Fundal massage is a manual procedure performed by healthcare providers immediately following childbirth. It involves applying firm, rhythmic pressure to the abdomen over the uterus. This technique is implemented to manually stimulate the uterus to contract after the delivery of the placenta. This swift and deliberate application of pressure serves a singular, life-preserving function for the birthing parent.
Anatomy of the Fundus and Uterine Atony
The term “fundus” refers to the dome-shaped top portion of the uterus. After pregnancy, the uterus is significantly enlarged, and the fundus is typically located near the level of the belly button. The uterus is a muscular organ that must begin involution, the process of shrinking back toward its pre-pregnancy size.
The uterine muscle fibers, or myometrium, are normally expected to contract firmly after the placenta detaches. This contraction is what gives the uterus a firm texture, often described as being like a hard grapefruit. Uterine atony is the failure of these uterine muscles to contract effectively after birth.
When the uterus remains soft and relaxed, it is described as “boggy” upon palpation. This atonic state is problematic because the relaxed organ is unable to adequately compress the numerous blood vessels that previously supplied the placenta. Recognizing this soft, uncontracted state signals that intervention, such as manual massage, is required.
The Primary Goal: Preventing Postpartum Hemorrhage
The fundamental purpose of fundal massage is to prevent a serious complication known as postpartum hemorrhage (PPH). When the placenta separates from the uterine wall, it leaves a large, open wound inside the uterus. Numerous large blood vessels, called spiral arteries, are torn open at this site of detachment.
Normally, the robust contraction of the uterine muscle fibers acts as a tourniquet to compress these vessels. This natural clamping action physically stops the flow of blood, allowing clots to form and preventing excessive bleeding. If uterine atony occurs, these vessels remain wide open, leading to rapid and significant blood loss.
Uterine atony is the most common cause of early PPH, accounting for about 70% to 80% of all cases. Severe bleeding is a medical emergency that can quickly lead to shock and is a leading cause of maternal mortality globally. Fundal massage is the immediate, first-line intervention to prevent this complication. The manual pressure initiates the contraction the uterus is failing to achieve on its own, reducing the danger of hemorrhage.
Physiological Mechanism of Uterine Contraction
Fundal massage works by providing a direct physical stimulus to the muscle fibers of the uterus. The firm, repetitive kneading motion directly irritates the myometrial smooth muscle tissue. This external stimulation prompts the muscle cells to depolarize and trigger a coordinated contraction response.
When the muscle fibers shorten and tighten, they effectively constrict the blood vessels running through the uterine wall. These interwoven muscle bundles act like “living ligatures,” mechanically strangling the spiral arteries at the former placental site. This squeezing action is necessary to achieve hemostasis, or the stopping of blood flow, which is the body’s natural response to trauma.
The physical act of massage also encourages the release of endogenous oxytocin from the pituitary gland. Oxytocin is a powerful uterotonic hormone that naturally causes the uterine muscle to contract. The massage action works synergistically with this hormonal release, augmenting the intensity and duration of the contractions.
This combination of mechanical and hormonal stimulation attempts to achieve a sustained, tonic contraction. A successful response is indicated by the uterus becoming noticeably smaller and achieving a hard, firm texture. This hardening confirms that the muscular ligatures have successfully clamped down on the blood supply, significantly reducing the risk of further hemorrhage.
Patient Experience and Post-Procedure Care
The fundal massage is performed immediately after the delivery of the placenta. It is repeated frequently, typically every 15 minutes for the first one to two hours, or until the uterus maintains firmness on its own. While the procedure is brief, it is often described as intensely uncomfortable or painful, as it requires necessary firmness over a recently stretched abdomen.
Healthcare providers work to perform the massage effectively while offering reassurance and explaining its purpose.
After the initial checks, the patient’s uterus will continue to be monitored for tone, height, and location. The nurse or midwife will gently palpate the fundus to ensure it remains firm, midline, and is continuing its descent back into the pelvis. A sudden gush of blood or a return to the soft, “boggy” state indicates the need for another massage and potentially additional medical interventions.
Some patients are taught a gentle form of self-massage, or fundal checks, to monitor their uterine tone in the days following birth. This empowers the patient to participate in their recovery and recognize warning signs. Patients should be instructed to immediately alert nursing staff if they notice a significant increase in bright red bleeding, the passage of large clots, or if they feel persistent softness in their lower abdomen.