Revisiting fundal pressure to assist in vaginal delivery

  • Hofmeyr GJ & al.
  • BMJ Glob Health
  • 1 Jan 2018

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Gentle assisted pushing (GAP) and upright position does not speed the second stage of labor.

Why this matters

  • The use of fundal pressure during the second stage of labor to assist vaginal birth is strongly discouraged in the United States but routinely used elsewhere.
  • Little scientific evidence supports or refutes this practice.
  • Women should be encouraged to use the most comfortable labor positions.

Key results

  • There was no difference in time to delivery between labor positions.

Study design

  • Open-label, hospital-based, randomized trial conducted between 2015 and 2017.
  • Women with healthy, nulliparous, cephalic pregnancies were invited to participate.
  • Participants were randomly assigned to 1 of 3 groups after 15 minutes of pushing without delivery: GAP (n=388), upright position (n=386), or routine labor positions (n=384).
  • Primary outcome was defined as the mean time from randomization to birth.
  • Funding: United Nations Development Programme/United Nations Population Fund/United Nations Children's Fund/WHO/World Bank Special Programme of Research; Development and Research Training in Human Reproduction at WHO.   

Limitations

  • Continuous electronic fetal monitoring was not used routinely; this is performed in the United States and can be difficult to perform in certain positions.
  • Study could not be blinded, as allocation of group could not be concealed.

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