Massaging the Fundus - An Unnecessary & Painful Intervention (for most women).

If you’ve given birth in a US hospital hopefully you have fond memories of meeting your baby. But how fond are the memories of the fundal ‘massage’ you probably received from your nurse after the placenta was delivered?

Shortly after your baby was born the nurse lifted your gown and proceeded to firmly rub the top of your uterus (fundus) through your abdominal muscles as she commiserates with you about how awful it feels but how necessary it is… (If you didn’t have this ‘massage’ you didn’t miss out). Massaging the fundus even sounds sort of relaxing (I’m a big fan of massage…just not this kind - when it’s done without a medical reason).

Learn more about your options for this stage of labor.

I’ve spoken to mothers who have had empowering, life changing unmedicated labors who found this ‘massage’ more painful than the strongest contractions they experienced. Others felt traumatized that they felt they had no choice but to consent to this painful procedure because what they were told was necessary.

But the evidence suggests if you have a managed 3rd stage of labor (in US hospitals that might be an IV or a shot of Pitocin) there is no benefit to having this painful intervention.

If you didn’t experience this agonizing ‘grab and rub’ of your uterus let’s look at what you missed.

Fundal checks are evidence based - fundal massage in the absence of complications isn’t.

Uterine or Fundal Checks?

Fundal checks are an important aspect of your immediate postpartum care to make sure your uterus is doing what it’s supposed to do – involute.  That means it’s getting smaller and the walls of the uterus are coming together in conjunction with the spiral arteries slowing and stopping any unnecessary bleeding.  So your nurse/midwife wants to make sure the top of the uterus is now firm to the touch and is sitting at about your belly button soon after birth.  The nurse is checking the fundal tone, this is done with with a light touch to the top of the uterus to feel whether or not it’s contracting.  Depending on where you live and how your labor went will determine how frequently these fundal checks happen.  Fundal checks are considered a necessary immediate post partum intervention worldwide but it shouldn’t be excessively painful.   Slow breathing will definitely help.

How does blood clot? - Postpartum blood clots

A platelet plug is formed, and the external bleeding stops. Next, small molecules, called clotting factors, cause strands of blood-borne materials, called fibrin, to stick together and seal the ‘wound’ left behind after the placenta has been delivered.

Imagine you’ve just had a tooth out. Does your dentist tell you to keep checking that clot that’s forming in the space left behind? Does your dentist tell you to keep sticking your finger into it - just to check…no…they’ll usually tell you to leave it alone and not to eat on that side for a bit - so the blood clot can continue to form as the healing happens underneath. Seems kinda logical.

Fundal Check and Uterine Massage - Demonstration Video

This is what a fundal check looks like (2:11 in the video). At 3:38 uterine ‘massage’ is also demonstrated.

Fundal/Uterine Massage After Birth

Fundal Massage is an intervention used to ‘irritate’ the uterus into contracting and stopping excessive bleeding. It’s a potentially life saving maneuver if you are bleeding uncontrollably while other supports are being put in place such as IV fluids and medication.  It’s definitely something you want IF you are bleeding uncontrollably. However most US hospitals use this approach routinely.   As in - it’s their policy to grab and squeeze your uterus without any medical indication - because they’ve been taught that it will stop bleeding…(there’s no evidence that this routine procedure prevents bleeding in an uncomplicated birth).

It’s painful and unnecessary for most women.  Most likely you fall into that category.

Uterine Massage Video

This is what fundal (uterine) massage looks like. It’s very common for staff to do this all over the US - even when women have a managed 3rd stage (synthetic oxytocin) to manage bleeding.

Fundal Massage After a Cesarean

Yes - this is commonly done too in the US and in some parts of Canada - why this is happening is bizarre. The uterus is already doing it’s best to contract now that the placenta is out (and it’s likely you’re on IV Pitocin to keep it contracting) and now it has to form another clot over the surgical site - so of course it makes even more sense (being facetious here…) to disrupt that process even more with fundal massage after major surgery.

Say No to Fundal Fiddling

In Europe and Australia it’s called ‘fundal fiddling’ and only done in emergencies. Why? Because when eager hands keep messing around every 15 minutes, interrupting oxytocin flow and bonding, while increasing pain and anxiety it’s causing harm. The irony is that in a well meaning effort to reduce bleeding by constantly irritating the uterus in this way we may in fact be interfering with the clotting process your uterus is trying to get on with.

 Have you thought about how this stage of labor will be managed for you and what your preferences are in the absence of any complications?

If it does become necessary all of the breathing practices will be so helpful!

I would encourage you to find out what’s routine in your hospital and if fundal massage is their routine practice.  If it is you can include in your birth preferences that if all is well you prefer not to have fundal/uterine massage. This means in the unlikely event that you did start to bleed excessively that of course you’re open to all options especially if you’ve opted for a physiological (natural) 3rd stage of labor.

If you’re giving birth in the US will you be having a one or two step ‘delivery’? OBs are taught to pull your baby out instead of waiting for the natural expulsion and lining up of baby’s shoulders. Learn more here - it’s another very important consideration for your birth preferences.

*Routine fundal massage also happens in other countries where evidence based care and midwifery care is limited.

Did you have this painful intervention? Would you opt for it again?

Note: there is currently no research comparing a physiological 3rd stage and fundal massage.