Making sense of fundal pressure: A qualitative study on women’s experiences of a non-evidence-based yet commonly practiced intervention

Introduction

Fundal pressure (FP) during second stage of labour has been discussed controversially. The intervention involves pressure to the uppermost part of the uterus to assist vaginal birth. While evidence is lacking, women report differing experiences from violent and traumatic to positive and helpful. This paper examines the experience of FP from the perspective of women without evaluating the intervention itself.

Methods

The informed grounded theory study included 12 experiences of FP. The inclusion criteria were hospital births with application of FP no longer than 12 months ago. Inductively generated codes were aligned with a previously developed theoretical model on perception formation during obstetric situations.

Results

The women’s appraisal of FP was determined by the level of perceived comprehensibility (understanding of situation and intervention) and manageability (ability to cope) as well as respective subcategories. Depending on the depictions of the participants, we determined six FP experiences as positive, three as neutral and three as negative. In all classifications, there were cases of low comprehensibility largely tied to brief medical explanations given the urgency of the situations. Regarding manageability, positive experiences were connected to high, neutral experiences to moderate, and negative experiences to low levels of manageability.

Conclusion

Our study indicates that women’s appraisal of FP is determined by the level of comprehensibility and particularly manageability. In light of the controversies around FP, we do not take position whether FP should be applied or banned but conclude that if FP is applied, women’s comprehensibility and manageability need to be safeguarded.