Uterine massage is a common practice following childbirth, a procedure many new parents may encounter. This intervention is often performed by healthcare providers as part of routine care.
What Uterine Massage Involves
Uterine massage, also known as fundal massage, is a physical technique healthcare professionals use on the lower abdomen. It involves applying firm, repetitive massaging or squeezing motions to the top portion of the uterus, called the fundus, through the abdominal wall. This action aims to stimulate the uterus. Nurses, midwives, or doctors typically perform this procedure.
During the massage, the healthcare provider will often place one hand over the pubic bone while firmly kneading the uterine fundus with the other. The goal is to encourage the uterus to become firm, like a grapefruit, rather than soft or “boggy”. Patients may find it uncomfortable or even painful, though it is often not unbearable. The massage essentially simulates a uterine contraction to help expel any remaining blood and clots.
The Role of Uterine Massage
The purpose of uterine massage is to prevent excessive bleeding after childbirth, known as postpartum hemorrhage (PPH). After delivery of the baby and placenta, the placental attachment site is left with open blood vessels. For these vessels to close and bleeding to stop, the uterus must contract firmly.
Uterine atony, a condition where the uterus fails to contract adequately after delivery, is the most common cause of PPH, accounting for approximately 70% of cases. When the uterus remains relaxed, blood vessels at the placental site bleed freely, leading to significant blood loss. PPH can result in a sharp drop in blood pressure, hypovolemic shock, and, if not treated promptly, can be life-threatening.
Uterine massage physically stimulates the uterus to contract, thereby helping to compress these blood vessels and minimize blood loss. This manual stimulation works in conjunction with the body’s natural processes. Oxytocin, a hormone naturally released during labor and after birth, also plays a role by causing uterine muscles to contract. Breastfeeding can also stimulate oxytocin release, which aids in uterine contraction.
Studies have shown that uterine massage can reduce blood loss and the need for additional medications that help the uterus contract, known as uterotonics. This intervention is particularly valuable in settings where access to uterotonic medications might be limited.
When Uterine Massage Might Not Be Performed
While widely practiced, uterine massage may not be performed or considered less beneficial in specific circumstances. If the uterus is already firmly contracted and there is no excessive bleeding, massage may not be necessary. In such cases, continued vigorous massage could potentially cause discomfort without offering additional benefits. Healthcare providers regularly assess the uterus’s firmness and bleeding to determine the need for massage.
In many settings, synthetic oxytocin is routinely administered after delivery to stimulate uterine contractions and prevent PPH. When oxytocin has been given, some research suggests that routine uterine massage may not provide significant additional benefits in reducing blood loss, though it is often still performed. The discomfort associated with the massage, especially after a vaginal or cesarean delivery, leads some to question its routine application when uterotonics are already in use.
Certain rare medical conditions, such as uterine rupture, would also contraindicate uterine massage due to the potential for worsening the condition. Healthcare providers evaluate each individual’s situation to determine the most appropriate postpartum care, considering factors like overall health, delivery complications, and the uterus’s response to other interventions.