When families learn about complications that occurred during delivery, they often hear medical terms that were never explained to them in the moment. Fundal pressure is one such intervention that some women experience during labor, sometimes without clear understanding of what it involves or why it was used. For parents trying to make sense of a difficult birth or understand why their child sustained an injury, knowing what happened and whether it followed safe medical practice can bring clarity during an overwhelming time.

This page explains what fundal pressure is, when and why it may be used, what the medical evidence shows about its safety and effectiveness, and what risks it may pose to both mother and baby.

What is Fundal Pressure?

Fundal pressure, sometimes called the Kristeller maneuver, refers to the application of manual pressure or device-assisted force to the upper part of the uterus during the second stage of labor. The goal is to help push the baby down through the birth canal and speed up delivery.

The technique can vary significantly. In some cases, a provider may use steady, controlled downward pressure with their hands or forearm, while in others, the pressure may be more forceful, inconsistent, or poorly monitored. Because there is no universal standard for how fundal pressure should be applied, practices differ not only between countries but also between hospitals and even individual practitioners.

When and Why It May Be Used

Fundal pressure is typically considered when labor is not progressing as expected during the pushing stage. Providers may turn to it in situations where they want to avoid a cesarean section or the use of forceps or vacuum extraction.

Common reasons include a prolonged second stage of labor, maternal exhaustion, or concerns about the baby’s heart rate that make a faster delivery seem necessary.

According to recent estimates, around 23 percent of women may experience some form of fundal pressure during labor. However, many may not be told it is happening, especially when the focus is on getting the baby delivered quickly.

Does Fundal Pressure Work?

The short answer is that fundal pressure may shorten labor, but it does not clearly improve outcomes for mothers or babies.

Research shows that fundal pressure can reduce the length of the second stage of labor by roughly 20 minutes. That may sound helpful, but multiple systematic reviews and analyses have found that it does not significantly reduce the need for cesarean delivery or the use of forceps or vacuum. It also does not improve newborn Apgar scores, reduce admissions to the neonatal intensive care unit, or lower rates of trauma to the baby.

In other words, while fundal pressure may make delivery happen faster, it does not make delivery safer or more successful in most cases.

Risks to Mother and Baby

The concern with fundal pressure is not whether it speeds things up, but whether it does so safely. Medical literature points to several documented risks.

Risks to the Mother

Women who undergo fundal pressure, particularly when it is applied with excessive force or poor control, face increased risk of:

Severe perineal tearing
Vaginal and cervical lacerations
Greater likelihood of needing an episiotomy
In rare cases, uterine rupture

These injuries can cause significant pain, require surgical repair, and lead to long-term complications including pelvic floor dysfunction and chronic discomfort.

Risks to the Baby

For newborns, the risks depend largely on how the pressure is applied. Gentle, controlled fundal pressure performed by an experienced clinician under the right circumstances appears to carry lower risk. However, poorly controlled or forceful application has been linked to serious birth injuries, including:

Brachial plexus injury, which affects the nerves in the shoulder and arm and can lead to conditions like Erb’s palsy
Skull fractures or brain trauma
Hypoxic-ischemic encephalopathy, a form of brain injury caused by oxygen deprivation
Lower umbilical cord pH levels, indicating mild fetal acidosis and potential stress during delivery

Case reports and hospital audits have documented these injuries in association with fundal pressure, particularly when the technique was applied without proper training, supervision, or restraint.

What Do Medical Guidelines Say?

The American College of Obstetricians and Gynecologists does not recommend the routine use of fundal pressure. ACOG cites a lack of evidence that it improves outcomes and notes the potential for harm to both mother and baby.

A 2025 Cochrane review echoed this caution, stating that fundal pressure should be avoided in most situations or used only in extreme, carefully controlled circumstances when other safer options are not available. The review emphasized that technique matters. Gentle pressure applied by trained providers carries less risk than forceful, unsupervised attempts.

Many hospitals, particularly large academic medical centers in New York City, have developed internal policies that discourage or prohibit uncontrolled fundal pressure and encourage rapid escalation to safer operative delivery methods when labor is not progressing.

Safer Alternatives

There are other approaches that labor and delivery teams can use to help move a stalled labor forward without resorting to fundal pressure.

These include:

Changing the mother’s position to encourage the baby to descend
Using oxytocin to augment contractions
Allowing more time for passive descent before active pushing begins
When medically necessary, proceeding promptly to assisted delivery with forceps or vacuum, or to cesarean section

Good communication between the care team and the laboring mother is essential. Families should feel informed about what is happening and why, and providers should avoid using excessive force or continuing an intervention that is not working.

What Families Should Know

If you experienced fundal pressure during delivery, or if your baby was injured and you are trying to understand what happened, it is important to know that you have the right to clear answers.

Birth injuries related to fundal pressure are not always obvious right away. Some signs that warrant follow-up include:

Weakness or lack of movement in one arm
Difficulty feeding or latching
Abnormal muscle tone or reflexes
Bruising, swelling, or asymmetry of the head or face

If any of these signs are present, your pediatrician should be notified immediately. Early referral to pediatric neurology, physical therapy, or occupational therapy can make a significant difference in your child’s recovery and long-term development.

Mothers who sustained trauma during delivery should also receive appropriate follow-up care. Perineal tears, pelvic pain, or incontinence are not normal parts of motherhood and deserve proper medical attention.

How NYBirthInjury.com Can Help

At NYBirthInjury.com, we understand how isolating and confusing it can be to navigate a birth injury. Our goal is to provide families with accurate, compassionate information about what may have happened during labor and delivery, what it means for your child’s health, and what options you have moving forward.

We connect families with trusted medical resources, specialists who understand birth trauma, and support networks that can help you through this difficult time. You are not alone, and you deserve answers.

Moving Forward

Fundal pressure remains a controversial practice in modern obstetrics. While it may be used with good intentions, the evidence does not support its routine use, and the risks to both mothers and babies are real.

Understanding what happened during your delivery is an important step toward healing and advocacy. Whether you are seeking medical follow-up for your child, trying to process your own birth trauma, or simply looking for information, we hope this page has provided clarity and reassurance.

If you have questions or need guidance, please reach out. Your family’s health and wellbeing matter, and the right support can make all the difference.

Fundal Pressure