Fundal massage is a hands-on procedure performed immediately after childbirth, a physical intervention that plays a complex role in maternal safety. New parents often encounter this technique without prior warning, leading to questions about its purpose and scientific justification in modern obstetrics. The practice is a standard component of immediate postpartum care. This article examines the evidence base for fundal massage, exploring its defined mechanics, primary goal, research findings, and formal status in clinical protocols.
Defining the Procedure and Timing
Fundal massage is a technique involving the manual stimulation of the uterus through the mother’s abdominal wall. The fundus is the uppermost part of the uterus, located near the level of the belly button immediately following delivery. This procedure is typically carried out by nurses, midwives, or doctors, and its application is firm and deliberate.
The intervention begins immediately after the placenta has been delivered, marking the start of the early postpartum period. Healthcare providers perform a fundal assessment and massage every 15 minutes for the first hour, and then less frequently. The physical action involves repetitive motions to encourage the uterine muscle to contract and become firm.
The Primary Goal Postpartum Hemorrhage Prevention
The central purpose of fundal massage is the prevention and management of Postpartum Hemorrhage (PPH), defined as excessive blood loss after birth. PPH is a leading cause of maternal morbidity and mortality worldwide, making interventions to prevent it highly important. Following the delivery of the placenta, the inner lining of the uterus is left with a large, open wound.
The body’s natural defense relies on the uterus contracting rapidly, a process known as involution. Failure of the uterus to contract adequately, a condition called uterine atony, accounts for the majority of PPH cases. Fundal massage provides external, mechanical stimulation intended to overcome atony and encourage the uterus to achieve a firm, contracted state.
Reviewing the Evidence and Research Findings
The scientific literature on fundal massage reveals a nuanced picture, distinguishing between its use for prevention and its use for treatment. Studies have examined whether routine, prophylactic fundal massage significantly reduces the incidence of PPH when administered alongside standard pharmacological management. One Cochrane review indicated that in women who already received a uterotonic drug like oxytocin, the addition of prophylactic fundal massage did not show a statistically significant reduction in the overall incidence of PPH (blood loss greater than 500 mL).
However, the same research showed that routine massage significantly reduced mean blood loss in the first hour post-delivery and decreased the need for additional pharmacological agents to stimulate uterine contraction. One trial specifically demonstrated that performing massage every 10 minutes for an hour reduced blood loss and the need for extra uterotonics by approximately 80%. This suggests that while the procedure may not dramatically change the rate of severe PPH when uterotonics are used, it helps manage and control the overall volume of blood loss in the immediate period. The strongest evidence for fundal massage remains its therapeutic application—it is a consistently effective first-line response to a uterus that is soft or “boggy,” indicating atony and active hemorrhage.
Integration into Current Clinical Guidelines
Major international and national health organizations routinely incorporate fundal massage into their official protocols, often as part of the Active Management of the Third Stage of Labor (AMTSL). Organizations like the World Health Organization (WHO) recommend an immediate assessment of uterine tone for all women postpartum to identify atony early.
Fundal massage is formally recommended as a mechanical measure to be used concurrently with uterotonic drugs, such as intravenous oxytocin, which are the first-line pharmacological treatment for uterine atony. Current guidelines emphasize that sustained, routine fundal massage is not recommended as a standalone intervention to prevent PPH in women who have already received prophylactic oxytocin. Conversely, it remains a globally accepted, low-cost, and life-saving procedure for the treatment of established uterine atony. This dual role solidifies its position as a standard, evidence-informed component of postpartum care in all settings.