What Is Fundal Pressure?
Fundal pressure is a technique widely used in second-stage labor to shorten labor and to assist in vaginal delivery. This technique is used routinely to speed up the process when complications exist, such as failure to progress, fetal distress, maternal exhaustion, and medical conditions in which prolonged pushing is contraindicated.
As stated in an article published by the World Health Organization (WHO), there is no evidence to either discourage or support the use of fundal pressure, and further research is needed to evaluate its safety and effectiveness. However, in certain situations, fundal pressure can cause serious injury to the child.
In manual fundal pressure, the healthcare professional uses the hands to push on the upper part of the uterus, down toward the birth canal, for the purpose of accelerating the second stage of labor. Pressure can also be applied using an inflatable belt.
Fundal Pressure and Shoulder Dystocia
According to an article published in the American Family Physician, shoulder dystocia can happen without warning, and ranks among the most frightening emergencies that can occur during delivery. When shoulder dystocia occurs, the infant’s shoulder is impacting against the mother’s pubic bone, causing the child to be stuck inside the birth canal. The doctor or midwife has little time to deliver the baby to prevent serious birth injuries, particularly to the child’s brachial plexus – the nerves that travel from the spinal cord at the neck and supply the shoulder, arm, and hand.
Health care professionals may need to employ certain maneuvers in order to quickly free and deliver the child. These maneuvers may include suprapubic pressure, in which pressure is applied with the hands directly over the mother’s pubic bone to help push the baby’s shoulder downward and free of the pubic bone.
However, fundal pressure should be absolutely avoided with shoulder dystocia. It is unlikely to help free the infant and could cause injury to the baby and the mother. When fundal pressure is applied while shoulder dystocia is occurring, it can cause the baby’s shoulder to further impact the pubic bone, which can cause additional stretching and further damage to the nerves.
Potential Risks with Fundal Pressure
In addition to risks for the mother, such as sphincter damage and uterine rupture, there are risks of injury to the child associated with fundal pressure, and not only in shoulder dystocia situations. Fundal pressure birth injury risks reported include:
- Brain damage
- Increased blood transfusion between mother and fetus – this could be important if the mother has Hepatitis B, HIV, or another viral disease
Contact Birth Injury Attorney Laura Brown Today
Birth Injury Lawyer Laura Brown and her firm ensure that the rights of injured children are protected. If your child has been injured at birth because of inappropriately applied fundal pressure or any other medical error, please call (866) 393-2611 for a free consultation to discuss your legal options.
- WHO: Fundal pressure during the second stage of labor
- American Family Physician: Shoulder Dystocia
- Cochrane: Fundal pressure during the second stage of labor for improving maternal and fetal outcomes