As you probably know, the uterus grows a great deal during pregnancy. Just one of many necessary changes that take place in a woman’s body to accommodate baby. After giving birth, the uterus – which is mostly muscle – should contract down to its normal size. This is usually painful in a crampy kind of way, but it is normal and part of the postpartum process.
In some cases, however, the this doesn’t happen. When the uterus fails to contract after delivery, it’s called uterine atony. This can lead to postpartum hemorrhage (PPH), which is the leading cause of death in new mothers worldwide. PPH is defined as excessive bleeding in the first 24 hours after childbirth. There are many possible causes of PPH, such as retained placenta or tears of the cervix or vagina. Of these causes, uterine atony is the most common. You can read more about PPH here.
Uterine atony is suspected when there is heavy bleeding and the uterus doesn’t seem to be contracting down. To help determine if this is the case, your doctor or nurse or midwife will feel for your fundus (the top of the uterus) in your lower abdomen to see where it is. In the event of uterine atony, it is thought that massaging the uterus will help it contract down and control bleeding. Enter: uterine massage (or fundal massage, as it’s also called). This entails someone using his or her hands to massage or squeeze the uterus from outside the body through the abdominal wall. As you can imagine, this can be quite uncomfortable.
There is some controversy in the medical literature about how effective uterine massage is. But it is a cheap, safe, and readily available intervention. As such, the American College of Obstetricians and Gynecologists (ACOG) recommends certain interventions in the third stage of labor (delivery of the placenta) to prevent hemorrhage, including uterine massage. Other interventions include the use of uterotonics, or agents used to contract the uterus (such as oxytocin) and controlled cord traction (gently pulling on the umbilical cord). This is another reason early breastfeeding is encouraged – it stimulates release of oxytocin.
Although uterine massage may be uncomfortable, it’s an important first measure. Remember that your healthcare team will try more conservative measures first in order to try to avoid things like blood transfusions or more invasive treatments that may be needed in the event of PPH.