Following childbirth, healthcare providers routinely perform an abdominal procedure known as fundal massage. This hands-on technique is a standard part of immediate postpartum care, focusing on the uterus in the period directly after delivery. While the term “massage” might suggest a relaxing experience, this procedure is distinct and serves an important medical purpose during initial recovery.
The Purpose of Fundal Massage
The primary aim of fundal massage is to prevent postpartum hemorrhage (PPH), which is excessive bleeding after childbirth. Maintaining uterine tone is essential to manage this risk. After the placenta detaches, numerous blood vessels are exposed, and the uterus must contract firmly to compress these vessels and reduce blood loss.
This contraction process, known as uterine involution, is when the uterus shrinks back to its pre-pregnancy size. If the uterus does not contract adequately, uterine atony occurs, the most common cause of PPH. Fundal massage manually stimulates the uterine muscles, encouraging them to contract and remain firm, helping to “clamp down” on open blood vessels and prevent excessive bleeding.
Beyond preventing blood loss, the massage also assists in expelling any remaining blood clots or placental fragments. These retained materials can interfere with proper uterine contraction, increasing the risk of hemorrhage. The massage helps ensure the uterine cavity is clear, allowing the uterus to contract more efficiently. This physical intervention complements the body’s natural release of oxytocin, a hormone that also promotes uterine contractions.
What to Expect During the Procedure
Fundal massage involves firm pressure applied to the abdomen, specifically over the top of the uterus, known as the fundus. Many individuals describe the feeling as intense cramping or similar to strong contractions, which can be uncomfortable or even painful. Healthcare providers use one hand to stabilize the lower uterus near the pubic bone while the other applies downward and inward pressure to the fundus.
The procedure is typically brief, often lasting less than a minute for each assessment. During the massage, the healthcare provider monitors the uterus’s firmness, ensuring it contracts properly. They also observe the amount of vaginal bleeding, called lochia, and check for the presence and size of any blood clots. A firm uterus indicates effective contraction, while a “boggy” or soft uterus suggests it is not clamping down as it should, necessitating further intervention.
When and How Often it’s Performed
Fundal massage typically begins immediately after the placenta’s delivery. This timing is crucial because the uterine wall is left with open blood vessels once the placenta separates, making prompt contraction necessary. Initially, the massage is performed frequently to ensure the uterus remains firm and minimize bleeding.
In the first hour postpartum, healthcare providers commonly perform the massage approximately every 15 minutes. This frequency usually decreases to every 30 minutes for the subsequent hour. As the uterus continues to contract and bleeding stabilizes, the intervals between massages typically lengthen, often becoming hourly, then every few hours, or less frequently until discharge.
Addressing Concerns and Your Role
Communicating with your healthcare team is important during and after fundal massage. If discomfort is severe, or if you experience unusual pain or excessive bleeding, it is appropriate to inform your nurse or doctor immediately. Signs of excessive bleeding include soaking more than one sanitary pad per hour or passing blood clots larger than a golf ball. These symptoms could indicate the uterus is not contracting effectively, and further medical assessment may be necessary.
There are ways to support your comfort during the procedure. Practicing breathing techniques, similar to those used during labor, can help manage the intense sensation. Discussing pain management options with your provider beforehand can also be beneficial, as they can offer strategies to reduce discomfort. If the uterus does not respond adequately to massage or medication, other medical interventions may be considered.