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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.<br>
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.<br>
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).<br>
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.<br>
I have had mamas do it for me - feeling it and telling me it was just as low as before - that works just fine.<br><br>
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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<div>Originally Posted by <strong>Apricot</strong> <a href="/community/forum/post/7799586"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">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.<br>
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.<br>
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).<br>
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.<br>
I have had mamas do it for me - feeling it and telling me it was just as low as before - that works just fine.<br><br>
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?</div>
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Probably not, but the difference between 400 and 500 is important, at least in a semantic sense.
 

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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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<div>Originally Posted by <strong>Defenestrator</strong> <a href="/community/forum/post/7801743"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">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.</div>
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This is exactly what I was thinking too.
 

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Discussion Starter #25
Yup, that makes a lot of sense. Also, traction to deliver the placenta.<br><br>
ETA: Thanks for posting your experiences <b>Apricot</b>, it's helpful to see the variation in applications.
 

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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.<br>
I have watched some do really aggressive fundal massage, and it seems like they are the women who haven't experienced painful fundal massage.<br>
cindy
 

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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.<br><br>
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.<br><br>
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.<br><br>
Hope that helps.
 

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great point<br>
Courntey<br><br>
Aimee
 

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<div>Originally Posted by <strong>Aimee21972</strong> <a href="/community/forum/post/7812181"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">great point<br>
Courntey<br><br>
Aimee</div>
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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.<br><br>
In my hospital it is done every 15 minutes following birth for two hours <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> Seems excessive to me. It does quickly and easily firm the rare boggy uterus though.
 

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Discussion Starter #30
<b>junamoss</b> It's the "standard" thing that I'm questioning and <b>Courtney</b> thank you for explaining all of that. You put into words what I was thinking in my head.<br><br>
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 <i>pleasantly</i> 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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<div>Originally Posted by <strong>touka</strong> <a href="/community/forum/post/7813941"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;"><b>junamoss</b> It's the "standard" thing that I'm questioning and <b>Courtney</b> thank you for explaining all of that. You put into words what I was thinking in my head.<br><br>
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 <i>pleasantly</i> 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.)</div>
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OT but I am doing nursing clinical in a very large (10000+ births a year) hospital and I have only seen one mom who did not initiate breastfeeding and she was a previous breast surgery/ previous unsuccesful breastfeeding. Almost every mom at least initiates breastfeeding.
 

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Yes, I think the stats are something like 75% of moms breastfeed in the immediate post partum period. However, when you're in an area that isn't really supportive of breastfeeding, many post partum/L&D/pediatric nurses will pull things like, "I'll just give them a bottle to "jump start" their sugar, so they want to nurse" or "I'll just give him a bottle now, so that you can rest, your milk isn't in anyway, so it won't matter now" I've heard these and a hundred other reasons that a newborn is given a bottle rather than put to the breast immediately post partum. In fact, I support probably five to ten mothers who are struggling with the resultant breastfeeding/latch issues every month. So, it's not necessarily, I suppose, that they don't PLAN to breastfeed, it is hugely that they are just not educated enough, and often just plain too exhausted and hormonal, not to be sabotaged, whether it's happening on purpose or just situationally. Immediately post partum LOTS of babies don't get the breast they're supposed to get.<br><br>
I just got a note from a mom today, whom I've been helping for three months. The nurses in her post partum unit convinced her that her baby was too big for just colostrum alone to feed him well enough. The resultant supplements caused her milk to take five days to come in, and now she pumps three oz a day, nurses once in the morning, and formula feeds the rest of the time, because she was convinced at the child's <i>birth</i> that HER BODY couldn't support his caloric needs.<br><br>
She was a Bradley mom, came to LLL meetings, took breastfeeding classes, read books...the thing is, her faith in her body was compromised during a crucial period in her life. She certainly didn't plan for her child's first feeding to be from a bottle. But it happened that way. She feels like she is in no way a breastfeeding mother. She's embarressed to come to LLL meetings because she's "not a nursing mother" (quoting her). Sooooo. That's why I put it out there. Because it happens, whether moms mean it to or not. Whether the hospital staff are aiming for formula kickbacks/fancy vacations, or trying to make their jobs easier, or simply working from their own limited knowledge base, it happens. In my area, anyway.<br><br>
More "crunchy" moms <b><i>may</i></b> be a little more on the defensive at their child's birth, and thus less likely to allow that to happen. Notice I said may, as the above situation proves. However, my sister, a MUCH more mainstream parent than I am, deperately wanted to breastfeed. Her son was jaundiced three days after birth, so the pediatrican said she had to wean. So she did. She just didn't know. She also didn't have the wide body of support system to tap into to MAKE sure that was the best thing to do. The doc said so, so she followed orders.<br><br>
That's my 2 cents.
 

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<b>courtney</b> I don't at all disagree with anything you just posted as regards to a dirth of proper support/knowledge in a lot of hospitals, and how that effects an ongoing BFing relationship (which is what came through in your second option). I think I was just reacting to how general "mainstream=won't breastfeed" felt vs. saying mainstream=lack of good support therefore BFing can get screwed up." The first felt like it was negating the good intentions of most Moms, while the second is critiqueing WHY it happens instead of being critical of a Mom.<br><br>
Does any of that make sense?? I can't seem to put the right words together to explain what I was talking about. Sorry. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/redface.gif" style="border:0px solid;" title="Embarrassment">
 

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I don't think fundal massage is always necessary. I usually just lightly check the fundus and if its boggy, then I massage trying to cause as little pain as possible.<br><br>
I did find one metanalysis that stated massage did significantly reduce PPH<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/neg.gif" style="border:0px solid;" title="negative">nt J Gynaecol Obstet. 2006 Jun;93(3):238-9. Epub 2006 May 6. It sounded like pretty intense massage though. There is nothing on Cochrane about it, but I did see there is something comparing drugs and there was no clear outcome (for example with miso).
 

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When I was doula-ing at a local hospital a few months back, I learned that it's now SOP to just give all moms postpartum pitocin IVs. "Helps the uterus contract," the nurse explained when I asked why the change in SOP. This hospital also routinely separates mom and baby after delivery, too. Any time I try to get someone to keep baby, the nurses bully them into sending baby to the nursery b/c "it's hospital policy that all babies be admitted and observed in the nursery." <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked">:
 

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Yup. Makes sense. Sometimes my brain skips steps, so I knew what I meant, sorry if it sounded offensive. In the end, the outcome is the same...IN MY EXPERIENCE, the more mainstream moms are less likely to immediately put baby to breast after birth, and more likely to allow a bottle feeding, even if in the end they leave the hospital "breastfeeding"...and those are <i>usually</i> the moms who quit sooner rather than later, or who end up calling an IBCLC or a LLL leader for help because they have problems and they have no idea where they came from.<br><br>
In the end, though, that's one of the reasons I believe they end up having to do fundal massage...because rather than being put immediately to the breast and nursing, babies are taken away, and end up being given bottles for convenience (whose convience isn't under discussion here) or "medical reasons" or whatever. The end result being that the mother's body isn't releasing the same amount of oxytocin at the needed time, so they have to manually massage to make the uterus clamp down.
 

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My (very limited!) experience has been that it isn't standard. I'm a nursing student and we weren't taught that it should be standard, and I haven't seen it done on a routine basis. I was taught and have seen frequent fundal checks though- followed by massage if needed.
 
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