Fundal Pressure Birth Injury: Everything You Need To Know

The words “fundal pressure” probably mean nothing to you. If you’re not a medical practitioner, particularly in obstetrics, gynecology, or pediatrics, you’ve probably never even heard them before. If you’re a mother who’s delivered a baby, you’ve probably never heard them either and that’s a part of the problem. You may have experienced fundal pressure during labor and you or your baby may be suffering because of it right now.

Your physician, midwife, or attending nurse may have taken their hands, placed them on your stomach, and pressed down hard while you were giving birth. If that sounds familiar, you were experiencing fundal pressure. Keep reading to find out everything you need to know about fundal pressure birth injury.

What Exactly Is Fundal Pressure and When Is It Used?

Fundal pressure is the application of pressure to the upper part of the uterus, directed towards the birth canal to assist the mother in pushing out the baby. It is also called a “fundal push” or the Kristeller maneuver. The fundus is the top part of the uterus farthest away from the opening. When a doctor applies fundal pressure, he or she will use one band, both hands, or fists to push down. This is called manual pressure.

The technique is named for German gynecologist Samuel Kristeller who developed it in 1867 as a way to move the baby through the birth canal more quickly during a difficult vaginal birth or other emergency situations in the second stage of labor. The second stage is where the mother would normally push the baby down the birth canal. Fundal pressure may also be applied with an inflatable belt.

Use of Fundal Pressure Goes Against Medical Guidance Around the World

While the Kristeller maneuver is age-old and became widely practiced all over the world, it eventually became the subject of much controversy. Many medical professionals discourage its use and some places have outright banned it due to the purported risks it poses to the mother and baby. Broken bones and ruptured organs are just a few of those risks.

The World Health Organization (WHO) does not recommend the use of the Kristeller maneuver. The use of fundal pressure is prohibited in the United Kingdom and generally not recommended by many medical facilities and practitioners in the United States. Despite this, many practitioners still use the technique regularly during the labor and delivery process in the U.S. and abroad, particularly in Europe.

Europe is known for maintaining many outdated and dangerous childbirth practices. The Associated Press reveals that fundal pressure is used in 22% of births in France while doctors, nurses, and midwives in countries like Bulgaria, Croatia, Hungary, Italy, Portugal, Romania, and Spain have reported seeing the maneuver used weekly, if not daily on the job.

The Risk of Using Fundal Pressure in Child Birth

Fundal pressure is overused and understudied. A 2017 study on fundal pressure published in Cochrane Reviews found that there isn’t enough information to conclusively support the benefits or harmful effects of the technique. Ultimately, the study concludes that there is no evidence to support its use in the second stage of labor whatsoever.

Other studies and anecdotal information point to very clear and concerning risks of using fundal pressure in the labor ward. The risks are birth injuries to the mother and the infant. One of the most worrisome is the risk of levator ani muscle avulsion or tearing the major muscle of the pelvic floor off the pubic bone. This injury can lead to muscle weakness that may result in incontinence and/or the organs falling from their normal position and protruding into the vagina (a condition known as pelvic organ prolapse).

The following is a list of fundal pressure birth injuries and complications:

Birth Injury to the Mother:

  • Damaged or ruptured organs
  • Pelvic prolapse
  • Severe abdominal pain
  • Broken bones such as a rib fracture
  • Vaginal tears (perineal tears)
  • Urinary or fecal incontinence
  • Painful intercourse (Dyspareunia)
  • Inability to urinate after

delivery (Postpartum urinary retention)

  • Other pelvic floor complications

Birth Injury to the Infant:

  • Shoulder getting stuck behind mother’s pubic bone (shoulder dystocia)
  • Nerve damage
  • Damaged blood vessels resulting in hemorrhaging
  • Fetal acidosis (high amounts of acid building up in the blood)
  • Detachment of the placenta which can lead to oxygen deprivation

Any of these injuries can lead to other severe complications and conditions.

Cerebral palsy, for instance, can be caused by damaged and bleeding blood vessels in the brain.

Doctors and Nurses Rarely Ask for Consent To Use Fundal Pressure

Fundal pressure is often applied without the mother’s informed consent. Some medical care providers believe it to be a routine procedure in labor and delivery. They use it without so much as speaking to the mother about it beforehand and may ignore the mother’s pleas to stop. The use of the technique is rarely reported in the medical documentation regarding the patients, making its occurrence hard to track. Further, lack of reporting could indicate the medical professionals’ awareness of the risks and the taboo nature of its use.

Fundal Pressure Birth Injury Is Not Acceptable, Seek Legal Help

With all the associated risk of fundal pressure, it’s no wonder medical guidance around the world frowns upon its use. If you or your baby were injured during the birthing process due to the use of fundal pressure, you may be able to demand compensation. Armed with everything you need to know about a fundal pressure birth injury, you can pursue justice and hold the offending medical practitioners accountable. A birth injury lawyer at Brown & Barron can help you file a medical malpractice claim against the negligent doctor, nurse, midwife, or medical facility that caused you harm. Call us to set up a free consultation today.

Newborn baby
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