Fundal Pressure

Specialties Ob/Gyn

Published

: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 know what you think and what your policy is! Thanks!
Specializes in LDRP; Education.

I've used fundal pressure only once in my 4 year career. At our facility, we've used it under the direct order of the attending during a case of severe shoulder dystocia.

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.

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

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!!!

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.

Specializes in Nurse Education, Obstetrics, Surgery.

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.

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.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

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!!!!

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...

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."

what about fundal pressure after the baby is delivered to help with the placenta coming out? Is that bad to do also?

Specializes in Nurse Educator; Family Nursing.

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/entrez?cmd=retrieve&db=pubmed&list_uids=11265438&dopt=abstractplus

http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=search&term=fundal%20pressure&itool=querysuggestion

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

http://findarticles.com/p/articles/mi_go1617/is_200310/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.

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