What Is a Fundal Massage? Complete Guide to Postpartum Uterine Massage
If you’ve just given birth or are preparing for delivery, one unexpected part of the postpartum experience is something called a fundal massage. This hands-on technique may not feel like a spa day, but it plays a crucial role in post-birth recovery and maternal safety.
In this complete guide, you’ll learn what a fundal massage is, why it’s done, how it’s performed, and what to expect after different types of deliveries. Whether you're curious, anxious, or planning your recovery in advance, this article answers your top questions using current medical research and real nursing procedures.
Fundal Massage vs. Uterine Massage: What’s the Difference?
A fundal massage also called a uterine massage or “massage of the fundus” is a technique used by medical professionals to help the uterus contract after childbirth. The term "fundus" refers to the top portion of the uterus. Massaging this area helps stimulate uterine contractions, aiding in the expulsion of clots and minimizing bleeding.
Fundal rubs are typically performed by nurses, midwives, or doctors during the immediate postpartum period, especially within the first 1 to 2 hours after delivery.
Why Do They Massage the Uterus After Birth?
The main reason is to prevent a dangerous condition called postpartum hemorrhage (PPH), which is excessive bleeding after childbirth. Fundal massage helps the uterus “clamp down” and reduce blood flow from the placenta site. If the uterus remains “boggy” or relaxed, heavy bleeding can occur.
The World Health Organization and standard nursing guidelines often include uterine massage as part of active management of the third stage of labor (AMTSL).
Fundal Massage After C‑Section or Miscarriage
Fundal massage is not limited to vaginal births. It may also be performed after C-sections, D&Cs, or miscarriages, especially if there's a risk of retained blood or uterine atony. However, techniques may differ based on the patient's recovery needs and physical condition.
Does Fundal Massage Work to Prevent Postpartum Hemorrhage?
A Cochrane Review analyzed multiple studies and concluded that while uterine massage might reduce blood loss modestly, the results were inconclusive when used alone. It’s most beneficial when combined with medications like oxytocin. According to PubMed studies, fundal massage may reduce the need for further interventions but only in specific clinical situations.
Impact Among Women Who Received Oxytocin vs. Those Who Didn’t
In cases where oxytocin (a uterotonic) was not used, fundal massage showed slightly more effectiveness. When oxytocin was administered, the additional benefit of massage was minimal, suggesting it may be more helpful as a preventive rather than essential technique.
Many women report that fundal massage hurts. Some describe it as deep abdominal pressure or intense cramping, particularly if done repeatedly. Today, many providers prioritize gentler techniques and always seek patient consent before performing this procedure.
Step-by-Step Fundal Massage Technique
There are two main techniques:
Single-Handed Massage: Common in routine care, involves pressing on the abdomen to assess uterine tone and encourage contraction.
Bimanual Massage: Used in emergencies, one hand compresses the uterus internally while the other hand applies external pressure. This can be painful and is used only when necessary.
Safe Frequency and Timing: How Often Should Fundal Massage Be Done?
Fundal massage is typically performed:
Immediately after delivery, every 15 minutes
Every 30 to 60 minutes over the next few hours
Rarely after 24 hours unless complications arise
Some postpartum care providers may teach gentle self-massage at home, especially if clinical visits are limited.
When Fundal Massage Is Really Necessary
Indications: Uterine Atony and Postpartum Hemorrhage Risk
Fundal massage is most often recommended when:
Labor is prolonged
The baby is large or there are multiple births
The uterus is not contracting well (uterine atony)
There is a history of postpartum hemorrhage
No uterotonic medication is used
Can You Refuse Fundal Massage in the Hospital?
Yes. While medical staff may recommend it, you are within your rights to refuse a fundal massage. Open communication is key. If you're concerned about pain, trauma history, or have specific preferences, be sure to include them in your birth plan and speak with your provider ahead of time.
Alternatives to Fundal Massage
Some alternative or complementary options include:
Uterotonic medications like oxytocin or misoprostol
Fundal checks without vigorous massage
Self-guided gentle uterine massage
Lymphatic drainage massage to aid postpartum healing
Can Fundal Massage Cause Harm or Bleeding?
When done correctly, fundal massage is considered safe. However, potential risks include:
Uterine inversion (rare but serious)
Internal bruising
Increased pain or anxiety
Trauma to surgical areas in post-cesarean births
When to Avoid Fundal Massage
Caution or medical avoidance is advised if you have:
Placenta previa or retained placenta
Uterine infections
Major abdominal surgery
Blood clotting disorders
Always consult with your provider about what’s safest for your individual case.
Postpartum Scenarios and Massage Protocols
If oxytocin was administered during labor, uterine tone may be strong enough without frequent massage. Without oxytocin, more active fundal assessments and massages might be performed.
Fundal Massage After Cesarean Delivery
Yes, it is done but with more caution. Post-surgery, uterine tissue is delicate, and providers typically use gentle external pressure. Internal or bimanual massage is generally avoided.
After Miscarriage or D&C
Fundal massage can be used to assist uterine involution and prevent retained tissue, especially if heavy bleeding occurs. However, it is not done routinely unless indicated.
SpaTheory offers mobile massage services in select cities. We bring licensed therapists to your home to assist with:
How Much Does Fundal Massage Cost?
Postpartum massage sessions typically range from $60 to $150, depending on:
Your location
Therapist credentials
Service duration
Insurance coverage (some plans may reimburse under maternal care codes)
Final Thoughts
Fundal massage is a widely practiced postpartum procedure that plays a role in preventing hemorrhage. But its necessity and comfort level can vary greatly from person to person. Informed choices, gentle handling, and postpartum education are key to making recovery safer and more empowering.
FAQs
What is a uterus massage?
A uterus massage (fundal massage) is a hands-on technique used to help the uterus contract after childbirth and prevent excessive bleeding.
Is fundal massage done before or after the placenta comes out?
It is done after placental delivery to promote uterine involution and expel any clots.
Can fundal massage cause bleeding or pain?
Yes, if done aggressively or without proper technique. However, when performed correctly, it can be safe and effective.
Are fundal massages necessary for everyone?
Not always. Some women may not need it, especially if medications are used. Discuss your situation with a healthcare provider.