It’s very common for doctors or nurses to push down on a woman’s stomach after she gives birth. This is done for a few important reasons:
To expel blood clots
During delivery, the placenta detaches from the uterine wall. This leaves large open blood vessels that can bleed freely into the uterus. Pushing down on the stomach helps the uterus contract and compress these blood vessels to stop heavy bleeding.
This uterine massage, as it’s called, helps expel any blood clots that may have formed in the uterus. Blood clots that remain in the uterus can prevent it from contracting and lead to continued bleeding.
To check uterus size
As the uterus contracts after birth, it should progressively get smaller and firmer. Pushing on the stomach allows the provider to assess the size and firmness of the uterus.
If the uterus feels larger or softer than expected, it could indicate:
- The placenta isn’t detached completely
- The uterus isn’t contracting well
- There is abnormal bleeding into the uterus
Identifying an abnormally large or soft uterus early allows measures to be taken to help the uterus contract and avoid severe bleeding.
To expel placenta
The placenta usually detaches from the uterine wall shortly after the baby is delivered. Pushing down on the lower abdomen can help expel the placenta by assisting with uterine contractions.
If the placenta does not detach on its own, providers may push on the stomach while gently pulling on the umbilical cord to help guide the placenta out of the uterus.
To expel clots and debris
After the placenta delivers, small blood clots, tissue debris or amniotic fluid can remain in the uterus. Firm pressure on the abdomen helps the uterus expel any remaining clots or debris.
Removing this material reduces the risk of infection and allows the uterus to contract and close off blood vessels.
To check for bleeding
Pressing on all areas of the lower abdomen after birth allows providers to check for any continued bleeding or hemorrhage. Bleeding may not be visible externally if it collects inside the uterus or vagina.
By massaging the uterus through the abdomen, providers can identify areas of bleeding that need additional attention.
To stimulate breastfeeding
Nipple stimulation releases oxytocin, which helps the uterus contract. During a uterine massage, providers may also gently rub the breasts and nipples to stimulate oxytocin release.
This helps the uterus stay firm and discourages postpartum bleeding as the woman begins breastfeeding her baby.
When is uterine massage done?
Uterine massage is commonly performed:
- Right after the placenta delivers
- Every 15 minutes for 1-2 hours after delivery
- During breastfeeding in the first day after delivery
- Any time postpartum bleeding seems excessive
It may be done more frequently if the uterus feels enlarged or soft or if bleeding is heavy.
Pain level
Having your abdomen pressed on soon after labor can be uncomfortable. However, it should not be significantly painful.
Let your provider know if the uterine massage causes intense or worsening pain. This may indicate:
- Placenta still attached to the uterine wall
- Tissue trapped in the cervix
- Uterus not contracting well
- Bladder distension
Any of these issues will need to be addressed to help the uterus contract and minimize bleeding.
Duration
Uterine massage in the early postpartum period often lasts:
- 5-10 minutes after the placenta delivers
- 1-2 minutes periodically in the first 1-2 hours after delivery
As the uterus becomes smaller and firmer, the duration needed is less. Postpartum nurses will continue periodic massages as needed over the first day.
What mothers can expect
If you’ve just given birth, you may be wondering why pressing on the abdomen is necessary. Here’s what you can expect:
- Your nurse will massage your lower abdomen right after birth and delivery of the placenta. This helps the uterus contract and expel blood clots.
- The nurse will keep checking your uterus by pressing on your abdomen. This ensures your uterus is firm and prevents heavy bleeding.
- You may get uterine massages periodically over the first day after delivery, especially before breastfeeding. These quick massages help maintain uterine tone.
- Let your nurse know if the massages become very painful. Some discomfort is normal, but excessive pain could indicate a problem.
- The massages will get less frequent as your uterus gets smaller and firmer. By 24 hours, they are usually no longer needed.
While postpartum abdominal pressing may not be comfortable, it plays a key role in preventing hemorrhage and minimizing blood loss after delivery.
Risks of not doing uterine massage
Skimping on uterine massage can have consequences, including:
- Hemorrhage – Without massage, blood clots and heavy bleeding into the uterus are more likely. This can lead to potentially life-threatening postpartum hemorrhage.
- Infection – Retained clots and tissue raise the risk of developing a uterine infection.
- Subinvolution – The uterus may not shrink back down in size normally, a condition called uterine subinvolution.
- Anemia – Excessive blood loss leads to anemia and its complications like fatigue, weakness and shortness of breath.
That’s why following standard guidelines for postpartum uterine massage is so important to minimize blood loss and related complications.
Special situations
In some cases, extra precautions may be needed with postpartum uterine massage:
- Cesarean birth – Abdominal pressing is still done routinely after a C-section for the same reasons. However, the incision site is avoided.
- Placenta accreta – This is an abnormal attachment of the placenta into the uterine muscle. Excessive pressing could disrupt the placenta so uterine massage is done very gently.
- Vaginal tears – If severe vaginal tears occurred, providers avoid prolonged massage until the tear is repaired, to prevent worsening bleeding.
- Atonic uterus – If the uterus is not contracting well, prolonged, firm massage may be needed along with medication.
Talk to your provider if you have any conditions that may require special care with postpartum uterine massage.
Medications to enhance uterine massage
Sometimes medications may be given along with uterine massage to improve uterine tone and contraction. These can include:
- Oxytocin – Given IV or as an intramuscular injection (common trade name Pitocin). It stimulates uterine contractions.
- Methylergonovine – Taken orally or via injection. It causes intense uterine contractions (common trade name Methergine).
- Carboprost – Given as an intramuscular shot. This also stimulates labor-like contractions (common trade name Hemabate).
- Misoprostol – Dissolving tablets placed in the vagina near the cervix. It causes uterine contractions.
These medications combined with uterine massage work synergistically to shrink the uterus and decrease postpartum bleeding.
Compression devices
Sometimes special devices are used to assist with uterine massage after delivery:
- Belly binders – These canvas bands wrap around the abdomen and hip area to gently compress the uterus.
- Anti-shock garments – These inflatable compression suits can be applied to the legs and abdomen to aid uterine contraction.
When paired with massage, these devices provide constant pressure to encourage the uterus to contract and remain firm.
| Compression Device | How It Works | When Used |
|---|---|---|
| Belly binders | Wraps around abdomen to provide gentle continuous compression | In first 24 hours after delivery |
| Anti-shock garments | Inflatable compression suit covers abdomen and legs | Immediately after birth for hemorrhage |
Tips for an effective uterine massage
Here are some tips providers follow to perform the most effective uterine massage after delivery:
- Use a circular, kneading motion – This stimulates uterine contractions most effectively.
- Gradually increase pressure – Start light, then use deeper pressure as tolerated.
- Press down during a contraction – Time massage pressure with contractions for added effect.
- Massage all areas – Ensure the top, sides and bottom of the uterus are massaged.
- Assess shape and size – Note if there are any abnormal enlargements during the massage.
- Do frequent short massages – For example, massage for 1 minute every 10-15 minutes.
Let your care team know if you have any concerns or severe discomfort during the massage process.
After a cesarean delivery (C-section)
Uterine massage is still commonly performed after a C-section delivery. However, some modifications are made:
- The incision area is avoided – Pressure is only applied above or sideways from the incision.
- Firm pressure and circular massage are not used – Gentle palpation helps check uterine tone.
- Duration is shorter – 1-2 minutes every 10-15 minutes is typical.
- Medications may used more readily – Like oxytocin to enhance uterine tone.
The gentler massage and medications help maintain uterine contraction while avoiding trauma to the incision.
C-section massage technique
Here are some good techniques for providers to use when massaging the uterus after a cesarean delivery:
- Palpate the fundus gently using an open hand.
- Apply very light pressure over the incision using finger pads.
- Massage the upper sides of the uterus away from the incision.
- Perform short 1-2 minute massages periodically.
- Stop if the mother complains of incisional pain.
This gentler approach allows the critical uterine massage while protecting the vulnerable abdominal incision site.
Self-massage after birth
After the initial day postpartum, providers will instruct women how to periodically massage their own uterus.
Self-massage helps the uterus continue to contract and reduces bleeding as mothers become more mobile.
To perform self-massage:
- Place one hand just above the pubic bone.
- Gently but firmly press back towards the spine.
- Massage in a circular, sweeping motion up the side of the uterus.
- Alternate hands and massage all areas for 1-2 minutes.
- Repeat massage every 1-2 hours in the first few days after delivery.
Let your provider know if any worrisome bleeding, pain or uterine enlargement occurs.
Tips for effective self-massage
Keep these tips in mind for the best postpartum self-uterine massage:
- Massage before nursing or pumping – This enhances contractions more.
- Use lotion or oil – Reduces friction and discomfort on your abdomen.
- Increase pressure gradually – Start light, then use firmer pressure.
- Do massage on each side – Helps ensure the whole uterus is stimulated.
- Perform in a relaxed state – Tensing abdominal muscles reduces effectiveness.
With practice, self-massage gets easier and quicker to perform. Most women only need to do it for the first 3-5 days postpartum.
When to call a doctor
Be sure to contact your healthcare provider if you have any of the following during postpartum uterine massage:
- Bleeding heavier than a period
- Severe or worsening pain
- Foul-smelling lochia discharge
- Uterus feels soft or larger than expected
- Fever over 100.4°F (38°C)
- Feeling lightheaded or dizzy
These could indicate a problem like infection, retained tissue or hemorrhage needing prompt medical care.
Takeaway
Having your abdomen pressed and massaged after giving birth can be uncomfortable. But it plays a vital role in preventing excessive blood loss and its complications.
Uterine massage causes contractions that stop bleeding, expel clots and help the uterus return to normal tone and size.
While pressure on the abdomen after delivery may not be fun, keep in mind that it’s an important part of your postpartum recovery process.