After welcoming your newborn into the world, you may be bonding with your baby, admiring tiny fingers and toes, or learning to breastfeed when your nurse comes in to check your bleeding. This often includes a uterine massage after birth, also called a fundal massage. While it may catch you off guard, this is a common part of postpartum care.
A uterine massage, also called a fundal massage, is a common postpartum procedure that helps your care team check that your uterus is contracting, monitor bleeding, and support normal recovery.12
Regardless of whether you delivered vaginally or by Cesarean section, with or without an epidural, uterine massage may be used to help monitor uterine involution. This is the process of the uterus returning to its pre-pregnancy size and position. Understanding why uterine massage is performed and what to expect can help make the experience less surprising.10
Key Takeaways
- Uterine massage after birth is also called fundal massage.
- It helps your care team check whether your uterus is firm and contracting.
- It may be used to help monitor or manage postpartum bleeding.
- Fundal massage can feel uncomfortable or crampy, but it is usually brief.
- Tell your nurse or provider if the pain feels severe or something does not feel right.
What Is a Uterine Massage?
Uterine massage, also called fundal massage, is when a nurse or obstetric provider applies firm pressure to the uterus to help it contract after childbirth.2 With one hand stabilizing your uterus at your pubic bone, your nurse or obstetric provider will use the other to provide downward and inward pressure on your stomach to firmly rub the fundus or the top part of your uterus. This helps the uterine muscles contract so the uterus becomes firm.2
Muscular contraction of the uterus begins uterine involution, or the process of your enlarged uterus returning to its pre-pregnancy size and position. Uterine involution starts immediately after delivery and will assist in managing the bleeding that typically accompanies childbirth.2,8
Uterine massage is a routine part of postpartum care, especially after a hospital birth.1
Related: What is Postpartum Lochia? What You Need to Know
Why Is Uterine Massage Done After Birth?
Uterine massage is done after birth to help the uterus contract, monitor bleeding, and reduce the risk of excess postpartum bleeding.2,6
As the placenta detaches from the uterine wall, the spiral arteries of the uterus that feed the placenta are left exposed and bleeding. Spiral arteries are unique because they lack the musculature needed to contract on their own.11
The uterus must contract to compress these arteries and stop blood flow from the area where the placenta once attached. The body’s natural release of oxytocin will cause the uterus to contract. Sometimes the uterus becomes “boggy,” meaning it stays too relaxed after delivery. A relaxed or atonic uterus post-delivery will lead to increased bleeding. In this instance, uterine massage helps the uterus contract and may help control bleeding.2,6
Uterine massage is a helpful tool for expressing blood clots that may restrict uterine contractions, evaluating postpartum bleeding, and monitoring uterine involution. Uterine massage will be used with other medical interventions if bleeding is significant.2
Related: C-Section Recovery: Week-by-Week Guide for Healing After Birth
When Is Fundal Massage Performed?
Uterine massage is typically performed immediately after delivery and during the first hours after birth.
Your provider may perform a uterine massage right after the birth of your baby, either before or after the delivery of the placenta. The two hours following birth are critical for monitoring uterine firmness and assessing vaginal bleeding. During this time, uterine massage may be performed as often as needed, generally every 10 to 15 minutes, to help ensure a firm fundus and appropriate postpartum bleeding.1
Once your labor and delivery recovery period is complete, uterine massage is usually performed less frequently, often every 12 hours by your nurse, unless there is a need for more frequent massage or additional interventions due to active bleeding.
Related: Postpartum Essentials: What You Really Need for Mom and Baby
Uterine Massage and Postpartum Hemorrhage
Because uterine massage is often used to assess postpartum bleeding, it helps to understand postpartum hemorrhage. Postpartum hemorrhage (PPH), or severe bleeding after delivery, is a significant cause of maternal illness and death during childbirth. Postpartum hemorrhage can happen even in healthy pregnancies and is not always predictable.1,6 Ineffective uterine contraction after delivery accounts for approximately 75% of PPH cases.1,6
Every pregnant parent is at risk for postpartum hemorrhage. PPH is defined as a cumulative blood loss of greater than or equal to 1,000 milliliters, or blood loss accompanied by signs or symptoms of hypovolemia, within 24 hours after birth.3,12
Uterine massage can help a relaxed uterus contract or express a blood clot that may interfere with effective uterine contraction. However, it is not the frontline treatment for significant postpartum bleeding.1
Related: Understanding Postpartum Hemorrhage and How To Recover
What Does a Uterine (Fundal) Massage Feel Like?
Uterine massage can be uncomfortable, and some people find it painful. The pressure applied to the uterus may vary depending on who is performing the massage. The discomfort can vary from an aching period cramp to the pain of a strong contraction.
If bleeding or blood clots are suspected, a more aggressive massage may be used to contract the uterus purposely. If your fundus remains firm and bleeding is stable after delivery, the uterine massage may be gentler to ensure your uterus remains contracted.6
In some studies, uterine massage and frequent urination have reduced the pain of childbirth after pains or postpartum cramping. Frequent bladder emptying allows the uterus more space to contract effectively. This technique may reduce your need to take pain medication to manage afterpains.7
Uterine massage after birth can be uncomfortable, but it is a common part of postpartum care. Your nurse or provider uses it to check whether your uterus is firm, monitor bleeding, and support your recovery after delivery.
If the pressure feels intense, try to breathe through it and let your care team know how you are feeling. The checks are usually brief and meant to help keep you safe as your body begins to heal.
