“Heyyyyy, let me take a quick peek at your bleeding and give your uterus a little rub…” your sweet L&D nurse says to you.
Blissfully unaware of anything other than your brand new squishy baby, you reply “yeah…ok…” not thinking twice about what “little rub” really means…..
Often times I hear birthing people say they were never warned about or had even heard of a fundal massage until their nurse or midwife performed it for the first time. Fundal massages are not pleasant! I often liken it to the old video of Lucy from I Love Lucy kneading vigorously on some bread dough… Many newly postpartum individuals would describe fundal massages as very uncomfortable, or even downright painful. Maybe massage ins’t the best word….maybe something like coaxing or stimulation? Regardless of the name or what it does or does not imply, this massage is critical to your immediate postpartum recovery and has to be performed a handful of times. But the good news is the massage is over fairly quickly.
After birth, and after the delivery of the placenta, your nurse or midwife will want to locate your uterus, more specifically the top of the uterus which is called the fundus, and “give it a good rub”. Sounds perfectly harmless, right? Well, once the uterus is located—which should be found right at or right below your belly button—it is “massaged” in a not so gentle downward and inward motion. This helps the uterus contract and expel blood and/or clots.
Why is it performed?
Fundal massages are performed to encourage the uterus to contract and to prevent postpartum hemorrhaging. It is usually done every ten minutes or so, depending on your rate of bleeding. If you are bleeding a little heavier you may have more vigorous and frequent fundal massages.
After the placenta is delivered you are left with an open, bleeding wound in your uterus. Think of the placenta as a scab, and once it is removed the wound is exposed. As this wound bleeds, the uterus needs to contract to push out the blood and clots very similarly to how it helped push your baby and placenta out. If the uterus isn’t contracting, the blood will sit and collect in the uterus which can sometimes cause back pain. During a fundal massage you may feel blood and/or clots coming out of your vagina—your care provider will let you know how much is too much, or if there is a cause for concern.
Care providers do not want a “boggy” uterus. In other words, when your provider goes to perform the fundal massage, they’re looking for your uterus to be about the size and firmness of a soft ball, at or below your belly button. (Ask them to show you how to find and feel for your uterus so you can rub it yourself.) If it isn’t firm, it will usually firm up after the massage and the blood and/or clots are expelled. Sometimes the uterus is off to the side because your bladder is full. This could also prevent the uterus from contracting efficiently enough and may lead to excess bleeding or even hemorrhage. If you’ve taken our Birth Prep or Comfort Measures classes, you already know the importance of an empty bladder during labor!
One Method of Defense
In the hospital setting, synthetic oxytocin (called Pitocin) is given prophylactically immediately after birth. This is a preventative measure against postpartum hemorrhaging, though it can still happen even with the administration of Pitocin. It is usually given through the IV you already have placed. If you don’t have an IV placed, or are opting out of receiving prophylactic Pitocin, there are other things you can do to help ward off a hemorrhage. One of those things is fundal massage, and another is initiating breastfeeding by latching your baby onto your breast. If you’re having a home birth, latching baby and fundal massages become even more important. That is not to say Pitocin isn’t available in a home birth setting—it is, but isn’t routinely given unless necessary. Speak to your home birth midwife about what you can do to prenatally and during labor to minimize the chance of a postpartum hemorrhage.
If you have specific questions about the use of Pitocin after labor or fundal massages, speak with your provider,