fundal pressure

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I have been a labor nurse for 12 years at the same hospital. Although not used often, fundal pressure has been something used in our institution for emergent cases. Recently our new manager sent out a general email that was very threatening to everyone that we would lose our job and be every penny we own if we do it. She also gave us a scripted response to share with the doctors that ask for fundal pressure. I see fundal pressure being used very often on c sections as well, although that issue is being ignored. I have read many articles about fundal pressure and it's very "wishy washy." I know that fundal pressure is not appropriate for shoulder dystocia, but how about at other times, say when the patient is crowning, heart tones are down and there is now maternal effort with pushing because her epidural level is so dense she can't move her legs? Thanks

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Specializes in Education, FP, LNC, Forensics, ED, OB.
I have been a labor nurse for 12 years at the same hospital. Although not used often, fundal pressure has been something used in our institution for emergent cases. Recently our new manager sent out a general email that was very threatening to everyone that we would lose our job and be every penny we own if we do it. She also gave us a scripted response to share with the doctors that ask for fundal pressure. I see fundal pressure being used very often on c sections as well, although that issue is being ignored. I have read many articles about fundal pressure and it's very "wishy washy." I know that fundal pressure is not appropriate for shoulder dystocia, but how about at other times, say when the patient is crowning, heart tones are down and there is now maternal effort with pushing because her epidural level is so dense she can't move her legs? Thanks

Hello, labor93,

View this thread regarding fundal pressure. It should answer all of your questions:

https://allnurses.com/forums/showthread.php?t=117544

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

GOOD QUESTIONS! these things do come up a lot.

The short answer is "NO" to fundal pressure, ever. Csections are a bit different case, when the uterus is open, already.

But during labor, at no time, are you to employ or participate in fundal pressure. (note, NOT the same thing as suprapubic pressure).

Good luck!

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Specializes in Case Mgmt; Mat/Child, Critical Care.
GOOD QUESTIONS! these things do come up a lot.

The short answer is "NO" to fundal pressure, ever. Csections are a bit different case, when the uterus is open, already.

But during labor, at no time, are you to employ or participate in fundal pressure. (note, NOT the same thing as suprapubic pressure).

Good luck!

:yeahthat: Exactamundo, my friend! Never, never, never!

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Deb said it. NEVER EVER EVER EVER do fundal pressure.

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keep in mind, I have only been a labor nurse for 2 years...but we were taught never to do fundal pressure. our manager states that it is ok to place your hand on the fundus when the doctor asks, "but don't push" this is rediculous to me because when you don't push, the doctor reaches up and gives fundal pressure himself with your hand under his-not good. I also have seen twice now where the same doctor has delivered babies from a +2 or +3 station with fundal pressure-horribly scary and painful for the mom, epidural or not.

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QUOTE=labor93]I have been a labor nurse for 12 years at the same hospital. Although not used often, fundal pressure has been something used in our institution for emergent cases. Recently our new manager sent out a general email that was very threatening to everyone that we would lose our job and be every penny we own if we do it. She also gave us a scripted response to share with the doctors that ask for fundal pressure. I see fundal pressure being used very often on c sections as well, although that issue is being ignored. I have read many articles about fundal pressure and it's very "wishy washy." I know that fundal pressure is not appropriate for shoulder dystocia, but how about at other times, say when the patient is crowning, heart tones are down and there is now maternal effort with pushing because her epidural level is so dense she can't move her legs? Thanks

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Professional organizations have discouraged and even forbidden fundal pressure for lady partsl deliveries since 1987. Some boards of nursing have even addressed this http://www.msbn.state.ms.us/rnsuprapubic.htm During lady partsl delivery this is a dangerous thing and should be avoiding to prevent maternal and fetal injury.

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I know that fundal pressure is not appropriate for shoulder dystocia, but how about at other times, say when the patient is crowning, heart tones are down and there is now maternal effort with pushing because her epidural level is so dense she can't move her legs? Thanks

As has already been stated, it is never, ever appropriate to perform fundal pressure in a lady partsl delivery. In a situation such as you have quoted, the provider has the option of using a vacuum or forceps if they feel intervention is appropriate. If you were ever placed in a position where you were pressured to perform fundal pressure, clearly your manager would support your decision not to risk your license. Should a doctor decide to do it him or herself, there's little you can do except DOCUMENT and bring it up the chain of command.

I have to ask, what articles have you read that are "wishy washy" on the subject? I'm only asking because I haven't read anything even remotely current that supports it...

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

This is yet one more reason I have to recommend membership in AWHONN, if you are a GYN, labor/delivery/post-partum or newborn nurse in the USA. There are no "wishy washy" articles in their journals, and the standards are there for us all, crystal-clear. They are what we are held to, believe me, if we are taken to court. I think membership ought be mandatory -----and I think workplaces should offset costs for membership for their L/D nurses.

Yep, it's that important to me.

http://www.awhonn.org

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Professional organizations have discouraged and even forbidden fundal pressure for lady partsl deliveries since 1987. Some boards of nursing have even addressed this http://www.msbn.state.ms.us/rnsuprapubic.htm During lady partsl delivery this is a dangerous thing and should be avoiding to prevent maternal and fetal injury.

excellent reference. Thank you.

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

Employing fundal pressure, in fact, was taught to some physicians and used in times past, to relieve dystocia. So, some physicians, especially of the "old school" may ask you to apply this intervention even now. It's our obligation to refuse to do so----and if need be, alert your charge nurse and/or house supervisor if this physician persists in this. Careful documentation of this situation needs to be done also, as a follow-up, using your occurence/incident reporting system and Risk Management Department. It's hard to say "no" when a doctor orders us to do something, particularly when it's a "freak out moment" like a dystocia. But you have to refuse. For the reasons already stated, this must not be done.

Hope this helps.

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Specializes in L&D.

No one has mentioned this, but what about when you have a doc doing an AROM on a patient with a -3 station?

I applied light fundal pressure at AROM per the doc for a 2nd twin who was at a -3 during a lady partsl delivery of twins. Not the first time I've been asked and done it for AROM of baby B either.

Jen

L&D RN

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