Congratulations, mama! You’ve just welcomed a new life into the world, and now it’s time to focus on your own healing journey.
While those first few days and weeks are filled with snuggles and sleepless nights, let’s not forget an important part of postpartum recovery: the fundal massage.
Fundal massage is a far cry from the spa treatment it might sound like. Trust me though, this hands-on technique is crucial in helping identify potential complications after birth.
Let’s dive in and discover what fundal massage is all about, why it matters, and how to navigate those (sometimes a little uncomfortable) moments with grace and a touch of humor.
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The lowdown on fundal massage
First thing’s first – after discussing fundal massages (also known as fundal rubs) with the MLN community, I have discovered they are not routinely performed in some places. This especially holds true for mamas giving birth outside the U.S, but I have learned, from you guys, that this is true for a lot of mamas that gave birth in the U.S. too.
For the hospital where I spent 10 years working as an L&D nurse, fundal massages were a standard of care and routinely done on all of our patients after delivery. Just know, when reading this article, that the facility where you deliver your baby might not do things exactly like the hospital where I worked!
What in the world is a fundal massage?
Picture this: you’ve just given birth to your little one, and you’re basking in that blissful newborn bubble. Then, your nurse comes in and starts pressing on your belly. What’s going on?!
That, my friend, is a fundal massage. It might not be the most pleasant sensation, but it’s a crucial part of helping your uterus shrink back to its pre-pregnancy size and prevent you from losing too much blood!
Why does my uterus need a massage?
During pregnancy, your uterus expands dramatically to accommodate your growing baby. It’s like a superhero stretching its cape to protect its sidekick! But after birth, that superhero cape needs to shrink back down, just like your uterus. That’s where the fundal massage comes in.
By gently but firmly massaging the top of your uterus (fundus), your nurse helps stimulate contractions. These contractions help your uterus clamp down and expel any leftover blood and tissue, preventing excessive bleeding or hemorrhage.
The feels: it might be uncomfortable
Let’s be real, fundal massages aren’t exactly enjoyable for most mamas. The word massage might be a tad misleading. They can feel like strong period cramps or even mild contractions. But here’s the thing: it’s temporary, and it’s totally worth it for a healthy recovery.
If it’s particularly uncomfortable, take some deep breaths, focus on your little one’s face, or ask your nurse to adjust their technique.
When to expect it
Fundal massages typically begin right after your baby is born and continue for the first several hours postpartum. Your nurse will usually check your fundus and massage it every 15 minutes for the first two hours. This holds true for both vaginal and C-section births. As your uterus continues to contract and bleeding decreases, the frequency of massages will space out and then taper off if everything is looking good.
When I’m doing a fundal rub, I’m assessing how firm your uterus feels, where it’s located in your abdomen, and how much bleeding I’m seeing on your pad. I want to feel that your uterus is firm, midline, and your bleeding is appropriate (there isn’t a TON coming out with clots and such).
It will take roughly 6 weeks for your uterus to shrink all the way back to its pre-pregnancy size. Fundal massages definitely help your body get a jump-start on that process and are one effective way to prevent a postpartum hemorrhage from happening.
What if something is abnormal?
If anything appears to be out of the norm on any of the assessments, there are a few things that might happen next. First off, what is considered abnormal with a fundal massage? If your uterus is “boggy” or soft when we massage it, if it’s deviated from midline, or if you are passing a lot of blood and/ or clots, there might be something more concerning going on.
You should already have postpartum Pitocin infusing through your IV (or given intramuscularly if you don’t have IV access) to help with hemorrhage prevention (more on this below). As your labor nurse, if something abnormal is discovered, here are the things I would do next (not necessarily in any particular order):
- Increase the frequency of fundal massages
- Empty your bladder (especially if your uterus isn’t midline)
- Notify your OB provider
- Weigh your peri pads if the volume of blood is a concern
The next steps will depend on whether or not the above interventions were effective. Sometimes, simply emptying the bladder or being a bit more aggressive with those initial fundal massages is all it takes. If the uterus continues to be too soft or the bleeding is too heavy, there are more invasive things that your medical team can do.
Our ultimate goal here is to prevent you from having a postpartum hemorrhage. According to the governing body of obstetricians, ACOG, “Maternal hemorrhage, defined as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process, remains the leading cause of maternal mortality worldwide.” (source)
Tips for Surviving Fundal Massages
- Empty Your Bladder: A full bladder can make the massage more uncomfortable, so try to empty your bladder beforehand
- Communicate: Let your nurse know if the massage is too painful or if you need a break
- Focus on the Goal: Remember, this is all about helping your body heal and preventing complications
- Deep breaths: Try and take a big deep breath before your nurse begins, it might help make the fundal massage a little more tolerable
Postpartum Pitocin: The Contraction Helper
Along with fundal massages, you might also receive Pitocin (the same medication used for inductions, but in a much higher dose) to help your uterus contract. This can be given through your IV or as an injection if you don’t have IV access. Don’t worry, these contractions won’t be as intense as labor contractions, but they might feel a bit crampy.
You’ve Got This, Mama!
I know fundal massages aren’t the most glamorous part of postpartum, but they’re an essential step in your recovery journey. By understanding the process and working with your healthcare team, you’ll be well on your way to a smooth and healthy recovery in no time.
Mama, you are a total rockstar! You just brought a new life into the world. Now it’s time to focus on taking care of yourself so you can enjoy those precious early moments with your little one.
Additional Resources:
- 10 Totally Weird Things That Happen Before Labor!
- Preparing for Postpartum: What You Can Do Before Birth
- The Golden Hour After Birth
