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After childbirth, the uterus bleeds quite badly, since all the veins and arteries that connected with the fetus during pregnancy have been ripped from the uterine walls. The Uterine Fundus is the top area of the uterus, easily accessible under the skin of the stomach area, and is a good indicator by touch of the state of the uterus and its contents. After birth, the uterus must expel most of the material inside, including the placenta, so that it can shrink. The shrinking of the uterus is vital so the severed blood vessels can be clamped, preventing constant and possibly fatal bleeding.
A post-birth uterine fundal massage is often performed by the doctor, midwife, or nurse attending the birth. The purpose of the massage is to help expel material from the uterus, allowing it to shrink, and to give an indication of the status of the uterus itself; often, abnormalities can be felt through the skin, allowing potential problems to be diagnosed and healed. If the bleeding is not stopped, or worse, if material is allowed to remain inside the uterus, infection and clotting could develop, putting the mother's life at risk. The massage itself is usually non-painful and non-invasive, and is routine in most childbirth facilities.
Uterine massage is used after the placenta is expelled. The reason they do this is that research has shown that the massage releases more oxytocin, which enhances contraction. As the blood vessels in the uterus contract, there is decreased blood loss. Since postpartum hemorrhage is a major risk, the uterine massage decreases the risk. If the fundus remains "flabby," blood loss is of concern. The massage should firm the fundus to the feel of the thigh muscle. If this procedure is not enough, the mother may be given pitocin too enhance contraction even more.
- Because the fundus must be firm to compress bleeding vessels at the placenta site. Do not over massage the uterus because it is a muscle and excessive stimulation to contract it will tire it and can actually cause inability of the uterus to contract.
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