Fundal pressure

Specialties Ob/Gyn

Published

Specializes in labor & delivery.

I am a new L&D nurse and saw somthing today I was very uncomfortable with. Apparently it is something some of the "old school" docs do.... Do any of your MD's still use fundal pressure as a means of delivery? I don't mean asking you for fundal pressure (which I won't do either)... but coming to a delivery and applying fundal pressure himself from the very first push? :idea:

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Specializes in L&D.

It is against our policy. There are doctors (and nurses) who will ask for or perform fundal pressure regularly. Usually not from the first push, though. I know that some docs are really lazy when it comes down to it (and should probably retire or take a break from OB). I am still relatively new to L&D, so who knows what I'll run into with some of these docs here!

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Specializes in L&D,- Mother/Baby.
:idea: In my 22+ years of OB, I have done fundal pressure and continue to see one or two docs that do it now, mainly because they are inpatient. They are the same ones who want the patient to start pushing at about 8 cm, too. Suprapubic pressure can be helpful if you have a dystocia and need to get the shoulder down and under the symphysis pubis. Fundal pressure can actually wedge the shoulder against the symphysis. IF you ever do fundal pressure, do it from the patients right side to help prevent liver damage and make sure you can justify your reason if you end up giving a deposition!
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Specializes in L&D, Antepartum.

What about fundal pressure when breaking the amniotic sac? In one day I had two docs ask me to do this. My preceptor told me its kind of a no-no and that she just puts her hand there but doesn't press down. I guess the idea is to put more pressure on the cervix to prevent a cord prolapse? What do you all do at your hospital?

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Specializes in L&D.

When the doc asks for fundal pressure for AROM, and I will put my hand there, and just pretend. Often, they'll get so frustrated with my lack of "muscle strength" and do it themselves. That's fine...then it's all on them.

Docs will ask for it if the sac is too high and they can't really get to it. Which means, that the baby is NOT engaged well enough and it is NOT the appropriate time to AROM (not that it's really ever "time" to do something like that)...docs are impatient!

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Specializes in labor & delivery.

Thanks for the responses. I appreciate it. I really just needed to have some nurses with experience tell me I wasn't wrong for feeling uneasy about it :)

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When the doc asks for fundal pressure for AROM, and I will put my hand there, and just pretend. Often, they'll get so frustrated with my lack of "muscle strength" and do it themselves. That's fine...then it's all on them.

Docs will ask for it if the sac is too high and they can't really get to it. Which means, that the baby is NOT engaged well enough and it is NOT the appropriate time to AROM (not that it's really ever "time" to do something like that)...docs are impatient!

AWHONN basically says no fundal pressure ever. Why in the world would a nurse just "pretend" and still allow a physician to perform it themself when she is in the room? This is not advocating for the patient at all and still opening up the nurse to a lawsuit if she knew it was against current standards but allowed it to happen anyway.

Physicians are not be all, end all. By allowing the physician to perform fundal pressure and put the patient at risk of a negative outcome, is irresponsible and unprofessional in my opinion.

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Specializes in L&D.

Last night I was asked to perform fundal pressure, but it was because twin A was just delivered, and twin B's sac was still intact and tacchycardic with periodic deep variables and we wanted twin B to be delivered. I performed fundal pressure while physician AROM'd. Did I do the wrong thing?

This was my first delivery of twins by the way and babies are doing very well with apgars of 9 and 9! It went very smooth.

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Specializes in L&D.

When I used to work in the big city medical center, I was sometimes asked to give gentle fundal pressure for AROM. This was usually on someone who was going to have her baby that day one way or another. A severe diabetic, or PIH, or Rh sensitized mom on the 3rd or 4th day of a serrial induction (prostiglandin, sleep, Pit for 8 hours, shower and dinner, prostiglandin, sleep, pit and so on without progress). Inductions do work better after ROM and if today's induction didn't work, mom would be sectioned anyway.

Your example with the second twin is similiar. The baby is going to come out very soon, one way or another. Fundal pressure to facilitate AROM is not the same as fundal pressure to push a baby out (I'm old enough to have done that as a young nurse). You can rupture a uterus with the hard kind of pressure. Guiding the head down for a second twin is not the same.

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Specializes in L&D,- Mother/Baby.

Speaking of inductions working better after ROM, I just saw this article: http://www.medscape.com/viewarticle/564597?src=mp entitled Amniotomy Has Little Effect on Progression of Labor

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Specializes in L&D, High Risk OB, OR, Med-Surg, PHN.

]:nono: Fundal pressure one word NO.

Lisa

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Speaking of inductions working better after ROM, I just saw this article: http://www.medscape.com/viewarticle/564597?src=mp entitled Amniotomy Has Little Effect on Progression of Labor

Can you give me the author(s) of the article? I tried to use the link but it didn't work...well it did but I'm not a member of the site so I couldn't access it. I tried to look it up by title through my school and didn't have a lot of luck.

Thanks!

RNin'08

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