Fundal massage is a common postpartum procedure performed after childbirth. This technique is a standard component of care in many healthcare settings, supporting the body’s natural recovery processes.
What Fundal Massage Is
Fundal massage is a manual technique performed on the abdomen following childbirth. A healthcare professional gently but firmly massages the top part of the uterus, called the fundus. This action stimulates the uterus immediately after placenta delivery, encouraging it to contract and become firm.
The procedure typically involves the care provider placing one hand over the pubic bone while using the other hand to massage the fundus through the abdominal wall. This action helps expel any remaining blood clots from the uterus. The massage can be performed externally, but in some cases, a bimanual technique might be used, involving one hand internally to support the uterus.
Why Fundal Massage is Performed
The medical rationale behind fundal massage is to prevent and manage postpartum hemorrhage (PPH), or excessive bleeding after childbirth. PPH is a major cause of maternal morbidity. The most common reason for PPH is uterine atony, where the uterine muscles do not contract effectively after birth.
Normally, after the placenta detaches, the uterus contracts strongly to compress the blood vessels that supplied the placenta. If the uterus remains soft or “boggy” due to atony, these blood vessels continue to bleed freely, leading to excessive blood loss. Fundal massage assists the uterus in contracting firmly, helping to “clamp down” on these blood vessels and reduce bleeding.
The Evidence Supporting Fundal Massage
Scientific evidence and clinical guidelines from major health organizations support fundal massage as part of postpartum care. Organizations like the World Health Organization (WHO) and the American College of Obstetricians and Gynecologists (ACOG) include it in their recommendations for active management of the third stage of labor.
While specific randomized controlled trials on fundal massage alone might show varied results, particularly when uterotonic medications like oxytocin are also administered, its inclusion in bundled interventions for PPH prevention is widely accepted. For instance, some studies suggest continuous uterine massage may not provide additional benefits when prophylactic oxytocin has already been given. However, uterine massage is consistently recommended for the treatment of PPH once it is diagnosed. The practice remains a well-established aspect of postpartum care.
Patient Experience and Important Considerations
Individuals undergoing fundal massage can expect a sensation that is often described as uncomfortable or even painful, rather than relaxing. This is because the procedure involves firm pressure on a sensitive area that has just undergone significant physiological changes. Despite the discomfort, the massage is typically brief, lasting only a minute or so for each assessment.
Nurses, midwives, or doctors commonly perform fundal massage during the immediate postpartum period. It is often done every 15 minutes for the first hour after birth, then less frequently, such as every 30 minutes for the next hour, and subsequently every few hours until discharge. During these checks, healthcare providers also monitor for any excessive bleeding or clots.