Mothers who are about to give birth often spend some time searching for things to expect during labor and delivery. Often, they want to have a glimpse of what will happen once they are in the hospital or birthing clinic. Will they need intravenous fluid? What medications will the doctor give? How long before they can push their baby out? Can nurses or doctors really help them give birth through fundal push?
The last question is particularly important because the practice of performing fundal push is still widespread. However, it’s riddled with controversy and is no longer recommended by many healthcare professionals. In this article, we’ll talk about the potential benefits and risks of fundal pressure.
Fundal Push, An Overview
Fundal push or fundal pressure is the basic technique of helping mothers push their baby out during vaginal delivery. Some practitioners also call it gentle assisted pushing (GAP) or uterine fundal pressure maneuver (UFPM).
Fundal pressure simply refers to the application of manual pressure above the uterus during the 2nd stage of labor or the “pushing stage.” The nurse, doctor, or midwife typically uses their palm, elbow, or forearm to help the mother push. Some healthcare practitioners believe that GAP helps hasten the delivery of the baby. The idea is that the faster the baby is born, the less the possibility of needing instruments (forceps, etc.) and C-section.
However, various studies suggest that fundal pressure isn’t helpful. In fact, it may even lead to serious complications. To better understand the risks of fundal push, let’s look into these findings:
It May Result In The Laceration Of The Birth Canal
In a study involving 265 participants¹, the researchers observed that the most frequently occurring adverse effect with respect to UFPM is the laceration of the birth canal, followed by the laceration of the cervix.
They also noted that while some of the newborn babies needed intensive care confinement, all of them eventually developed without a problem.
In connection with UFPM, the study DIDN’T observe:
- Cases of uterine rupture
- Adverse effects that resulted in longer hospital stay
- Cases of maternal deaths
There’s Not Enough Evidence That The Practice Is Helpful
A Cochrane Review featuring a total of 9 studies aimed to understand if there are benefits to practicing fundal push during the 2nd stage of labor³.
Five of the studies involving more than 3,000 participants checked the difference between using GAP and not using it at all. Four of the studies involving almost 900 women checked if fundal push using an inflatable belt is helpful.
Results of the review showed that:
- Fundal push doesn’t appear to affect the speed of vaginal delivery.
- Fundal push doesn’t appear to affect the need for instrument-assisted birth or C-section.
- The number of babies who did not cope well with labor and those with low APGAR score or arterial cord pH is the same whether or not the mother received fundal push.
- Some evidence suggests that a fundal push with inflatable belt may hasten vaginal delivery and lower the number of women who needed instrument-assisted birth or C-section. However, the report said the evidence was of “very low-quality.”
The bottom line is that there’s not enough evidence to say that fundal push is helpful. There’s also not enough evidence to ascertain the practice’s safety for the baby⁴.
It May Lead To Other Problems
Besides the possibility of birth canal and cervix lacerations, a report mentioned that side effects also include⁵:
- Postpartum urinary retention
- Severe perineal trauma and pain
- Postpartum dyspareunia (painful intercourse)
- Rib fracture
- Potential neonatal distress or trauma
Key Takeaways
Despite being a widespread and highly accepted practice, many experts are against fundal pressure. There’s not enough evidence that it helps with vaginal birth, and its safety for both mother and baby is still questionable.
To know more, please consult your obstetrician-gynecologist.
Learn more about Giving Birth here.
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