#41 Fundal Message

A fundus is any part of a body organ furthest from the organ opening. The term is used for stomachs, gall bladders, and even eyes. In the discussion of fundal message here, we are referring to the fundus of the uterus.

After delivery, it’s possible you are losing too much blood because your hormones are not working to help your uterus shrink back to its normal size and shut off blood loss. A uterus which doesn’t begin shrinking back to normal size is termed floppy. Fundal massage can be used by your physician to help your uterus shrink back to its normal size and stop blood loss.

The uterine fundus is located directly in the midline of your abdomen, a little below your belly button. When your healthcare provider rubs this area, your uterus will contract and clamp down to stop the bleeding from your wound inside the uterus. This pushes out blood clots and stops postpartum hemorrhaging.

Fundal massage is an old, safe, cheap, and effective method to treat postpartum hemorrhage. It is usually performed on the uterus with the index and middle finger of the dominant hand. The fingers are placed at the navel and moved in a circle about two inches in diameter. In my experience, this method worked well for me and my patients.

Usually fundal massage does not require a lot of time to be effective, although I once did fundal massage on a patient for six hours. She recovered from the hemorrhaging well and had no complications.

This massage does not need to be hard or painful. Pushing the uterus to expel hidden clots in not helpful and is painful.

Medications such as intravenous (IV) Pitocin or intramuscular (IM) methergine are helpful to reduce blood loss.

For more information on fundal message, see Dr. Lindemann’s podcast on the topic.