Fundal pressure isn’t beneficial and can be dangerous

2126717272_ffff239341Now, I realise that many of the lovely people who visit my blog and website and facebook page (thank you) will already know that fundal pressure isn’t a positive addition to a woman’s journey of birth.  In fact, some might shudder at the very idea of using fundal pressure – that is, pressing on the top of a woman’s womb during her labour or birth, a practice also known as the Kristeller manoeuvre – but I feel compelled to write about it for a couple of reasons.

Firstly, although this manoeuvre or practice has been confined to the annals of herstory in many countries, it is still too prevalent in others.  And secondly, because a few clinicians and researchers are concerned enough about this that they are still doing studies in order to show to their colleagues that it doesn’t work and can be harmful, so I think the least I can do is write a blog post in an attempt to help share their findings. So please forgive the repetition if you knew this already, though do feel free to share it anyway for the benefit of those who don’t.

The most recent paper that I have seen on this topic described a retrospective cohort study which included data on 9743 women’s births (Furrer et al 2015).  These women all had single, cephalic (head down) babies and had given birth between 2004 and 2013.  The Swiss authors found that fundal pressure was used with 8.9% of women in spontaneous labour and 12.1% of women who had assisted vaginal deliveries. The use of fundal pressure was associated with a higher incidence of shoulder dystocia and fetal acidosis in both groups.  In women who had spontaneous births, it was also associated with a higher incidence of lower APGAR scores and more anal sphincter tears.

Not helpful, then.  And potentially harmful.  So please don’t do it, and please share this information so that we can protect women and babies from potentially dangerous practices such as fundal pressure.  Thank you very much 😀

 

The Research

Aim: This study aimed to evaluate maternal and fetal outcomes after uterine fundal pressure (UFP) in spontaneous and assisted vaginal deliveries.

Methods: In a retrospective cohort study, 9743 singleton term deliveries with cephalic presentation were analyzed from 2004 to 2013. Spontaneous and assisted vaginal deliveries were analyzed separately with and without the application of UFP. Odds ratios were adjusted in a multivariate logistic regression analysis.

Results: Prevalence of UFP was 8.9% in spontaneous and 12.1% in assisted vaginal deliveries. UFP was associated with a higher incidence of shoulder dystocia in both spontaneous (adjusted odds ratio [adj. OR] 2.44, confidence interval [CI] 95% 1.23–4.84) and assisted vaginal deliveries (adj. OR 6.88 CI 95% 3.50–13.53). Fetal acidosis (arterial umbilical pH<7.2) was seen more often after the application of UFP in spontaneous vaginal deliveries (adj. OR 3.18, CI 95% 2.64–3.82) and assisted vaginal deliveries (adj. OR 1.59 CI 95% 1.17–2.16). The incidence of 5′-Apgar<7 (adj. OR 2.19 CI 95% 1.04–4.6) and 10′-Apgar<7 (adj. OR 3.04 CI 95% 1.17–7.88) was also increased after the application of UFP in spontaneous deliveries. A higher incidence of anal sphincter tears (AST) (adj. OR 46.25 CI 95% 11.78–181.6) in the UFP group of spontaneous deliveries was observed.

Conclusions: UFP is associated with increased occurrence of shoulder dystocia and fetal acidosis. In spontaneous deliveries, the risk for lower Apgar scores after 5 and 10 min is increased, as well as the risk for AST.

Furrer R, Schäffer L, Kimmich N et al (2015). Maternal and fetal outcomes after uterine fundal pressure in spontaneous and assisted vaginal deliveries.  Journal of Perinatal Medicine.  Online ahead of print.
photo credit: Terracotta hand on belly mask via photopin (license)

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