Okumu Mi-Ran, Bach Lisa, Karbach Ute, McKee Lorna, Recker Florian, Haid-Schmallenberg Lissa, Stöcker Arno, Volkert Anna, Scholten Nadine
Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, University Hospital Bonn, Bonn, Germany.
Chair of Health Services Research, Faculty of Human Sciences and Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany.
Arch Gynecol Obstet. 2025 Jul 24. doi: 10.1007/s00404-025-08130-3.
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.
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.
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.
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.
分娩第二阶段的宫底加压（FP）一直存在争议。这种干预措施是指对子宫最上部施加压力以协助经阴道分娩。虽然缺乏相关证据，但女性对其体验的描述各不相同，从暴力和创伤性到积极和有帮助。本文从女性的角度审视宫底加压的体验，而不评估该干预措施本身。
这项基于扎根理论的知情研究纳入了12例宫底加压的体验。纳入标准为在不超过12个月前进行过宫底加压的医院分娩。归纳生成的编码与先前开发的关于产科情况中感知形成的理论模型相一致。
女性对宫底加压的评价取决于感知的可理解性（对情况和干预的理解）和可管理性（应对能力）水平以及各自的子类别。根据参与者的描述，我们确定6例宫底加压体验为积极，3例为中性，3例为消极。在所有分类中，都存在可理解性较低的情况，这在很大程度上与因情况紧急而给出的简短医学解释有关。关于可管理性，积极体验与高可管理性相关，中性体验与中等可管理性相关，消极体验与低可管理性相关。
我们的研究表明，女性对宫底加压的评价取决于可理解性水平，尤其是可管理性水平。鉴于围绕宫底加压的争议，我们不表明宫底加压是否应该应用或被禁止的立场，但得出结论，如果应用宫底加压，女性的可理解性和可管理性需要得到保障。
