Fundal Pressure - page 2

:confused: I would like any input that you have on fundal pressure. Do it? Don't do it? Do it under certain circumstances? Does anyone have a specific policy r/t fundal pressure? I would love to... Read More

  1. by   rdhdnrs
    I've reviewed a couple of malpractice cases about shoulder dystocia and in my research, I've found that in cases where large damages were awarded, fundal pressure was almost always used. Fundul pressure during a delivery is not the standard of care and some large jury verdicts have hinged on this fact.
    Just my two cents' worth.
  2. by   kennedyj
    If you use fundal pressure and the outcome is not a perfect delivery you can bet that it will add a better opportunity for a money hungry lawyer to make an easier case. Fundal pressure was used in the US I think up into the 80's then forbidden.
    They use it over here in Europe very frequently. Sometimes applying a sheet across the fundus and having two people pull w/ full weight (this is a terribly way to speed up a delivery).
    Risks are what have been already mentioned, bad tears if the person applying it doesn't stop at the right time, invertion of uterus, fetal trauma. Here they use it before vacuum or forceps. A firend told me of a lady who was 4-5cm and had decels. There was not a doc on to do a crash c/s, They manual dilated here to
    complete and delivered the baby in about 20 minutes.

    When you are checking stress effects on a cervix a little fundal pressure can be useful. Sometimes a little fundal pressure may not hurt anything during delivery- you can yank from one end w/ a vacuum or forceps. Pushing on the fundus may serve a similar effect but since it is criticised in the US dont use it to facilitate delivery.

    J
  3. by   HazeK
    In our hospital, MD must verbally request fundal pressure (the RN is NEVER to suggest it). Also, the RN may decline to do so if she disagrees w/ the MD's rationale.

    Most commonly used when prolonged decel of FHR and the Vtx is +3/on the perineum AND the pelvis is adequate BUT the patient is pushing ineffectively!

    We deliver 500 babies a month...
    probably use fundal pressure on 10!

    **RNs are instructed to decline to use fundal pressure if Sx of possible shoulder dystocia noted: ex: macrosomia, maternal morbid obesity, Hx of previous shoulder dystocia or forceps or vacuum delivery, poorly-controlled diabetic, prolonged active phase, etc. In these cases, the RN must, instead, be ready to apply suprapubic pressure properly!!!
  4. by   kids
    My L&D experience is limited to my own and school. A couple of weeks ago on TLC there was an episode of L&D...older OB-baby's head got stuck...vaccume didn't work on several tried-just stuck the baby worse...doc called for the OB resident to do fundal pressure.

    I know it was a life of death situation but was incredibly barbaric...resident looked like she was gonna pass out...video running...Mom passing out...family screaming.

    Really glad I chose a different path, I'd pass out.
  5. by   MickeymomRN
    I agree with Raizie and Hazek, Please, know when you're supposed to use fundal not suprapubic pressure. Thank you for referring to AWHONN.
    I have to tell my personal story. With my first son, I thought that I had an epidural placed. Anesthesia Residents covered OB. It ended up being a spinal (hence the h/a after the delivery and the reason why I couldn't move my legs at all. Not one muscle!) While pushing, the doctor asked for fundal pressure. This was 1990! The nurse being new didn't know how but tried anyways. Oh, forgot to tell you that tracing had severe late decels and MSAF was noted. They told me to take a deep breathe and PUSH! Well, it was not possible to breathe at all since the new RN took the liberty of leaning directly on my CHEST! After the doc tried the vacuum several times and with me not being able to push b/c I trying to just breathe, she called for a c/s. After everyone started moving including the new RN, I shouted that I wanted to try to push (and pointing to the new nurse) WITHOUT her on my chest! I pushed my son out with 2 pushes. He only weighed in at 6#9oz. (I'm 4'11" if you must know). My last one (#4) didn't get pushed out at all. I let my uterus do all the work. No epidural, no episiotomy! Had to strut my stuff! Of course, I didn't deliver again with that first doctor. She was incompetent!
    Oh, the anesth. resident said after the delivery "you're only 4'11. I should've given you less meds." DUH!

    Oh, almost forgot, if the doc asks for fundal pressure, I note what time he asked and document it as such and write it as a verbal.
    Last edit by MickeymomRN on Feb 19, '02
  6. by   alohanursejenn
    I just read all your comments after I researched fundal pressure for my final midwifery paper and presentation.
    I will be submitting an article to JOGNN regarding fundal pressure use in second stage labor, I will be including a literature review of the topic and randomized control trials as well as recommendations from the literature.
  7. by   SmilingBluEyes
    Let us know if/when it is published. I am very interested to read....being an AWHONN member, I get this journal and read it cover to cover! Good luck to you!!!!
  8. by   midwife2b
    Quote from rdhdnrs
    Do not give fundal pressure during a delivery unless you are assisting in a c-section. I know some nurses are intructed by some OB docs to do so, but where I work it is considered malpractice and we don't do it.
    Sometimes during amniotomy, we'll apply a little fundal pressure to bring the sac down, but that's the only time.
    Hope this helps.
    Agreed... sometimes fundal pressure will make amniotomy a little easier...
  9. by   mugwump
    My preceptor addressed this with me today I can almost quote her "Never do fundal pressure but if the doctor is adimate you can place your had there that way it makes the doctor think your doing something."
  10. by   futureobgynnurse
    what about fundal pressure after the baby is delivered to help with the placenta coming out? Is that bad to do also?
  11. by   KYCNM
    i know of no midwifery that advocates the use of fundal pressure for expedited delivery. physicians are another issue, they take responsibility for their own actions, but a nurse can get listed on a lawsuit for participating and if there is no hospital policy, you can find yourself in a difficult position. here are some articles you may find interesting:

    http://www.ncbi.nlm.nih.gov/sites/en...t=abstractplus

    http://www.ncbi.nlm.nih.gov/sites/en...uerysuggestion

    www.idph.state.ia.us/hpcdp/common/pdf/perinatal_newsletters/progeny_may2004.pdf -

    http://findarticles.com/p/articles/m...10/ai_n9384194

    the use of fundal pressure for delivery of the placent is also controversial. see:

    http://www.cochrane.org/reviews/en/ab005462.html

    hope this helps.
  12. by   33-weeker
    Fundal pressure for C/S, but only suprapubic pressure for shoulders.

    We do occasionally do mild fundal pressure to keep the baby's head from retreating back in between pushes when the mom is getting tired or a baby needs to get on out of there in a timely fashion. I've not seen this cause problems. If anything, it has helped. But it is done sparingly, carefully & wisely.
  13. by   danissa
    Quote from futureobgynnurse
    what about fundal pressure after the baby is delivered to help with the placenta coming out? Is that bad to do also?
    No, still no pressure used, but palpation and v gentle massage of the fundus, if the placenta is adhering. The massage often helps and you feel that hard ball under your hand. Mega awareness of the risk of uterine inversion and PPH is required.

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