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Re: fundal pressureFrom: SLF, RNC (SLF430@aol.com)Sun Mar 30 10:56:08 1997
At Tue, 25 Mar 1997, Jennifer Hali Enoch wrote: > >I'm not a doctor and I just lurk on this list to learn what I can, but I >have a question that I hope you might be willing to answer. >Is fundal pressure used in VBACs? I've seen fundal pressure used almost >routinely during second stage in hospitals, but there seems to be no >official policy concerning its use. And I haven't been able to find a >journal article on its use other than the survey in J. Nurse-Midwifery >and a few articles specifically concerning fundal pressure in shoulder >dystocia. Do you consider fundal pressure contraindicated with VBACs, >or do you believe it would cause no harm? >Back to lurking, >Jennifer Enoch >student nurse > >On Sat, 22 Mar 1997, David Zimmerman wrote: > >> About six weeks ago, I was assisting a CNM with the delivery of a G3P2 who >> was pooped and not pushing well. The CNM does not have privledges for >> vaccuum extraction (vtx at +2) so I placed it. After one contraction, >> there was little progress, so I asked the L&D nurse for fundal pressure. >> She flatly refused (in front of the patient) stating the L&D staff had >> recently attended a conference where they were advised it was >> "contraindicated" to provide fundal pressure. As I picked my jaw off the >> floor and tried to decide if there was something wrong with my hearing, the >> CNM quickly assisted me and we completed the delivery uneventfully. >> >> At the ob-gyn department meeting in my hospital today, the incident was >> discussed. The notes of the conference the L&D nurse attended were >> distributed and it became apparent that the prohibition on fundal pressure >> was meant to apply to *shoulder dystocia*. Obviously, suprapubic, not >> fundal, pressure is the maneuver for a shoulder dystocia, since fundal >> pressure will only further impact the shoulder. But the nursing >> administration maintained they had done a survey of many other hospitals >> within our state, and NONE of them allowed the nurses to apply fundal >> pressure. >> >> What is the situation in your hospital? Do you folks use fundal pressure >> as part of your armamentarium? >> >> Terri Rosenbaum, M.D. >> private practice >> Kauai, HI >> >> A pat on the back is only a few centimeters from a kick in the butt. >> I am a RN in a mid size community hospital where fundal pressure is a hot topic right now. We are being asked by some physicians to do prolonged fundal pressure (>1/2-1 hr.) on some pts,sometimes w/ horrendous outcomes (we recently had a fetal death after prolonged fundal/vacuum). We know that this is not right & a comittee has been set up to develop guidelines for "appropriate?" fundal. So far thet have come up w/ 15 min. limit, vertex presentation, MD required to be in room. I have mixed feelings about this because there is no literature to support the use of fundal for any time period (or possibly at all). If anyone can give us some insight on this "sticky" situation, please email me. Needless to say, the docs that use this often are up in arms that the nurses are upset about this practice. Thank you...SLF430@aol.com
-- SLF, RNC
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