After vaginal birth, recovery!

[CrazyMommy, BSN, RN]

Orientee question!

I understand that pressing on Mums tummy is to make sure no blood clots are being left behind. Why do some RNs press SO hard that sometimes Mum is crying?

[bagladyrn, RN]

Usually it is because the uterus is boggy or full of clots and the discomfort of fundal massage for a minute or so is preferable to the complications of hemorrhage.

[BellsRNBSN]

Also, sometimes the fundus just happens to lie deeper in some women, or there is more fatty tissue in the woman's abdomen, over her uterus, making it harder for the nurse to palpate and massage the fundus. In this case, the nurse will have to push down harder on mom's tummy to find her fundus, which is often uncomfortable and even painful to mom. But like the PP said, this is all in the best interest of the mother to make sure that the fundus is firm and midline, so as to prevent possible serious consequences such as postpartum hemorrhage from progressing by detecting the s/sx early on.

[cindyloowho]

Fundal massage is to help the uterus contract which decreases the change of hemorrhage. The harder you masage, the more you can get the uterus to contract. Also, even light uterine massage after birth is very painful, so you might see women cry and think the massage is harder than it really is. But you know what is the best thing for uterine contractions after birth...nursing. Put that baby to the breast immediately, and there should be very little need to massage. I think that often times many L&D health care providers go above and beyone what is nescessary for actual needed interventions. Just my .

[Elvish, BSN, DNP, RN, NP]

It's been my experience that moms tend to find it less painful after the first delivery than after subsequent deliveries as well. There are some nurses who press harder than others, but as a nurse there are some moms that I am worried about than others as well. I'd much rather mash a little hard on her tummy than leave her with a boggy uterus, have clots in there that need expressed, and win herself a ticket to a manual clot extraction. That is more painful by far than a fundal massage.

[nurseprnRN, BSN, RN]

"i understand that pressing on mums tummy is to make sure no blood clots are being left behind. why do some rns press so hard that sometimes mum is crying?"

pressing on the "tummy" is not done to push clots out. it's to massage the uterus to make it contract and be hard and firm, so the open blood vessels in its surface (where the placenta was attached) are closed off, thus stopping postpartum bleeding.

the rn will palpate the uterus to see if it is contracted and hard-- that takes an experienced nurse just a second to find out. if all is well, no massage is needed. the rn will massage more deeply if the uterus is unexpectedly or undesirably soft, needing increased stimulation to contract down and be hard. this may account for some of the differences in nursing care you observe.

breastfeeding the baby releases hormones which tell the uterus to contract. that's the way the system was designed. good idea, huh?

[PetsToPeople]

What bothers me is not when they are pressing hard, it's when they act like the belly isn't attached to a person! No smile, no "hi, how are ya feeling?", nope, let me just start painfully grinding away on your stomach because I have 5 other pt's to deal with.

[CrazyMommy, BSN, RN]

Thank you guys for all of your input and thanks for the advice on having baby breastfeed immediately to have the uterus contract, makes a lot of sense.