• Control or limit Postpartum Haemorrhage (PPH)
Patient Factors & Considerations
  • Massaging a firm, central and contracted fundus may interfere with normal placental birth separation and worsen bleeding. Fundal massage should only be applied when the fundus is not firm.
  • Do not pull on the cord to assist delivery of the placenta in the pre-hospital environment.
  • The aortic compression will be painful to the mother and tiring to the officer.
  • Prepare for birth of placenta

Natural stimulation

  • Breast feeding promotes the natural release of oxytocin and stimulates uterine contraction.

Fundal Massage – only performed after the placenta has been delivered

  • Place one hand above and one below the fundus in a cup formation[1]
  • Rub fundus till its tone is restored.
  • Repeat as required ensuring uterine contraction is ongoing.

Aortic Compression (life-threatening uncontrolled bleeding[2])

  • Explain the procedure to mother: Manually diminishing the flow of blood to the arteries (5) supplying the uterus (2).
  • Place yourself on the left side of the patient.
  • Place your fist just above the umbilicus and slightly to the left (3).
  • Lean over the woman, so that your weight increases the pressure on the aorta (3), against the vertebral column (4).
  • Before exerting aortic compression, feel the femoral artery (6) for a pulse using the index and third fingers of your left hand.
  • Identify the femoral pulse and lean forward and apply pressure to the aorta. To confirm placement, palpate femoral pulse.
  • Increase pressure if required, no Femoral pulse should be palpable. Should the pulse become palpable, adjust the right fist and the pressure until the pulse is not palpable.
  1. PPH1

  3. Aortocaval
Additional Information


World Health Organization (2012), WHO recommendations for the prevention and treatment of postpartum haemorrhage, accessed on 16/06/2017.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (2016). Management of Postpartum Haemorrhage. Accessed 15/06/2017.

Figure 2 adapted from: Managing Postpartum Haemorrhage: Education Material for Teachers of Midwifery, Second Edition. Geneva: World Health Organization, 2006.p. 128.

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