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.
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
What Is a Uterine Massage?
Uterine massage, also known as fundal massage, involves applying firm pressure to the uterus to help it contract after childbirth. 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 will cause the uterine muscles to contract and the uterus to become 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 currently considered a part of routine postpartum care management. It is an experience that nearly every postpartum parent will likely encounter, especially if delivering in a hospital.1
Reasons for a Uterine Massage
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. Occasionally and for various reasons, your uterus may be “boggy” or 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
When Will This Happen?
Uterine massage is typically performed immediately after delivery and during the early postpartum period.
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.
What Is a Postpartum Hemorrhage?
It is difficult to discuss uterine massage without briefly addressing 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 Massage Feel Like?
Uterine massage is not a comfortable experience. 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 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 the discomfort of afterpains.7
Uterine massage after birth is routinely used to help ensure the uterus stays firm and bleeding remains controlled. While it can be uncomfortable, it is a safe and effective intervention that plays an important role in postpartum recovery. If your nurse performs frequent uterine checks, know that the discomfort is temporary and intended to support your health as your body heals.
