Most postpartum hemorrhages are caused by the caregiver. Any massage of the
uterus before the placental delivery will almost ensure unnecessary
bleeding.
In rare instances a hemorrhage may begin before the placenta is delivered.
This is not just an isolated gush or two of blood, but a steady stream.
This is the only time it is appropriate to massage the uterus-yet even
then, it may worsen matters. The best thing is to immediately administer an
oxytocic and when the uterus contracts, use the Brandt-Andrew maneuver to
hasten the placental delivery. Once the placenta is delivered or if
bleeding continues without the placenta coming out, massage and bimanual
compression are employed.
-Valerie El Halta, Midwifery Today Issue 48
Reprinted from Midwifery Today E-News (Vol 2 Issue 9 March 3, 2000)
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