Postpartum Fundal Massage: Ob Gyn Debunking Myths
Fundal massage postpartum is a technique used to help reduce postpartum blood loss and associated morbidity and mortality. It involves the rubbing of the uterus to stimulate uterine contractions, which helps the uterus contract and reduces the risk of postpartum hemorrhage.
Fundal Massage Postpartum: Why Its Done
As expected the body changes significantly after childbirth. Let’s examine why postpartum massage is done.
What Happens After Childbirth?
After childbirth, the uterus begins to contract and return to its pre-pregnancy size. Fundal assessments are used to determine the position and size of the uterus. During a fundal check, the nurse presses down on the woman’s lower abdomen to feel the top of the uterus and assess its size and position. The nurse will make sure the top of the uterus is at the level of the belly button or lower.
Why Massage The Top Of Your Uterus?
The rubbing of the uterus helps to stimulate contractions. This helps the uterus contract and reduce the risk of postpartum hemorrhage. Postpartum hemorhage is the leading cause of maternal deaths worldwide.
In addition to reducing the risk of postpartum hemorrhage, fundal massage postpartum can also help with milk production. The stimulation of the uterus can help to increase milk production in breastfeeding women.
Fundal Massage Postpartum: Anatomy
Fundal massage postpartum is a technique that is used to promote uterine involution and prevent postpartum hemorrhage. The technique involves applying pressure to the top of the uterus to help it contract and reduce in size. To understand how fundal massage postpartum works, it is important to understand the anatomy of the uterus.
The uterus is a muscular organ that is located in the pelvic area of the female reproductive system. It is made up of three layers: the perimetrium, myometrium, and endometrium. The perimetrium is the outer layer of the uterus, while the myometrium is the middle layer and the thickest layer of the uterus. The endometrium is the innermost layer of the uterus and is shed during menstruation.
During pregnancy, the uterus expands to accommodate the growing fetus. The myometrium, which is made up of smooth muscle fibers, stretches to accommodate the growing fetus. The top of the uterus, which is also known as the fundus, rises as the fetus grows. Blood vessels that supply the uterus with oxygen and nutrients also increase in size to support the growing fetus.
After delivery, the uterus begins to contract and return to its pre-pregnancy size. The myometrium contracts to reduce the size of the uterus, while the blood vessels that supplied the uterus during pregnancy shrink. Fundal massage postpartum helps to stimulate uterine contractions, which helps to reduce the size of the uterus and prevent postpartum hemorrhage.
Fundal Massage Postpartum: When Is It Done
Fundal massage postpartum is usually performed after the delivery of the placenta. It is typically performed in the first hour after delivery, and is recommended for all women who have given birth vaginally or via cesarean section.
During vaginal delivery, fundal massage is usually done immediately after placental delivery. The goal is to help the uterus contract and prevent excessive bleeding. In cases where the delivery of the anterior shoulder is difficult, fundal massage may be performed to help the uterus contract and reduce the risk of postpartum hemorrhage.
For women who have had a cesarean section, fundal massage is typically done immediately after the baby is delivered. This is because the uterus may not contract as effectively after a cesarean section, and there is a higher risk of bleeding.
Active management of the third stage of labor, which involves the administration of uterotonic drugs, can also help to reduce the risk of postpartum hemorrhage. Fundal massage may be performed in conjunction with this technique to help the uterus contract and reduce bleeding.
Fundal Massage Postpartum: Does It Hurt?
It is important to note that fundal massage postpartum should not be painful. The nurse or doctor should use gentle pressure and avoid putting too much pressure on the uterus. The uterus should also be massaged in a circular motion, rather than a side-to-side motion. If fundal massage is painful, that could be a sign of an infection.
Fundal Massage Postpartum: What Happens If It’s Not Done
There are a few things that can happen if fundal massage is not done.
Uterine Atony
One possible consequence of not performing fundal massage postpartum is the risk of uterine atony. Uterine atony is the inability of the uterus to contract after delivery, which can lead to postpartum hemorrhaging. This can be due to a variety of factors, including retained placenta, prolonged labor, a large baby, excess amniotic fluid, fibroids, or a uterine infection. Uterine atony can result in large blood clots forming in the uterus, that can further prevent the uterus from contracting and increase the risk of hemorrhage.
Fundal Massage Postpartum: Does It Actually Help?
It is worth noting that the effect of uterine massage on reducing postpartum hemorrhage is still a topic of debate. While fundal massage is an effective technique to help the uterus contract and reduce the risk of postpartum hemorrhage (PPH), it is often used in conjunction with medications like oxytocin for optimal results. Relying solely on fundal massage may not be sufficient in all cases, especially if the uterus is not contracting effectively.
Fundal Massage Postpartum: Other Ways To Reduce Postpartum Bleeding
Fundal massage postpartum is one of the ways to reduce postpartum bleeding. While it is a simple inexpensive intervention, it is usually an initial step in controlling postpartum bleeding. In some cases, especially if a patient’s vital signs are unstable, further steps are taken.
Stopping postpartum bleeding, also known as postpartum hemorrhage (PPH), is critical to ensure the health and safety of the mother. Here is a stepwise approach health care providers may use to reduce vaginal bleeding and reduce maternal mortality from PPH.
Immediate Measures
These are first line therapies for controlling postpartum blood loss.
Fundal Massage
As described above a medical provider can try this first after a vaginal birth. Fundal massage can also be done after a cesarean delivery with special caution around the wound area.
Lactation
Stimulating the breast either by breast feeding or pumping naturally causes a release in oxytocin that helps the uterus contract.
Medications
Medications may also be needed to control postpartum bleeding. One of the biggest downsides to having a home birth is that some of the medications may only be available in hospital settings and during a home birth.
- Oxytocin: Synthetic oxytocin is very commonly administered to help the uterine muscles contract.
- Misoprostol: This drug is used if oxytocin is unavailable or ineffective.
- Methergine: This is another medication that promotes uterine contractions.
Emptying The Bladder
A full bladder can prevent the uterus from contracting properly. Helping the mother urinate can alleviate this issue.
Advanced Interventions
If the inital steps above don’t work, here are some more advanced options for helping the uterine wall to contract. As mentioned above, in the situation of a home birth, some of these advanced interventions may not be availalbe to the patient.
Bimanual Compression
A healthcare provider uses one hand inside the vagina and the other on the abdomen to compress the uterus and control bleeding.
Intravenous (IV) Fluids And Blood Transfusions
IV fluids may be needed in cases where a patient’s blood loss is severe and vital signs are unstable. A blood transfusion may be needed as well. Both of these interventions can help to maintain a safe blood pressure for the patient.
Intrauterine Devices
- Bakri: A balloon is inserted into the uterus and inflated to apply pressure and stop the bleeding.
- Jada: A suction device that helps to bring the walls of the uterus together and stop the bleeding.
Surgical Interventions:
In some cases, more aggressive interventions may be needed. Here are some potential surgical options that can be performed in hospital settings.
- Dilation and Curettage (D&C): To remove any remaining placental fragments.
- Uterine Artery Embolization: To block blood flow to the uterus.
- Hysterectomy: As a last resort, removal of the uterus may be necessary.
Home Care
Once a. patient is discharged from the hospital, it is important for them to get adequate rest. For many new moms, especially those who are breastfeeding, this can be challenging. Ensuring good hydration and nutrition to support overall recovery is important as well.
Postpartum Hemorrhage: General Information
It is normal for a woman to bleed after having a baby. However, when the bleeding is excessive, this is what doctors call postpartum hemorrhage. The incidence of PPH varies depending on definitions and settings. Overall, PPH affects approximately 3-5% of all deliveries globally.
PPH
PPH is defined as blood loss of 1,000 milliliters or more within the first 24 hours after birth. The incidence is about 2-3% of vaginal deliveries and 6% of cesarean deliveries. Blood loss over 500 milliliters after a vaginal birth is considered abnormal.
Developed Countries Vs Developing Countries
There are lower rates of PPH in developed due to better access to medical care, skilled birth attendants, and interventions like uterotonics. In developed nations, the incidence is around 1-2% of deliveries.
In developing nations, there are higher rates of PPH because of limited access to healthcare facilities, lack of skilled birth attendants, and insufficient access to uterotonic drugs. The incidence can be as high as 10% or more in some regions.
Fundal Massage Postpartum: Summary
Controlling postpartum hemorrhage in a postpartum mom is very important. The use of uterine massage is one method but there are also many other methods to help control postpartum bleeding.
Fundal massage postpartum is a technique that is used to promote uterine involution and prevent postpartum hemorrhage. The technique involves applying pressure to the top of the uterus, which stimulates uterine contractions and reduces the size of the uterus. Understanding the anatomy of the uterus is important in understanding how fundal massage postpartum works.
If the uterine cavity doesn’t respond to massage, medications can be given and there are advanced interventions available too. It is important to remember that some of these advanced interventions may only be available in hospital settings.