“Just a little help”: A qualitative inquiry into the persistent use of uterine fundal pressure in the second stage of labor in Spain

Abstract

Introduction Uterine fundal pressure, or the Kristeller maneuver (KM), is a non–evidence‐based procedure used in the second stage of labor to physically force the fetus to delivery. Even though officially banned, the KM is practiced in 25% of vaginal deliveries in Spain. Methods Using semi‐structured interviews (N = 10 women, N = 15 midwives, N = 3 obstetricians), we sought to understand how providers justify using the KM, and to describe the current circumstances in which the KM is practiced. Women described their preexisting knowledge of and experiences with the KM; providers described how they learned and practiced the KM. We used framework analysis to analyze the transcripts, and we consensus‐coded across three independent investigators. Results Providers reported practicing a new, gentler Kristeller to which official policy did not apply. Providers knew the KM posed risks, but they assumed the risks resulted from poor technical training. Providers did not learn the KM through standard means, and they practiced it in secret. Women knew about the KM before delivery, and many had planned to refuse the procedure. Providers made women's refusal more difficult by offering the KM in coded terms as “just a little help.” Women did not experience the KM as gentle, and the force of the procedure made their refusal nearly impossible. Conclusions The normal birth policy has failed to achieve its objectives due to maternity care providers’ unique logic surrounding a new KM technique. Women’s ability to refuse the Kristeller is limited.

Design and Validation of the PercOV-S Questionnaire for Measuring Perceived Obstetric Violence in Nursing, Midwifery and Medical Students

“…Regarding this point, a large proportion of non-protocolized or invisible OV was identified in this study. This broad factor encompasses practices such as lack of respect, violent language or the use of prohibited practices, such as the performance of the Kristeller manoeuvre; however, although it is known that such practices occur in delivery rooms, they are difficult to identify due to factors such as the lack of recording of the clinical histories of births [35]. Regarding this factor, it is worth noting the low factorial load of the item related to allowing "skin-on-skin contact after the paediatric examination", which the authors decided to maintain nonetheless since it is the only item that refers to this practice.…”

“…Other items that were statistically significantly higher among the midwifery students and where midwives perceived more OV were related to performing the Kristeller manoeuvre, performing an episiotomy without anaesthesia, and not allowing the woman to be accompanied if the delivery is instrumented and if a caesarean section will be performed. It is known that, in Spain, the Kristeller manoeuvre is performed in 25% of vaginal births and that, despite being recognized by professionals as a practice that is not free of risks (which are unilaterally assumed), it is practised in secret and health care providers describe how they learn and practice this manoeuvre [35]; therefore, it is evident that it is still being learned and put into practice in Spanish delivery rooms. For episiotomy without anaesthesia, midwives may feel that an episiotomy should only be performed if there is clinical need and that anaesthesia should only be administered in cases of emergency due to acute foetal compromise [29] based on the salutogenesis approach highlighted above.…”

Der kinästhetische Händedruck – eine schonende und effiziente Alternative zur Kristellerhilfe

“…Eine spanische Studie fand heraus, dass viele Frauen vor der Geburt vom Kristeller-Manöver gehört hatten und dieses ablehnen wollten. Mit dem Hinweis durch das medizinische Personal, es sei eine "kleine Hilfestellung", willigten sie dennoch ein und empfanden das Vorgehen im Nachhinein als schmerzhaft und unangenehm [17]. Zu den Erfahrungen und Empfindungen von Frauen in Bezug auf den Kristeller-Handgriff gibt es keine nationalen Studien.…”

„Just a little help …“ – zum 200. Geburtstag von Samuel Kristeller (1820 – 1900)

“…"Kristeller-Manövers" liegen kaum vor. Rubashkin et al gaben in einer Publikation aus dem Jahr 2019 für vaginale Geburten in Spanien eine Rate von 25 % an [9]. In der wissenschaftlichgeburtshilflichen Gemeinschaft blieb es bei der von Breisky angedeuteten ambivalenten Haltung.…”