Letter writing for fundal pressure

Specialties Ob/Gyn

Published

Hi all.

I am a relatively new Doula (the good kind, I hope :)) and although I have only seen a few births, which have run the gauntlet of interventions, the last birth I witnessed was horrific for me.

Like many of the postings I have read on this site, I believed I would never see this outdated practice of fundal pressure (FP). It is giving me nightmares.

I would love to write to someone somewhere, if nothing else than to vent. I have read a post where it is recommended that I write to the risk management dept. at the hospital and the chief of OB. My concern is, as a Doula, do you think my letter will be taken seriously or will I be regarded as a birthing zealot? Nothing would make me happier than seeing this procedure eliminated or atleast minimalized at this hospital.

Here is some bkgd. info on the pt.: prim with SROM but checks into hospital next morning. 3-4 cm, 75%, -2, soft, ant. epideral and amp. for ROM. Pit given for irregular ctx, few hours later mom is complete, starting to move legs, wants to get on hands and knees, EFM belts uncomfortable, etc. (I am not sure if nurse slowed epi or not.) Mom asks nurse if gma, doula, and dad can stay for delivery...nurse says yes even though sign on door says only 2 visitors per patient.

An aside, I overheard head nurse, nurse aneth. and aneth. talking in hall (our door wouldn't latch closed) They thought I was feeding mom food since I brought lunch up to the room. I think this is why they didn't section her for fear of aspiration? She had a few bolis of epi because epi. cath. was in so deep she had a hotspot which aneth. finally fixed by pulling it out a bit.

After mom was complete, NO laboring down was allowed! Dr. comes in says only 1 person allowed in room (besides her and nurse and mom). Gma leaves, dad stays, I say, I am a Doula---OB says only if mom wants you here---mom says yes. Mom says to OB---I would like to avoid an episiotomy, if possible. OB says---verbatim---you don't want to tear, episi heal faster. OMG! I stand by her head while dad is south of the border. Mom on her back with legs up in supports in squat position.

Nurse does directed pushing count to 10 and hold breath for 2 ctx! OB says ineffective---nurse do FP! Nurse pulls up a stool, stands on it leaning over mom grabs railing across moms chest to get more leverage and proceeds to stick elbows into moms uterus! Tells mom to hold breath and push. When nurse gets off her, mom says she can't breath, wait a sec for her to catch her breath. Nurse does, but mom shrieks in pain upon subsequent FP says nurse get off me, while baby is moving all over the uterus. Nurse says she can't seem to get ahold of him. FHT are fine, from what I remember, hence my wondering why and the world FP was being done. It didn't appear to be an emergency, just an OB in a hurry.

While my mouth gapes open, OB says to me---you need to get out of here---remember I haven't said a word the whole 10 minutes this OB was in the room! As I leave room, OB says to mom ---you need to trust that we know what we are doing. (Never mind the fact that a uterus/lady parts movements are involuntary! A mom can be dead and her body will still birth her baby!)

Not 10 minutes pass and Gma and I, who are standing in the hallway outside door that won't close hear baby cry and rush in to congratulate mom---OB says you need to get out---we aren't done yet, even though baby is on mom's chest.

We leave again. Nurse keeps going in and out of room (she's the only nurse in there) each time telling us to go sit in waiting area. We decline and remain there. OB leaves 10 minutes later and 30 minutes later nurse is done cleaning up battlefield from episiotomy and foreceps---for a 6 lb baby. Never have I seen so much blood on a baby's face, even after the clean up!

I am not blaming nurse for ANY of her actions, as I know she was ordered to do this procedure. I just want to learn more about why this dangerous procedure is used and when. I know mom had to be bruised from this! I was so scared that I would be witness to a rupture!

On top of all this...baby has a mandatory 4 hr minimum stay in the nursery after birth! Yes we have come along way from knock em out births...but we need to go waaaaaaaay back to when women were allowed the freedom to let their bodies perform naturally. Thanks for any input!

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Specializes in High Risk In Patient OB/GYN.

I understand your frustration, but I sadly doubt that you would be taken seriously.

Sorry that you and mom were treated that way. did the mother talk to her OB about no episiotomy before she was ready to push?

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Specializes in High Risk In Patient OB/GYN.

Just saw your other thread....

This thread in combination with your other thread gives a lot of details about your client. Is she comfortable with you sharing this information on a board where her nurse or doctor could possibly read it and identify her?

Are you comfortable posting birth reports where nurses you've worked with or may work with in the future may be posting?

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Sorry about the experience. Whether they would take you seriously is hard to say. I honestly didn't know FP was still used anywhere, it is expressly forbidden at our facility for any reason.

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I have been in midwifery for over nine years and have never heard of this practise durning labour with in the UK. We do use FP for a controlled ARM whaen the presenting part is high. Sounds horific to me.

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Our facility will not do an ARM if the presenting part is high. I have never heard that before so I guess since we only ARM when the head is well applied, that's why we don't do FP

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Specializes in L & D; Postpartum.

Sounds horrible to me, all around. My comment on waiting outside the door is one you may not like. Where I work, it is a fire marshall thing: no waiting in the halls. It is not our policy, but one I try to regulate as much as possible. We, at times, have had 10-15 people wanting to wait just outside the door. With our without toddlers who thinks it's romper room. The place for anybody who is not in the room is in the waiting room. And if you enforce it for the big crowds, you have to enforce it for the small ones too.

Other than that, I agree that it was a bad experiece but also would caution you about sharing the details here.

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Just saw your other thread....

This thread in combination with your other thread gives a lot of details about your client. Is she comfortable with you sharing this information on a board where her nurse or doctor could possibly read it and identify her?

Are you comfortable posting birth reports where nurses you've worked with or may work with in the future may be posting?

Thank you for the post. I did remove the hospital name from the other post, even though mom doesn't care one way or the other. Mom is processing her birth and trying to fall in love with her newborn, not caught up in the drama that ensued during labor. She tried to switch OBs at her last checkup because OB said she does perform episiotomies, will induce with pit., foreceps, etc. Mom wanted a natural labor or one with as few interventions as possible. Yes, mom clearly stated before birth that she did NOT want an episiotomy.

I am very comfortable communicating with nurses. I know you all have a wealth of knowledge and experience to help me understand what went on here and why. I always try and befriend and help the nurses and staff in any way that I can when I am at the hospital, especially since they are usually understaffed (as in this case), work long shifts, and are required do do procedures I can't imagine doing.

I hope nurses from hospitals performing fundal pressure see this post and are empowered to write their own letters. We need to all work together to get our patients the best care we possibly can, even under doctor's orders.

I guess I won't write any letters, but just inform future patients that this procedure has been used at this hospital before.

Thank you for the post about the fire codes---that makes complete sense. I will go to the waiting room next time, so as not to be a hazard.

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Specializes in OB high rish low risk PP antepart..

Sounds like you experienced birth with an older Dr. Some on occassion still ask for FP. Knowing that this is an antiquated and dangerous practice the nurses at my facility accomodate the Dr by "performing" fundal pressure. Place the side of your hand on Mom's fundus and "push down" The pressure that is applied is minimal. Most of it is in the Nurses face but it satisfies the Dr and doesn't get the Nurse yelled at by this old guy.

I have to agree with tntrn (above) that waiting outside in the hall is not a good idea. I have had security remove people when they refuse to relocate to the designated WR. It is also a HIPPA thing. Not everybody has the right to hear the patients cries or her information no matter what THEY may think.

Sounds like the Pt and her Dr were on 2 different wave lengths and perhaps would have benefited from discussing the birth plan prior to the delivery. Most OBs will accommodate the Mom's wished if they don't interfere with the safety of both Mom and baby. If they do, the Dr will usually explain why Mom's wishes can't be done. I am not a big supporter of Doulas for in my experience they have undermined my care of the pt by countermanding my orders of needed FSE,IUPC,PIT etc. I always try to explain to Mom why we do what we do but if she has objections I try to take them back to the Dr and mediate a compromise. I have found that the Doula interferes with this exchange more often that not. Just my experience.

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

I am glad the other member provided a reminder about posting too much information on a public board such as this. Please, never, ever use specifics such as hospital names, city names, staff names or even specific dates. It's amazing how quickly people can put pieces of these puzzles together and it has landed a couple members of this very board in very hot water in the past (I know of one who lost a job). I can't overstress caution when posting on this or other online boards----remember HIPAA and protect yourself and your patients/clients.

Good luck in this situation. It does sound horrific to me. Since I was not there, it's hard for me to evaluate the whole situation. It may be useful for you to carefully approach your client and ask her how she feels (now) about her birth experience. And if you do witness anything dangerous (such as fundal pressure as you state in this case), you might approach the manager/charge nurse of that unit (behind closed doors) with your concerns.

Take care and keep on being there for your clients!

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Sounds like you experienced birth with an older Dr. Some on occassion still ask for FP. Knowing that this is an antiquated and dangerous practice the nurses at my facility accomodate the Dr by "performing" fundal pressure. Place the side of your hand on Mom's fundus and "push down" The pressure that is applied is minimal. Most of it is in the Nurses face but it satisfies the Dr and doesn't get the Nurse yelled at by this old guy.

I have to agree with tntrn (above) that waiting outside in the hall is not a good idea. I have had security remove people when they refuse to relocate to the designated WR. It is also a HIPPA thing. Not everybody has the right to hear the patients cries or her information no matter what THEY may think.

Sounds like the Pt and her Dr were on 2 different wave lengths and perhaps would have benefited from discussing the birth plan prior to the delivery. Most OBs will accommodate the Mom's wished if they don't interfere with the safety of both Mom and baby. If they do, the Dr will usually explain why Mom's wishes can't be done. I am not a big supporter of Doulas for in my experience they have undermined my care of the pt by countermanding my orders of needed FSE,IUPC,PIT etc. I always try to explain to Mom why we do what we do but if she has objections I try to take them back to the Dr and mediate a compromise. I have found that the Doula interferes with this exchange more often that not. Just my experience.

Where i work and I believe the standard of care nowadays is NO FUNDAL PRESSURE!!!! Nurses are not to do it, neither are doctors. I have been all over this subject because we had a doc that routinely asked for it, when we refused he would quickly teach the dad to do it! I used to do exactly what you said and innocently put my hand and "pretend" to push on her fundus, then someone on this board pointed out that if a picture or video was snapped of you doing that, how are you going to prove to a jury you were just "pretending." I have seen more shoulder dystocias with that same doctor doing his beloved fundal pressure than I care to count.

I believe if you sent a letter w/ some recent literature supporting the practice of FD as outdated and unsafe(use ACOG, and/or Awhonn as these are highly respected sources of information for hospitals) and stating what you witnessed, I believe you might be taken seriously. Fundal pressure is risky for so many reasons and inpatience is hardly a justifiable reason.

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This was not an old OB! Looked fresh out of school!

PT. and OB couldn't agree on a birth plan before labor, unfortunately.

And I completely forgot about HIPPA! Thank you for your help, everyone. Maybe letters with some lit. from ACOG will get some attn. I'll start writing...

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