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Saturday, September 13, 2014

Fundal Massage After Birth To Reduce Risk of Post Natal Hemorrhage

As a pre and post natal massage therapist, I was taught the technique of fundal massage. Fundal massage is most useful in the first hours and days following labor. Fundal massage loses its effectiveness two weeks after delivery.

According to several articles published in medical journals and consumer magazines, fundal massage has long been known as a technique to prevent postpartum hemorrhage. Varying techniques are used in hospitals and by medical practitioners, and they are similar to the technique used by massage therapists certified in pre and post natal massage. Fundal massage in a gentle manner is also beneficial during the pregnancy, and has been traditionally performed by midwives, doulas, and certified massage therapists.

Several techniques of fundal massage have been used by obstetricians after the birth. Some physicians use an internal and external technique, where the uterus is massage posteriorly from inside the vagina, and anteriorly from the upper abdomen. This type of massage is performed if there appears to be excess bleeding after birth.

Another technique is a much less invasive one that would be used more often by labor and delivery nurses, midwives, doulas, and massage therapists. One hand is placed toward the pubic bone under the bulge of the fundus. The other hand is placed directly on the bulge of the fundus, and circular kneading is performed until the uterus is felt by the therapist to harden or by the patient to contract.

This technique is used to help facilitate uterine involution and prevent hemorrhage in the days following birth. Studies cited in the articles that will be linked to at the end of this article mention that this has been an effective technique to reduce the risk of postpartum hemorrhage. In many hospitals, this technique will be performed at least once, although if there is greater blood loss than normal it may be done every fifteen minutes or every hour for several days until release. Release may be delayed if there is excess blood loss for monitoring of the patient. The continuation of this massage after hospital release extends the benefits of the technique.

Since most births happen in hospitals, it helps postpartum women to receive this type of massage after their birth since they often leave the hospital within a day or two. For women who have a doula or a midwife, these techniques will often be performed by those caregivers as they are generally experienced with it. For those women whose midwives are more medically orientede, they may need to receive this technique from their doula or postnatal massage therapist (see this link also shared below for more on touch in and after pregnancy).

Read more about this technique, as well as how it is used in hospitals in conjunction with oxytocin and other medications, in the articles below. For those women who prefer a nonmedicated birth and after birth period (especially since many medications can be transferred to the baby during breastfeeding), manual fundal massage is an excellent way to prevent hemorrhage by itself without medication. If you would like more information about prenatal and postnatal massage in general, please visit our prenatal page by clicking here, and our postnatal page by clicking here.
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