The manual pressure applied to the lower abdomen immediately following childbirth, often called a fundal massage, is a standard part of postpartum care. This action, while surprising and frequently uncomfortable, serves a specific medical purpose. The procedure involves a healthcare provider, typically a nurse or doctor, firmly pressing and massaging the top of the uterus through the abdominal wall. This forceful action prevents a potentially life-threatening complication that can occur immediately after delivery.
Preventing Postpartum Hemorrhage
The primary reason for this abdominal pressure is to prevent Postpartum Hemorrhage (PPH), which is excessive bleeding after the baby’s birth. PPH is a serious, life-threatening complication requiring immediate medical intervention. It is most commonly caused by the uterus failing to contract sufficiently after the placenta is delivered.
The physiological mechanism involves the site where the placenta was attached to the uterine wall, which leaves behind a large wound with exposed blood vessels. Normally, after the placenta is expelled, the muscles of the uterus, called the myometrium, contract forcefully. These contractions act like natural clamps, squeezing the blood vessels shut to stop the bleeding.
When the uterus fails to contract effectively, this is known as uterine atony, the leading cause of PPH, accounting for approximately 70% of cases. An atonic uterus remains soft, or “boggy,” instead of becoming firm and contracted. If the muscles do not tighten, the blood vessels where the placenta was attached remain open, leading to rapid blood loss.
The manual pressure of the fundal massage acts as an external stimulus to encourage the uterine muscles to contract vigorously. This technique helps the uterus “clamp down” on the bleeding vessels, promoting hemostasis and reducing the risk of PPH. The massage also assists in expelling any accumulated blood clots or tissue fragments that could interfere with the uterus’s ability to maintain a firm tone.
What the Procedure Involves
The procedure involves the healthcare provider locating the fundus, the top portion of the uterus, usually found near the belly button immediately after delivery. The provider places one hand above the pubic bone to stabilize the uterus and uses the other hand to apply firm, rhythmic pressure to the fundus through the abdomen. This action assesses uterine tone and encourages contraction.
The goal of the fundal massage is to ensure the uterus becomes firm, described as “firm and midline,” indicating a sustained contraction. If the uterus feels soft or boggy upon palpation, the provider continues the massage until muscle tone improves. This manual stimulation triggers the muscle fibers to tighten and compress the blood vessels, achieving the necessary contraction.
For most people, the sensation is one of intense pressure, often described as strong cramping or an exaggerated contraction. This discomfort is heightened because it occurs immediately after the intensity of labor and delivery. Due to the risk of PPH, the procedure is performed frequently in the immediate postpartum period: typically every 15 minutes for the first hour, and then every 30 minutes for the second hour.
Continued Monitoring and Recovery
Once the uterus is successfully contracted and the immediate danger of excessive bleeding has passed, the intense fundal massage transitions into a routine assessment of uterine tone. Healthcare providers continue to check the firmness and location of the fundus, spacing out the checks over the next several hours. The uterus should progressively descend into the pelvis, shrinking by about one centimeter each day.
Monitoring also focuses on the amount and characteristics of lochia, the normal postpartum vaginal discharge made up of blood, mucus, and tissue. The nurse assesses perineal pads for flow rate and the presence of large blood clots, as an increase in lochia can signal a loss of uterine tone or other complications. A rapid saturation of a pad or the passage of golf-ball sized clots requires immediate attention.
During this recovery period, the patient or their partner may be taught a gentler version of the massage to perform on themselves. This self-massage encourages uterine involution, the process of the uterus returning to its pre-pregnancy size. Patients are instructed to report any persistent bright red bleeding, a sudden increase in flow, or a feeling that the uterus is becoming soft again.