ALERT
Excessive massage of the uterus may cause increased bleeding instead of supporting hemostasis. Therefore, fundal massage should be performed only as needed, rather than when the uterus is firm.
Fundal massage without the support of the lower uterine segment may lead to uterine inversion, which is an obstetric emergency that may lead to maternal hemorrhage and shock.
Perform hand hygiene and don gloves.
Verify the correct patient using two identifiers per organization policy.
Position the patient supine, with her knees flexed.
Palpate the bladder for distention, and instruct the patient to void if needed. If she is unable to empty her bladder, assess the need for urinary catheterization per practitioner order.
Perform a fundal assessment for tone and position.
Cup one hand over the fundus and the other hand on the lower portion of the uterus at the symphysis pubis, ensuring proper placement of the hands.
Gently massage the fundus.
Apply firm downward pressure, toward the vagina, to expel any clots while continuing to support the lower segment of the uterus with the lower hand.
Perform perineal care.
Reassess the uterus with palpation every 15 minutes after fundal massage.
Assess, treat, and reassess pain according to organization standard.
Discard supplies, remove gloves, and perform hand hygiene.
Document the procedure in the patient's record.