicates ongoing uterine atony and risk of excessive bleeding.
Excessive or rapidly increasing vaginal bleeding, such as soaking through more than one sanitary pad in an hour, requires immediate medical attention. The passage of large blood clots, especially those larger than a golf ball, indicates the uterus is not contracting adequately. These signs suggest the hemorrhage is not being controlled by the massage alone.
Signs of shock, such as sudden lightheadedness, dizziness, blurred vision, or faintness, are medical emergencies requiring immediate attention from a healthcare professional. While uterine massage is a helpful intervention, any indication that the bleeding is uncontrolled warrants a rapid escalation of care.