fundal pressure

[mark_LD_RN]

Is fundal pressure ever an appropriate nursing intervention?

we are having a little debate over this, some are saying that it is never to be used . what do you think? do you use it?

[bagladyrn, RN]

Never in terms of delivery! Only have used it to facilitate reaching a very high cervix or to keep the head firmly against the cervix during AROM. I have had doc's demand it, I won't do it, not with all the literature contraindicating it - don't want to find myself in a courtroom someday saying "But he told me to..."

[Gator,SN]

I just wanted to say that during my OB rotation in school last semester, the instructor, (who is an OB nurse) told us NEVER, ever apply fundal pressure, even if instructed to do so by the doctor. She said that she has seen it before but would not do it herself and we shouldn't either.....

[shay]

Originally posted by mark_LD_RN

Is fundal pressure ever an appropriate nursing intervention?

Sure.......................

if you want a prolapsed cord or inverted uterus........

[mark_LD_RN]

well thats what i been saying but we got a couple of docs who keep trying to get us to do it. I have avoided it. used to do it yrs ago never actually had a problem but all the recent studies warn against using it.

[SmilingBluEyes]

I must be naive in the extreme. never have I heard of such a thing in a PREGNANT woman. What is the rationale for this?

[mark_LD_RN]

they claim that it helps decrease pushing time. i must say i have witnessed it help with women who were in effective pushers. but that was a few yrs ago. I have never personally done it, and all the recent literature i can find says it is not worth the risk. has increase risk placental abruption ,uterine rupture etc. but i still see a doc who will ask for it on occassion. iwas just wondering if it was doing anywhere else or if it was just an old southern tradition,:)

[anitame]

I've seen it done exactly twice in the last 2 years, both times to hold fetal head down against cervix for AROM with polyhydramnios patients. NEVER seen it used to speed up pushing. Scary stuff.

[mark_LD_RN]

from what i have heard from older nurses it used to be used on a regular basis, like i said i have seen it work, but just don't think it is worth the risk. and since it is not an accepted standard of care and position statemnents against have been made by acog and awhonn. i refuse to do it, it would be hard to defend myself in court otherwise.

i have used light fundal pressure during AROM. i dont think that is bad. but the severe fundal pressure used during pushing is something different. a nurse i worked with was telling me how they used fundal pressure from two nurses during deliveries in the past, one would get on one side and other nurse on the other side of pt, the would lock arms together and place on fundus and pull down while using other hands to pull against the bed or the patients legs. sounds a little horifice and severe to me.

[SmilingBluEyes]

ok, Mark, I use LIGHT fundal pressure, I guess one would call it. When a lady's cervix and presenting parts are SKY HIGH and I need to reach them. BUT ONLY LIGHT LIGHT LIGHT pressure. Heavy pressure, I cannot ever see using. Also, the bedpan under the bottom (or hands) works wonders, too.

[shay]

Mark, I was told when I first started L&D that if a doc asked me to give fundal pressure, to FAKE IT. I.E., strain your arm and make it 'look' like you're pushing......but don't.

Yeah, I give a little fundal pressure for AROM on occasion, but man........I get a belly flip-flop every single time.

I would never and have never given it during pushing. If asked, I would simply pull the 'fake' maneuver.

[mark_LD_RN]

i do the fake manuever it seems to make them happy!