Traditional postpartum protocols often emphasize uterine massage as a primary intervention to prevent hemorrhage. However, research and clinical experience show that aggressive or unnecessary fundal massage can be counterproductive. Instead, we recommend a gentler, more effective approach: lightly lifting the uterus rather than massaging it.

Why We Do NOT Recommend Uterine Massage

• Can Disrupt Natural Contraction – The uterus is designed to contract on its own after birth, effectively clamping down on blood vessels to prevent hemorrhage. Vigorous massage can actually interfere with this process, leading to uterine atony and increased bleeding instead of preventing it.
• May Cause More Harm Than Good – Forceful or repeated uterine massage can:
  
  
  - Increase pain and discomfort for the birthing person.
  - Risk uterine inversion, especially if the placenta has not yet detached.
  - Potentially weaken the uterus, making it less responsive to oxytocin and contributing to ongoing bleeding.
• Fails to Address the Root Causes of Hemorrhage – Uterine atony is often related to fatigue, overdistension, retained tissue, or clotting disorders. Massage does not address these underlying factors and may provide a false sense of intervention while the real issue goes untreated.

What We Recommend Instead: Lightly Lifting the Uterus

• Instead of massaging the uterus, gently lift it upward toward the umbilicus with one hand while supporting the lower uterine segment with the other. This encourages a physiological response, helping the uterus contract effectively without unnecessary stimulation.
• Assess for Firmness, Height, and Position – A properly contracting uterus should feel firm and midline. If the uterus is soft or displaced, address potential causes rather than defaulting to aggressive massage.
• Prioritize Other Proven Interventions – If hemorrhage occurs, consider:
  
  
  - Ensuring an empty bladder to allow proper uterine contraction.
  - Assessing for retained tissue or clots that may be preventing adequate involution.
  - Using uterotonics (if indicated) rather than relying on manual manipulation.

Have you see this interesting study where they dismantled the active managment trifecta of treatment and discovered uterine massage alone increases the risk of bleeding?