I was pregnant the first time almost 15 years ago, and I didn’t really do a lot of research. I figured as long as I did what my doctor told me it’ll be fine. I had complete trust in her, and everything went well. But I remember waking up in my room after giving birth with an ache in my tummy. It felt like someone punched me in the stomach, but I didn’t have any bruising.
I wondered then if it was a usual post-birth symptom, and I didn’t think much of it then. What mattered was my baby and I were okay. It was only years later when I heard the term “fundal push” that it all came back to me — that was what happened to me. I distinctly remembered the resident doctor saying “konti na lang” and then “Mommy, tutulungan na kita, ha.” Then, she pressed the top of my baby bump to help me push.
I didn’t know how to push then, and my baby’s head became a little pointy (not a cause for concern click here why). Perhaps the fundal push did cut my labor short and got me through a vaginal birth, saving me a considerable sum since I did not need a C-section (CS).
I could only express relief after finding out that what happened was not recommended anymore. According to the World Health Organization (WHO), “application of manual fundal pressure to facilitate childbirth during the second stage of labor is not recommended” due to the risks.
What is a fundal pressure
A fundal push, also called fundal pressure, is when a doctor uses his hands or an inflatable belt to press the upper part of the uterus toward the birth canal, according to Birth Injury Safety. It’s also sometimes referred to as the Kristeller’s maneuver after the German gynecologist Samuel Kristeller in 1867 as aid for a difficult vaginal birth and emergency situations.
Before the procedure was widely discouraged, a fundal pressure was performed to assist in spontaneous vaginal births to lessen the need to use forceps or vacuum. It was also believed to speed up the pushing stage during labor (learn more about the stages of labor here).
Doctors do a fundal pressure when the contractions aren’t strong enough to help push the baby out, and the mom doesn’t know how to push or is already exhausted. It’s also an option when the baby’s heart rate is slowing down or stuck in the birth canal with his head and shoulders already out.
The fundal push should never be performed if the baby’s head is much bigger than the birth canal or there is a cyst that blocks it. It’s also not advised if the mom previously had a C-section or an operation to remove a uterine fibroid.
The risks in performing a fundal push
When carried out incorrectly, a fundal pressure poses a lot of risks and complications both for the mom and baby. It has been linked to unbearable pain, causing the mom to lose focus on the overwhelming emotions of welcoming a baby. Few studies have been done on its effectivity or adverse effects, but below are the medical reasons it’s not a recommended procedure today.
Fundal pressure put the mom at risk of:
- Cuts on the vagina and perineum. She may even need an episiotomy and further expose her to all the risks associated with it, including painful sex (learn why an episiotomy is not routine here)
- Damage the stomach muscles because of the pressure on the abdomen
- Untimely detachment of the placenta, which may affect the baby’s oxygen supply and lead to brain damage
- Bruising of the uterus is also a risk that can lead to the rupture of the uterus, which can cause excessive bleeding
Fundal pressure can put baby at risk of:
- Stretching and nerve damage to the baby’s shoulder if it’s stuck behind the mom’s pubic bone or is smashing into the mom’s pelvis (read more about shoulder dystocia here)
- Low APGAR score (click here to know what a newborn’s APGAR score mean.)
- Bone fractures in other parts of the body
- Bleeding outside the blood vessels due to birth trauma
Doctors aim for vaginal birth but always consider both the health and safety of the mom and the baby. New recommendations let low-risk births progress on its own, reducing the need for labor interventions, and that includes a fundal push.