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Written by

Roxanne Albert, BSN, RNC-OB

What Is a Fundal Massage? What to Expect After Birth

  • Birth Options, Postpartum
After doing all the hard work of laboring and then pushing a baby out, we think the painful part is all over…until the nurse tells you that we need to do a belly massage to monitor bleeding and hopefully prevent any postpartum hemorrhage from occurring. Anyone who has felt this “massage” knows it’s NOT comfortable…so is it needed for everyone? Or is a fundal assessment enough?

What exactly is a fundal massage and why are they doing it?

A fundal massage is when your provider or nurse is assessing the location in your belly and firmness of the top of the uterus, which is called the fundus.

Typically after birth, the fundus is located around the belly button or a little below, and directly midline in the abdomen.

Then they are rubbing/massage the fundus and monitoring for any bleeding associated with the rubbing. Some do a more aggressive rub than others but they are all assessing and monitoring the same thing. The reason for the fundal massage is to prevent or treat postpartum hemorrhage. The massage causes the uterus to contract and clamp down to stop the bleeding from the wound inside the uterus where the placenta was located. That is why they are assessing if the fundus is firm.

How often is a fundal assessment/massage?

Immediately postpartum typically they will do a fundal massage every 15mins for the first hour, then every 30mins for the next hour. After that it differs per hospital, some do every hour, some do every 4 hours, and other do every 12 hours. There’s not a recommended time frame by any governing bodies. Some recommend doing a gentle fundal massage on yourself for the next 2-3 weeks to help encourage the uterus to continue to shrink back to its normal size.

I found that once out of the initial postpartum period fundal massages aren’t routinely done, they’re more often just fundal assessments. This is where they are just gently pressing the top of the fundus to assess its location, firmness, and then assessing any lochia (vaginal bleeding) that comes out during the press. The nurse may teach you how to massage your fundus yourself and educate you to do it every so often to help encourage the shrinking of the uterus, but they won’t routinely do it for you anymore.

Can You Skip a Fundal Massage??

One study found no difference in postpartum blood loss of those who received postpartum oxytocin versus postpartum oxytocin with a fundal massage. So if you received postpartum oxytocin and your fundus is firm you can probably opt out of the fundal massages! No research though on those who do not receive postpartum oxytocin if fundal massage would lessen blood loss. Important to note that fundal assessments are still recommended. This is a gentle assessment of the fundal tone than a vigours rubbing of it though!

Fundal massages are a tool that healthcare providers use after birth to prevent and treat postpartum hemorrhage. It’s not a comfortable procedure, have yet to meet someone to enjoyed it. Good new is that if you received postpartum oxytocin, you may not need the fundal massages!