Fundal massage is a routine procedure performed immediately after childbirth. It involves a healthcare provider manually compressing the uterus. This intervention is a common part of postpartum care in many clinical settings.
What is Fundal Massage?
Fundal massage, also known as uterine massage, is a technique applied to the uterus following birth. A healthcare provider performs this manual compression. The procedure typically involves placing one hand above the pubic bone to support the lower uterine segment and using the other hand to firmly massage the top of the uterus, known as the fundus, through the abdominal wall. This action stimulates the uterus, encouraging it to contract.
This process usually begins shortly after the delivery of the placenta. It is performed frequently in the initial hours, with frequency decreasing as the uterus becomes firm and bleeding reduces. The goal is to ensure the uterus remains firm.
Why Fundal Massage is Performed
Fundal massage prevents excessive blood loss after childbirth, a condition known as postpartum hemorrhage (PPH). PPH is a leading cause of maternal complications globally. After delivery, the uterus needs to contract firmly to compress blood vessels that were connected to the placenta, effectively sealing them off and preventing bleeding from the site where the placenta was attached.
When the uterus fails to contract adequately, a condition called uterine atony, the blood vessels remain open, leading to uncontrolled bleeding. Uterine atony accounts for a large percentage of PPH cases. Fundal massage stimulates these contractions, aiding in uterine involution, the process where the uterus returns to its pre-pregnancy size. This promotes firm uterine contractions, helping the uterus clamp down on bleeding vessels and reducing hemorrhage risk.
Consequences of Not Performing Fundal Massage
Not performing fundal massage, or performing it inadequately, increases the risk of postpartum hemorrhage. If the uterus remains soft and relaxed, often described as “boggy,” it cannot effectively compress the blood vessels that supplied the placenta. This leads to continuous, potentially severe blood loss. Postpartum hemorrhage can lead to complications such as hypovolemic shock, a life-threatening condition where the body loses too much blood, causing a sharp drop in blood pressure and restricting blood flow to organs.
Uterine atony, the primary cause of PPH, can result in substantial blood loss, potentially requiring blood transfusions and extended recovery periods. A lack of massage can lead to the uterus failing to properly involute, meaning it does not shrink back down efficiently. This can prolong bleeding and increase the mother’s susceptibility to anemia and fatigue, impacting her overall postpartum recovery and potentially increasing the risk of PPH in subsequent pregnancies.
Patient Experience and Considerations
The experience of a fundal massage can be quite uncomfortable or even painful for many patients. Despite the term “massage,” it involves firm pressure and rubbing of the abdomen, which can feel like strong cramps or contractions. Healthcare providers prioritize this procedure due to its role in preventing life-threatening hemorrhage, even though it causes discomfort. The typical duration of the direct massage is often brief, lasting about a minute, though checks and repeated massages can occur frequently in the initial hours after birth.
It is a routine part of postpartum care in many hospitals, often alongside the administration of uterotonic medications like oxytocin, which also help the uterus contract. While patients have the right to refuse medical procedures, healthcare providers will explain the medical implications of refusal, particularly the increased risk of hemorrhage. Open communication with the care team about comfort levels and potential alternatives is encouraged, as sometimes a gentler assessment may be sufficient if the uterus is contracting well on its own.