Applying Fundal Pressure To Enhance The Expulsive Force
If at the end of the delivery period, the expulsive force is not strong enough, performing an episiotomy can reduce resistance and uterine fundal pressure can be applied to increase the force of the contraction. A condition for this is that the head has descended to the pelvic floor and that the pressure should not be applied more than three times. During the application of fundal pressure, the myometrium is pushed together between the hand applying pressure and the foetus. The force exerted must be spread over as large a surface area as possible to prevent bruising. This can be realised using the Kristeller manoeuvre.
Procedure
- The person applying pressure should stand next to the bed facing the foot end.
- Place hands with the wrists and the thumbs against each other and the fingers joined together, pointing sideways to the fundus so that both hands form a large surface.
- Wait until a contraction starts.
- Exert external pressure on the fundus in the direction of the pelvic brim. Only do this during a contraction and during a maximum of three contractions.