Which sequence correctly lists the steps for performing a fundal massage?

• A. Lie on back with knees flexed; Place a hand around the top of the fundus; Position a hand just above the symphysis pubis; Rotate the upper hand; Use downward pressure to compress.
• B. Lie on back with knees flexed; Place a hand just above the symphysis pubis; Rotate the upper hand to massage; Position a hand around the fundus; Use downward pressure.
• C. Lie on back with knees flexed; Place a hand just above the pubis; Position a hand around the fundus; Rotate the upper hand to massage; Use downward pressure to compress.
• D. Lie on back; Place a hand just above the symphysis pubis; Position a hand around the top of the fundus; Rotate the upper hand to massage the uterus; Use slight downward pressure to compress the fundus.

Answer: (D)

Fundal massage is done to stimulate uterine contractions and prevent postpartum hemorrhage by promoting a firm, midline uterus. The correct sequence starts by positioning the patient supine with knees flexed, which relaxes the abdomen and makes palpation easier.

First, place one hand just above the pubic symphysis to support the lower uterine segment and help prevent inversion during massage. Then position the other hand around the top of the fundus. Using the fingertips, rotate the upper hand in a circular motion to massage the uterus. Finally, apply a slight downward pressure to compress the fundus. This combination—stabilizing the lower uterus, massaging the fundus, and gently compressing—helps stimulate contractions, expel any clots, and promote firm uterine tone. If bleeding worsens or pain occurs, reassess and stop as needed.