Fundal massage is a hands-on technique performed immediately after childbirth to stimulate the uterus to contract. The fundus refers to the top portion of the uterus, which becomes a large, muscular organ after carrying a baby. The primary purpose of this procedure is to help the uterus “clamp down” and shrink, which physically compresses the blood vessels where the placenta was previously attached. This action prevents a serious complication called postpartum hemorrhage (PPH), or excessive bleeding after delivery. Fundal massage is a medical intervention typically taught by a healthcare professional, such as a nurse or midwife.
Identifying the Uterus Location
Properly locating the fundus is the first step before any massage is attempted. The patient must be positioned lying flat on their back, as this relaxes the abdominal muscles and allows for accurate palpation. A full bladder can push the uterus out of its midline position, so ensuring the bladder is empty before the assessment is necessary.
To find the fundus, the caregiver uses one hand to stabilize the lower uterine segment, placing it just above the pubic bone. This stabilizing hand is crucial for preventing uterine inversion during the massage itself. The other hand then gently but firmly probes the abdomen, starting near the belly button and moving downward until a firm, rounded mass is felt.
Immediately after the placenta is delivered, the fundus is typically located near or slightly below the level of the umbilicus. The goal of this assessment is to determine the tone and position of the uterus. A healthy, contracted uterus feels firm, like a hard ball, while a uterus that is not contracting adequately (uterine atony) feels soft or “boggy”.
Step by Step Fundal Massage Technique
Once the uterus is located and determined to be soft or boggy, the massage can begin to encourage firm contraction. The technique requires the use of two hands for safety and effectiveness. The non-dominant hand remains positioned just above the pubic bone to support the lower segment of the uterus.
The dominant hand is then placed on the fundus, cupping it gently but with firm pressure. The massage motion involves applying deep, rhythmic pressure in a downward and circular motion over the fundus. This pressure stimulates the muscle fibers of the uterus to contract, helping to expel any blood clots or retained tissue.
The goal is to massage until the uterus responds by becoming firm and contracted. The process should continue until the boggy uterus feels distinctly hard under the hands. Supporting the lower uterine segment throughout the massage anchors the uterus and guards against moving the organ out of its proper position.
Post Massage Assessment and Red Flags
Following the fundal massage, the caregiver must immediately reassess the uterus for sustained firmness. The uterus should maintain a contracted, hard texture, and its position should be midline and at or below the umbilicus. If the uterus quickly reverts to a soft or boggy state, the massage should be repeated to prevent blood loss.
Monitoring vaginal bleeding, known as lochia, is an equally important assessment following the procedure. Normal lochia flow is expected, but the caregiver must watch for signs of hemorrhage, such as soaking through more than one sanitary pad in 15 minutes. The passage of large blood clots, especially those bigger than a golf ball, is another sign that the uterus is not contracting effectively and requires further intervention.
Red Flags
Red flags that signal an emergency and necessitate immediate medical attention include a uterus that remains persistently soft and boggy despite massage. Signs of maternal shock, such as dizziness, a rapid heart rate, or a sudden drop in blood pressure, also require urgent professional help. The inability to locate the fundus or a uterus that is deviated significantly to one side can indicate a distended bladder or other complication requiring prompt medical evaluation.