Fundal Pressure

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    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!
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    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.
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    fundal pressure is a big no-no where i work too. i am a obt currently but i have been in on more than one delivery where a inexperienced rn is directed by the ob to give fundal pressure during delivery and we have ended up in the or because of this. i think it is old school ob training that uses this technique, it seems a few of our older traditional ob use this. some can be down right beligerant about it "i am the doctor you are the nurse do as i say" attitude. but stand your ground! don't do it. especially if this is to facilitate a delivery unnecessarily, usually around dinnertime or in the middle of the night when the ob doesn't want to be there. it really irritates me that some are more concerned with their schedule than the health and wellfare of this family!
    i do know that it is used during arom to apply the head to the cervix in hopes of preventing a prelapsed cord or exposing the membranes. and of course is allowed during a c/s. but i highly suggest looking this one up in your policy and procedures book, because you do not want to end up in a law suit.

    nicole
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    I was in one delivery that fundal pressure was used. Let me outline what led up to it's use:

    Pt was a midwife homebirth attempt. Brought into the hospital after 2+ hrs pushing at home. MW thought baby was OP, after the pt pushed for 2 hrs. Pt was pushing when admitted, 10cm/+2 station (MW exam, I did not examine her). MD arrives, we prep pt for delivery. MD observes her pushing attempts, examines her. Finds her to be OA, not OP like the MW thought she might have been. MD cuts RML epis (ouch! MD was not happy to have to do that either). MD then applies vacuum, and tries vacuum extraction with fundal pressure (NOT me....I was operating the vacuum for the MD). Vaccum used x2 - popped off on 2nd attempt with fundal pressure. MD then used low forceps and delivered a viable male. (Trying to recall if fundal pressure was used with the forceps too...I don't think so). Apgars 8 & 9.

    Mom ended up having a 3rd degree lac extending from the RML epis too. NOT an easy delivery!! Had some PP hemorrhage, under good control with IV pit, cytotec (per rectum), and methergine. EBL was 400-500.

    Now that I read others responses on fundal pressure, it makes me concerned about exactly what our hospital policy is on it. Like I said before, I was not the nurse doing fundal pressure, as the MD wanted a nurse who had already done fundal pressure in the past and knew what she was doing. I did NOT feel comfortable doing fundal pressure, since I had never done it before.

    PS - this was the first and only time I've seen it used in the 4 months I've been an RN at this facility.

    Jennifer
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    Let me brag about how we just about "solved" the fundal pressure "situation" at our hospital. Our risk manager asked me to write a policy (I'm the OB CNS) after an OB involved in a lawsuit claimed, in his defense, that the infant's head trauma was related to a delay on the perineum caused by the nurse's refusal to provide fundal pressure.
    Keep in mind that current literature DOES address fundal pressure (I'll send references at another time), risks, benefits, how to apply it correctly.
    Our policy states, in part, that any request for fundal pressure will be written as a verbal MD order,and that its use will be documented in the notes (who provided it, through how many contractions, etc.)
    Needless to say, you would be amazed at how use of fundal pressure has dropped off amazingly!
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    Why is fundal pressure risky? Risky to the mom AND the baby?
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    The added pressure can cause uterine rupture. Also if the passage is that diffucult, there is some reason the baby is not coming down. It's always dangerous to try to force something that won't fit.
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    Fundal pressure is not always used to "force" something that won't fit. It can be used to supplement maternal pushing efforts and can actually be indicated - for example with fetal bradycardia. On the other hand it can be very harmful when used for shoulder dystocia - when suprapubic pressure IS recommended. Is that forcing something that won't fit?
    There are guidelines in the literature for when and how to apply fundal and suprapubic pressure. If you go to www.awhonn.org and look at their fax on demand list, you will find an "ask the experts" column about fundal pressure which you might find helpful.
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    Shoulder dystocia is often (not always but often) an unforseen problem and is always an obstetric emergency. Suprapubic pressure is, as you know, totally different from fundal pressure.
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    Fundal pressure? In the name of God, why? When everything is going fine?
    Hey, I think we have to go back to nature more! It is hardly possible for a woman (or for an animal by the way) to press a fullterm child out of her body in 2 presscontractions (or how you call them), it takes more than that (normally, we are not talking about these women who "lose" their children while walking)

    Sometimes a woman presses for an hour, as long as she and the baby are ok, let it be!!

    Take care of them, Renee


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