The postpartum period after childbirth involves significant physical and emotional recovery. The body undergoes remarkable changes as it adapts from pregnancy to a non-pregnant state. Understanding common postpartum practices helps in navigating this recovery journey.
Understanding the Postpartum Uterus
The uterus, a muscular organ, expands considerably during pregnancy to accommodate a growing baby. Its uppermost part is called the fundus. After childbirth, the uterus needs to return to its pre-pregnancy size, a process known as involution. Immediately after delivery, the uterus begins to contract, reducing in size and becoming firm. The fundus’s location and firmness indicate how well the uterus is contracting, which is essential for healing.
Preventing Postpartum Bleeding
Fundal massage stimulates uterine contractions to prevent excessive postpartum bleeding, known as postpartum hemorrhage (PPH). Uterine atony, where the uterus fails to contract adequately after delivery, is the leading cause of PPH. If the uterus does not contract firmly, blood vessels where the placenta was attached remain open, leading to blood loss.
The massage helps the uterus contract strongly, compressing these open blood vessels and minimizing bleeding. It also aids in expelling any remaining blood clots or placental tissue that could hinder proper uterine contraction. By encouraging the uterus to become firm, fundal massage directly addresses uterine atony, reducing hemorrhage risk and sealing the internal wound created by the placenta’s detachment.
The Procedure: What Happens During Fundal Massage
Fundal massage is performed by healthcare providers shortly after delivery, often initiated immediately after the placenta is delivered. The frequency of the massage can vary, but it is commonly done every 15 minutes for the first hour postpartum, then every 30 minutes for the next hour, with intervals spacing out as the uterus becomes firmer.
During the massage, the healthcare provider locates the fundus by placing one hand on the lower abdomen and the other on the top of the uterus. They apply firm pressure, gently massaging the fundus in a downward, circular motion to encourage contraction. Individuals may experience discomfort or strong cramping during the massage.
Recognizing Normal vs. Concerning Signs
After childbirth, a normally contracting uterus should feel firm. Its size should steadily decrease, with the fundus descending about one centimeter per day below the navel. Vaginal discharge, called lochia, is also expected; it is red and moderate in amount initially, gradually becoming lighter.
However, certain signs indicate a problem warranting immediate medical attention. These include excessive vaginal bleeding, defined as soaking more than one sanitary pad per hour for several consecutive hours, or passing large blood clots. A uterus that remains soft, “boggy,” or unusually enlarged despite massage can be a sign of uterine atony. Any sudden increase in bleeding, worsening pain, or signs of dizziness or faintness should be reported to a healthcare provider promptly.