Hospital after-birth care question - Mothering Forums

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#1 of 37 Old 04-09-2007, 02:54 PM - Thread Starter
 
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I'm a member of a much more mainstream board and a recent thread was mentioning all of the painful uterine massage done after the birth.

Given that most of the birth stories around here finish something like: hold baby, delivery placenta (while holding baby ), check baby over, go to sleep - I'm a little confused as to why hospital birth moms are subjected to this repetitive (and it would seem unnecessary) massage.

What am I missing?
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#2 of 37 Old 04-09-2007, 02:56 PM
 
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I had DS in the hospital, and they didn't do that to me, I delivered the placenta about 20 minutes after DS was born.
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#3 of 37 Old 04-09-2007, 02:59 PM
 
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i had a few, but didn't think they were that painful. CNM did first two, and the night nurse did a couple more that night.

I thought they were pretty standard.

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#4 of 37 Old 04-09-2007, 03:08 PM - Thread Starter
 
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artgoddess So they didn't do any massage later on during your stay (if you stayed)?

aimee Yeah, my question is WHY is it standard? I'm trying to see the "evidence-based" reason for doing the massages. I'm sure they can be helpful to some degree or another to encourage the uterus to begin shrinking, but are they absolutely necessary?
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#5 of 37 Old 04-09-2007, 03:11 PM
 
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No, I remember them recommending that I do it, but not anyone else touching me. Maybe I'm just forgetting.
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#6 of 37 Old 04-09-2007, 03:15 PM
 
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I had them done to me the entire time I was in the hospital. I had it done twice with my homebirth...my uterus was tired so we were trying to stimulate it. It did the trick with 2 massages...

A doula who married a cop & became a mama to 3 boys: G 12/22/00, my rainbow baby B 2/2/07 and L 2/10/10 my CBA2V baby, waiting for my little caboose late February 2013 & always remembering my two angels 2006 & 2012.

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#7 of 37 Old 04-09-2007, 03:18 PM
 
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but are they absolutely necessary?
I guess very very few things are ABSOLUTELY necessary -- :

but as it is a "non-intervention" care SOP I saw no issue with it. it isn't a drug or a shot or anything unnatrual..... it is just kinda TLC for the new mom.

Ima sure tehre is anidotal evidence that is helps -- ie pople who didn't have it who had issues....but i don't know that it has ever been studied. a couple fo the books i read before haivn T stated it was a normal thing, nothing pro or con about it.

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#8 of 37 Old 04-09-2007, 03:57 PM - Thread Starter
 
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Gray's Mommy Yeah, I figured that's how it's typically used, which makes sense to me. I think it's the "policy" vibe of the other thread that is throwing me off.

Aimee Of course you're right. I don't think it's a necessarily frivolous or unnecessary treatment, I guess I'm just trying to get a grasp of the prevalence of the treatment. Like I said to GM, the way the poster's were talking it seemed like if they had said they didn't want it, it would have been an issue and I'm just wondering if it really is a big deal (I've been doing SO much reading, but haven't gotten to that part yet. )
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#9 of 37 Old 04-09-2007, 04:01 PM
 
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I've been doing SO much reading, but haven't gotten to that part yet.
i don't remember reading much about it anyway



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#10 of 37 Old 04-09-2007, 04:03 PM - Thread Starter
 
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Originally Posted by Aimee21972 View Post
i don't remember reading much about it anyway



Aimee
Exactly! That's why I'm confused.
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#11 of 37 Old 04-09-2007, 05:32 PM
 
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My mw did it to me a few times before I left the hospital, but I wasn't under the impression that it was neccessary, mandatory, or even essential.... I had twins, so I'm not sure if I would have even known about it otherwise, because I never read anything about it either.

Perhaps it would be more important for mamas who do not intend to BF, since bfing is so helpful with uterine contraction. I guess that would also explain why it is more prevalent on a more mainstream board.

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#12 of 37 Old 04-09-2007, 05:37 PM
 
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I had it done right after dd was born in the hospital. It seemed like they did it for a really long time.
dd2, it never happened, and that was ina birth center.
dd3, at a birth center, the mw did it a few times, as i was bleeding pretty heavily.

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#13 of 37 Old 04-09-2007, 05:42 PM - Thread Starter
 
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hairy armpits & midstreammama Both of the circumstances that you mentioned (twins and bleeding) make perfect sense to me have massage done. From the very small sampling here it doesn't seem like it's carried out everywhere for everyone, but perhaps more often where there are indications for it (there were no details in the other thread so I have no idea of actual circumstances).
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#14 of 37 Old 04-09-2007, 05:46 PM
 
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for me i am not sure what would count

forcept deleivery

i was breastfeeding already by first time

had Pit and Epdural and 33 hours of labor and 3 hours of pushing

i don't knwo that there was any real "reson" i can think of


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#15 of 37 Old 04-09-2007, 06:00 PM - Thread Starter
 
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aimee there you go throwing a wrench in to my nicely forming theory. Actually, your "just because" experience it probably pretty typical, which is what got me started on this question to begin with.
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#16 of 37 Old 04-09-2007, 09:09 PM
 
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I think that is much more standard of care in the hospital, they do it for all rather than some. I think with a midwife it becomes a as needed treatment.

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#17 of 37 Old 04-09-2007, 09:27 PM
 
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I check a fundus frequently postpartum (because even if bleeding is WNL, the uterus can be filling with clots or blood), but it can be done very gently, just to verify that the uterus is contracted. If it's not, then the massaging does start, though..

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#18 of 37 Old 04-09-2007, 09:36 PM
 
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aimee there you go throwing a wrench in to my nicely forming theory. Actually, your "just because" experience it probably pretty typical, which is what got me started on this question to begin with.
sorry



hey

maybe my forcept deliever was the reason, or my 33 hours of labor, or my 4th dregree tear or.......

jsut trying to help

or it is SOP for our CNM?

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#19 of 37 Old 04-09-2007, 09:55 PM
 
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sorry



hey

maybe my forcept deliever was the reason, or my 33 hours of labor, or my 4th dregree tear or.......

jsut trying to help

or it is SOP for our CNM?

AImee

33 hours of labor and I'd keep an eye out for a post-partum bleed. So she may have been more massage-happy than usual.

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#20 of 37 Old 04-09-2007, 10:58 PM
 
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Sometimes they do not do it on those who would normally NEED it because they give a post partum pit injection instead.
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#21 of 37 Old 04-10-2007, 12:08 AM
 
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In my experience, sometimes frequently checking the fundus can decrease blood loss by ensuring the uterus is very tightly contracted and gets used to that in the first hour post partum. After an hour, the uterus is pretty adept at it's new job.
Some women clot blood very nicely - usually a good trait, unless the clots block the cervix and blood fills up the uterus behind the clot - that hurts as the uterus tries to clamp down and fails, again and again. Feeling that change means that I will encourage a mama to go pee as soon as her baby takes a nursing break, to let gravity and an empty bladder work.
Some women are very very sensitive to any touch to the uterus, others don't flinch one bit and don't complain. I tell them it's my least favorite thing to do after poking babies, but they say it's nothing (some women).
Rubbing down a uterus when it's rising often gives immediate relief to a mama experiencing bad cramps - although perhaps it's just that any cramping is better than massage.
I have had mamas do it for me - feeling it and telling me it was just as low as before - that works just fine.

I have apprentised at a practice that did less massage, and less getting women out of bed and there were more pp hemhorrhages and more blood loss in total estimate by weight. The real question is - does it really matter if a woman has a 400 cc loss compared to a 250 cc loss?

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#22 of 37 Old 04-10-2007, 01:14 AM
 
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Originally Posted by Apricot View Post
In my experience, sometimes frequently checking the fundus can decrease blood loss by ensuring the uterus is very tightly contracted and gets used to that in the first hour post partum. After an hour, the uterus is pretty adept at it's new job.
Some women clot blood very nicely - usually a good trait, unless the clots block the cervix and blood fills up the uterus behind the clot - that hurts as the uterus tries to clamp down and fails, again and again. Feeling that change means that I will encourage a mama to go pee as soon as her baby takes a nursing break, to let gravity and an empty bladder work.
Some women are very very sensitive to any touch to the uterus, others don't flinch one bit and don't complain. I tell them it's my least favorite thing to do after poking babies, but they say it's nothing (some women).
Rubbing down a uterus when it's rising often gives immediate relief to a mama experiencing bad cramps - although perhaps it's just that any cramping is better than massage.
I have had mamas do it for me - feeling it and telling me it was just as low as before - that works just fine.

I have apprentised at a practice that did less massage, and less getting women out of bed and there were more pp hemhorrhages and more blood loss in total estimate by weight. The real question is - does it really matter if a woman has a 400 cc loss compared to a 250 cc loss?
Probably not, but the difference between 400 and 500 is important, at least in a semantic sense.

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#23 of 37 Old 04-10-2007, 10:08 AM
 
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I wonder if some of these protocols were developed in response to the reality of extended mother-baby separation in the hospital or formula feeding. I have found that having a nursing mom feed her baby in the first hour negates the need for fundal massage in most cases.

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#24 of 37 Old 04-10-2007, 10:32 AM
 
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I wonder if some of these protocols were developed in response to the reality of extended mother-baby separation in the hospital or formula feeding. I have found that having a nursing mom feed her baby in the first hour negates the need for fundal massage in most cases.
This is exactly what I was thinking too.

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#25 of 37 Old 04-10-2007, 10:46 AM - Thread Starter
 
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Yup, that makes a lot of sense. Also, traction to deliver the placenta.

ETA: Thanks for posting your experiences Apricot, it's helpful to see the variation in applications.
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#26 of 37 Old 04-11-2007, 08:01 AM
 
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I guess I just thought it was standard. I alway do a fundal massage in my first 2 hours of recovery (hospital RN) per protocol. I always support the uterus and try to be gentle, but there are times when you know that there is a clot in there somewhere and it has to come out. After the first 2 hours I do a quick gauge of how firm the uterus is and ask about bleeding and clots.
I have watched some do really aggressive fundal massage, and it seems like they are the women who haven't experienced painful fundal massage.
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#27 of 37 Old 04-11-2007, 10:21 AM
 
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Okay. It's my understanding that it would be more necessary in a mainstream hospital birth because 1)mainstream mamas are MUCH less likely to breastfeed. Breastfeeding causes the uterus to clamp down, because it releases oxytocin. Fundal massage causes the uterus to clamp down in lieu of that breastfeeding. and 2) a mainstream birth almost ALWAYS includes "whisking" the baby away to the warmer to be "checked..." for an hour or so. THis lack of "skin to skin" contact immediately after birth also precipitates a more difficult clamping down of the uterus...and since this is routine procedure, it makes sense that they would have to follow that up with a routine procedure to help the mama clamp down more easily. Thus, fundal massage.

I think that it's much less likely that you'll hear of that on MDC because most mamas here, even if birthing in a hospital, will be seeking out care that allows a more evidence based birth...thus they'll be making sure that baby is born to chest and is left skin to skin until after a sucessful breastfeeding. Soooo, the only time a MDC mama is likely to experience a fundal massage is in extenuating circumstances (ie, uterus recovering from twins, maternal exhaustion, etc), or in the sad case of a specific OB not attending a mama's birth when they are who she was planning to attend,so things go differently.

In general, if an unhindered birth occurs in a normal healthy mama, with a normal healthy baby, and baby is put skin to skin and allowed to nurse at will, fundal massage is much less often necessary than in a "normal" mainstream hospital birth.

Hope that helps.

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#28 of 37 Old 04-11-2007, 10:34 AM
 
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great point
Courntey

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#29 of 37 Old 04-11-2007, 01:41 PM
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great point
Courntey

Aimee
Just to add if you had a lot of pit or for a long time during your labor that would make you more susceptible to post-partum hemorrhage. That may be why it was done to you.

In my hospital it is done every 15 minutes following birth for two hours Seems excessive to me. It does quickly and easily firm the rare boggy uterus though.
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#30 of 37 Old 04-11-2007, 01:55 PM - Thread Starter
 
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junamoss It's the "standard" thing that I'm questioning and Courtney thank you for explaining all of that. You put into words what I was thinking in my head.

I do have to say though, mainstream = not likely to breastfeed correlation is starting to bother me. I'm subscribed to a BFing thread on a very mainstream board and I have been pleasantly surprised at how many of our members are planning and preparing to breastfeed. I would say a majority of the members I'm aware of who are currently pregnant or just delivered (I'd say 75% of the board is in this category) are using that thread as a primary means of support (along with LCs and LLL/hospital meetings). So I would say your second reason is more applicable than the first. (Let me make clear, I'm talking about initiating BFing, I know continuance rates are absurdly low.)
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