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?

[at your cervix]

Hey guys, be careful with the "fake it" maneuver!! If dad has it on video and ever goes to court and it looks like you were doing fundal pressure, you were! Or, if the pt or family ever testifies in court that fundal pressure was used, you could be up a creek even if you faked it. It really wouldn't sound good in court to say "well, yeah, it LOOKED like I was doing fundal pressure, you know with the straining arms etc, but I was faking it." I don't think that would go over well.

Personally, I have done fundal pressure per MD request when necessary-pt crowning, heart rate in the toilet, not coming up and faster to assist with forceps and a little fundal pressure than to do a c section. But, I always write a MD order for it stating the reason.

[mark_LD_RN]

my fake manuever is pretty obvious i just rest my hand on tor the fundus, thats about it,looks to me like i am feeling for ctx

[shay]

Originally posted by at your cervix

Hey guys, be careful with the "fake it" maneuver!! If dad has it on video and ever goes to court and it looks like you were doing fundal pressure, you were! Or, if the pt or family ever testifies in court that fundal pressure was used, you could be up a creek even if you faked it. It really wouldn't sound good in court to say "well, yeah, it LOOKED like I was doing fundal pressure, you know with the straining arms etc, but I was faking it." I don't think that would go over well.

Personally, I have done fundal pressure per MD request when necessary-pt crowning, heart rate in the toilet, not coming up and faster to assist with forceps and a little fundal pressure than to do a c section. But, I always write a MD order for it stating the reason.

Huh. Good point. Didn't think about that. Crap. Back to fightin' w/da docs! :chuckle

[rdhdnrs]

In the state where I practice, fundal pressure during delivery (except in a section) is malpractice.

[moonchild20002000]

Back in the 70's fundal pressure was used on occasion.

I don't remember any disasters occuring because of it.

I just never liked it,always thought it was scarey.

Now it is not ever used.

[shay]

Originally posted by rdhdnrs

In the state where I practice, fundal pressure during delivery (except in a section) is malpractice.

Hmmmmmmm....I wonder if it is in MY state. I can only hope.

[HazeK]

don't know if 21 years in L&D qualifies me as "old school" or not...

In the 'olden days', used fundal pressure quite frequently as epidurals back then gave moms a full motor block, so their pushing efforts were often very ineffective.

Recently, use fundal pressure probably once a month under very specific circumstances: Used for maternal fatigue or ineffective pushing when Vertex is +2/+3 station and outlet is generous, accompanied by nonreassuring fetal status requiring a facillitated delivery. No Sx of setup for shoulder dystocia can be present! (e.g. must have good labor progress, no Hx dystocia or macrosomia, no morbid obesity, etc.)

Ex: multip who does not speak english is pushing ineffectively with her light epidural.; she is perceiving pelvic/perineal pressure as pain and refuses to push; Vtx is visible but the baby has so much hair the vacuum cup has popped off twice; FHR shows severe variable decels with increasinly gradual return to baseline..... I can get that baby out in one to four minutes with fundal pressure faster than we could do a c/s. (most of our docs nowadays don't know how to use forceps at all)

One person, flat of forearm at fundus, with diagonal pressure towards perineum.

If that doesn't work quickly *and easily*, call the c/s, honey!

[fergus51]

I would prefer forceps. Docs should know how to use them. When the research says fundal pressure is not safe, I won't be doing it, under any circumstances.

[SmilingBluEyes]

I spoke w/two coworkers with 15 and 20 years' experience in OB....they said NO WAY NEVER, EVER would they do this now and only ONE had done it...and ONLY ONCE in her career. Food for thought...not all "old school" clinicians did this...and the ones I talked to said never would they NOW.

[rnsam]

Calling all virtual mentors......

Here's an old thread that I want to resurect.

Talk to me about fundal pressure and faking it. I have been in this position once. Mom was not pushing well at all. Baby was crowning and HR was YUCKY. Dr asked for fundal pressure. I performed light pressure. He firmly commanded "HARDER".

Tell me what you would do in this situation.

Thanks

[SmilingBluEyes]

Thsi may just be me, but....I would not fake it. I would take the dr aside after the case is through and explain clearly why I will NOT use fundal pressure on a pregnant uterus. You are accountable, after all, for your practices and so is the doctor. There is plenty of literature out there to back you up on this. Use it. If a mom is not pushing well, let her rest a bit, "laboring down"....the uterus WILL bring down the baby itself most the time and when she has the wherewithall and strength, she WILL push the baby out, especially if the baby is already CROWNING! at this point, if it's emergent enough, (you did say the heart rate was yucky, but I wonder for how long and was it a variable pattern that recovered between contractions, cause that is not necessarily emergent)......anyhow, the dr can get the baby out w/o the nurse putting fundal pressure on the uterus!

[profjanmc]

Sounds like you need to go to your manager and discuss this because your doctor (and the nurses, too) needs an inservice. If you have a clinical educator, she can get you some literature. Also your risk management department might want to know this too....

EGAD, this intervention makes a shoulder dystocia worse, and you have no defense at a malpractice trial because you knew better and should not have performed it, it is always difficult to refuse to do something in front of a patient during a delivery, especially a difficult one, I always invite my friends and charge nurses in with emergency call light and rally them around not performing contrindicated interventions. Look at the AHWONN website, you should be able to find all you need....