Uterine massage is a physical technique applied to the uterus, typically after childbirth. This procedure involves gently yet firmly kneading the top portion of the uterus, known as the fundus, through the abdomen. Its purpose is to help the uterus contract effectively and reduce bleeding.
Key Reasons for Uterine Massage
The primary reason for performing uterine massage is to address or prevent postpartum hemorrhage (PPH), particularly when it results from uterine atony. Uterine atony is a condition where the uterus fails to contract adequately after delivery, leaving blood vessels exposed at the placental site and leading to significant blood loss.
Normally, after the placenta detaches, the uterine muscles contract to compress the blood vessels that supplied the placenta, effectively stemming the flow of blood. If the uterus remains soft or “boggy” instead of firm, it indicates uterine atony, which is the most common cause of early PPH. PPH is defined as a cumulative blood loss of 1,000 mL or more, or any blood loss accompanied by signs of hypovolemia, within 24 hours after birth.
The uterus receives a substantial amount of blood. Consequently, unchecked bleeding due to uterine atony can lead to rapid and severe blood loss, potentially causing hypovolemic shock, organ failure, and in severe cases, death. Uterine massage serves as a first-line intervention in these scenarios to stimulate uterine contraction and minimize blood loss.
How Uterine Massage Works
Uterine massage works by directly stimulating the uterine muscles. These contractions compress the blood vessels that were previously open at the site where the placenta was attached.
This compression helps reduce bleeding by physically squeezing the vessels shut. The massage also helps expel any blood clots or retained placental fragments that might be preventing the uterus from contracting fully. As the uterus contracts, it becomes firmer, which is a sign that the blood vessels are being effectively compressed and bleeding is being controlled.
When Uterine Massage is Not Recommended
Uterine massage is not always appropriate and can be ineffective or even harmful in certain situations. It is indicated when excessive bleeding is due to uterine atony, where the uterus is not contracting sufficiently. However, postpartum hemorrhage can also be caused by other factors, such as lacerations of the cervix, vagina, or perineum, retained placental fragments, or uterine rupture.
In cases where bleeding is due to these other causes, uterine massage would not address the underlying problem and might delay more appropriate interventions. For instance, if a laceration is the source of bleeding, surgical repair is necessary. Similarly, if retained placental fragments are preventing the uterus from contracting, their removal would be the primary treatment. Patient refusal is also a reason to not perform the massage.
Receiving a Uterine Massage
Uterine massage is performed by trained healthcare professionals, including nurses, midwives, or doctors, typically in a hospital or birth center setting. The procedure involves the healthcare provider placing one hand on the lower abdomen, just above the pubic bone, and the other hand gently but firmly kneading the top of the uterus in a circular motion. This firm pressure can cause discomfort or pain for the patient.
The massage usually continues until the uterus feels firm, similar to the firmness of a grapefruit. It is performed every 15 minutes for the first two hours after delivery, with frequency decreasing as the uterus remains contracted. While uncomfortable, this intervention is important for patient safety, especially in preventing or managing postpartum hemorrhage.