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Evidence Based Essay: Fundal Massage and Postpartum Hemorrhages

Jacqueline Soweidan

Westminster College

April 7, 2017
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Postpartum hemorrhage is the number one source of maternal death. All women who

have passed twenty weeks’ gestation are at an increased risk for postpartum hemorrhage. A

primary postpartum hemorrhage is defined as a blood loss of more than or equal to 500 ml in the

first 24 hours proceeding childbirth, greater than 1000 mL would be considered serious bleeding

(“Postpartum Hemorrhage,” 2017). There are can have a variety of reasons as to why they occur.

Some hemorrhages occur due to the mother’s uterine atony, for example, lesions in the birth

canal, uterine rupture or retained placental tissue after labor and bleeding disorders (“Postpartum

Hemorrhage,” 2017). Also, atony can occur to many different mothers but multiple gestation,

large infant, prolonged labor, induction of labor, use of anesthesia and prolonged third stage of

labor are just some of the things that can increase the chances of a postpartum hemorrhage

occurring (Davidson, Ladewig, London, 2015). Although, some risk factors increase the chance

of having a postpartum hemorrhage it can also occur in mother’s who do not have the associated

risk factors, thus, making it very important for the nursing staff and medical team to be aware of

interventions and signs of postpartum hemorrhage. Fundal massages are an important

intervention for nurses to complete because it is a quick intervention that can prevent a

postpartum hemorrhage by stimulating the muscle fibers to contract (Davidson, Ladewig,

London, 2015).

A fundal massage is performed after a nurse has completed an assessment and finds a

boggy uterus in the immediate postpartum period. A boggy uterus is where the uterus is more

flaccid and does not feel firm. The goal of the intervention is to regain the firmness and stimulate

the muscle nerves to begin contracting. In the research article, Preventing postpartum

hemorrhage: active management of the third stage of labour, they stated that once the placenta is

expelled performing uterine massages are recommended by the ICM, FIGO and WHO (Castro,
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Gomes, 2013). A study was conducted to determine if the uterine massages were affective. The

study taken place in Egypt compared the practice of uterine massage in the third stage of labor

and not practicing uterine massage and just using active management of prophylactic

administration of oxytocin. The results of the study showed a reduction in blood loss in the

experimental group receiving the uterine massages (Castro Parreira, Gomes, 2013). The study

noted a statistically significant difference in the mean amount of blood loss, and the loss was

lower in the experimental group. An incidence of 3% was found in the experimental group

compared with the 10% blood loss found in the control group (Castro Parreira, Gomes, 2013).

Moreover, concluding that uterine massage after delivery of the placenta is an advisable

intervention to prevent PPH. The study also focused on using uterine massage along with

uterotonic administration, controlled cord traction, delayed ligation of umbilical cord and

placental blood drainage to create a plan of active management (Castro Parreira, Gomes, 2013).

The study concluded with determining that if the following are completed in this order it will

help reduce the risk of postpartum hemorrhage from occurring; delay the clamping of the

umbilical cord by three minutes, after clamping the cord it must be unclamped so there is

drainage, administer oxytocin, implement traction of umbilical cord and after removal of

placenta perform uterine massage to promote contraction of the uterine muscles (Castro Parreira,

Gomes, 2013).

Learning about nursing interventions allows evidence based practices to be performed in

hospitals through an understanding of the technique that is being performed. Moreover, it can be

assumed that health care based on evidence is one that incorporates the best available evidence

on clinical decision. It is important to understand fundal massaging as a nurse because it is a

quick interventional that can be performed to help prevent postpartum hemorrhaging, which,
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could be deadly. Overall, fundal massaging is found to be an effective method in postpartum

mothers (Castro Parreira, Gomes, 2013).

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Works Cited

Davidson, M., Ladewig, P., & London, M. (2015). Olds' maternal-newborn nursing & women's

health. Place of publication not identified: Appleton & Lange

Castro Parreira, M. V., & Gomes, N. F. (2013). Preventing postpartum haemorrhage: active

management of the third stage of labour. Journal Of Clinical Nursing, 22(23/24), 3372-

3387. doi:10.1111/jocn.12361

Postpartum Hemorrhage. (2017). Retrieved April 7, 2017, from;

http://www.stanfordchildrens.org/en/topic/default?id=postpartum-hemorrhage-90-P02486