The fundal pressure maneuver, also known as Kristeller's maneuver, was first described in a published study by Samuel Kristeller in 1867. It involves applying pressure to the top of the uterus during the second stage of labor to assist in delivery.
Medical facilities have since shifted away from this practice due to the risks it poses for mothers and infants. Despite this attitude shift, this technique remains a topic of concern. A recent study found that this practice was used in more than 200,000 births across the globe in the last couple of decades alone (23.2% of the 898,544 births studied). It was also found that this practice is more prevalent in lower-resource areas.
In the US, given all the evidence of its risks, applying fundal pressure during labor can be considered negligent. Facilities that still utilize this outdated practice may be held liable for any harm that they would do to mothers and/or their babies. Families can look to file a medical malpractice claim against their provider/s to get legally compensated.
Birth Injuries from Fundal Pressure During Labor?
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Understanding Fundal Pressure
Kristeller’s maneuver gained popularity in the US in the late 19th century to early 20th century. Back then, many births still occurred at home. This technique was a means to expedite difficult deliveries – reducing the need for other labor tools. By the late 20th century, wherein most deliveries were done in medical facilities, experts began to question the safety and efficacy of the practice.
Today, many birthing facilities restrict this practice. It is widely discouraged within the medical community – which has since moved to a less interventionist approach. Doctors steer clear from this practice to avoid birthing injuries and malpractice liabilities.
Is the Use of Fundal Pressure Illegal?
At a federal level, the use of Kristeller’s maneuver is not explicitly illegal. However, medical state regulations urge medical providers to prioritize patient safety and to follow evidence-backed practices. Any injuries acquired by both mother and infant are the liability of their negligent healthcare provider.
Professionals who partake in such practices face serious legal repercussions. State-wide regulations require hospitals to have quality assurance programs that review obstetrical practices. These programs typically discourage outdated practices like routine fundal pressure.
Risk of Using Fundal Pressure in Labor
Fundal pressure during labor is associated with several risks for both the mother and the infant.
Potential Maternal Injuries
| COMPLICATION | DESCRIPTION |
| Uterine rupture | A tear in the uterine wall, often along previous surgical scars. Can cause severe bleeding, fetal distress, and requires immediate medical intervention. |
| Placental abruption | Premature separation of the placenta from the uterine wall before delivery. Can cause severe bleeding, fetal distress, and complications for both mother and baby. |
| Perineal trauma | Injury to the area between the vagina and anus during childbirth. Can range from minor tears to severe lacerations affecting muscles and sphincters. |
| Pelvic organ prolapse | Weakening of pelvic floor muscles causing organs (bladder, uterus, rectum) to descend. Can lead to discomfort, urinary issues, and sexual dysfunction. |
| Internal organ damage | Injury to abdominal organs like liver or spleen due to external force. Can cause internal bleeding, organ dysfunction, and require surgical intervention. |
Potential Child Injuries
| COMPLICATION | DESCRIPTION |
| Brachial plexus injury | Damage to nerves controlling arm and hand movement. Can cause weakness, loss of sensation, or paralysis. Often results from excessive stretching during delivery. |
| Hypoxic-ischemic encephalopathy | Brain injury caused by oxygen deprivation and reduced blood flow. Can lead to developmental delays, seizures, cognitive impairments, or cerebral palsy in infants. |
| Spinal cord injury | Damage to the spinal cord, potentially causing partial or complete paralysis. In newborns, it can result from excessive traction or trauma during delivery. |
| Intracranial hemorrhage | Bleeding within or around the brain. Can cause increased intracranial pressure, seizures, and developmental issues. May result from trauma during difficult deliveries. |
| Fractures | Broken bones, often involving clavicles or skulls in newborns. Can occur due to excessive force or difficult positioning during delivery. Usually heals well. |
| Meconium aspiration | Inhalation of first fetal stool (meconium) into lungs before or during birth. Can cause respiratory distress, infection, and in severe cases, persistent pulmonary hypertension. |
It's important to note that the severity and likelihood of these risks can vary depending on factors such as the force applied, the duration of the maneuver, and pre-existing conditions. The potential for these complications is a primary reason why fundal pressure is discouraged by many medical organizations and healthcare facilities
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Can Medical Teams Be Held Liable for This Practice?
Medical teams can potentially be held liable for using fundal pressure during labor and delivery. Despite being routinary once, the use of this technique may be considered negligent due to the professional consensus regarding the restriction of interventional labor practices.
The extent of liability can vary based on specific circumstances, local laws, and the resulting outcomes. Note that legal teams must first investigate your case to establish and strengthen your claim. When seeking compensation, both economic and non-economic losses incurred by the family must be compensated.
For more concrete figures, please refer to our previous wins.
Speak to a Birth Injury Lawyer Today
At the Porter Law Group, our team of proven medical malpractice lawyers delivers ideal results. We take pride in helping families rebuild after unfavorable circumstances. We operate on a contingency basis – meaning you do not need to pay us anything unless we win your case. Through this approach, we can better support families during their times of need.
If you or a loved one has been a victim of medical malpractice, please reach out to us for a non-obligatory free case evaluation. You can also contact us at 833-PORTER9 or info@porterlawteam.com to schedule a consultation.
